Masahiro Kuniyoshi

A case of tardive Tourette-like syndrome

Abstract: We have had experience in treating tardive Tourette‐like syndrome on a chronic schizophrenic patient. The patient was a 38‐year‐old woman. A diagnosis of schizophrenia was made in 1971 and she received repeated medications for 17 years. In 1989, she began to show vocal tic with coprolalia and motor tic. The medications were haloperidol 18 mg, zotepine 200 mg, levomepromseine 100 mg, biperiden 3 mg and nitrazepam 10 mg at the beginning of Tourette‐like syndrome. We have tried to change the medications but this tardive Tourette‐like syndrome continued to hang on. However, the symptoms gradually improved after a change in drugs; cessation of biperiden 3 mg and the administration of clonazepam 3 mg. The present case suggested that tardive Tourette‐like syndrome might be a subtype of neuroleptic‐associated tardive syndromes which might be treated with clonazepam.

Three Cases of Respiratory Dyskinesia

Abstract: We present here three cases of respiratory dyskinesia (RD). RD was observed with a video recording and other recordings were made of a respiratory airflow with a thermistor, and abdominal movement with a strain gauge. Neurological findings end CT scanning indicated marked organic changes in the brain in these 3 cases. RD was complicated with tardive dyskinesia of the tongue and lips, and the symptoms were aggravated during stress and absent during sleeping, which are the characteristic features of extrapyramidal symptoms. The symptoms of the three cases have improved by decreasing the dose of butyrophenone derivatives and discontinuing anti‐parkinsonian drugs, which suggested that an intracerebral imbalance of DA and ACh may be the cause of RD.

Parkinsonism Manifesting Depression as the First Sign

Abstract: We have had experience in treating two patients with parkinsonism of which the first manifestation was depression. Case 1 was a 61‐year‐old woman. A diagnosis of depression had been made and repeated medication consisting mainly of antidepressants was given. However, the depressive state persisted and the signs of parkinsonism gradually became evident. The initial treatment with antidepressant drugs was replaced with one based on L‐DOPA (400 mg a day).

Nondominant Temporal Lobe Epilepsy with Depressive Reaction

Abstract: A 56‐year‐old woman was admitted to our hospital because of insomnia and psychomotor retardation. This is her second admission. She was diagnosed as having depression and began to receive antidepressants. Her conditions got better after the treatment but the depressive state occurred again after she stopped taking those drugs. As EEG showed some spike discharges at the nondominant temporal lobe area, she was given anticonvulsants this time. Her depressive state improved rapidly by taking anticonvulsants instead of the antidepressants. The spike discharges at the nondominant temporal lobe area disappeared when the clinical symptoms improved.

Panic anxiety after abrupt discontinuation of mianserin

Abstract: We observed a case of withdrawal after abrupt discontinuation of mianserin. A 41‐year‐old woman was treated according to a diagnosis of depression, which was her 6th episode. Mianserin 30 mg/day, etizolam 1 mg/day and flunitrazepam 1 mg/day were administered. When the patient discontinued taking the drugs by herself because of subsiding of these symptoms, severe panic anxiety appeared. This panic anxiety was not relieved by taking etizolam and flunitrazepam again, but subsided rapidly by the re‐administration of mianserin 30 mg/day, and because of that the depressive symptom also disappeared.