Christos Theleritis

Using ECT in schizophrenia: A review from a clinical perspective

Abstract Objectives. Despite the fact that many studies have addressed the use of ECT in schizophrenia questions on clinical use remain poorly answered and clinical application is largely based on data originating from depressed patients. Methods. We review data on the use of ECT in schizophrenic patients drawn from original studies indicated by a Pubmed search and referenced in recent and older expert reviews with a specific focus on four issues: symptom response, technical application, continuation/maintenance ECT and combination with medication. Results. Catatonic patients are the most responsive. Positive symptoms such paranoid delusions and affective symptoms follow. There are indications that ECT may improve responsivity to medication. No particular technical features stand out in studies except lengthier courses, but not for catatonia. Combination with medication appears to be preferable over either treatment alone and effective combination particularly with clozapine is supported by data. Use of continuation and maintenance treatments in responders appears beneficial. Conclusion. Certain schizophrenic patients may benefit significantly from the use of ECT. More specific research is required to address particular questions.

Sleep disturbance in haemodialysis patients is closely related to depression

OBJECTIVE To investigate the relationship between depression and disturbed sleep in haemodialysis patients (HP), and its relative contribution in the development of reported sleep problems. METHOD A total of 101 patients suffering from end-stage renal disease (ESRD) were assessed through the Athens Insomnia Scale (AIS) for potential sleep problems. Anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS), and their health-related quality of life and functional status were assessed through the Short Form-36 questionnaire (SF-36). Socio-demographic, anthropometric and clinical data along with a series of biochemical measures were also collected. RESULTS Multiple logistic regression analysis showed that the independent predictors associated with insomnia in ESRD patients were female sex (OR=7.58) and depression as measured by the HADS (OR=2.59). CONCLUSION Incorporating a standard assessment and eventually treatment of depressive symptoms into the care provided to haemodialysis patients might improve psychological well-being, insomnia and quality of life, and, consequently, reduce mortality risk in this population.

Amisulpride for the treatment of very-late-onset schizophrenia-like psychosis

Although schizophrenia affects all age groups, late or very‐late‐onset schizophrenia‐like psychosis has not been well studied and various treatment issues remain unresolved. The objective of the present study was to evaluate the efficacy and safety of amisulpride monotherapy in a diagnostically homogeneous group of elderly patients without cognitive impairment suffering from very‐late‐onset schizophrenia.

Combination therapy with amisulpride and antidepressants: Clinical observations in case series of elderly patients with psychotic depression

Psychotic depression is classified as a clinical subtype of major depressive disorder. The combination of an antidepressant with an antipsychotic agent has been demonstrated to be efficacious for the treatment of psychotic depression. However, in elderly patients with psychotic depression, little information is available on the efficacy of such combinations. Therefore, we have evaluated combination treatment for 5 weeks with amisulpride and antidepressants in non-demented elderly patients with psychotic depression. Eleven patients were treated with either citalopram 20-40 mg/day (n=5) or mirtazapine 30-60 mg/day (n=6), and amisulpride 75-100 mg/day for 5 weeks. Clinical status was evaluated at baseline and after 3 and 5 weeks using the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale--17 items (HDRS) and the Clinical Global Impression Scale (CGI-S). In 5 of the 11 patients there was remission of depression, while in another 5 patients there was partial remission of depression and in one patient there was no remission. Finally, there was resolution of psychotic symptoms in all the patients involved. One patient developed tremor and rigidity but insisted on continuing with the drug since her psychopathology has improved considerably after the addition of amisulpride to antidepressant treatment. In conclusion, some of the elderly patients with psychotic depression may benefit from the combination of amisulpride and antidepressant pharmacotherapy.

Excessive weight gain after remission of depression in a schizophrenic patient treated with risperidone: case report

BackgroundThe use of atypical antipsychotics in schizophrenic patients has been associated with a risk of weight gain. Similarly, recovery from depression is often followed by improved appetite, greater food intake and potential increase in weight.Case presentationA Caucasian 33-year-old schizophrenic female patient was being treated with 6 mg/day of risperidone and 15 mg/day of clorazepate. She developed depressive symptomatology and 40 mg/day of fluoxetine was gradually added to her treatment regimen for about 9 months. After the remission of depression, and the discontinuation of fluoxetine, she experienced an increase in appetite and subsequently excessive weight gain of 52 kg. Re-administration of fluoxetine did not reverse the situation. The patient developed diabetes mellitus, which was successfully controlled with metformin 1700 mg/day. The addition at first of orlistat 360 mg/day and later of topiramate 200 mg/day has helped her to lose a significant part of the weight gained (30 kg).ConclusionThe case suggests a probable association between the remission of depressive symptomatology and weight gain in a schizophrenic patient.

Adolescent health and trauma

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