Gregory Katz

Olanzapine and sulpiride: a preliminary study of combination/augmentation in patients with treatment-resistant schizophrenia.

Coadministration of olanzapine, an atypical neuroleptic, with sulpiride, a selective D2 antagonist, is suggested as an efficient strategy for treating patients with resistant unremitting schizophrenia. The psychopharmacologic rationale that may account for the enhanced clinical efficacy of combining sulpiride with olanzapine and vice versa is the difference in affinity of the two drugs to brain receptors. Olanzapine affinity is related more to serotonin 5-HT2 than to dopamine-2, whereas sulpiride is considered a selective D2 blocker. The adjunction of a selective D2 antagonist to olanzapine may act as the olanzapines augmentor by enhancing D2 blockage. This mode of treatment was introduced to six patients with chronic schizophrenia who showed noteworthy and rapid clinical improvement, supported by a decrease in their scores on the Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale. No bothersome side effects were noticed. This clinical approach is in accordance with the findings of previous reports assessing the efficacy of the combined treatment of clozapine and sulpiride. The grounds for this treatment regimen using olanzapine rather than clozapine are discussed, calling for further studies to affirm the hypothesis and clinical results.

Kleptomania : Diagnosis and treatment options

Kleptomania--the inability to resist the impulse to steal objects, not for personal use or monetary gain--is currently classified in psychiatric nomenclature as an impulse control disorder. However, some of the principle features of the disorder, which include repetitive intrusion thoughts, inability to resist the compulsion to perform the thievery and the relief of tension following the act, suggest that kleptomania may constitute an obsessive-compulsive spectrum disorder. Kleptomania is commonly under-diagnosed and is often accompanied by other psychiatric conditions, most notably affective, anxiety and eating disorders, and alcohol and substance abuse. Individuals with the disorder are usually referred for treatment due to the comorbid psychiatric complaints rather than kleptomanic behaviour per se. Over the past century there has been a shift from psychotherapeutic to psychopharmacological interventions for kleptomania. Pharmacological management using selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) and other antidepressants, mood stabilisers and opioid receptor antagonists, as adjuvants to cognitive-behavioural therapy, has produced promising results.

Male Genital Self-Mutilation in the Context of Religious Belief: The Jerusalem Syndrome

The objective of this article is to draw attention to the phenomenon of selfmutilation ‘sanctioned’ by religious belief. Jerusalem, the center of the world’s monotheist religions, is a powerful magnet, calling believers to come and there, perform certain prescribed actions. Witztum and Kalian (1999) note that ‘the eccentric conduct and bizarre performance of these colorful yet psychotic visitors become dramatically overt once they reach the Holy city – a geographical locus containing the “axis mundi” of their religious belief.’ The correlation between the meaning of Jerusalem as a place central to religious experience and the nature of some psychotic episodes has been characterized as ‘The Jerusalem Syndrome’ (Bar-El et al., 2000). As a syndrome rather than a distinct nosological entity, Jerusalem syndrome may appear in relation to the proximity to the Holy Places in people from all monotheistic religions with or without previous psychopathology. Three main versions of the Jerusalem syndrome are identifiable (Bar-El et al., 2000): (i) superimposed on previous psychotic illness; (ii) complicated

Impulsivity, Sensation Seeking and Anhedonia as Possible Explanations forCannabis Abuse Comorbidity among First Psychotic Episode Inpatients

Objective: There have been relatively few reported carefully constructed studies to date concerning the link between psychoactive substance abuse among first-episode psychotic individuals and specific behavioral aspects that might clarify the comorbidity. Using standard toxicological testing, we compared consecutively admitted inpatients diagnosed with first psychotic episode with and without lifetime and/or active (last month) cannabis abuse or dependence and the levels of impulsivity, sensation seeking and anhedonia. Methods: Ninety-one consecutively admitted psychiatric patients diagnosed using the DSM-IV criteria with a first psychotic episode due to schizophrenia, schizophreniform disorder, bipolar disorder, brief psychotic episode, and psychosis NOS disorder were included in the study. Patients were aged 18 to 41 (mean 27.1+9.2); seventy-six of the patients (83.5%) were males. Standard urine tests for tetrahydrocannabinol (THC) were performed and self-report questionnaires were administered during the first 48 h after admission. The following rating scales were used: the PANSS (Positive and Negative Syndrome Scale), the Barratt Impulsivity Scale (a 34-item self-report), the Zuckerman Sensation-Seeking Scale (form V), and the Chapman Physical Anhedonia Scale (a 61-item self-report). Results: According to bivariate correlations, the PANSS Positive Scale was significantly correlated with the Barratt Rating Scale (0.260; p ≤ 0.05) and the PANSS Negative with Physical Anhedonia Scale (0.389, p ≤ 0.001). Rates for the Zuckerman Rating Scale (f=20.1, p ≤ 0.001) and the Barratt Rating Scale (f=5.15, p ≤ 0.05) were significantly higher in the group of cannabis abusers with no clear difference between abusers and nonusers in the PANSS and the Physical Anhedonia Scale. Conclusion: The results of the study showed high levels of impulsivity and sensation seeking in the group of inpatients suffering from first psychotic episode and cannabis abuse comorbidity compared to first-episode inpatients with no substance abuse.