Sotiris Kantartzis

Acute Dystonia with Low-Dosage Aripiprazole in Tourette's Disorder

Objective: To report a case of an acute dystonic episode in a patient with Tourettes disorder (TD) treated with the partial dopamine agonist aripiprazole. Case Summary: An 18-year-old male with TD was prescribed aripiprazole 10 mg orally daily, which produced a significant improvement in his symptoms. However, after 3 days of treatment, he experienced an acute episode of dystonia with facial muscle spasm, oculogyric crisis, and torticolis. All symptoms resolved after a single intramuscular injection of Dipendine 5 mg. The Naranjo probability scale indicated that the adverse events were probably caused by aripiprazole. Discussion: To our knowledge, as of this writing, this is the first report concerning an aripiprazole-induced dystonic episode in an adult, and it is especially notable because it occurred at low dosage. Aripiprazole is a dopamine partial agonist and a serotonin2A antagonist with a favorable adverse effect profile. Short-term clinical trials reported a very low incidence of extrapyramidal symptoms, with akathisia being the most common, although there have been reports of severe extrapyramidal symptoms in a 3-year-old child and in an adolescent with a previous history of such symptoms. Conclusions: Acute dystonic phenomena may be caused by aripiprazole, although the drugs suggested mode of action largely precludes them.

Peripheral thyroid dysfunction in depression

The involvement of the thyroid gland and thyroid hormones is generally believed to be important in the aetiopathogenesis of major depression. Major support comes from studies in which alterations in components of the hypothalamic–pituitary–thyroid (HPT) axis have been documented in patients with primary depression. However, screening thyroid tests are often routine and add little to the diagnostic evaluation. Overt thyroid disease is rare among depressed inpatients. The finding that depression often co-exists with autoimmune subclinical thyroiditis suggests that depression may cause alterations in the immune system, or that in fact it could be an autoimmune disorder itself. The outcome of treatment and the course of depression may be related to thyroid status as well. Augmentation of antidepressant therapy with the co-administration of thyroid hormones (mainly T3) is a well-documented treatment option for refractory depressed patients. Review of the literature suggests that there are no conclusive data on the role of thyroid function in depression. It is clear that depression is not characterised by an overt thyroid dysfunction, but it is also clear that a subgroup of depressed patients may manifest subtle thyroid abnormalities, or an activation of an autoimmune process. There is a strong possibility that the presence of a subtle thyroid dysfunction is a negative prognostic factor for depression and may demand specific therapeutic intervention.

Obesity and smoking in patients with schizophrenia and normal controls: a case-control study.

Cardiovascular risk factors, especially obesity and smoking are highly prevalent in patients with schizophrenia. Central obesity and the metabolic syndrome are conditions mostly attributed to the use of antipsychotic medication and lifestyle habits, and they constitute a significant health concern. Our study sample included 105 patients suffering from schizophrenia aged 36.25+/-10.03 and 156 normal control subjects aged 36.03+/-11.33. All patients were in- or out-patients of a private hospital. Clinical diagnosis was made according to DSM-IV-TR criteria. Height, weight, waist circumference and number of cigarettes smoked daily were recorded. Duration of illness was calculated based on records concerning the age of first onset of psychotic symptoms. Body Surface Area (BSA) and Body Mass Index (BMI) were calculated as well as % body fat, with the use of LifeWise Body Fat Analyzers No 63-1525. The results of analysis of variance suggested a significant main effect regarding diagnosis and sex as well as for their interaction. There were significant differences between patients and controls regarding body weight, waist circumference, BMI, BSA and % body fat, with patients, especially females, being more obese than controls. The results of the present study corroborate the increased prevalence of obesity in schizophrenia. The interpretation of this finding remains unclear.

Amisulpride-induced tardive dyskinesia

Tardive dyskinesia (TD) is a movement disorder that develops during the course of long-term treatment with neuroleptic agents and is characterized primarily by choreiform and athetotic movements. We report the case of a 34-year-old man suffering from schizophrenia, disorganized type. He received amisulpride (400 mg daily) and the result was much improvement. 20 months later, he was presented with TD, which resolved almost completely after change of treatment to 1200 mg quetiapine without any relapsing. To our knowledge, his is the first case report in the literature of tardive dyskinesia induced by amisulpride.

Development of a standardized scoring method for the Graphic Sequence Test suitable for use in psychiatric populations.

Although the graphic version of the Alternating Sequences Test which was introduced by Luria exists for years little has been done to standardize it. The aim of the current study was to develop a novel and detailed standardized method of administration and scoring. The study sample included 93 normal control subjects (53 women and 40 men) aged 35.87±12.62 and 127 patients suffering from schizophrenia (54 women and 73 men) aged 34.07±9.83. The psychometric assessment included the Positive and Negative Symptoms Scale the Young Mania Rating Scale, and the Montgomery-Asberg Depression Rating Scale. A scoring method was developed and was based on the frequencies of responses of healthy controls. Cronbach α and test-retest and interrater reliability were very good. Two indices and 6 subscales of the Standardized Graphic Sequence Test were eventually developed. The Standardized Graphic Sequence Test seems to be a reliable, valid, and sensitive to change instrument based on Lurias graphic sequence test. The great advantage of this instrument is the fact that it is paper and pencil, easily administered and little time consuming. Further research is necessary to test its usefulness as a neuropsychologic test.

Beneficial effect of long-acting injectable risperidone on the neurocognitive deficit of a schizophrenic patient: A case report.

We report the case of a 37-year-old female patient suffering from schizophrenia, disorganized type. Adherence to treatment was always a major problem. During the last 2 years the patient was disorganized and was refusing treatment. Since the patient was already receiving a very high (double) dose per os, it was decided to administer two 50 ml ampoules of long-acting, injectable risperidone plus 5 mg of haloperidol per os daily. After 80 days of treatment, all positive, negative and even neurocognitive symptoms improved markedly. Extrapyramidal side effects did not appear at any stage of treatment. The most impressive neurocognitive improvement concerned the clock drawing test, which was in parallel with her improvement in both the positive and negative symptoms of the PANSS.

Comparison of body fat in patients with schizophrenia and normal controls

Materials and methods The study sample included 105 patients suffering from schizophrenia (44 females−41.91% and 61 males− 58.09%) aged 36.25±10.03 (range 19-69) and 156 normal control subjects (65 females−41.66% and 91 males− 58.34%) aged 36.03±11.33 (range 19-68). Clinical diagnosis was made according to DSM-IV-TR criteria. Height, weight, waist circumference and number of cigarettes smoked daily were recorded. Duration of illness was calculated based on records concerning the age of first onset of psychotic symptoms. Body Surface Area (BSA) and Body Mass Index (BMI) were calculated as well as % body fat, with the use of LifeWiseTM Body Fat Analyzers No 631525. Results The ANOVA results suggested a significant main effect regarding diagnosis and gender as well as for their interaction. Scheffe post hoc test demonstrated significant differences between patients and controls regarding body weight (women only, p=0.002), waist circumference (men p=0.002, women p<0.0001), BMI (women only, p<0.001), BSA (women only, p<0.01) and % body fat (women only, p=0.033), with patients being more obese. The patients also smoked more cigarettes daily (men p=0.002, women p=0.016)

Peripheral Thyroid Dysfunction in depression: a review

The involvement of the thyroid gland and thyroid hormones is generally believed to be important in the etiopathogenesis of major depression. The major support comes from studies in which alterations in components of the hypothalamic-pituitary-thyroid (HPT) have been documented in patients with primary depression. However, screening thyroid tests are often routine and add little to the diagnostic evaluation. Overt thyroid disease is rare among depressed inpatients. The finding that depression often co-exists with autoimmune subclinical thyroiditis suggests that depression may cause alterations in the immune system, or that in fact could be an autoimmune disorder itself. The outcome of treatment and the course of depression may relate to the thyroid status as well. Augmentation of antidepressant therapy with the co-administration of thyroid hormones (mainly T3) is a welldocumented treatment option for refractory depressed patients. The review of the literature suggests that there are no conclusive data on the role of thyroid function in depression. It is clear that depression is not characterized by an overt thyroid dysfunction, but it is also clear that a subgroup of depressed patients may manifest subtle thyroid abnormalities, or an activation of an autoimmune process. There is a strong possibility that the presence of a subtle thyroid dysfunction is a negative prognostic factor for depression and may demand specific therapeutic intervention. from International Society on Brain and Behaviour: 3rd International Congress on Brain and Behaviour Thessaloniki, Greece. 28 November – 2 December 2007

Personality disorders diagnosis in psychiatric patients: comparison of DSM vs ICD criteria (preliminary data)

Results There was no diagnosis of Schizotypal PD, and Histrionic was the rarer diagnosis according both systems. Narchissistic and Dependent PD were the rarer according to DSMIV. There was a large discrepancy in the diagnosis of the Dependent PD between the two systems. The rest specific diagnostic categories manifested similar results, but a modest degree of disagreement was evident. More ICD based interviews reached a specific PD diagnosis in comparison to DSM based.

Comparison among measures of depression: reliability, validity, relationship to anxiety and personality and the role of age and life events

Materials and methods The study sample included 40 depressed patients 29.65 ± 9.38 years old, and 120 normal comparison subjects 27.23 ± 10.62 years old. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0. The depressive scales applied and standardized were the CES-D, ZDRS, BDI-I, and the KSQ. Also, the STAI, the Life Events scale (Holms and Rahe), and the EPQ were administered. The analysis included the comparison of psychometric properties and the use of Pearson correlation coefficient and factor analysis.