M. Meduri

The effect of lamotrigine augmentation of clozapine in a sample of treatment-resistant schizophrenic patients: a double-blind, placebo-controlled study.

Based on the evidence that lamotrigine added to clozapine in refractory schizophrenic patients has reported promising results, the present 24-week double-blind, randomized, placebo-controlled trial had the aim to explore the efficacy of lamotrigine add-on pharmacotherapy on clinical symptomatology and cognitive functioning in a sample of treatment-resistant schizophrenic patients receiving clozapine. After clinical and neurocognitive assessments patients were randomly allocated to receive, in a double-blind design, either up to 200 mg/day of lamotrigine or a placebo. A final sample of fifty-one patients completed the study. The results obtained indicate that lamotrigine added to stable clozapine treatment showed a beneficial effect on the negative, positive and general psychopathological symptomatology in a sample of treatment-resistant schizophrenic patients. Regarding cognitive functions, improvement was observed in some explored areas, such as attentional resistance to interference, verbal fluency and executive functioning. The findings provide evidence that lamotrigine augmentation of clozapine treatment is well tolerated and may be proposed as an effective therapeutic strategy to improve outcome in treatment-resistant schizophrenia.

The effect of mirtazapine augmentation of clozapine in the treatment of negative symptoms of schizophrenia: a double-blind, placebo-controlled study

The development of therapeutic strategies to effectively treat negative symptoms remains one of the primary goals in the treatment of schizophrenia. Mirtazapine is the first of a new class of dual action compounds, the noradrenergic and specific serotonergic antidepressants (NaSSa), whose activity is related to the enhancement of noradrenergic and serotonergic transmission by a presynaptic &agr;2 antagonism and postsynaptic 5-HT2 and 5-HT3 antagonism, respectively. This study was a 8-week double-blind, randomized, placebo-controlled trial of 30 mg adjunctive mirtazapine to clozapine therapy in 24 patients with DSM-IV schizophrenia. The main finding at the end of the trial was a significant reduction on the Scale for the Assessment of Negative Symptoms (SANS) total scores in the mirtazapine group compared to placebo (P<0.01) with a significant improvement on the SANS subscales avolition/apathy and anhedonia/asociality. The Brief Psychiatric Rating Scale total score at week 8 showed superiority of mirtazapine over placebo. These findings suggest a potential role for mirtazapine as an augmentation strategy in the treatment of negative symptoms of schizophrenia.

Fahr's syndrome: local inflammatory factors in the pathogenesis of calcification.

SummaryThree cases of Fahrs syndrome are described. All patients had disturbances of calcium metabolism and had had a meningoencephalitis in childhood. It is suggested that gliovascular changes, induced by cerebral inflammation, can later facilitate the occurrence of calcification of the striopallidodentate system when abnormality of calcium metabolism develops.

Temperament and Character Dimensions in Opiate Addicts: Comparing Subjects Who Completed Inpatient Treatment in Therapeutic Communities vs. Incompleters

The aim of this study was to compare temperamental profiles of patients who completed inpatient treatment of drug dependence with those who failed to complete the program. One hundred forty four opiate addicts, all resident in therapeutic communities and screened to exclude Axis I disorders, were assessed using the Temperament and Character Inventory (TCI). After one year, the TCI scores were compared between those who were still resident and those who had dropped out. Significant differences between groups were found in Reward Dependence, Persistence, Cooperativeness, Self-Transcendence. Temperament and character features may have an influence on motivation and on the adherence to treatment and community rules, as they modulate the maintenance of ongoing behaviors and the sensitivity to social rewards. The findings suggest that personality assessment with TCI in opiate addicts may be helpful in screening procedures to increase the efficiency of treatment and rehabilitative strategies.

Debrisoquine oxidation phenotype and neuroleptic-induced dystonic reactions

To evaluate the role of defective drug oxidation as a predisposing factor for neuroleptic‐induced dystonic reactions, 26 patients who developed the reaction and 53 with no history of dystonia were phenotyped by the debrisoquine hydroxylation test. The percentage of poor debrisoquine metabolizers was similar in patients with dystonic reactions (11.5%) and in the control group (9.4%). These results suggest that there is no association between the individuals drug oxidative status and the occurrence of neuroleptic‐induced dystonia.

Prevalence of acute dystonic reactions associated with neuroleptic treatment with and without anticholinergic prophylaxis.

The occurrence of acute dystonic reactions was intensively monitored in a population of 646 patients, 379 males and 267 females. aged 18–87 years, consecutively admitted to different psychiatric units and treated with neuroleptics alone or in combination with anticholinergic drugs. Thirty-four patients experienced acute dystonic reactions yielding a total incidence of 5.3%. There wasa tendency towards a higher frequency of dystonia in males than in females, and in young patients than in older ones. Patients without anticholinergic medication had a higher frequency of the reaction than those receiving anticholinergic drugs (8.5% vs. 2.8%; p < 0.02). Neuroteptic-induced dystonia was more common in patients treated with buthyrophenones than in those receiving phenothiazines or substituted benzamides.

Computerized tomography in amyotrophic choreo-acanthocytosis

SummaryCT has been performed in five patients affected by amyotrophic choreo-acanthocytosis (ACA) and bicaudate diameter, bicaudate index and frontal horn/bicaudate ratio (FH/CC) have been evaluated. Findings have been confirmatory of caudate nuclei atrophy as shown by previous ACA autopsy reports, but did not differ from Huntingtons chorea CT picture. There was no correlation between CT measurements and age, illness duration or degree of hyperkinesia in contradistinction to that reported for Huntingtons chorea.

Morphometrical and morphological analysis of lateral ventricles in schizophrenia patients versus healthy controls

The goal of this report was to highlight lateral ventricle morphology and volume differences between schizophrenia patients and matched controls. Subjects identified as suitable for analysis comprised 15 schizophrenia patients and 15 healthy subjects. The method applied is three-dimensional (3D) volume rendering starting from structural magnetic resonance imaging (MRI) studies of selected ventricular regions. Differences between groups relative to the global ventricular system and its subdivisions were found. Total lateral ventricle volume, right ventricle volume and left ventricle volume were all higher in schizophrenia patients than in controls; unilateral differences between the two groups were also outlined (right ventricle volume>left ventricle volume in schizophrenia patients vs. healthy subjects). Furthermore, occipital and frontal horn enlargement was found in schizophrenia patients compared with normal controls, but the difference in the temporal horn was not statistically significant. A substantial difference was noted in lateral ventricle morphology between the two groups. Our findings were consistent with the literature and may shed light on some of the discrepancies in previous reports on differences in lateral ventricle volume enlargement.

Urinary incontinence in schizophrenic patients treated with atypical antipsychotics: urodynamic findings and therapeutic perspectives

Objective The present study was a urodynamic evaluation of schizophrenic patients with urinary incontinence occurring during treatment with atypical antipsychotics Methods A total of 12 schizophrenic patients (mean age = 30.7 years, SD = 6.5) presenting urinary incontinence during treatment with atypical antipsychotics at stable doses underwent urodynamic evaluations. Clinical assessment included the administration of Positive and Negative Syndrome Scale (PANSS) Results Four patients out of 12 presented urodynamic patterns consistent with an overactive bladder, while five patients presented reduced bladder compliance; only three patients showed normal urodynamic patterns Conclusion Detrusor overactivity is a condition associated with urinary incontinence in schizophrenic patients treated with atypical antipsychotics. Urodynamic evaluations can improve our knowledge of the mechanisms that subtend atypical antipsychotic-induced incontinence, an invalidating side-effect with strong repercussion on compliance and rehabilitation in schizophrenic patients

Gender Role Identity in a Sample of Italian Male Homosexuals

ABSTRACT Gender role is a multifactorial concept, as gender-related attitudes, behaviors, and personality are partially autonomous. The aim of the study was to evaluate the prevalent gender role identity in a sample of male homosexuals. One hundred male homosexuals and 50 male heterosexuals matched for age and sex, have been assessed with the Italian version of the Bem Sex-Role Inventory (BSRI; Bem, 1974). Statistically significant differences have been found between the two groups at the dimensions “Masculine” (z = 1.963; p = 0.001) and “Androgyny” (z = 2.367; p < 0.0001). The results obtained from the present study tend to confirm that homosexuals view themselves as adrogynous individuals, sharing both features of masculine and feminine gender roles.