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Case Report: Clozapine use in two women with schizophrenia during pregnancy:

Stabilized patients who receive clozapine may wish to have children; but studies on pregnant women receiving clozapine treatment are limited. In this study, we report on clozapine use during pregnancy in two women. The first woman (Case 1) had two deliveries while she was receiving clozapine treatment for schizophrenia. Both her deliveries were term, uncomplicated vaginal deliveries, and the clozapine dose was reduced throughout pregnancy. The second woman (Case 2) developed schizophrenia after her first child was born. She became pregnant after clozapine initiation. She delivered twins by term, uncomplicated vaginal delivery. In our cases, no specific risks for the mothers and their children can be attributed to the use of clozapine. Physicians must be aware of the changes in fertility induced by prolactin-sparing drugs. Mothers who receive clozapine treatment should not be advised to breastfeed their children.

P wave and QT changes among inpatients with schizophrenia after parenteral ziprasidone administration

OBJECTIVE Although ziprasidone has been reported to cause ventricular arrhythmias, there have been no studies regarding the influence of ziprasidone on atrial conduction. Intraatrial and interatrial conduction time prolongation and inhomogeneous propagation of sinus impulses are indicated by P wave changes on surface electrocardiography. We aimed to evaluate proneness to atrial fibrillation after intramuscular ziprasidone in drug-free inpatients with schizophrenia. METHODS We evaluated 11 eligible inpatients who were drug free for at least 4 weeks with a primary diagnosis of schizophrenia disorder and 11 healthy controls who were hospital staff members. Electrocardiography was performed at baseline and 1.5-2h after ziprasidone injection. A 12-lead surface electrocardiogram was obtained from each subject in the supine position at a paper speed of 50mm/s and 2mV/cm. RESULTS The changes between baseline and the period after parenteral ziprasidone administration in P-wave duration, P-wave dispersion, QTc, QTc(max), QTc(min), and QT dispersion variables were significant (p>0.05). The initial P-wave dispersion was significantly longer in patients than in healthy controls (p<0.05). There were no correlations between electrocardiography parameters and clinical severity scores or demographic variables in either group. CONCLUSION Intramuscular ziprasidone administration does not seem to influence atrial and ventricular electrical conduction in drug-free inpatients with schizophrenia. However, schizophrenia might affect atrial conduction resulting in atrial fibrillation, which may be a cause of some complications in inpatients with this schizophrenia.

Effectiveness of olanzapine in neurosyphilis related organic psychosis: a case report.

The clinicians usually do not consider syphilis in the differential diagnosis for patients with acute and chronic psychiatric symptoms. To familiarize clinicians particularly with neurosyphilis (NS) and to discuss the atypical antipsychotic alternatives, we wish to present a case with agitated, resistant psychotic symptoms related to neurosyphilis. The case was a 55-year-old male who has had anxiety, irritability, auditory hallucinations, ataxia, dysarthric speech, paranoid and persecutory delusions and agitated behaviour. Parenteral ziprasidone 20 mg/bid was initialized at the first day of admission to reduce agitation. Then it was switched to olanzapine velotab 10 mg/bid because of inefficacy. Parenteral cephtriaxon 1 g/daily was administered because of seropositive VDRl and TPHA and positive cerebrospinal fluid VDRl. Olanzapine velotab may be a good alternative antipsychotic and should be considered in reducing agitation and psychotic symptoms in NS.