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Shelef A, Alaa H, Bloemhof-Bris E, Halperin D, Weizman S, Stryjer R. Short-term chloral hydrate as an add-on treatment may improve sleep and alleviate agitation in inpatients with treatment resistant schizophrenia: a retrospective case series study. Front Psychiatry 2024; 15:1293676. [PMID: 38487572 PMCID: PMC10937440 DOI: 10.3389/fpsyt.2024.1293676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/26/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Chloral hydrate (CH), a medication dating back to 1832, is tranquilizer and sleep promoter still used today. It remains an option for short-term insomnia therapy and sedation before medical procedures, despite its controversial safety profile. Methods This study investigated the potential benefits of chloral hydrate addition for increasing sleep duration and reducing agitation and violence in inpatients with treatment-resistant schizophrenia (TRS). A retrospective, observational case series design was utilized, analyzing data from fourteen patients diagnosed with TRS disorders. Results CH addition increased the rate of full night sleep and decreased the rates of agitation and verbal and physical violence events. Notably, no adverse events including falls were reported during CH addition. Discussion CH shows some short-term benefits in improving sleep disorders and reducing violent and agitated behavior in patients with TRS. Our study has limitations due to its small sample size, retrospective design and lack of a control group. A large-scale, double-blind, randomized trial is needed to further explore the efficacy and safety of CH in psychiatric populations with TRS accompanied by agitation, violence and disturbed sleep.
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Affiliation(s)
- Assaf Shelef
- Lev Hasharon Mental Health Center, Tzur Moshe, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Habashi Alaa
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Abarbanel Mental Health Center, Bat Yam, Israel
| | | | - Dania Halperin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Weizman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Abarbanel Mental Health Center, Bat Yam, Israel
| | - Rafael Stryjer
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Abarbanel Mental Health Center, Bat Yam, Israel
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Fridman J, Bloemhof-Bris E, Weizman S, Kessler T, Porat D, Ivry A, Wolf A, Stryjer R, Shelef A. Inflammation Markers Among Schizophrenia Patients Who Use Cannabis. Clin Neuropharmacol 2023; Publish Ahead of Print:00002826-990000000-00053. [PMID: 37335845 DOI: 10.1097/wnf.0000000000000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVES The mechanism of inflammation of the immune system, for example, such circulatory markers as the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), has been shown in many studies to be associated with schizophrenia. In addition, it has been shown that the cannabidiol component reduces the activation of the acquired immune system. This study examined the differences in the levels of NLR and MPV among schizophrenia patients with cannabis use versus those without. METHODS In 2019 to 2020, a retrospective cross-sectional study was conducted based on digital medical records. Demographic, clinical, and complete blood cell count data were collected from records of rehospitalization of active psychotic schizophrenia inpatients. Data on NLR, MPV values, and demographic and clinical characteristics were compared between the groups and according to the degree of prevalence of cannabis use. RESULTS No differences were found in the NLR and MPV values between the groups. CONCLUSION The results were contrary to our expectations. These results may be explained by the presentation of a "pseudo-balanced" picture created when multiple processes affect inflammatory indices.
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Sinai O, Stryjer R, Bloemhof-Bris E, Weizman S, Shelef A. Olanzapine intramuscular shows better efficacy than zuclopenthixol acetate intramuscular in reducing the need for restraint, but not in comparison to haloperidol intramuscular. Int Clin Psychopharmacol 2022; 37:9-13. [PMID: 34825897 DOI: 10.1097/yic.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Many psychotic patients are treated with antipsychotic medications during acute agitation and aggressive behavior episodes in an attempt to achieve a rapid calming effect. Those medications include olanzapine, zuclopenthixol acetate, and haloperidol intramuscular administration. This study compared the effectiveness of these injections in reducing the need for restraint during agitated-psychotic episodes that include aggression. Sociodemographical and clinical data were retrieved from the electronic medical records of 179 patients who needed rapid calming while hospitalized in a mental health center with acute psychosis. The treatments administered were olanzapine intramuscular, zuclopenthixol acetate intramuscular, and haloperidol intramuscular. The assessed outcomes were rate of restraint and violent behavior. Olanzapine was found significantly more effective in reducing the need for restraint compared to zuclopenthixol acetate. No significant differences were found between haloperidol and the other two with regard to restraint. Neither were other significant differences found between the groups with regard to violent or self-harming behaviors. No significant differences were found in the rate of violent behavior and antipsychotic dosage at discharge. In conclusion, in inpatients with acute agitated psychosis, olanzapine intramuscular shows better efficacy in reducing the need for restraint, at least as compared to zuclopenthixol acetate intramuscular.
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Affiliation(s)
- Omri Sinai
- Lev-Hasharon Mental Health Center, Tzur Moshe.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Rafael Stryjer
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv.,Abarbanel Mental HealthCenter, Bat-Yam
| | - Esther Bloemhof-Bris
- Lev-Hasharon Mental Health Center, Tzur Moshe.,Psychology Department, Haifa University, Haifa, Israel
| | - Shira Weizman
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv.,Abarbanel Mental HealthCenter, Bat-Yam
| | - Assaf Shelef
- Lev-Hasharon Mental Health Center, Tzur Moshe.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
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Shelef A, Brafman D, Rosing T, Weizman A, Stryjer R, Barak Y. Equine Assisted Therapy for Patients with Post Traumatic Stress Disorder: A Case Series Study. Mil Med 2020; 184:394-399. [PMID: 30839068 DOI: 10.1093/milmed/usz036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Equine assisted therapy (EAT) which includes therapeutic horseback riding (THR), grooming, horsemanship and ground level work with horses, has been studied as treatment for children with special needs and/or autistic spectrum disorder. Preliminary evidence indicates that EAT is also effective for improving self-efficacy and self-esteem in adults with psychiatric disorders. Empowerment, bonding and building trust with the horses, may promote functioning of patients struggling with post traumatic stress disorder (PTSD).The authors performed a prospective, pilot open case series study to assess the effect of EAT on patients with PTSD in terms of symptoms and functioning in work, family and social interaction. METHODS Patients with PTSD received EAT once a week for 3 consecutive hours for 6 months. The Short Post Traumatic Stress Disorder Rating Interview (SPRINT) and the Sheehan Disability Scale (SDS) were assessed at baseline, the SDS after 1 and 6 months, and the SPRINT after 6 months. RESULTS Thirteen of 23 participants completed the study. Ten participants withdrew from the study for various reasons including discomfort from horses. Total SPRINT scores showed a statistically significant improvement in PTSD symptoms (baseline vs. 6 months: 24.38 ± 6.4 vs. 21.54 ± 7.94 points; p < 0.05). SPRINT scores indicated improvement in the ability to work and perform daily tasks (p < 0.05). A statistically significant improvement in the total SDS score was revealed following 1 month (p < 0.03) and after 6 months (p < 0.02) of EAT. There was also a significant decline in the days of inefficiency (baseline vs. 6 months: 4.15 ± 2.73 vs, 1.88 ± 2.18 days per week, p < 0.02). CONCLUSION This preliminary pilot open case series study suggests that EAT may be a beneficial treatment for patients suffering from PTSD. The study demonstrated improved ability to work and perform daily tasks and reduction in the number of days of inefficiency. Further large-scale long-term studies are warranted to substantiate our observation.
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Affiliation(s)
- Assaf Shelef
- Abarbanel Mental Health Center, Bat-Yam, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit Brafman
- Therapy, Research & Care Institute, Tel-Mond, Israel
| | - Thom Rosing
- Therapy, Research & Care Institute, Tel-Mond, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Geha Mental Health Center and Felsenstein Medical Research Center, Petah Tiqva, Israel
| | - Rafael Stryjer
- Abarbanel Mental Health Center, Bat-Yam, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoram Barak
- Dunedin School of Medicine, Otago University, New Zealand
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Rubin-Kahana DS, Rubin-Kahana Z, Kuperberg M, Stryjer R, Yodashkin-Porat D. Cognitive enhancement drug use among resident physicians: Prevalence and motivations for use - results from a survey. J Addict Dis 2020; 38:250-256. [PMID: 32297564 DOI: 10.1080/10550887.2020.1747337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Non-medical use of prescription drugs for the enhancement of cognitive functioning has gained popularity in recent years, especially among young educated adults. To our knowledge, no previous study investigated this phenomenon among resident physicians.Objective: To analyze cognitive enhancement drugs use motivations and patterns among resident physicians.Methods: A survey and statistical analysis regarding the use of drugs traditionally prescribed for the treatment of Attention Deficit Hyperactivity Disorder: stimulants, amphetamines and modafinil.Participants: 1,453 residents who took their written residency exam in the summer of 2017. The response rate was 32.3%.Results: 28.1% of responders reported past use, with 73.67% of them reporting use without a related medical diagnosis. Almost half of the users (47.1%) acquired the drug with a prescription, but without a diagnosis of a related medical disorder. The first use was predominantly during residency (54.3%), with 45% reporting it as related to the residency exam.Factors found to positively impact non-medical use include: declaring undiagnosed Attention Deficit Hyperactivity Disorder, fear of failing the exam, a belief that more than 30% of other examinees take cognitive enhancements drugs, and a learning disability diagnosis. Self-reports of being a competitive person and being a parent, were negatively correlated with non-medical use.Conclusions: The use of drugs that are taken traditionally for the treatment of Attention Deficit Hyperactivity Disorder is common among resident physicians, both with and without related medical indication. Interestingly, factors associated with the fear of being "left behind" increase non-medical use and not the desire to succeed.
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Affiliation(s)
- Dafna Sara Rubin-Kahana
- Beer-Yaacov - Ness-Ziona Mental Health Center, Beer Yaakov, Israel.,Sackler Medical School of Tel Aviv University, Tel Aviv, Israel
| | | | - Maya Kuperberg
- Beer-Yaacov - Ness-Ziona Mental Health Center, Beer Yaakov, Israel.,Sackler Medical School of Tel Aviv University, Tel Aviv, Israel
| | - Rafael Stryjer
- Sackler Medical School of Tel Aviv University, Tel Aviv, Israel.,Abarbanel Mental Health Center, Bat Yam, Israel
| | - Dorit Yodashkin-Porat
- Sackler Medical School of Tel Aviv University, Tel Aviv, Israel.,Lev Hasharon Mental Health Center, Tzur Moshe, Israel
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Stryjer R, Grupper D, Strous R, Poyurovsky M, Weizman A. Mianserin for the rapid improvement of chronic akathisia in a schizophrenia patient. Eur Psychiatry 2020; 19:237-8. [PMID: 15196609 DOI: 10.1016/j.eurpsy.2003.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2003] [Revised: 12/05/2003] [Accepted: 12/19/2003] [Indexed: 11/21/2022] Open
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Stryjer R, Shriki Tal L, Gizunterman A, Amital D, Amital H, Kotler M. [NEUROPSYCHIATRIC MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS]. Harefuah 2017; 156:779-782. [PMID: 29292617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This review deals with the neuropsychiatric disorders resulting from systemic lupus erythematosus (SLE). SLE is a chronic autoimmune disease that impacts all systems in the human body, including the central nervous system. Neuropsychiatric symptoms in SLE are a common complication of the disease. This complication has significant implications for the severity of the illness. In most cases no thorough psychiatric assessment is performed during initial evaluation of the disease and no protocol or clear guidelines for treating the psychiatric symptoms in SLE are available. Early diagnosis of the psychiatric symptoms in SLE is critical since absence of treatment may result in severe psychiatric complications. Clinical pharmacological studies are needed in order to develop guidelines for treating psychiatric symptoms in SLE.
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Affiliation(s)
| | | | | | | | - Howard Amital
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel
| | - Moshe Kotler
- Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel
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Pollak L, Osherov M, Berkovitz N, Beckerman I, Stryjer R, Tal S. Magnetic resonance brain imaging in patients with visual vertigo. Brain Behav 2015; 5:e00402. [PMID: 26664788 PMCID: PMC4667762 DOI: 10.1002/brb3.402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 08/22/2015] [Accepted: 09/02/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Patients with visual vertigo (VV) report dizziness provoked by moving visual surroundings. It has been suggested that these subjects develop a compensation strategy for a vestibulo-proprioceptive deficit and rely excessively on visual input. We have postulated that patients with VV might have brain abnormalities that interfere with appropriate processing of visual stimulation and performed a brain MRI study to verify this hypothesis. MATERIALS AND METHODS Patients with VV of more than 3 months duration were included. They were asked to complete the Situational Characteristic Questionnaire (SCQ) that scores for the symptoms of VV. Dizzy patients without VV served as controls. A brain MRI was performed with a Siemens 1.5 Tesla scanner in patients and controls. RESULTS Twenty-four patients with VV were included. Their mean SCQ score was 1.45 ± 0.9 (normal 0.16 ± 0.28). In 50% of patients, abnormalities in MRI imaging were found. Thirty-three percent of 27 controls demonstrated an abnormal brain MRI. The two groups were similar in respect to the prevalence of a localized hemispheric or posterior fossa lesion (P = 0.13), but VV patients had more unspecific white matter brain changes than controls (P = 0.009). Patients and controls did not differ in age and gender distribution (P = 0.9) or the history of a neurotological event preceding their symptoms (P = 0.3). CONCLUSIONS Our study suggests that multiple white matter lesions might contribute to occurrence of the phenomenon of VV. Future prospective large-scale studies by specific MR techniques are indicated to validate our preliminary findings and elucidate the pathological mechanism of VV.
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Affiliation(s)
- Lea Pollak
- Department of Neurology The Assaf Harofeh Medical Center Zerifin Israel ; Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Michael Osherov
- Department of Neurology The Assaf Harofeh Medical Center Zerifin Israel ; Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Nadav Berkovitz
- Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel ; Department of Radiology The Assaf Harofeh Medical Center Zerifin Israel
| | - Inessa Beckerman
- Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel ; Department of Radiology The Assaf Harofeh Medical Center Zerifin Israel
| | - Rafael Stryjer
- Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel ; Public Health Hospital Beer Yaacov Israel
| | - Sigal Tal
- Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel ; Department of Radiology The Assaf Harofeh Medical Center Zerifin Israel
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Lowengrub KM, Stryjer R, Birger M, Iancu I. Social Anxiety Disorder Comorbid with Schizophrenia: The Importance of Screening for This Under recognized and Under treated Condition. Isr J Psychiatry Relat Sci 2015; 52:40-45. [PMID: 25841109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND While the presence of comorbid anxiety disorders such as obsessive-compulsive disorder and panic disorder have been well described in schizophrenia, comorbid social anxiety disorder (SAD) has been less emphasized. The goal of this study was to examine the prevalence of SAD in our ambulatory population of patients with schizophrenia. METHODS A group of 50 outpatients with schizophrenia randomly selected from our public mental health outpatient population was evaluated with the Structured Clinical Interview for DSM-IV (SCID)-schizophrenia section, the Positive and Negative Syndrome Scale (PANSS), the Schizophrenia Quality of Life Scale (SQLS), the Liebowitz Social Anxiety Scale (LSAS) and the Global Assessment of Functioning Scale (GAF). After completion of assessments, a retrospective chart review was conducted on all study patients who met criteria for a diagnosis of SAD in order to determine how many of these patients had been previously given a diagnosis of SAD. RESULTS Based on a cutoff score of 29/30 on the total LSAS score, 38% of our sample had a comorbid diagnosis of SAD. Compared to patients who did not suffer from comorbid SAD, patients with schizophrenia and comorbid SAD had lower ratings of quality of life, but similar GAF and PANSS scores. According to the results of the chart review, none of the affected patients had been previously diagnosed with SAD. CONCLUSIONS According to the results of our study, SAD as a comorbid condition is highly prevalent in schizophrenia and may be under-detected in the outpatient mental health care setting. Furthermore, the presence of SAD may lead to a decreased quality of life for patients with schizophrenia. Further studies should evaluate whether the diagnosis and treatment of comorbid SAD would improve the treatment and quality of life of patients with schizophrenia.
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Affiliation(s)
- Katherine Moss Lowengrub
- Rehovot Mental Health Center, Rehovot and the Beer Yaakov Mental Health Center, Beer Yaakov, both affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Rafael Stryjer
- Rehovot Mental Health Center, Rehovot and the Beer Yaakov Mental Health Center, Beer Yaakov, both affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Moshe Birger
- Rehovot Mental Health Center, Rehovot and the Beer Yaakov Mental Health Center, Beer Yaakov, both affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Iulian Iancu
- Rehovot Mental Health Center, Rehovot and the Beer Yaakov Mental Health Center, Beer Yaakov, both affiliated with the Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Pollak L, Segal P, Stryjer R, Stern HG. Beliefs and emotional reactions in patients with benign paroxysmal positional vertigo: a longitudinal study. Am J Otolaryngol 2012; 33:221-5. [PMID: 21872359 DOI: 10.1016/j.amjoto.2011.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 06/22/2011] [Accepted: 07/13/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Psychologic studies in patients with benign paroxysmal positional vertigo (BPPV) are scarce, considering the high frequency of the disorder. We performed a repeated-measures design questionnaire study in a cohort of patients with BPPV before and after treatment to investigate the dynamics of the psychologic findings and possible treatment consequences. METHODS Thirty-seven consecutive patients with idiopathic BPPV participated in the study. During the first visit and 2 to 3 months after therapy, the patients completed 4 questionnaires: the Dizziness Handicap Inventory, the Illness Perception Questionnaire-Revised, the Intolerance of Uncertainty Scale, and the State-Trait Anxiety Inventory. RESULTS The scores for all questioned items did not change before and after treatment except for the physical handicap scores. Correlation was found between the grade of functional and emotional impact of the disease and belief in consequences as well as anxiety levels of the patients. Moreover, uncertainty scores were in correlation with emotional impact, anxiety levels, and perceived consequences of the disease. The belief in personal control of the condition was correlated with the belief in treatment control and understanding of the disease. CONCLUSION The main finding in this study is the lack of a significant change in beliefs and emotional reactions in patients with BPPV after treatment of their condition. Physicians dealing with BPPV should be aware that the disease is not solely a somatic condition but has a serious impact on the patient's mental state. Selected patients might benefit from anxiolytic medication.
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Affiliation(s)
- Lea Pollak
- Department of Neurology, Assaf Harofeh Medical Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Rosenberg O, Zangen A, Stryjer R, Kotler M, Dannon PN. Response to deep TMS in depressive patients with previous electroconvulsive treatment. Brain Stimul 2010; 3:211-7. [DOI: 10.1016/j.brs.2009.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 11/23/2009] [Accepted: 12/01/2009] [Indexed: 10/20/2022] Open
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Stryjer R, Rosenzcwaig S, Bar F, Ulman AM, Weizman A, Spivak B. Trazodone for the Treatment of Neuroleptic-Induced Acute Akathisia. Clin Neuropharmacol 2010; 33:219-22. [DOI: 10.1097/wnf.0b013e3181ee7f63] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Shiloh R, Schapir L, Bar-Ziv D, Stryjer R, Konas S, Louis R, Hermesh H, Munitz H, Weizman A, Valevski A. Association between corneal temperature and mental status of treatment-resistant schizophrenia inpatients. Eur Neuropsychopharmacol 2009; 19:654-8. [PMID: 19493658 DOI: 10.1016/j.euroneuro.2009.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Revised: 04/12/2009] [Accepted: 04/28/2009] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Preliminary point-prevalent data suggest that drug-free schizophrenia patients may exhibit increased body/corneal temperature, that antipsychotic drugs (APDs) may decrease body/core temperature and that patients' mental status might be associated with their body/corneal temperature. Hence, we hypothesized that treatment-resistant psychotic APD-treated schizophrenia patients' mental status may correlate with their corneal temperature during a continuous 6-week period. METHODS Corneal temperature of 12 treatment-resistant schizophrenia inpatients and 16 healthy volunteers was evaluated 2-3 times a week during 6 consecutive weeks using a flir thermal imaging camera. RESULTS A significant and substantial correlation was found between inpatients' mean weekly Positive and Negative Syndrome Scale (PANSS)'s total scores and their mean weekly corneal temperature during the 6-week study period (r=0.82; n=6 weeks; p=0.043). There was no significant difference in mean 6-week corneal temperature between the patient group and the healthy subjects (34.25+/-0.64 degrees C vs. 34.39+/-0.69 degrees C, respectively; t=1.127, df=131, p=0.26). CONCLUSIONS This study indicates that treatment-resistant overtly psychotic schizophrenia inpatients' mental status (as assessed by the PANSS) correlates with their corneal temperature. The relevance of these phenomena to the pathophysiology of schizophrenia, the biological mechanism underlying corneal temperature alterations and the possible role of temperature-modulating drugs (neuroleptics or non-neuroleptics) on schizophrenic psychosis merits further large-scale investigation in both medicated- and drug-free schizophrenia patients compared to matched controls.
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Affiliation(s)
- Roni Shiloh
- Geha Mental Health Center, Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
BACKGROUND Schizophrenia patients may exhibit alterations in core/body temperature. Hence, we intended to examine the potential existence of thermoregulatory abnormalities in ambulatory schizophrenia patients. METHODS Anonymous electronic patient record data of the Leumit Health Fund (Israel) were screened for all schizophrenia patients who have no other apparent chronic co-morbidity (mental or non-mental) and had their oral temperature assessed during routine follow-ups (Schiz-rFUs) or for various transitory infectious/inflammatory processes (Schiz-Infect) during the years 1999-2005 (n = 535). The comparison group consisted of a comparable sample (n = 560) of healthy subjects (Control-rFUs and Control-Infect). RESULTS The sub-group of Schiz-rFUs (n = 216) exhibited significantly lower mean oral temperature compared to the matched group of Control-rFUs (n = 140) (36.72 +/- 0.54 vs. 36.94 +/- 0.64C, respectively; P<0.05). There was no significant difference in mean oral temperatures between the Schiz-Infect (n = 319) and the Control-Infect (n = 420) (37.32 +/- 0.92 vs. 37.28 +/- 0.98C, respectively; NS). CONCLUSIONS Ambulatory schizophrenia patients without a concomitant infectious/inflammatory process exhibit altered thermoregulation manifested by a substantial (about 0.2 C) and significantly lower oral temperature compared to healthy comparison subjects as well as a potential exaggerated increase in oral temperature during transitory infectious/inflammatory processes. The relevance of these phenomena to the pathophysiology of schizophrenia as well as the potential immune-mediated pathologies in schizophrenia merit further investigation.
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Affiliation(s)
- Roni Shiloh
- Geha Mental Health Center, Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Avital A, Gross-Isseroff R, Stryjer R, Hermesh H, Weizman A, Shiloh R. Zolmitriptan compared to propranolol in the treatment of acute neuroleptic-induced akathisia: a comparative double-blind study. Eur Neuropsychopharmacol 2009; 19:476-82. [PMID: 19342206 DOI: 10.1016/j.euroneuro.2009.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Revised: 02/14/2009] [Accepted: 02/25/2009] [Indexed: 11/19/2022]
Abstract
Neuroleptic-induced akathisia (NIA) is a common, sometimes incapacitating adverse effect of anti-psychotic medication. Zolmitriptan is a selective 5-HT(1D) agonist. We aimed to determine its anti-NIA efficacy in comparison to propranolol. Thirty-three neuroleptic-treated patients were randomly allocated in a double-blind design to receive either 7.5 mg/d of zolmitriptan or 120 mg/d of propranolol for 3 consecutive days, followed by 3 days without any anti-NIA treatment. Patients were assessed at baseline and on days 3 and 7 by the Barnes Akathisia Rating Scale (BARS), PANSS, HAMD, HAMA, Pulse, and Blood Pressure. Both groups showed improvement of akathisia (BARS) along the treatment period, with significant effect for time but not for group. No significant differences were found between the groups in all other measurements. Taken together, zolmitriptan was found to be as effective as propranolol for the treatment of NIA. Further placebo-controlled studies are warranted.
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Affiliation(s)
- Ayelet Avital
- Research unit, Geha Mental Health Center, Petach Tikva, Israel.
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Shiloh R, Kushnir T, Gilat Y, Gross-Isseroff R, Hermesh H, Munitz H, Stryjer R, Weizman A, Manor D. In vivo occipital-frontal temperature-gradient in schizophrenia patients and its possible association with psychopathology: a magnetic resonance spectroscopy study. Eur Neuropsychopharmacol 2008; 18:557-64. [PMID: 18554876 DOI: 10.1016/j.euroneuro.2008.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 04/06/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Accumulating data suggest that schizophrenia patients' mental status might be modulated by their core/brain temperature. Hence, we intended to assess in vivo brain temperature (Tb) of schizophrenia patients vs. healthy subjects and to evaluate its potential association with patients' mental status. METHODS Absolute values of Tb were measured in 9 neuroleptic-treated schizophrenia patients and 10 healthy comparison subjects using 1H magnetic resonance spectroscopy (MRS). Values were extracted by measuring the chemical shift between the peaks of water and N-acetyl-aspartate in the 1H MRS spectra. RESULTS A substantial (about 1.1 degrees C) and significantly higher occipital-frontal temperature-gradient was found in the schizophrenia patients compared to the healthy controls (1.27 degrees C vs. 0.18 degrees C; p=0.032). Furthermore, a trend was found between the above mentioned occipital-frontal temperature-gradient in the schizophrenia patients and the severity of their psychopathology, as assessed by the total Positive and Negative Syndrome Scale (PANSS) scores (r=0.61; p=0.08). CONCLUSIONS Our findings corroborate previous results indicating putative correlation between core/brain temperature and the mental status of schizophrenia patients, emphasizing the possible role of within patients decreased frontal temperature and a significant occipital-frontal temperature-gradient as modulators of psychopathology. In addition, the MRS technique used for brain temperature assessment seems to be a potential non-invasive method to assess in vivo absolute Tb in schizophrenia.
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Affiliation(s)
- Roni Shiloh
- Geha Mental Health Center, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Israel.
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17
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Shiloh R, Munitz H, Stryjer R, Weizman A. A significant correlation between ward temperature and the severity of symptoms in schizophrenia inpatients--a longitudinal study. Eur Neuropsychopharmacol 2007; 17:478-82. [PMID: 17234387 DOI: 10.1016/j.euroneuro.2006.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 12/04/2006] [Accepted: 12/05/2006] [Indexed: 01/22/2023]
Abstract
BACKGROUND Preliminary data suggest that schizophrenia outpatients' mental status might be affected, at least to some extent, by environmental temperature. To further substantiate the potential role of environmental temperature and schizophrenic symptoms we examined, in a naturalistic design, the relationship between environmental temperature of schizophrenia inpatients (i.e., ward temperature) and their mental status. METHODS Mean daily temperature of a closed psychiatric ward was monitored for 32 consecutive weeks. Temperature assessments were performed at 3 different locations within the ward at the same hour daily. Mean daily temperature was defined as the average of the 3 values. During each of the 32 weeks of the study, the inpatients were divided into two sub-groups: schizophrenia patients (n=22-34 patients/week) and non-schizophrenia psychotic patients (n=5-12 patients/week). The mental status of all participants was evaluated weekly using the positive and negative syndrome scale (PANSS). All participants were treated with antipsychotics during the entire study period. RESULTS Schizophrenia patients' total PANSS score, as well as each of the PANSS' subscales (positive, negative, general psychopathology, depression) were positively and significantly correlated with ward temperature (r=0.52-0.64; p=0.002-0.0001). No correlation was found between ward temperature and any of the PANSS' subscales in the non-schizophrenia psychotic subjects. CONCLUSION Our results suggest that schizophrenia inpatients' mental status might be modulated, at least to some extent, by environmental (i.e., ward) temperature and that this phenomenon is specific to schizophrenia patients. Our findings imply the need for optimally adjusting ward temperature (e.g., about 19 degrees C in this study) for the management of patients with acute psychotic exacerbation of schizophrenia.
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Affiliation(s)
- Roni Shiloh
- Geha Mental Health Center, Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Strous RD, Stryjer R, Maayan R, Gal G, Viglin D, Katz E, Eisner D, Weizman A. Analysis of clinical symptomatology, extrapyramidal symptoms and neurocognitive dysfunction following dehydroepiandrosterone (DHEA) administration in olanzapine treated schizophrenia patients: a randomized, double-blind placebo controlled trial. Psychoneuroendocrinology 2007; 32:96-105. [PMID: 17208382 DOI: 10.1016/j.psyneuen.2006.11.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 11/06/2006] [Accepted: 11/08/2006] [Indexed: 11/22/2022]
Abstract
Several studies have demonstrated the effective use of dehydroepiandrosterone (DHEA) in the management of mood, however studies of its use in psychosis remain limited. The aim of this study was to investigate for the first time efficacy of DHEA augmentation with standardized antipsychotic medication (olanzapine) and to explore effects of DHEA augmentation on side-effect profiles including weight gain, glucose tolerance, aggression, quality of life and neurocognitive function. Finally, we aimed to analyze any relationship between plasma levels and clinical response to DHEA administration. Forty patients with chronic schizophrenia stabilized on olanzapine were randomized in double-blind fashion to receive either DHEA (titrated up to 150mg) or placebo augmentation for a period of 12-weeks. Blood samples were collected at baseline, mid-study and study completion. Results indicated improvement of negative symptoms (SANS scale) even when baseline scores were controlled as a covariate. Some improvement in Parkinsonism and akathisia compared to baseline was seen in patients receiving DHEA. No change in psychosis as reflected by the PANSS was noted. Patients receiving DHEA appeared to demonstrate relatively stable glucose levels compared to controls at the end of the study. An improvement in cognitive performance (most notably memory), which did not reach significance due to low sample number, was observed following DHEA administration. Results further suggest preliminary evidence of involvement of the neurosteroid system in schizophrenia pathophysiology, and confirm initial "cautious" findings identifying an agent capable of improving negative symptoms and certain features of extrapyramidal side effects.
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Affiliation(s)
- Rael D Strous
- Beer Yaakov Mental Health Center P.O. Box 1, Beer Yaakov 70350, Israel.
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19
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Abstract
BACKGROUND Vestibular evoked myogenic potentials (VEMPs) provide assessment of vestibular function. They consist in picking up compound muscle action potentials in the sternocleidomastoid (SCM) muscles in response to auditory stimulation of the vestibulum. VEMP testing has found application mainly in peripheral vestibular disorders, whereas reports about VEMPs in central vestibular lesions are rather scarce. AIMS OF THE STUDY Based on the physiological connections between the cerebellum and the vestibular nuclei, we investigated the influence on VEMPs of cerebellar and lower-brainstem strokes. We examined whether or not this method may be suitable as a clinical tool for the evaluation of the extent of cerebellar strokes. PATIENTS AND METHODS Nineteen patients with cerebellar ischemic stroke and 15 patients with lower-brainstem ischemic stroke (11 in the pons, four in the medulla) were included. The latencies and amplitudes of P13 and N23 in both groups of patients were compared with those obtained in a control group of 53 normal individuals. RESULTS VEMP responses were obtained in all patients and controls. At the group level, mean peak latencies and amplitudes, and the number of subjects with significantly deviant values did not differ between patients and controls. There were no latency or amplitude differences ipsilaterally or contralaterally to the lesion. At the individual level, there was no correlation between laterality of lesion and that of P13 or N23 abnormalities in patients with cerebellar strokes; however, there were two patients (one pontine, one medullar stroke) who presented P13 and N23 latency abnormalities ipsilaterally to the lesion. CONCLUSION Cerebellar strokes do not influence VEMPs. Moreover, despite previous reports, we were unable to find at a group level any statistically significant VEMP changes in patients with lower-brainstem strokes as compared with controls. Therefore, VEMPs do not appear a suitable tool for assessment of brainstem integrity in patients with posterior fossa strokes. However, they could constitute a sensitive method for documentation of involvement of the central vestibular pathways in patients with brainstem stroke.
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Affiliation(s)
- L Pollak
- Department of Neurology, The Assaf Harofeh Medical Center, Zerifin, Israel; Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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20
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Abstract
BACKGROUND Bilateral benign paroxysmal positioning vertigo (bBPPV) is rather rare, accounting for up to 10% in the reported benign paroxysmal positioning vertigo (BPPV) series. Inappropriate head positioning during testing in unilateral BPPV causes the otolith debris in the uppermost ear to move toward the cupula, resulting in an inhibitory nystagmus and mimicking bBPPV. PURPOSE We analyzed the clinical data of patients with bilaterally positive Dix-Hallpike maneuver and compared them with the characteristics of patients with unilateral BPPV. We further tried to propose a simple schematic approach to the treatment of patients with bilaterally positive Dix-Hallpike maneuver. MATERIALS AND METHODS Medical records of 232 patients treated for BPPV at our dizziness clinic during 1999 to 2003 were reviewed. An algorithm used for the treatment of patients with bilaterally positive BPPV is discussed. RESULTS Twenty-eight patients with bilaterally positive Dix-Hallpike test were found. Sixteen were diagnosed with bBPPV, and 12 were diagnosed with unilateral mimicking bBPPV. Thirty patients with unilateral posterior canal BPPV served as control subjects. No difference in age, sex distribution, duration of symptoms, number of treatments per ear, and recurrence was found between bBPPV and unilateral BPPV. The female sex appeared to be predisposed for more treatments. The total duration of BPPV symptoms obtained by history was found to correlate with the number of recurrences after treatment. CONCLUSIONS We conclude that bBPPV can be readily distinguished from unilateral mimicking bBPPV. Patients with bBPPV do not differ from patients with unilateral BPPV in clinical characteristics. The mechanism of otolith debris dislodgment appears to be the main cause of bilaterality, trauma being a more common trigger than other known causes of BPPV.
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Affiliation(s)
- Lea Pollak
- Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.
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21
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Shiloh R, Munitz H, Portuguese S, Gross-Isseroff R, Sigler M, Bodinger L, Katz N, Stryjer R, Hermesh H, Weizman A. Corneal temperature in schizophrenia patients. Int J Neuropsychopharmacol 2005; 8:537-47. [PMID: 15927092 DOI: 10.1017/s1461145705005377] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2004] [Revised: 01/09/2005] [Accepted: 01/16/2005] [Indexed: 11/05/2022] Open
Abstract
Most data imply that dopaminergic transmission is essential for proper hypothalamic-mediated core temperature regulation. Altered central dopaminergic transmission is suggested to be involved in the pathophysiology of schizophrenia. Thus, hypothetically, schizophrenia patients might be at increased risk of developing thermoregulatory dysregulation manifested by alterations in core temperature, as well as in peripheral tissue, the temperature of which has been shown to correlate with core temperature (e.g. cornea). Previous small pilot studies of ours showed that schizophrenia patients may exhibit corneal temperature abnormalities. Hence, we assessed corneal temperature in a controlled sample of drug-free ( n =11) and medicated ( n =28) schizophrenia patients compared to healthy comparison subjects ( n =9), using a FLIR thermal imaging camera. Drug-free schizophrenia patients exhibited significantly higher corneal temperature compared to healthy subjects, typical antipsychotic drug (APD)-treated patients ( n =16) and atypical APD-treated patients ( n =12) (37.08+/-1.46 degrees C vs. 33.37+/-2.51 degrees C, 31.08+/-1.43 degrees C and 31.67+/-0.44 degrees C respectively, p <0.0001; p <0.001 vs. each group separately). The healthy comparison subjects and the atypical APD-treated patients exhibited comparable corneal temperatures and these two groups exhibited higher corneal temperatures compared to the typical APD-treated patients ( p <0.01 and p =0.051 respectively). In conclusion, this study indicates that drug-free schizophrenia patients exhibit substantially higher corneal temperature compared to healthy comparison subjects or medicated patients, and that APDs may decrease corneal temperature either to normal (atypical APD) or to subnormal (typical APD) values. The relevance of these phenomena to the pathophysiology of schizophrenia, the biological mechanism underlying drug-induced corneal temperature alterations, the possible role of temperature-lowering drugs (neuroleptics or non-neuroleptics) on schizophrenic psychosis as well as the role of corneal temperature as a tool to evaluate adherence to APD treatment merit further investigation via larger samples of both medicated and drug-free schizophrenia patients compared to matched controlled subjects.
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Affiliation(s)
- Roni Shiloh
- Geha Mental Health Center, Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Israel
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22
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Schwartz K, Iancu I, Stryjer R, Chelben J, Kotler M, Weizman A, Rehavi M. Reduced platelet vesicular monoamine transporter density in smoking schizophrenia patients. Eur Neuropsychopharmacol 2005; 15:557-61. [PMID: 16139173 DOI: 10.1016/j.euroneuro.2005.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 02/22/2005] [Indexed: 11/20/2022]
Abstract
Brain vesicular monoamine transporter 2 (VMAT2) has a critical role in the regulation of monoaminergic neurotransmission. In our previous study we have found decreased platelet VMAT2 density in healthy habitual smokers. Schizophrenia is associated with high rate of cigarette smoking. In the present study we assessed platelet VMAT2 pharmacodynamic characteristics in a population of medicated schizophrenia patients (n=36) comparing smokers (n=23) vs. non-smokers (n=13). A significant decrease in platelet VMAT2 density (24%, p=0.005) was found in the smokers compared to the non-smokers . This decrease was not ascribed to the pharmacotherapy. An inverse correlation was found in the smokers between the platelet VMAT2 density and the severity of schizophrenia as assessed by the positive and negative syndrome scale (PANSS). Our observation in schizophrenia patients is consistent with that found in healthy smokers. The complex relationship between VMAT2 expression, cigarette smoking and schizophrenia merits a further large scale study.
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Affiliation(s)
- Karin Schwartz
- Tel-Aviv University, Sackler Faculty of Medicine, Physiology and Pharmacology, 69978 Tel-Aviv, Israel
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23
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Stryjer R, Klein C, Treves TA, Rabey JM. The effects of acute loading with levodopa and levodopa with selegiline on blood pressure and plasma norepinephrine levels in chronic Parkinson's disease patients. Acta Neurol Scand 2005; 111:89-94. [PMID: 15644067 DOI: 10.1111/j.1600-0404.2005.00294.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Contradictory possible cardiovascular side effects of selegiline have been reported. Therefore, we studied the effect of acute administration of selegiline with levodopa (LD) compared with LD alone, on blood pressure, pulse and norepinephrine (NE) plasma levels, during an orthostatic test on chronically treated Parkinson's disease patients (PDpts) and controls. MATERIALS AND METHODS Twelve PDpts treated with LD (group D), 12 PDpts treated with selegiline and LD (group S) and eight volunteers (CTRL) underwent the orthostatic test. Patients repeated the test twice, before and after acute loading with 125 mg LD (group D) and 125 mg LD +5 mg selegiline (group S). RESULTS Group S showed more episodes of postural hypotension (n = 10; two symptomatic) than group D (n = 4) and CTRL (n = 2), however not statistically significant. Plasma NE also rose significantly higher (P < 0.001) in group S. CONCLUSION PD patients treated with selegiline showed more orthostatism and higher plasma NE after submission to the orthostatic test. These findings may be relevant to explain its deleterious effect.
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Affiliation(s)
- R Stryjer
- Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel
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Reznik I, Yavin I, Stryjer R, Spivak B, Gonen N, Strous R, Mester R, Weizman A, Kotler M. Clozapine in the treatment of obsessive-compulsive symptoms in schizophrenia patients: a case series study. Pharmacopsychiatry 2004; 37:52-6. [PMID: 15048611 DOI: 10.1055/s-2004-815525] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Obsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. There are some reports describing the appearance de novo or reemergence of preexisting OC symptoms under clozapine (CLZ) therapy. However, there are also reports describing a positive effect of CLZ therapy in OC schizophrenic patients. It seems that comorbid OC symptoms are common among CLZ-treated refractory schizophrenic patients and are likely to be an integral part of their illness. The complex nature of the treatment response in this group of schizophrenic patients is as yet unclear. The effects of CLZ on OC symptoms may vary, with evidence of improvement in some and worsening among others. METHODS The present case series study describes our experience with CLZ as a sole agent (n = 10) or in combination with serotonin reuptake inhibitors (n = 5), in schizophrenic patients with prominent OC symptomatology. RESULTS Systematic analysis of clinical features of our patients, as well as findings in the literature to date, led us to suggest some factors that may predict response to CLZ treatment in treatment-resistant schizophrenic patients with prominent OC symptoms: 1) schizophrenic patients who began to exhibit OC symptoms within the course of the psychotic process need and might to be successfully treated with CLZ alone; 2) when OC symptomatology preceded the development of schizophrenic process, CLZ monotherapy is inefficient and may even worsen OC symptoms; therefore, it should be treated concomitantly with specific anti-obsessive agents; 3) in both groups there is a definite dose-related pro-obsessive influence of CLZ when it is given in high doses. DISCUSSION Further controlled investigations in a larger cohort of OC schizophrenic patients are needed to substantiate our hypothesis. OCD:Obsessive-compulsive disorder OCS:Obsessive-compulsive symptoms SRI:Serotonin reuptake inhibitors
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Affiliation(s)
- I Reznik
- Ness-Ziona Mental Health Center, Ness-Ziona, Israel.
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25
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Stryjer R, Strous R, Bar F, Shaked G, Shiloh R, Rozencwaig S, Grupper D, Buchman N, Kotler M, Rabey JM, Weizman A. Donepezil augmentation of clozapine monotherapy in schizophrenia patients: a double blind cross-over study. Hum Psychopharmacol 2004; 19:343-6. [PMID: 15252826 DOI: 10.1002/hup.595] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Increasing evidence suggests that the cholinergic system is involved in the pathogenesis of schizophrenia. Donepezil, a central cholinesterase inhibitor, improves psychotic symptomatology in demented patients, however, evidence for its role in the management of active psychosis in schizophrenia remains limited. An 18-week double blind cross-over study was conducted in which eight patients were randomly assigned to either donepezil (5 mg/day for the first 4 weeks and 10 mg/day for the following 4 weeks) or placebo as augmentation treatment to clozapine. After this initial phase, there was a 2-week washout period of the study medication after which the same regimen was crossed over at the same dose and for the same period (8 weeks). No significant difference was noted in the total positive and negative symptom scale scores when donepezil was compared with placebo (16.7%+12.97% vs 3.20%+13.94% respectively, p = 0.18). However, three patients improved (>15%) in the total PANSS scores (37.03%, 16.6% and 25.33%) during the donepezil treatment phase, while only one patient improved (20.87%) during the placebo phase. No differences were noted in the Calgary depression scale (p = 0.305), Simpson Angus scale (p = 0.374), clinical global impression-improvement scale (p = 0.23) and clinical global impression-severity of illness scores (p = 0.116). Although this preliminary study failed to demonstrate a clear effect of donepezil augmentation in clozapine treated chronic schizophrenia patients, it seems that the subtle positive effect of donepezil observed in some of our patients should encourage further investigation in a larger sample of this patient subpopulation.
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26
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Nahshoni E, Manor N, Bar F, Stryjer R, Zalsman G, Weizman A. Alterations in QT dispersion in medicated schizophrenia patients following electroconvulsive therapy. Eur Neuropsychopharmacol 2004; 14:121-5. [PMID: 15013027 DOI: 10.1016/s0924-977x(03)00098-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2003] [Revised: 06/17/2003] [Accepted: 06/17/2003] [Indexed: 11/24/2022]
Abstract
QT dispersion (QTd) is a measure of interlead variations of the surface 12-lead electrocardiogram (ECG). Increased QTd, found in various cardiac diseases, reflects cardiac instability and is associated with increased risk for cardiac death. Research suggests a link between antipsychotics, ECG abnormalities (QT prolongation) and increased sudden cardiac mortality rates. However, QTd analysis has been scarcely investigated in schizophrenia patients. We calculated QTd in 20 medicated psychotic inpatients with schizophrenia, before and 3 days after electroconvulsive therapy (ECT), concomitantly with Brief Psychiatric Rating Scale (BPRS) assessment. QT interval and the rate-corrected QT (QTc) were abnormally prolonged before ECT. However, although QT was significantly shortened, QTc showed only a marginal decrease after ECT. QTd, the rate-corrected QTd, as well as BPRS, showed a significant decrease after ECT. Further large-scale studies are warranted to determine if QTd can serve as a marker for response to ECT, and if it is a risk factor for sudden cardiac death in schizophrenia patients.
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Affiliation(s)
- Eitan Nahshoni
- Geha Mental Health Center, Campus Beilinson, Petach Tivka, Israel.
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Strous RD, Stryjer R, Weiss M, Ofir D, Bar F, Baruch Y, Kotler M. DSM-IV self-report and subjective evaluation by psychiatrists in Israel. Isr J Psychiatry Relat Sci 2004; 41:197-207. [PMID: 15754523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Psychiatric disorder, with the range of both subsyndromal and syndromal manifestation, is an important, yet often unrecognized and unacknowledged, problem among physicians. It is a subject that remains understudied, particularly among psychiatrists. The purpose of this study was to explore the subjective perception of mental illness among members of the psychiatric profession. METHOD Psychiatrists attending an educational symposium completed, anonymously, a self-evaluation questionnaire in which they were asked to self-diagnose the presence of DSM-IV disorders. RESULTS 110 responses were received (response rate: 52.1%); 90% of respondents indicated the presence of at least one syndrome or trait. The most common disorders on axis I and axis II were "mood disorder" and "narcissistic traits" respectively, with the least common being "psychotic disorder" and "schizotypal traits." Female psychiatrists reported more impairment, particularly among axis I disorders. The reported number of axis I and II conditions decreased with subjects' age. CONCLUSIONS Manifestations of psychiatric conditions including the range of subthreshold phenomena, as self-diagnosed according to DSM-IV criteria, appear to be prominently reported, albeit with low severity, in a subjective manner by psychiatrists. Our findings may be of importance in encouraging the implementation of special programs in training and ongoing occupational support.
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Affiliation(s)
- Rael D Strous
- Beer Yaakov Mental Health Center, Beer Yaakov, Israel.
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28
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Stopkova P, Saito T, Fann CSJ, Papolos DF, Vevera J, Paclt I, Zukov I, Stryjer R, Strous RD, Lachman HM. Polymorphism screening of PIP5K2A: a candidate gene for chromosome 10p-linked psychiatric disorders. Am J Med Genet B Neuropsychiatr Genet 2003; 123B:50-8. [PMID: 14582145 DOI: 10.1002/ajmg.b.20012] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lithium is a potent noncompetitive inhibitor of inositol monophosphatases, enzymes involved in phosphoinositide (PI) and inositol phosphate metabolism. A critical component of the PI pathway is phosphatidylinositol 4,5-bisphosphate (PtdIns(4,5)P(2)), which is hydrolyzed to second messengers and has a direct role in synaptic vesicle function. Interestingly, a number of genes involved in the synthesis and dephosphorylation of PtdIns(4,5)P(2) are found in regions of the genome previously mapped in bipolar disorder (BD) including 10p12, 21q22, and 22q11, among others. Some of these regions overlap with loci mapped in schizophrenia (SZ). One gene involved in PI metabolism that maps to a region of interest is 10p12-linked PIP5K2A, a member of the phosphatidylinositol 4-phosphate 5-kinase family. Polymorphism screening revealed the existence of an imperfect CT repeat polymorphism located near the exon 9-intron 9 splice donor site. A modest difference was found in the distribution of alleles from this highly polymorphic variant when bipolar and schizophrenic subjects were compared with controls; relatively rare short repeat variants were found more commonly in patients and homozygosity for a common long repeat variant was found more commonly in controls. These data suggest that the imperfect CT repeat in PIP5K2A intron 9 should be further investigated as a possible candidate allele for 10p12-linked psychiatric disorders.
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Affiliation(s)
- Pavla Stopkova
- Department of Psychiatry and Behavioral Sciences, Division of Psychiatry Research, Albert Einstein College of Medicine, New York 10461, USA
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Shiloh R, Bodinger L, Katz N, Sigler M, Stryjer R, Hermesh H, Munitz H, Weizman A. Lower corneal temperature in neuroleptic-treated vs. drug-free schizophrenia patients. Neuropsychobiology 2003; 48:1-4. [PMID: 12886032 DOI: 10.1159/000071820] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Antipsychotic drugs (APDs) can decrease core body temperature in schizophrenia patients. Core temperature may correlate with corneal temperature and thus, we hypothesized that neuroleptic-treated schizophrenia patients would display lower corneal temperature compared with drug-free patients. Corneal temperature of 12 typical APD-treated and 9 drug-free male schizophrenia patients was assessed using a FLIR thermal imaging camera. The APD-treated patients exhibited substantially and significantly lower corneal temperature compared with the drug-free patients (31.57 +/- 0.98 degrees C vs. 34.55 +/- 1.65 degrees C; p < 0.0001). Our results suggest that APDs may decrease corneal/core temperature in schizophrenia patients. The relevance of this finding to the pathophysiology of schizophrenia or to the antipsychotic effect of neuroleptics merit further investigation.
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Affiliation(s)
- Roni Shiloh
- Geha Psychiatric Hospital, Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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30
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Abstract
Akathisia is a common and distressful extrapyramidal adverse side effect usually resulting from the use of antipsychotic medications. Early management of akathisia is important because it may be associated with poor treatment response and medication noncompliance. Unfortunately many patients fail to respond to standard management of akathisia. In addition to dopaminergic mechanisms, it has been hypothesized that serotonin may play a prominent role in the pathophysiology of akathisia. Trazodone is an antidepressant agent demonstrating prominent serotonergic antagonistic properties. This open-label pilot study investigates the efficacy of trazodone in the management of akathisia. Nine female patients with a score of at least "mild akathisia" on the Barnes Akathisia Scale, and receiving a stable dose of antipsychotic medication, were administered trazodone, titrated up to a dosage of 100 mg/day over a period of 5 days. The patients demonstrated marked improvement in symptoms of akathisia. In addition, some improvement was noted in symptomatology of anxiety, depression, and psychosis. These observations suggest the use of trazodone as a beneficial and relatively safe medication for the treatment of antipsychotic medication-induced akathisia. Further study in the context of a double-blind, placebo-controlled trial is mandated to substantiate these preliminary findings.
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Stryjer R, Strous RD, Shaked G, Bar F, Feldman B, Kotler M, Polak L, Rosenzcwaig S, Weizman A. Amantadine as augmentation therapy in the management of treatment-resistant depression. Int Clin Psychopharmacol 2003; 18:93-6. [PMID: 12598820 DOI: 10.1097/00004850-200303000-00005] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Treatment-resistant depression is an important clinical problem presenting a major challenge to clinical psychiatry. While several strategies have been attempted, including medication switch, antidepressant polypharmacy and various augmentative regimens, success remains limited. Amantadine (AMN), an agent traditionally used in the treatment and prophylaxis of influenza, is now known to exhibit prominent effects at the level of dopaminergic, monoamine oxidase and N-methyl-D-aspartate systems. The present reports on the efficacy of AMN as augmentation to standard antidepressant treatment in patients with treatment-resistant depression. Eight patients with treatment-resistant depression consented to receive AMN, titrated up to a dose of 300 mg, over a period of 4 weeks in a non-blinded fashion. Improvement in both depression and anxiety scores were observed from week 1, with patients exhibiting improvement of depressive scores of up to 49% by study completion. Females appeared to exhibit a stronger response, and within a shorter period of time. Side-effects reported included dry mouth and sedation. AMN appears to demonstrate efficacy as a safe and effective augmentative agent in treatment-resistant depression. Further studies are clearly mandated to test these preliminary observations in a double-blinded manner.
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Strous RD, Maayan R, Lapidus R, Stryjer R, Lustig M, Kotler M, Weizman A. Dehydroepiandrosterone augmentation in the management of negative, depressive, and anxiety symptoms in schizophrenia. Arch Gen Psychiatry 2003; 60:133-41. [PMID: 12578430 DOI: 10.1001/archpsyc.60.2.133] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Negative symptoms of schizophrenia are a prominent feature of the illness, and frequently remain refractory to treatment. Dehydroepiandrosterone (DHEA), along with its sulfated form, DHEA-S, is an important circulating neurosteroid with several vital neurophysiological functions, including the regulation of neuronal excitability and function. OBJECTIVE Since the administration of DHEA has demonstrated improvement in mood, sense of well-being, interest, activity, and energy in several subpopulations, we investigate the efficacy of DHEA in the management of the negative symptoms of schizophrenia. DESIGN Thirty DSM-IV-diagnosed schizophrenic patients with prominent negative symptoms (inpatients in a large referral state hospital) were randomized to receive either DHEA or placebo in double-blind fashion, in addition to regular antipsychotic medication, dose-stabilized prior to study entry. The DHEA was titrated up to a dose of 100 mg in divided doses during 6 weeks. RESULTS Results indicated significant improvement in negative symptoms (P<.001), as well as in depressive (P<.05) and anxiety (P<.001) symptoms in individuals receiving DHEA. This effect was especially noted in women. The improvement in negative symptoms was independent of improvement in depression. No differences were noted on the positive symptom subscale of the Positive and Negative Syndrome Scale (PANSS) or on the total PANSS score as compared with placebo. Subjects receiving DHEA demonstrated a significant increase in DHEA (P<.05) and DHEA-S (P<.01) plasma levels, without changes in cortisol levels. Increases in DHEA and plasma DHEA-S levels were correlated with improvement in negative symptoms (P<.05), but not with improvement in depressive and anxiety symptoms. No obvious adverse effects were experienced by participating subjects. CONCLUSIONS Our preliminary observations report for the first time in double-blind fashion the efficacy of DHEA augmentation in the management of negative, depressive, and anxiety symptoms of schizophrenia. The findings from this study raise important issues regarding the role of neurosteroids in general, and DHEA in particular, in the ongoing symptomatology and pharmacotherapy of schizophrenia.
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Affiliation(s)
- Rael D Strous
- Beer Yaakov Mental Health Center, P.O. Box 1, Beer Yaakov 70350, Israel.
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Affiliation(s)
- Rael D Strous
- Beer Yaakov Mental Health Center, P.O. Box 1, Beer Yaakov 70350, Israel
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Strous RD, Stryjer R, Zerzion M, Weiss M, Bar F. Accent echoing: a newly described imitation phenomenon of psychosis? Isr Med Assoc J 2003; 5:61-2. [PMID: 12592963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Rael D Strous
- Beer Yaakov Mental Health Center, Beer Yaakov, Israel.
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Stryjer R, Strous RD, Bar F, Werber E, Shaked G, Buhiri Y, Kotler M, Weizman A, Rabey JM. Beneficial effect of donepezil augmentation for the management of comorbid schizophrenia and dementia. Clin Neuropharmacol 2003; 26:12-7. [PMID: 12567159 DOI: 10.1097/00002826-200301000-00004] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Comorbid schizophrenia and dementia is a common clinical phenomenon; however, management of the coexisting illnesses remains incomplete. Donepezil, a cholinesterase inhibitor, may be beneficial for the management of symptoms of Alzheimer's disease, a disease in which cholinergic pathways in the cerebral cortex and basal forebrain are well known to be compromised. Furthermore, impaired cognition in elderly schizophrenic patients has been observed to be more than two thirds; however, there are no published controlled studies reporting the use of cholinesterase inhibitors in the management of schizophrenia in patients with associated dementia. In this study, six patients with chronic schizophrenia and comorbid dementia were administered donepezil, 5 mg, in single-blind fashion as augmentation to their standard antipsychotic medication for a 4-week period. Patients were evaluated with the Mini Mental State Examination (MMSE); Alzheimer's Disease Assessment Scale, Cognitive subscale; Positive and Negative Symptom Scale (PANSS); and the Clinical Global Impression (CGI) scales. A significant improvement was noted in MMSE scores (P < 0.01) and for CGI scores (P < 0.01). In addition, three patients demonstrated improvement on the PANSS. Donepezil appears to be an effective treatment for the management of symptoms of dementia accompanying patients with comorbid schizophrenia and dementia. Since cholinergic dysfunction may be present in some patients with schizophrenia, the authors' findings further demonstrate the possibility that this disorder may be managed with cholinergic medications as augmenting agents, at least in this specific subpopulation of patients with comorbid dementia. To confirm the findings of this preliminary trial, further investigation is mandated with a larger sample of subjects in the context of a double-blind medication trial.
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Affiliation(s)
- R D Strous
- Beer Yaakov Mental Health Center, Israel
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