Stuttering as a spectrum disorder: A hypothesis

Childhood-onset fluency disorder, commonly referred to as stuttering, affects over 70 million adults worldwide. While stuttering predominantly initiates during childhood and is more prevalent in males, it presents consistent symptoms during conversational speech. Despite these common clinical manifestations, evidence suggests that stuttering, may arise from different etiologies, emphasizing the need for personalized therapy approaches. Current research models often regard the stuttering population as a singular, homogenous group, potentially overlooking the inherent heterogeneity. This perspective consolidates both historical and recent observations to emphasize that stuttering is a heterogeneous condition with diverse causes. As such, it is crucial that both therapeutic research and clinical practices consider the potential for varied etiologies leading to stuttering. Recognizing stuttering as a spectrum disorder embraces its inherent variability, allowing for a more nuanced categorization of individuals based on the underlying causes. This perspective aligns with the principles of precision medicine, advocating for tailored treatments for distinct subgroups of people who stutter, ultimately leading to personalized therapeutic approaches.

An unexpected iron in the fire of speech production

This scientific commentary refers to ‘Elevated iron concentration in putamen and cortical speech motor network in developmental stuttering’, by Cler et al. (doi:10.1093/brain/awab283).

Dopamine, vocalization, and astrocytes

Dopamine, the main catecholamine neurotransmitter in the brain, is predominately produced in the basal ganglia and released to various brain regions including the frontal cortex, midbrain and brainstem. Dopamine's effects are widespread and include modulation of a number of voluntary and innate behaviors. Vigilant regulation and modulation of dopamine levels throughout the brain is imperative for proper execution of motor behaviors, in particular speech and other types of vocalizations. While dopamine's role in motor circuitry is widely accepted, its unique function in normal and abnormal speech production is not fully understood. In this perspective, we first review the role of dopaminergic circuits in vocal production. We then discuss and propose the conceivable involvement of astrocytes, the numerous star-shaped glia cells of the brain, in the dopaminergic network modulating normal and abnormal vocal productions.

Investigation of Risperidone Treatment Associated With Enhanced Brain Activity in Patients Who Stutter

Stuttering is a childhood onset fluency disorder that leads to impairment in speech. A randomized, double-blinded placebo-controlled study was conducted with 10 adult subjects to observe the effects of risperidone (a dopamine receptor 2/serotonin receptor 2 antagonist) on brain metabolism, using [¹⁸F] deoxyglucose as the marker. At baseline and after 6 weeks of taking risperidone (0.5–2.0 mg/day) or a placebo pill, participants were assigned to a solo reading aloud task for 30 min and subsequently underwent a 90-min positron emission tomography scan. Paired t-tests were performed to compare the pre-treatment vs. post-treatment in groups. After imaging and analysis, the blind was broken, which revealed an equal number of subjects of those on risperidone and those on placebo. There were no significant differences in the baseline scans taken before medication randomization. However, scans taken after active treatment demonstrated higher glucose uptake in the specific regions of the brain for those in the risperidone treatment group (p < 0.05). Risperidone treatment was associated with increased metabolism in the left striatum, which consists of the caudate and putamen, and the Broca’s area. The current study strengthens previous research that suggests the role of elevated dopamine activity and striatal hypometabolism in stuttering. We propose that the mechanism of risperidone’s action in stuttering, in part, involves increased metabolism of striatal astrocytes. We conclude that using neuroimaging techniques to visualize changes in the brain of those who stutter can provide valuable insights into the pathophysiology of the disorder and guide the development of future interventions.

How and when to treat the most common adverse effects of antipsychotics: Expert review from research to clinical practice

OBJECTIVE

As most treatment guidelines for antipsychotics focus on clinical efficacy, we will instead focus on adverse effects and how to manage them. In this review, we aim to provide an up-to-date clinical resource for providers who prescribe antipsychotics and have included here "what's new" and "what to do" for numerous antipsychotic-induced adverse effects.

METHODS

A review was performed of relevant literature, studies, randomized clinical trials, and systematic reviews. This information was combined with the clinical experience of the authors to formulate a practical guide for treating adverse effects of antipsychotics with an emphasis on metabolic and movement disorder adverse effects and brief mention of some others (sedation and sexual dysfunction).

CONCLUSIONS

Antipsychotics are an integral part of psychiatric care and are often prescribed lifelong. When choosing an antipsychotic, special consideration must be given to adverse effects which have an undeniable impact on quality of life and can often be the deciding factor in patients' medication compliance. While patients may respond well to one specific medication, they may still experience adverse effects that lead them to discontinue it or switch to a more tolerable but less effective option. However, strategies do exist for managing and treating adverse effects, especially metabolic and movement adverse effects, allowing better personalization of antipsychotic choice.

Case Report: Deutetrabenazine as an Adjunctive Treatment for Stuttering

Childhood-Onset Fluency Disorder (Stuttering) is a neurodevelopmental disorder in which disturbances occur in the normal fluency and time patterning of speech. While the dopamine system has been well-described in its neurophysiology, there currently is no FDA-approved treatment for stuttering. Second-generation antipsychotics, which have been effective in the treatment of schizophrenia and bipolar disorder, act as dopamine D-2 receptor antagonists at the postsynaptic neuron and have been shown to reduce the symptoms of stuttering. However, the D-2 receptor antagonist and partial agonist agents carry the potential for metabolic side effects and can potentially lead to movement disorders. Deutetrabenazine, a VMAT-2 inhibitor indicated to treat hyperkinetic movement disorders, is a potential candidate in the treatment of stuttering, based on its mechanism of action in decreasing dopamine activity while not carrying the risk of metabolic adverse events.

Scientists, society, and stuttering

More than 70 million people worldwide are affected by developmental stuttering. It is important to reach out to the public, scientific and medical communities, and those who stutter with a goal to raise awareness about stuttering. In this short perspective, we argue that to educate, advocate, and spread awareness about stuttering, we need role models, support, and opportunities.

New Medications for Neuropsychiatric Disorders

This article seeks to summarize the mechanisms of action, clinical trials, and FDA approval status of several psychiatric medications that are either newly available or in the FDA approval process. This article highlights medications that demonstrate novel mechanisms of action, examines nonpsychiatric medications that are being used to augment existing psychiatric treatments, and elucidates treatments for illnesses that have not previously received FDA indications.

The Pharmacologic Treatment of Stuttering and Its Neuropharmacologic Basis

Stuttering is a DSM V psychiatric condition for which there are no FDA-approved medications for treatment. A growing body of evidence suggests that dopamine antagonist medications are effective in reducing the severity of stuttering symptoms. Stuttering shares many similarities to Tourette's Syndrome in that both begin in childhood, follow a similar male to female ratio of 4:1, respond to dopamine antagonists, and symptomatically worsen with dopamine agonists. In recent years, advances in the neurophysiology of stuttering have helped further guide pharmacological treatment. A newer medication with a novel mechanism of action, selective D1 antagonism, is currently being investigated in FDA trials for the treatment of stuttering. D1 antagonists possess different side-effect profiles than D2 antagonist medications and may provide a unique option for those who stutter. In addition, VMAT-2 inhibitors alter dopamine transmission in a unique mechanism of action that offers a promising treatment avenue in stuttering. This review seeks to highlight the different treatment options to help guide the practicing clinician in the treatment of stuttering.

Ecopipam as a pharmacologic treatment of stuttering

BACKGROUND

Stuttering, also known as childhood-onset fluency disorder, is a chronic neurodevelopmental disorder that affects 1% of the population and can greatly impact an individual's social, occupational, and academic functioning. Prior research has shown dopamine D2 antagonists are effective in reducing the severity of stuttering symptoms, but these compounds can be associated with metabolic and movement disorder adverse effects. Ecopipam is an investigational medication that acts as a selective dopamine D1 receptor antagonist. This mechanism should reduce the likelihood of metabolic and movement disorder adverse effects of D2 antagonists.

METHOD

This open-label pilot study investigated ecopipam in the treatment of adults who stutter.

RESULTS

The results showed that a majority of participants demonstrated improvement in their stuttering. The medication was well tolerated.

CONCLUSIONS

These positive, preliminary findings suggest that a doubleblind, randomized controlled clinical trial to examine the efficacy of ecopipam in the treatment of stuttering is warranted.

A case series on the effectiveness of lurasidone in patients with stuttering

BACKGROUND

The prevalence of stuttering is approximately 1% of the population, affecting an estimated 3 million individuals in the United States. The dopamine hypothesis of stuttering explains that abnormally increased cerebral dopamine affects the balanced levels that maintain the basal ganglia circuits, which helps with timing cues in initiating speech. This is especially significant when considering treatment strategies. We report a reduction in stuttering with lurasidone, a potent D2 receptor antagonist with a relatively favorable adverse effects profile.

METHODS

We conducted a non-randomized, open-label study of lurasidone in patients with stuttering (N = 7). Patients self-reported stuttering severity, locus of control, and avoidance using the Subjective Screening of Stuttering (SSS) scale and were assessed with the Clinical Global Impression (CGI) Scale.

RESULTS

We observed a notable, statistically significant improvement in all areas of stuttering, as rated by the SSS scale. According to the CGI-Improvement Scale, 2 patients were scored as "very much improved" and 5 were scored as "much improved."

CONCLUSIONS

This open-label study of lurasidone in patients with stuttering showed improvement in subjective symptoms, in CGI scores, and on the SSS scale.

The treatment of behavioral disturbances and psychosis associated with dementia

Behavioral disturbances and psychosis associated with dementia are becoming an increasingly common cause of morbidity in patients with dementia. Approximately 70% of individuals with dementia will experience agitation, and 75% will experience symptoms of psychosis such as delusions or hallucinations. The goal of this article is to review the pharmacologic treatment options for behavioral disturbances and psychosis associated with dementia. A literature review was conducted on PubMed/Medline using key words of "dementia" and "interventions." The results were filtered for meta-analysis, clinical trials, and systematic reviews. The results were then reviewed. At this time, the most evidence exists for the use of a second generation antipsychotics (SGAs), but consideration should be given to their collective boxed warning of morbidity/mortality. The evidence for second line treatments are limited. There is limited evidence to support the use of first generation antipsychotics (FGAs), antidepressants, anticonvulsants, cognitive enhancers, and analgesics. Additional randomized control trials are needed to guide clinical decision making regarding the behavioral disturbances and psychosis associated with dementia.

A randomized controlled trial of the effect of sublingual orally disintegrating olanzapine versus oral olanzapine on body mass index: the PLATYPUS Study

BACKGROUND

Patients with schizophrenia and bipolar disorder have frequently reported weight gain during olanzapine treatment. Previous studies have observed a decrease in weight gain, or weight loss, in patients switching from standard olanzapine tablets (SOT) to orally disintegrating olanzapine (ODO) tablets. The primary objective of this study was to investigate the change in body mass index (BMI) in patients who had previously gained weight with SOT and continued with this therapy during the study period, compared with those patients who switched to ODO during the study period.

METHODS

This was a 16-week, multicentre, randomized, double-blind, double-dummy, study of outpatients diagnosed with schizophrenia, schizoaffective disorder, related psychotic disorder or bipolar disorder, who were taking 5-20 mg SOT daily. Patients continued treatment with 5-20 mg olanzapine in a flexible single daily dose, and were randomized to either receive sublingual ODO plus an oral placebo, or sublingual placebo plus SOT.

RESULTS

No statistically significant between group differences in mean change from baseline in BMI, weight or waist circumference were observed. Analysis of change in body weight from baseline, by pre-specified category (no change, loss of >or=1.5 kg, gain of >or=1.5 kg), revealed a significant difference between groups, favoring ODO patients, who also experienced a significant reduction in subjective appetite and better treatment compliance, compared to patients in the SOT group.

CONCLUSIONS

In this study, patients treated with ODO experienced a similar mean change in BMI and weight from baseline, to those patients treated with SOT.

Orally disintegrating olanzapine and potential differences in treatment-emergent weight gain

Several papers and communications have reported possible weight reduction or less weight gain when patients start or switch to orally disintegrating olanzapine, as contrasted with standard oral olanzapine tablets. In this paper, the current literature is reviewed and hypothesized mechanisms of action are discussed. The data are still preliminary and mechanisms of action are not well understood. Randomized controlled trials are needed to further evaluate change in weight during treatment with orally disintegrating olanzapine.

Improvement in hyperprolactinemia and reproductive comorbidities in patients with schizophrenia switched from conventional antipsychotics or risperidone to olanzapine

This open-label, prospective, 4-month study in hyperprolactinemic patients with schizophrenia explored whether prolactin levels decrease after switching antipsychotic therapy to olanzapine. A secondary objective was to determine if reproductive morbidities and sexual dysfunction occurring with hyperprolactinemia improved with prolactin normalization. Clinically stable patients with schizophrenia, who had hyperprolactinemia defined as >18.8 ng/ml for males and >24.2 ng/ml for females, were randomized to: remain on current therapy (n=27) or switch to olanzapine, 5-20 mg/day, (n=27). Baseline prolactin levels in female patients randomized to receive olanzapine (n=14) were 66.3+/-38.7 ng/ml and were 82.0+/-37.6 (p=.32) in those remaining on their pre-study antipsychotic medication (n=14). In male patients, baseline prolactin levels were 33.7+/-12.1 and 33.5+/-13.8 ng/ml (p=.97), respectively, for those randomized to olanzapine (n=13) or remaining on pre-study treatment (n=13). At study end, patients switched to olanzapine experienced significant reductions in mean serum prolactin levels of 19.8+/-18.1 ng/ml in males (p=.02), and 32.3+/-47.5 ng/ml in females (p=.01), but prolactin continued to be elevated in patients who remained on pre-study antipsychotic treatment. After switching to olanzapine treatment, male patients experienced significantly (p=.03) increased free testosterone levels but there were no significant improvements in total testosterone levels; some female patients experienced improved menstrual cycling, as well as resolution of galactorrhea and gynecomastia, and sexual functioning was significantly improved in both genders. Patients switched to olanzapine, as well as those remaining on their pre-study medication, maintained clinical stability, their symptoms continued to improve, although there were no significant between-treatment differences in improvement. Treatment-emergent adverse events did occur in both treatment groups; however, they were not significantly different between groups. Olanzapine-treated patients experienced significantly lower eosinophil counts and higher elevations in low-density lipoproteins and standing blood pressure than non-switched patients. Olanzapine treatment may offer sustained reduction in serum prolactin and improvement in sexual and reproductive comorbid symptoms in patients with schizophrenia who have treatment-emergent hyperprolactinemia.

Alleviating stuttering with pharmacological interventions

Stuttering is a speech disorder characterised by frequent prolongations, repetitions or blocks of spoken sounds and/or syllables. Stuttering is very common and is classified by the Diagnostic and Statistical Manual of Mental Disorders -- Fourth Edition (DSM-IV) as an Axis I disorder. In spite of this, stuttering treatment is sporadically addressed by a practicing physician, especially in the US. Much has recently been learned of the neurophysiological basis of this disorder, which has provided insight into novel treatment strategies, thus helping to guide the practising clinician. Stuttering is likely to be associated, at least in part, to dopamine hyperactivity in the brain. Novel dopamine antagonists such as risperidone and olanzapine, have recently been shown to improve the symptoms of stuttering providing a strong foundation for physicians to more effectively treat this disorder.

Olanzapine in the treatment of developmental stuttering: a double-blind, placebo-controlled trial

Stuttering is a speech disorder that affects one-percent of all adults and much has been learned recently of its neurologic correlates. Stuttering has been associated with excessive cerebral activity of the neurotransmitter, dopamine. Pharmacologic research has suggested that older generation dopamine antagonist (i.e. "typical antipsychotic") medications improve stuttering symptoms, but are associated with poorly tolerated adverse effects. The purpose of this study was to compare the efficacy and tolerability of olanzapine, a novel dopamine antagonist (or "atypical antipsychotic"), versus placebo in the treatment of adult developmental stuttering. Twenty-four adults who stutter participated in a twelve-week, randomized, double-blind, placebo-controlled trial conducted at two separate sites. Subjects received either olanzapine (2.5 mg titrated to 5 mg) or matching placebo. Subjects were rated on an objective measure of stuttering severity (SSI-3), a clinician based global impression (CGI), and a subject-rated self-assessment of stuttering (SSS). Subjects were also monitored for potential side-effects. Twenty-three of the twenty-four subjects enrolled in the trial successfully completed the full course of the study. Olanzapine was statistically superior to placebo on the three ratings of stuttering severity, the SSI-3, the CGI and SSS (p < .05). Olanzapine is a promising medication for the treatment of stuttering and further research is warranted.

Olanzapine vs haloperidol in geriatric schizophrenia: analysis of data from a double-blind controlled trial

OBJECTIVES

To compare the six-week clinical response and safety profile of schizophrenia patients, age > or =60 years, receiving olanzapine (OLZ) vs haloperidol (HAL) in a double blind, randomized trial.

METHODS

Double-blind data on patients age > or =60 randomized to 5 mg/d OLZ (n=83) or 5 mg/d HAL (n=34) (Week 1) then flexibly dosed to 5-20 mg/d over six weeks, with a 48-week extension for responders, were analyzed post-hoc. Efficacy indices included the PANSS Total and PANSS Psychosis Core Total (PPCT). Safety measures included the Simpson-Angus Scale (SAS), Barnes Akathisia Scale (BAS), Abnormal Involuntary Movement Scale (AIMS), treatment-emergent adverse events, and laboratory values. Mixed model, repeated measures (MMRM) analyses were applied to all continuous data measured at each visit. Continuous data recorded only at phase completion or termination were analyzed with a fixed effect last observation carried forward (LOCF) model. Frequencies of categorical response data were analyzed using Fisher's exact methods. Differences were tested for significance at Week 6 using a two-sided alpha value of 0.05.

RESULTS

HAL group (n=34; age range 60-80) received a mean modal dose 9.4 mg/d while OLZ group (n=83; age range 60-86) received a mean modal dose 11.9 mg/d. At Week 6, OLZ was superior to HAL on both the PANSS Total (p=0.015) and PPCT (p=0.043). Considering safety, OLZ was superior to HAL for the SAS and BAS (p<0.001; p<0.001). No spontaneous adverse event occurred more frequently with OLZ than with HAL. In patients never receiving adjunct anticholinergic therapy, no significant differences were present for anticholinergic-like side effects including blurred vision, dry mouth, constipation, or urinary difficulties.

CONCLUSIONS

In elderly schizophrenia patients, olanzapine was more efficacious and better tolerated for extrapyramidal signs than was haloperidol. Olanzapine was equivalent to haloperidol for anticholinergic-like side effects when corrected for anticholingergic agents.

Effectiveness of rapid initial dose escalation of up to forty milligrams per day of oral olanzapine in acute agitation

BACKGROUND

Patients experiencing an acute decompensation of schizophrenia or bipolar disorder often present in an agitated state. Agitation presents a barrier to therapy, interrupting the typical physician-patient alliance and creating a disruptive, even hazardous, environment. Rapid assessment and effective treatment are necessary to manage agitation and, potentially, to shorten the time to recovery.

METHODS

One hundred forty-eight acutely agitated patients received either: rapid initial dose escalation (RIDE) in which up to 40 mg of oral olanzapine was allowed on days 1 and 2, up to 30 mg on days 3 and 4, and 5 to 20 mg thereafter; or usual clinical practice (UCP) in which patients received 10 mg/d olanzapine plus up to 4 mg lorazepam on days 1 and 2, up to 2 mg on days 3 and 4, and olanzapine 5 to 20 mg/d thereafter. The Positive and Negative Syndrome Scale-Excited Component (PANSS-EC: poor impulse control, tension, hostility, uncooperativeness, and excitement) measured at 24 hours was the primary measure. Secondary assessments of agitation and safety were also performed.

RESULTS

Agitation improved significantly from baseline for both treatment groups; however, improvement with the RIDE strategy was superior to UCP. The RIDE group improvement was superior on the primary efficacy measure (PANSS-Excited) at 24 hours; it was superior on all agitation measures at the end of double-blind treatment. Both treatments were well tolerated, with no clinically significant differences in safety measures. Treatment was not limited by oversedation and attention improved from baseline in both groups.

CONCLUSIONS

This study demonstrates the value of olanzapine in the treatment of acutely agitated patients. A new approach to olanzapine dosing that expands the initial dose range up to 40 mg/d may offer superior efficacy in rapidly and effectively controlling the symptoms of agitation.

Computer detection of cognitive impairment and associated neuropsychiatric dimensions from the content analysis of verbal samples

This is a report of a study testing the capacity of a computerized measure of the content analysis of five minute verbal samples to detect and measure cognitive impairment and comorbid neuropsychiatric dimensions in 117 drug-abusing inpatients. The cognitive impairment scores obtained from the computerized procedure correlated significantly with independent scores from the Trails B and Stroop Color and Word test as well as with ANAM (Automated Neuropsychiatric Assessment Metric) neuropsychological tests, including the Matching to Sample Efficiency and Accuracy, the Code Substitution Efficiency, the Continuous Performance Task Efficiency and Accuracy, the Code Substitution Delayed Recall Accuracy, and the Simple Reaction Time Efficiency. When the computerized verbal-content-analysis-derived cognitive impairment scores were combined with scores of selected other ANAM measures, more and higher intercorrelations occurred with Trails A, Trails B, the Stroop Color and Word test, and the Wisconsin Card Sort test. In addition, validated measures of a broad range of associated neuropsychiatric dimensions can be obtained simultaneously from the same five minute verbal samples providing the cognitive impairment scores. No significant effects were found on the cognitive impairment scores of age, education, gender, race, and duration of drug-abuse abstinence.

Comprehensive understanding of schizophrenia and its treatment

An overview of schizophrenia is presented, including diagnostic criteria, etiology, neurologic findings, pharmacotherapy options, quality-of-life issues, and the financial impact of the disease. Schizophrenia is a chronic disease characterized by positive symptoms, negative symptoms, mood symptoms, and cognitive deficits. Often comorbid substance abuse is present. Schizophrenia accounts for 20% of all hospital bed-days and over 50% of all psychiatric beds in the United States. There is a strong genetic component to schizophrenia, and other possible contributing factors are explored. The diagnostic workup should include a detailed longitudinal history, mental status exam, physical and neurologic exams, and laboratory tests. A magnetic resonance imaging scan can rule out structural causes of psychosis and should be considered at the time of diagnosis. Treatment is based on a biopsychosocial model including pharmacotherapy in combination with individual, group, and family therapies. Rather than classifying antipsychotics as typical or atypical, a new classification scheme has been proposed based on risk of causing extrapyramidal symptoms and tardive dyskinesia (TD), effect on prolactin level, and efficacy profile: first-generation or traditional agents (e.g., chlorpromazine and haloperidol); second-generation agents (e.g., risperidone and ziprasidone); and third-generation agents (e.g., clozapine, olanzapine, and quetiapine). The binding affinities of antipsychotics in the brain help explain the mechanisms by which different antipsychotics alleviate specific symptoms of schizophrenia, as well as cause specific adverse effects. Improved cognition, fewer depressive and mood symptoms, and decreased risk of TD associated with third-generation antipsychotics have improved the quality of life for patients with schizophrenia.

Are there any clinical indications for measuring IgG subclasses?

It is questionable as to whether a low serum concentration of one of the IgG subclasses identifies a disease state. A low IgG(1) concentration is found in primary or secondary immunodeficiency states but does not occur in isolation. Low IgG(2) concentration is associated with an increased risk of bacterial infections but only in some individuals and not in others. Isolated IgG(3) and IgG(4) deficiency have not been convincingly demonstrated. Therefore, the isolated finding of low concentrations of one or more IgG subclass does not identify individuals at risk. In contrast, the finding of low serum concentrations of antibodies to specific bacterial antigens (Haemophilus influenzae type B, pneumococcus, tetanus and diphtheria) does identify individuals at risk and these measurements should be used in preference to IgG subclass measurement.

Prolactin elevation with antipsychotic medications: mechanisms of action and clinical consequences

Antipsychotic agents differ in efficacy and side effects such as movement disorders and prolactin elevation because of varying mechanisms of action. A revised nomenclature for antipsychotic agents, which categorizes the drugs according to efficacy, risk of movement disorders, and risk of prolactin elevation, is described. Prolactin elevation, a potential side effect of some antipsychotic medications, is underdiagnosed but can have serious short-term and long-term consequences. Short-term problems include menstrual irregularities, sexual dysfunction, and depression. Long-term problems related to prolactin elevation include decreased bone density and osteoporosis, relapse of psychosis because of poor compliance due to sexual dysfunction or depression, and perhaps cancer, although more research in this area is needed. Despite the serious nature of these effects, prolactin elevation is seldom detected because clinicians often fail to inquire about sexual function or other symptoms that signal that a patient's prolactin may be elevated. These are problems that patients may not bring up with clinicians unless they are asked. Therefore, when patients are taking antipsychotic medications, clinicians should regularly inquire about sexual dysfunction, depression, menstrual disturbances, galactorrhea, and gynecomastia.

Impact of Antipsychotics on Geriatric Patients: Efficacy, Dosing, and Compliance

People today are living longer. Old age is the number one risk factor for dementia, which is often associated with behavioral disturbances and psychosis as well as cognitive and memory impairment. Elderly persons with dementia-particularly those who are agitated or aggressive-are often placed in nursing homes and consequently treated with antipsychotic medications. Most of the studies of antipsychotic efficacy and safety have been conducted in young schizophrenic patients, but there are differences in dosing schedules, efficacy, and compliance when these drugs are used in elderly patients with dementia and psychosis. A review of both nonpharmacologic and pharmacologic treatment is herewith presented for the treatment of elderly dementia patients, especially those living in long-term care facilities.

Computerized measurement of cognitive impairment and associated neuropsychiatric dimensions

This study aimed to cross-validate the capacity of a computer software program to detect and measure, using a measurement method applied to the content and form analysis of 5-minute speech samples, cognitive impairment and associated comorbid neuropsychiatric psychobiological dimensions in drug-abusing patients. At the University of California-Irvine (UCI) Neuropsychiatric Center, 28 drug-abusing inpatients using illegal drugs were clinically evaluated. Their scores for cognitive impairment derived by the computerized content analysis method were compared with scores derived from selected tests from the Halstead-Reitan Neuropsychological Test Battery, the computerized Automated Neuropsychological Assessment Metric Battery (ANAM), the Alzheimer's Disease Assessment Scale-Cognitive Portion, the Stroop Color and Word Test, the Symbol Digit Modalities Test, and the Controlled Oral Word Association Test. The statistical significance (P value) of the correlations of scores from these different measures with scores obtained from the computerized content analysis measures was less than .05 to .001. The comparative "hit rate," detecting cognitive impairment above the norms for each measure administered to these drug-abusing patients, for the computerized content analysis measures and some of the ANAM neuropsychological measures was 75% to 89%, and for the other neuropsychological measures, 25% to 64%. In conclusion, the computerized content analysis methodology applied to 5-minute verbal samples is a valid, rapid, easily administered measurement instrument for assessing the magnitude of cognitive impairment and comorbid neuropsychiatric dimensions.

Risperidone for the treatment of stuttering

A randomized, double-blind, placebo-controlled study was conducted to assess the efficacy of risperidone in the treatment of developmental stuttering in 16 adults. Eight subjects received placebo and eight received risperidone at 0.5 mg once daily at night, increased to a maximum of 2 mg/day. After 6 weeks of treatment, decreases in all measures of stuttering severity were greater in the risperidone group than in the placebo group; the between-treatment difference was significant (p < 0.05) on the most important measure, the percentage of syllables stuttered. In the risperidone group, reductions from baseline in scores for the percentage of syllables stuttered, time stuttering as a percentage of total time speaking, and overall stuttering severity were significant (p < 0.01); changes in scores on the fourth measure of stuttering, duration, were not significant. No significant decreases occurred in the placebo group. Among the eight patients in the risperidone group, five responded best to 0.5 mg/day, with stuttering recurring at higher doses. The remaining three patients responded better with increasing doses of risperidone. Risperidone was generally well tolerated. The results of this small study indicate that risperidone may be effective in the treatment of developmental stuttering. This finding needs to be confirmed in a larger trial.

Management of child and adolescent stuttering with olanzapine: three case reports

Vast arrays of medications have been used, with limited success, to manage stuttering. Haloperidol and risperidone are the only two medications that have shown efficacy via double-blind studies in controlling stuttering symptoms. We present the first case reports of olanzapine in the management of stuttering. Three case histories are presented: a 10-year-old boy, a 16-year-old male adolescent with developmental stuttering, and a 9-year-old boy with medication-induced stuttering whose symptoms are successfully controlled with olanzapine. These case studies suggest that olanzapine may be a pharmacologic option in the management of stuttering.