Abstract: BACKGROUND: Motor disturbances in vitamin B6-deficient animals were described. Some clinical experiments showed that vitamin B6 may ameliorate different drug-induced movement disorders, including tardive dyskinesia (TD). The aim of this study was to compare plasma pyridoxal-5-phosphate (PLP) levels in schizophrenic patients with and without TD. METHOD: This study was conducted in the Be'er Sheva Mental Health Center from February 2006 to August 2006. Eighty-nine schizophrenic inpatients (40 have TD, 22 men and 18 women, 20-66 yrs old [mean, 48 yrs] and 49 schizophrenic inpatients, 30 men and 19 women, 21-66 yrs old (mean, 49 yrs), without any symptoms of motor disturbances [the control group]) were enrolled in the study. Measurement of PLP is performed by high-performance liquid chromatography separation in all patients. RESULTS: There was a significant difference in plasma PLP levels between patients with TD and those without TD. The discrepancy between the groups was almost entirely attributable to the PLP levels of male patients: 12.4 +/- 11.4 vs 29.0 +/- 12.9 nM in men (P < 0.001), and 19.7 +/- 14.8 vs 22.0 +/- 13.6 nM in women (P > 0.5). CONCLUSIONS: Our results suggest that schizophrenic and schizoaffective male patients with TD have lower PLP plasma levels than non-TD patients.
Abstract: OBJECTIVES: Bexarotene is a synthetic retinoid used for treatment of neoplastic or dermatologic disorders. Based on the retinoid dysregulation hypothesis, it was hypothesized that bexarotene augmentation would have a beneficial effect in the antipsychotic treatment of schizophrenia patients. This study is the first to investigate the safety and efficacy of add-on oral bexarotene to ongoing antipsychotic treatment in chronic schizophrenia patients who were stabilized on regular antipsychotic treatment. METHODS: A 6-week open label trial was conducted in 2 mental health centers from October 2005 to October 2006. Twenty-five patients with chronic schizophrenia received a low dose of bexarotene (75 mg/d) augmentation. Mental condition and laboratory tests were assessed at baseline and after weeks 2, 4, and 6 of the study. The primary outcome measure was change from baseline in 4 symptom scales: the Positive and Negative Symptom Scale, Extrapyramidal Symptom Rating Scale, Abnormal Involuntary Movement Scale, and Barnes Akathisia Scale. Blood cell count, liver and thyroid functions, cholesterol, and triglyceride rates were followed. RESULTS: Significant improvement from baseline to endpoint was observed on total Positive and Negative Symptom Scale score (P = 0.022), general psychopathology (P = 0.024), positive (P = 0.012), and the dysphoric mood (P = 0.028) factor scores. Furthermore, a trend to a diminishing Extrapyramidal Symptom Rating Scale score (P = 0.053) was found. Bexarotene was found to be a safe medication as measured by all laboratory parameters with the exception of increased total cholesterol serum level. CONCLUSIONS: This short-term pilot study supports bexarotene as a potential valuable adjunct in management of schizophrenia. Low doses of bexarotene were well tolerated. A double-blind controlled study should be performed to replicate these preliminary positive results.
Abstract: OBJECTIVES: Acute lithium intoxication is a frequent complication of this treatment used for manic depressive disorders. Because lithium has a narrow therapeutic index and widespread use, its neuropsychiatric side effects are more prevalent than those of other psychotropic medications. There are only few reports about it within therapeutic serum levels. The question of toxic interactions resulting from combinations of lithium and neuroleptic drugs is largely based on anecdotal reports. METHODS: We report here a case of a patient with schizophrenia with severe delirium developed shortly after initiation of a lithium-quetiapine combination therapy, despite therapeutic doses of both medications. CONCLUSIONS: The psychiatric symptoms disappeared when lithium was stopped. We interpret these symptoms as delirium with pseudodementia at therapeutic lithium serum levels. Our conclusion is that lithium-induced neurotoxicity should be suspected in any patient receiving lithium in combination with neuroleptics or any other clinical variable. In such cases, regardless of lithium serum levels, the clinician should consider immediate discontinuation of the medication.
Abstract: The Russian landscape painter Alexey Savrasov lived in the middle of the 19th century. He was overwhelmed with grief at the loss of several of his children and he used alcohol to blunt the pain and anguish. The effects of psychoactive substances and especially alcohol have been linked closely to creativity. His life story demonstrates the bitter relationship between the bottle and the muse. He became dependent on alcohol, his family broke up and he was fired from work, his creativity declined and his health deteriorated. At death, he was a lonely and a forgotten man and only two persons attended his funeral.
Abstract: Vitamin B6 plays an essential role in the normal functioning of the central nervous system. Normal homocysteine (Hcy) serum level is maintained by remethylation of Hcy to methionine by enzymes that require folic acid and vitamin B12 and by catabolism to cysteine by a vitamin B6-dependent enzyme. These findings may be consistent with the hypothesis that the vitamin B6 status may influence plasma Hcy levels. The aims of this preliminary study were (1) to determine whether a correlation exists between Hcy and vitamin B6 levels in patients with schizophrenia and schizoaffective disorders and (2) to investigate whether treatment with high-dose vitamin B6 may reduce Hcy levels in these patients. METHODS: In this preliminary study, we enrolled 11 patients with schizophrenia or schizoaffective disorders (7 men and 4 women; mean age +/- SD, 50 +/- 12 years) receiving high doses of vitamin B6 treatment (1200 mg/d) for 12 weeks. Blood samples for the assessment of pyridoxal-5-phosphate and Hcy serum levels were obtained at baseline and after 12 weeks of treatment. RESULTS: Age was significantly positively correlated with Hcy levels at baseline (r = 0.392, P = 0.004). All other parameters, including diagnosis, disease duration, and pyridoxal-5-phosphate serum level, were not correlated with Hcy serum levels at baseline. After vitamin B6 treatment, Hcy serum levels significantly decreased (14.2 +/- 3.4 vs. 11.8 +/- 2.0 micromol/L, respectively, t = 2.679, P = 0.023); this decrease being statistically significant in men but not in women. CONCLUSIONS: High doses of vitamin B6 lead to a decrease in Hcy serum level in male patients with schizophrenia or schizoaffective disorder.
Abstract: The aim of the current study was to assess the prevalence of tardive movement disorders (TMD) among a group of institutionalized schizophrenic and schizoaffective patients in southern region of Israel. Chronic schizophrenic and schizoaffective inpatients of a psychiatric hospital and its affiliated hostels were screened for the presence of TMD subsyndromes. Twenty percent (107 patients) of 523 patients with schizophrenia and schizoaffective disorder exhibited TMD. Of those with TMD, 36% had only one subsyndrome, whereas 64% had a combination of several TMD subsyndromes. With regard to patients with TMD, the most frequent TMD subsyndrome was tardive tremor (TT). TT appeared more often in males compared to females and at a younger age (44.3+/-8 vs. 54.3+/-11 years, P<0.04). TD appearing in combination with other TMD subsyndromes was significantly more prevalent among females than in males (57% vs. 35%; P<0.02). TMD generally appears in a combined fashion. Further prospective studies from different geographical areas are recommended.
Abstract: BACKGROUND: Piracetam is a potent antioxidant, a cerebral neuroprotector, a neuronal metabolic enhancer, and a brain integrative agent. More than 20 years ago, an intravenous preparation of piracetam demonstrated an improvement in the symptoms of tardive dyskinesia. The aim of our study was to reexamine the efficacy of piracetam in the treatment of tardive dyskinesia using an oral preparation. METHOD: The study was conducted at the Be'er Sheva Mental Health Center from May 2003 to December 2004 and involved a 9-week, double-blind, crossover, placebo-controlled trial assessing 40 DSM-IV schizophrenic and schizo-affective patients with DSM-IV-TR tardive dyskinesia. All study subjects received their usual antipsychotic treatment. Initially, subjects were randomly assigned to receive 4 weeks of treatment with either piracetam (4800 mg/day) or placebo. Thereafter, following a washout period of 1 week, they entered the crossover phase of the study for a further 4 weeks. The change in score of the Extrapyramidal Symptom Rating Scale from baseline to the study endpoint was the primary outcome measure. RESULTS: The mean decrease in score from baseline to endpoint in the clinical global impression subscale in patients treated with piracetam was 1.1 points compared to 0.1 points in the placebo group (p = .004). The mean decrease in the tardive parkinsonism subscale was 8.7 points in patients treated with piracetam and 0.6 points in those on placebo (p = .001). The mean decrease in the tardive dyskinesia subscale was 3.0 points in the piracetam group in contrast to deterioration of condition in the placebo group by -0.2 points (p = .003). CONCLUSION: Piracetam appears to be effective in reducing symptoms of tardive dyskinesia. The specific mechanism by which piracetam may attenuate symptoms of tardive dyskinesia needs to be further evaluated. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier NCT00190008.
Abstract: OBJECTIVES: Although depression is a recognized side effect of many medications, the association of this condition with neuroleptics has received limited attention in the literature. Atypical antipsychotics may demonstrate a beneficial effect on affective symptoms. On the other hand, they may also cause depression both in those with and without a history of psychiatric illness. Although ziprasidone has been reported to have antidepressive properties, we are not aware of reports regarding ziprasidone-induced depression. METHODS: We describe 3 cases of ziprasidone-associated depression in patients treated for schizophrenia who had no previous history of depressive illness. To the best of our knowledge, this is the first description of such an association. CONCLUSIONS: This case series suggests that atypical antipsychotics may have a causal relationship in the development of depression in schizophrenic patients. This is noteworthy because these medications have been found in the past to have an antidepressant action. If neuroleptic-induced depression is mistaken for negative symptoms of schizophrenia, this condition may go untreated. Further data based on controlled studies are required.
Abstract: The article presents the problems and difficulties that psychiatrists from the former Soviet Union (FSU) have to cope with in Israel. Immigration and acculturation in a new milieu is a complex process and even more complicated for those whose specialty is medicine and particularly psychiatry. There is a wide gap between the skills and knowledge that new immigrants brought with them from the FSU and the professional demands in the new country. Psychiatry and psychiatric education in the FSU were determined by the cultural practices and traditions of the region and the organizational principles of the USSR which were very different than those of western society and the State of Israel. In comparison to the West, postgraduate psychiatric training in the USSR was shorter and less rigorous with an emphasis on biological therapy. Soviet "psychotherapy" was more reality oriented and more authoritarian than in the West, stressing "collective" group therapy. We describe the basic principles of Soviet medical education and the radically different social, intellectual and political history of the former Soviet Union. We relate the experiences of psychiatrists in the FSU in learning dynamic psychotherapy and the difficulties connected with this education. Moreover, the process of educating psychiatric residents is described from a supervisor's point of view. This complex process led to some major difficulties. In order to cope with the difficulties the supervisor employed a broad variety of means and techniques: an introductory course and a basic seminar about fundamental cornerstones of psychotherapy were offered.
Abstract: BACKGROUND: Tardive dyskinesia (TD) is a significant clinical problem. Vitamin B(6) is a potent antioxidant and takes part in almost all of the possible mechanisms that are suggested as being associated with appearance of TD. The aims of this study were (1) to reexamine the efficacy and safety of higher doses of vitamin B(6) versus placebo in a greater sample of patients for a longer time and (2) to evaluate the carryover effect of vitamin B(6). METHOD: A 26-week, double-blind, placebo-controlled trial was conducted in a university-based research clinic from August 2002 to January 2005 on 50 inpatients with DSM-IV diagnoses of schizophrenia or schizoaffective disorder and TD. In a double-blind crossover paradigm, all study subjects were randomly assigned to start treatment with either vitamin B(6) (daily dose of 1200 mg) or placebo. After 12 weeks of treatment and then a 2-week washout, subjects were crossed over to receive the other treatment for 12 weeks. The primary outcome measure was the change from baseline in Extra-pyramidal Symptom Rating Scale (ESRS) scores. RESULTS: The mean decrease in ESRS clinical global impression scores from baseline to endpoint was 2.4 points in patients treated with vitamin B(6) and 0.2 points in patients treated with placebo (p < .0001). The mean decrease in the parkinsonism subscale score was 18.5 points and 1.4 points, respectively (p < .00001), and the mean decrease in the dyskinesia subscale score was 5.2 points and -0.8 points, respectively (p < .0001). CONCLUSION: Vitamin B(6) appears to be effective in reducing symptoms of TD. The specific mechanisms by which vitamin B(6) attenuates symptoms of TD are not clear.
Abstract: Treatment strategies against acute neuroleptic-induced akathisia (NIA) include anticholinergic (antimuscarinic) agents, dopamine agonists, GABAergic agents, beta-blockers, benzodiazepines, and serotonin antagonists. However, many patients who have acute akathisia fail to respond. In previous studies, mianserin and vitamin B6 were found to be effective in the treatment of acute akathisia. The purpose of this study was to compare the efficacy of B(6), mianserin and placebo in the treatment of acute NIA. Sixty schizophrenia and schizoaffective inpatients who have NIA were randomly divided to receive vitamin B(6) 1,200 mg/d, mianserin 15 mg/d, or placebo for 5 days, in a double-blind design. The Barnes Akathisia Rating Scale, Brief Psychiatric Rating Scale, and Clinical Global Impression were used to assess the severity of NIA and psychotic symptoms. The assessment was made at baseline and daily for the duration of the study. Compared with the placebo group, the vitamin B(6)-treated and mianserin-treated patients showed a significant improvement in the subjective (P < 0.0001), subjective distress (P < 0.0001), and global (P < 0.0001) subscales. The objective subscale did not show significant positive results (P = 0.056), but there was a trend toward symptom amelioration in both groups. A reduction of at least 2 points on the Barnes Akathisia Rating Scale global subscale was noted in the vitamin B(6) group (13/23, 56%) as well as in the mianserin groups (13/20, 65%), and in only one patient in the placebo group (1/17, 6%; P < 0.0005). Our results indicate that high doses of B(6) and a low dose of mianserin may be a useful addition to current treatments of NIA. The efficacy of vitamin B(6) and mianserin suggests that the pathophysiology of acute NIA is heterogeneous with the various subtypes of acute NIA responding differently to the various pharmacological approaches.
Abstract: BACKGROUND & AIMS: Deficiencies of cobalamin and folate may play a causal role in the development or exacerbation of psychiatric illnesses. We compared cobalamin and folate levels in newly admitted psychiatric patients to mentally healthy controls and assessed their correlation with various psychiatric conditions. METHODS: All patients consecutively admitted to a psychiatric hospital were examined for serum cobalamin and folate levels. Controls were obtained from a population with no known mental illness. Values were considered to be below normal if cobalamin was <223 pg/ml and folate <3.1 ng/ml. RESULTS: The 224 newly admitted patients did not differ significantly from controls, both with regard to the mean cobalamin level and to the prevalence of lower than normal levels. About 30% of patients had low folate values compared to 2.5% in the control group (P<0.0001). Mean folate level in controls was significantly higher than in patients (P<0.0001), where a positive correlation was found between low folate levels and depression. CONCLUSIONS: The results of our study suggest that folate levels be assessed in patients admitted to psychiatric wards, especially in those with depression. Further study is needed to evaluate the role of folate and cobalamin in psychiatric illness.
Abstract: Quetiapine, a dibenzothiazepine derivative, is an atypical antipsychotic, multireceptor antagonist that has a preclinical profile similar to clozapine. Randomized studies have demonstrated the efficacy of quetiapine relative to placebo in the treatment of acute relapse and the long-term management of schizophrenia. Quetiapine is generally well tolerated relative to other antipsychotic medications, although side effects include sedation, orthostatic hypotension, anticholinergic and metabolic side effects. The purpose of this article is to critically review the current literature on quetiapine with an emphasis on emergent themes and key findings in the use of this agent for the treatment of schizophrenia. There are also continued efforts to understand, predict and manage the side-effect risk with quetiapine.
Abstract: The inclusion of computers and the Internet in our daily lives has become an increasingly pervasive phenomenon. Naturally, this phenomenon found its reflection in the quick inclusion of these technologies in the content of delusions. There have already been a few reports describing patients with Internet delusions. In this report, we describe two patients and their social background who were without previous psychiatric history and whose first psychosis involved delusions surrounding the Internet. Our opinion is that Internet delusions do not represent a new diagnostic entity, but rather modified delusions of persecution, broadcasting and control.
Abstract: Forty-one males with drug abuse who had tattoos with designs related to drug use were selected from a larger sample of tattooed males in forensic psychiatric wards, prisons and military recruitment centers during the period 1986-2000 in the former Soviet Union. Two-thirds of the tattoo images were related to a specific drug, some served to hide signs of repeated drug use, others to identify ideal sites for injection. Knowledge of these details may be helpful to clinicians, although images may be influenced by current trends.
Abstract: BACKGROUND: The aims of our study were (1) to compare the dose of clozapine needed to achieve remission in patients who stopped their treatment (study group) versus patients who continued taking this medication (control group) and (2) to compare the clinical characteristics of remission between these 2 groups. METHOD: We retrospectively reviewed the medical records of all treatment-resistant schizophrenic and schizoaffective patients (according to DSM-IV criteria) who were treated with clozapine over a period of 9 years, from January 1995 through December 2003. The study group consisted of 43 patients and the control group of 12 patients. All patients' files from both groups were examined, and each patient's remission was scored twice--initially on discharge from the hospital and subsequently after final discharge for the study group, or at the end of the study for the control group. RESULTS: The change of clozapine dose from the first to the last remission expressed by percentage shows a significant difference between the 43% increase in clozapine dose in the study group and the 12.5% decrease in clozapine dose in the control group (p < .001). Quality of remission assessment showed deterioration in the global remission score in the study group, while the quality of remission assessment in the control group did not show any change. CONCLUSIONS: Our findings suggest that the discontinuation of clozapine treatment leads to a deterioration in the quality of remission, with a need for an increased dose of clozapine. Further prospective studies on larger samples are needed to confirm these findings.
Abstract: Alexander Ivanov was an outstanding Russian painter who lived in the middle of the nineteenth century, during the romantic period. He did not accept romanticism but instead tried to create his own original style, an ambitious combination of spiritual profundity and a manner of execution unparalleled in Western European art. Ivanov's intention and style are best reflected in his major work The Appearance of Christ to the People, a picture on which he worked for over 20 years. He painted more than 400 sketches of the picture while attempting to bring his masterpiece to perfection. At the end of his life Ivanov became disillusioned, renounced his strong religious conviction and became suspicious. This study examines the influence of his background, life story and personality on the creative process. From a diagnostic perspective, Ivanov's personality featured obsessive, narcissistic and schizoid traits. In his final years he suffered from a delusional disorder.
Abstract: BACKGROUND: Tardive dyskinesia and other delayed-onset abnormal involuntary movement disorders may occur as a result of the use of psychotropic drugs. A distinction is usually made between classic tardive dyskinesia (TD) (orobuccal-lingual-facial) and tardive dystonia, tardive tremor (TT), tardive akathisia, and other related syndromes. In spite of the development of atypical antipsychotics with fewer side effects, tardive movement disorders nevertheless continue to present a significant clinical and therapeutic challenge. Several reports have suggested that donepezil may be helpful in the treatment of TD. METHOD: A preliminary study was conducted of 7 patients (5 women and 2 men) enrolled over a period of 6 months who had been experiencing TT for a period of at least 1 year. The ages of the patients ranged from 64 to 79 years, and all patients were on stable antipsychotic therapy. Donepezil was added to their usual treatment for 8 weeks. The severity of patients' extrapyramidal symptoms was assessed using the tremor subscale of the Simpson-Angus Scale (SAS) and self-rated with a modification of the Clinical Global Impressions scale, the Subjective Clinical Improvement Impression scale. The clinical response was evaluated by comparing the rating scores at baseline prior to donepezil treatment and every 2 weeks thereafter. RESULTS: The addition of donepezil (up to 10 mg/day) was associated with a clinically significant improvement (from 37.5% to 63.6%) on the SAS tremor subscale following 4 weeks of therapy. Only 1 patient discontinued follow-up due to side effects. CONCLUSION: The results suggest that donepezil may be effective in the treatment of TT, and this finding should be evaluated further by a randomized controlled study.
Abstract: Despite the effectiveness of antipsychotic medications in treatment of schizophrenia, about 30% of patients who receive an adequate treatment have significant persisting symptoms. The problem of treatment-resistant psychosis is an important and difficult one. The aim of this study was to retrospectively evaluate the efficacy and safety of amisulpride augmentation in treatment-resistant schizophrenic patients. To the best of our knowledge, this is the first report about resistant schizophrenic and schizoaffective patients treated with the combinations of risperidone and amisulpride and ziprasidone and amisulpride. Data were collected from patient records. A total of 15 resistant schizophrenic patients (7 men, 8 women, 54.0 +/- 16.9 years old) were included in the study. Before addition of amisulpride, the patients were treated with monotherapy by atypical neuroleptics (clozapine, olanzapine, risperidone, or ziprasidone). The mean amisulpride dose was 693.3 +/- 279.6 mg/d. The mental state of 12 (80%) patients treated with combination was improved. Three (20%) patients showed no change in their mental state. Only 2 patients treated with a combination of risperidone and amisulpride had mild side effects. The results are preliminary and require confirmation in a randomized controlled trial. The authors suggest that amisulpride may be a promising option as an augmentation strategy in treatment-resistant schizophrenic patients.
Abstract: BACKGROUND: The pathogenesis of neuroleptic-induced tardive movement disorders (TMD), including tardive parkinsonism and tardive dyskinesia (TD), has not yet been established. An elevated serum level of total homocysteine has been implicated as a risk factor for various neuropathologic states and some movement disorders. The aim of our study was to determine whether there is an association between serum total homocysteine level and the presence of TMD among schizophrenic and schizoaffective patients. METHOD: This study was conducted in Be'er Sheva Mental Health Center from August 2002 to May 2004. Fifty-eight patients with schizophrenia or schizoaffective disorder (DSM-IV) and TMD for at least 1 year (38 men, 20 women; age range, 28-73 years) were compared to a control group of 188 patients with DSM-IV-diagnosed schizophrenia or schizoaffective disorder without TMD (123 men, 65 women; age range, 19-66 years) regarding serum total homocysteine levels. RESULTS: Men with TMD (demonstrating tardive parkinsonism and/or TD) had significantly higher mean serum total homocysteine levels compared to sex- and age group-matched controls. The difference between groups was almost entirely attributable to the homocysteine levels of young male patients (age group, 19-40 years old) with TMD. CONCLUSION: High serum total homocysteine level may constitute a risk factor for certain variants of TMD, especially in young schizophrenic or schizo-affective male patients. Further prospective studies are needed to clarify these findings.
Abstract: Depression has been reported as a side effect of a wide variety of drugs in clinical medicine. Neuroleptics may cause depression in persons with or without any past history of psychiatric illness. Clinically, these drug-induced depressions may go unnoticed and thus create therapeutic problems. The authors present a case of quetiapine-associated depression in a patient being treated for schizophrenia. To the best of our knowledge it is the first description of depression associated with quetiapine treatment. This case report suggests that atypical antipsychotics may be a cause of depression. This is noteworthy because these medications have been found in the past to have an antidepressant action. Further data based on controlled studies are needed.
Abstract: Antipsychotic agents have been used for the treatment of mood disorders in schizophrenic and schizoaffective patients. It has also been suggested that combinations of lithium and antipsychotics may be more effective than either class alone in treatment of schizoaffective patients. Lithium is known to interact with a variety of medications, including conventional and atypical antipsychotics. Although these combinations are generally well tolerated, they may sometimes lead to various adverse side effects. The authors report two schizoaffective patients with manic psychotic state and psychomotor agitation treated with lithium. Both patients developed symptoms of lithium intoxication after intramuscular ziprasidone treatment. To the best of their knowledge, this is the first description of such an adverse effect of this new atypical neuroleptic drug. They assume that lithium intoxication in the two presented cases was associated with the fast increase of ziprasidone serum level after its parenteral application, possibly affecting lithium excretion and thereby leading to lithium intoxication.
Abstract: Bekhterev was one of the prominent scientists of his era. He played a crucial role in the study of the development of the brain's organization, neurophysiology and neuropathology and in the objective study of psychological phenomena. Due to a trick of fate, Bekhterev's name and scientific contributions were neglected and consigned to oblivion. In this article we would like to restore the historical injustice done to Bekhterev. Based on newly discovered documents and testimonies, we present little known details about his life history, his clinical work and the tragic circumstances of his death.
Abstract: BACKGROUND: This article reviews the published clinical data on treatment-resistant schizophrenic and schizoaffective patients managed with combinations of "atypical" antipsychotic medication. METHOD: A computerized MEDLINE literature search covering an 18-year period (1985-2003) was conducted. All pertinent papers on the subject of the use of combination "atypical" antipsychotic medication in the management of treatment-resistant schizophrenia and schizoaffective disorder were obtained with subsequent analysis and discussion of the retrieved data. RESULTS: The search identified 29 case reports and case series reports (172 patients) and one double-blind placebo-controlled trial (28 patients) describing the use of combination "atypical" antipsychotic medication (clozapine-risperidone; clozapine-sulpiride; clozapine-olanzapine; clozapine-quetiapine; olanzapine-sulpiride; olanzapine-quetiapine; risperidone-olanzapine; risperidone-quetiapine) in the treatment of resistant schizophrenic and schizoaffective patients. An overview of results suggests that the combinations were beneficial in the described patients with reduction of positive symptoms and occasionally negative symptoms. Significant adverse effects, while rare, were reported in a few cases and did not appear to different in nature from those managed on monotherapeutic regimens. CONCLUSION: Combinations of "atypical" antipsychotic medications are well tolerated and may be effective in the management of treatment refractory schizophrenia and schizoaffective disorder. However, further double-blind placebo-controlled trials are required in order to test and confirm these observations.
Abstract: The health of heads of states is not always handled in the same way as an incapacitating disability in ordinary professionals. Instead of suspension of responsibilities, the health status of political leaders is concealed, especially when the illness is perceived as stigmatizing, such as organic mental impairment or sexual disorder. The objective of the present paper is to analyse the malady of Lenin (1870-1924) in the light of relevant and new medical information. It is hoped that this will accentuate the need for transparency when the health of a statesman is concerned.
Abstract: BACKGROUND: Treatment strategies for acute neuroleptic-induced akathisia (NIA) contain anticholinergic (antimuscarinic) agents, dopamine agonists, gamma-aminobutyric acid (GABA)-ergic agents, beta-blockers, benzodiazepines, and serotonin antagonists. Nevertheless, many patients who suffer from acute akathisia fail to respond to treatment. In earlier studies, vitamin B6 was found to be effective in the treatment of neuroleptic-induced movement disorders. The purpose of this study was to evaluate the efficacy of vitamin B6 in the treatment of acute NIA. This is the first report of B6 as a treatment for NIA. METHOD: This study was conducted in 2 mental health centers from February 2003 to November 2003. Twenty schizophrenia and schizoaffective inpatients with a DSM-IV diagnosis of NIA were randomly divided to receive vitamin B6 600 mg/day b.i.d. (N = 10) or placebo (N = 10) twice a day for 5 days in a double-blind design. The Barnes Akathisia Scale (BAS), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impressions scale (CGI) were used to assess the severity of NIA and psychotic symptoms. The BAS assessment was made at baseline and every day during the study. The BPRS and CGI were completed at baseline and at the end of the study. RESULTS: The vitamin B6-treated patients in comparison with the placebo group showed a significant improvement on the subjective-awareness of restlessness (p = .0004), subjective-distress (p = .01), and global (p = .004) subscales of the BAS. The objective subscale did not demonstrate significant positive results (p = .079), but there was a trend of symptom amelioration in the vitamin B6 group. A reduction of at least 2 points on the BAS global subscale was noted in 8 patients in the vitamin B6 group (80%), and in only 3 patients in the placebo group (30%) (p = .037). CONCLUSION: Our preliminary results indicate that high doses of vitamin B6 may be useful additions to the available treatments for NIA, perhaps due to its combined effects on various neurotransmitter systems.
Abstract: Traditionally, the neuropsychiatric symptoms of Alzheimer's disease (AD) have been managed with neuroleptics or benzodiazepines, which have serious side effects. Preliminary observations suggest the possible value of cholinesterase inhibitors in the amelioration of psychotic symptoms in patients with dementia of the Alzheimer's type, dementia with Lewy bodies, and in patients with Parkinson's disease. Twelve inpatients with AD with psychotic symptoms and lack of improvement of their delusions/hallucinations during perphenazine treatment (8 mg/day) for 3 weeks received random open-label donepezil 5 mg daily in addition to an ongoing treatment of 8 mg/day perphenazine or 16 mg/day perphenazine. Assessments conducted at baseline and after weeks 2 and 4 included the Mini-Mental State Examination, the Global Deterioration Scale, the Positive and Negative Symptoms Scale, and the Clinical Global Impressions scale. Frequency of extrapyramidal symptoms was measured according to the Abnormal Involuntary Movement Scale. The donepezil-perphenazine group exhibited substantially greater and clinical improvements in mental state. At the end of the trial (4 weeks), Positive and Negative Symptoms Scale scores revealed significant differences between both groups (p = 0.006). The Clinical Global Impressions scale and the Mini-Mental State Examination scores also showed significant differences between the donepezil-perphenazine group and the perphenazine group (p = 0.028 and p = 0.027 respectively). No significant differences were found in the Global Deterioration Scale scores. Abnormal Involuntary Movement Scale scores showed a significant deterioration in extrapyramidal symptoms in the perphenazine group compared with the donepezil-perphenazine group (p = 0.016). Donepezil augmentation of neuroleptics may be appropriate for those patients for whom neuroleptic monotherapy either does not lead to symptom remission or is associated with intolerable adverse effects. This was an open-label study and there is need for larger studies with double-blind control and a long-term study design to define the efficacy of donepezil for patients with AD and psychotic symptoms.
Abstract: The aim of our paper is to describe Kandinsky-Clerambault's Syndrome, which has important cultural-historical value in the history of psychiatry, and to illustrate the syndrome by means of a case report. Although its component symptoms are known among Western psychiatrists, the syndrome's specific name is generally unknown. The authors suggest that detailed clinical descriptions of some specific conditions may contribute to a more detailed knowledge of psychopathology, a more colorful and memorable view of conditions, with an increased awareness of the historical and cultural origins of psychiatry.
Abstract: To date there is no common or adequate therapeutic strategy for treatment of refractory schizophrenic patients. Increasing antipsychotics' doses in treatment-resistant schizophrenic patients is the most common intervention used by clinicians. Olanzapine is an atypical antipsychotic, which in a number of double-blind, placebo-controlled studies has been found to be more effective than haloperidol for the treatment of positive and negative symptoms of schizophrenia. During the last few years there have been several reports of successful results in prescribing olanzapine at dosages of more than 25 mg/day for treatment-resistant schizophrenic and schizoaffective patients. This report presents the results from the treatment of three resistant schizophrenic patients treated successfully with high dosages of olanzapine (35, 40, and 60 mg/day). None of the patients had any side effects, including abnormal laboratory levels and weight gain. The results and literature data suggest that in clinical practice some schizophrenic patients resistant to conventional neuroleptic treatment and not responding to olanzapine at recommended dosages as high as 20 mg/day may respond to higher dosages such as 40 or 60 mg/day, and these dosages are well tolerated. Further prospective clinical studies are needed.
Abstract: OBJECTIVE: During the last few years there have been numerous publications concerning glucose dysregulation and antipsychotic treatment with new-onset diabetes and exacerbation of existing disease being reported. At the same time three anecdotal reports describing decrease of blood glucose level during clozapine and olanzapine treatment were published. Here we report two cases of clinically significant dose-related reductions in glucose levels in schizophrenic and schizoaffective patients suffering from pre-existing type 2 diabetes during high dose (40 mg/day) olanzapine treatment. To the best of our knowledge, this is a first report of decreasing glucose blood levels in association with olanzapine therapy in pre-existing type 2 diabetes. Antipsychotic treatment with high doses of olanzapine showed that the relationship between olanzapine and glucose regulation is more unambiguous than usually assumed. CONCLUSIONS: There is a need for further studies in order to define the influence of high dose olanzapine for schizophrenic and schizoaffective patients suffering from type 2 diabetes.
Abstract: INTRODUCTION: Although there is great progress in the treatment of positive symptoms in schizophrenic patients and movement disorders induced by neuroleptics, it is still a problem for clinicians. In this study vitamin B6 treatment was provided to 15 patients who suffered from schizophrenia and schizoaffective disorder with positive psychotic symptoms and tardive dyskinesia. METHODS: This study was a double-blind crossover controlled during 9 weeks. Each patient was treated with up to 400 mg/day vitamin B6 versus placebo. Every week the patients' conditions were evaluated with Positive and Negative Symptoms Scale (PANSS), Extrapyramidal Symptoms Rating Scale (ESRS) and a blood sample of level pyridoxal was taken. RESULTS: The results did not show any therapeutic effect of psychotic symptoms from vitamin B6 added to antipsychotic agents, which patients received on a constant base. On the other hand, there was significant improvement in tardive dyskinesia and parkinsonian symptoms. There was no direct correlation between pathological symptoms and the serum baseline level of vitamin B6 nor its level during the treatment. CONCLUSION: The authors suggest that vitamin B6 may be efficient as the treatment for tardive dyskinesia and parkinsonism induced by neuroleptic agents. There is a need for further studies with larger samples and higher doses of vitamin B6 in order to examine the possibility of a positive therapeutic effect as an augmentation agent for the treatment of psychotic symptoms.
Abstract: The life of Mikhail Vrubel (1856-1910), the Russian painter, combined remarkable artistic accomplishments with severe psychopathology. We have attempted to examine the influence of the changes in the artist's emotional state on the creative process. The contradictions that abound in the descriptions of Vrubel's character and conduct should, in all likelihood, be attributed not only to the complexity of his personality but also to the effect of psychopathology on his behaviour. We believe that Vrubel suffered from mood disorder, complicated by syphilis.
Abstract: BACKGROUND: Vitamin B6, or pyridoxine, plays an intrinsic role in the synthesis of certain neurotransmitters that take part in development of psychotic states. Several reports indicate that vitamin B6 may be a factor in a number of psychiatric disorders and related conditions, such as autism, Alzheimer's disease, hyperactivity, learning disability, anxiety disorder, and depression. Moreover, there are anecdotal reports of a reduction in psychotic symptoms after vitamin B6 supplementation of psychopharmacologic treatment of patients suffering from schizophrenia or organic mental disorder. The aim of this study was to examine whether vitamin B6 therapy influences psychotic symptoms in patients suffering from schizophrenia and schizoaffective disorder. METHOD: The effects of the supplementation of vitamin B6 to antipsychotic treatment on positive and negative symptoms in 15 schizophrenic and schizoaffective patients (DSM-IV criteria) were examined in a double-blind, placebo-controlled, crossover study spanning 9 weeks. All patients had stable psychopathology for at least 1 month before entry into the study and were maintained on treatment with their prestudy psychoactive and antiparkinsonian medications throughout the study. All patients were assessed using the Positive and Negative Syndrome Scale (PANSS) for schizophrenia on a weekly basis. Patients randomly received placebo or vitamin B6, starting at 100 mg/day in the first week and increasing to 400 mg/day in the fourth week by 100-mg increments each week. RESULTS: PANSS scores revealed no differences between vitamin B6- and placebo-treated patients in amelioration of their mental state. CONCLUSION: Further studies with larger populations and shorter duration of illness are needed to clarify the question of the possible efficacy of vitamin B6 in treatment of psychotic symptoms in schizophrenia.
Abstract: The risk of psychosis among patients with Parkinson's disease (PD) is high, and the management of these patients remains a substantial problem for physicians. Atypical antipsychotics, despite their advantages over conventional antipsychotics, can cause different side effects and deterioration of PD. Several reports have suggested that donepezil can be helpful in the treatment of psychotic conditions in patients with dementia with Lewy bodies and Alzheimer's disease. This report presents the results of preliminary study of six patients (four women, two men; age range, 60-75 years) with PD (range of duration, 3-7 years) and dementia complicated by psychosis. All patients were treated with antiparkinsonian therapy, and donepezil was added to their regular treatment. The severity of the psychotic symptoms was assessed using the Scale for the Assessment of Positive Symptoms, and extrapyramidal symptoms were assessed using the Simpson-Angus Scale. With the addition of donepezil (as much as 10 mg/day) to their constant antiparkinsonian treatment, five patients had clinically significant (more than 53%) improvement on the assessment scale, and one patient had minimal (24%) improvement after 6 weeks of the treatment. None of the patients had side effects or deterioration of parkinsonian symptoms. The results suggest that donepezil may ameliorate psychotic symptoms in patients with PD, but this will need to be tested further in controlled, double-blind trials.
Abstract: OBJECTIVE: Vitamin B12 (cobalamin) is a key component in the catabolism of monoamines. B12 deficiency is associated with various neuropsychiatric disorders and may be more frequent in psychiatric inpatients. The authors describe a case report of a newly admitted and relatively young patient (52 years old) with organic psychosis secondary to vitamin B12 deficiency. No other overt clinical features of cobalamin deficit were observed. Symptoms were resolved with B12 and folate replacement. The patient's mental status remained stable over the 3 months after the treatment. The authors note that organic mental changes were reversible with B12 replacement. CONCLUSIONS: The authors propose that determination of serum vitamin B12 and folic acid levels should be recommended as routine screening in all new admissions of psychiatric patients regardless of their age or previous state of health.
Abstract: OBJECTIVE: The occurrence of tremor in patients receiving lithium is well known, but the management of this side effect is a significant problem both for patients and physicians. Although some reports have suggested that beta-blockers may be useful in treating lithium-induced tremor (LT), these agents have different side effects which limit the possibility of their use. Vitamin B6 has been reported to be effective in treatment of patients suffering from different kinds of neuroleptic-induced movement disorders including parkinsonism and tardive dyskinesia. METHODS: This report presents the results of a preliminary four-week open-label clinical trial of five patients who suffered from LT and who were treated with vitamin B6 (900-1200 mg/d). The severity of tremor was assessed using the tremor subscale from the Simpson-Angus Scale (SAS) and Subjective Clinical Improvement Impression scale (SCII). RESULTS: After the addition of vitamin B6 to their treatment, according to the SAS scores four patients showed an impressive improvement until total disappearance of tremor. The subjective scale, on which the patients' scored their impression of clinical improvement, showed similar results. None of the patients suffered from any side effects attributable to vitamin B6. CONCLUSIONS: The results suggest that vitamin B6 may alleviate LT, double-blind controlled trials are needed to establish this effect.
Abstract: A difficult problem that arises periodically involves the physical and psychological problems of political leaders. Unlike the ordinary person, where the presence of physical or psychiatric disability that interferes with functioning will be revealed and will result in suspension from work responsibilities (e.g. pilot, bus driver, physician), the situation is different with regard to political leaders. Concerning the latter, the information may remain concealed because it is conceived of as stigmatizing, e.g., mental illness, and sexual disorder. The result of hiding such information is that sick leaders may continue to hold their positions of vast power in spite of their disability. Examples of world leaders who suffered from sustained disability as a result of incapacitating neurological or psychiatric illnesses, physical problems or medication effects include Woodrow Wilson, Franklin Roosevelt, Dwight Eisenhower, Winston Churchill and Conrad Adenauer. In the present article we will discuss in detail Lenins severe illness--whose differential diagnosis and real facts were kept hidden from the public--and the consequences of this cover-up.
Abstract: The dexamethasone suppression test (DST) is a widely studied state marker for endogenous depression. Several drugs cause false positives or negatives in this test. Since inositol is a new treatment for depression it is important to determine if it causes artifacts in the DST. Five patients with major depression diagnosed according to DSM-IV underwent a dexamethasone suppression test before and after one and two weeks of 12 grams daily inositol treatment. Three normal subjects underwent the same procedure before and after one week of inositol treatment. Four depressed patients and all three normal subjects demonstrated pretreatment dexamethasone suppression of plasma cortisol. One or two weeks of inositol treatment had no effect on post-dexamethasone cortisol plasma levels in patients or subjects. One depressed patient was a non-suppressor before treatment and continued to show elevated post dexamethasone cortisol levels after one week of inositol treatment. However, after two weeks on inositol, when substantial clinical improvement was noted, he converted to a normal DST. Chronic inositol treatment does not seem to induce false positive DST results.
Abstract: OBJECTIVE: The authors' goal was to conduct a double-blind trial of vitamin B(6) in the treatment of tardive dyskinesia in patients with schizophrenia. METHOD: Fifteen inpatients with schizophrenia who met research diagnostic criteria for tardive dyskinesia were randomly assigned to treatment with either vitamin B(6) or placebo for 4 weeks in a double-blind crossover paradigm. The Extrapyramidal Symptom Rating Scale was used to assess patients weekly. RESULTS: Mean scores on the parkinsonism and dyskinetic movement subscales of the Extrapyramidal Symptom Rating Scale were significantly better in the third week of treatment with vitamin B(6) than during the placebo period. CONCLUSIONS: Vitamin B(6) appears to be effective in reducing symptoms of tardive dyskinesia.
Abstract: Eponymic terms or eponyms are labels describing phenomena that reflect the name(s) of the person(s) who first described the phenomena. Using a similar term to describe different forms of pathology leads to a muddle. In this paper, we describe "Clerambault's syndrome" and "Kandinsky-Clerambault's syndrome" and discuss and clarify the confusion surrounding these different syndromes.
Abstract: OBJECTIVE: The authors describe a patient with an unusual combination of polydipsia and isolated hypernatremia without any other changes of electrolytes. The patient had two attacks of hypernatremia which were successfully treated with clozapine. Some speculations about possible mechanisms of this unusual combination are discussed.
Abstract: Risperidone has been primarily marketed for the treatment of schizophrenia. There are reports about its potential role for the treatment of affective illness. We report here another case of a patient with psychotic depression who was treated successfully with risperidone as monotherapy. This case report suggests that risperidone can be an efficient treatment mode for psychotic depression; however, it needs more data based on controlled study.
Abstract: Oneiroid syndrome (OS), or dream-like fantastic delusional derangement of consciousness, is characterized by a kaleidoscopic quality of psychopathological experiences, wherein reality, illusions and hallucinations are merged into one. It is typically accompanied by motor and, in particular, catatonic disturbances. This syndrome is an uncommon psychiatric state, which is hardly mentioned in standard psychiatric textbooks. OS is a neglected entity among DSM-oriented psychiatrists because it deals with a phenomenological approach in contrast to the European attitude, which deals with detailed clinical descriptions. Here, we propose detailed clinical descriptions with a number of consecutive stages of the OS development, illustrated by two vignettes with typical variants of oneiroid syndrome, in order to raise the awareness of psychiatrists who are not familiar with this state, and to try to open a window to the inner life of those patients suffering from this syndrome. These cases may also serve as illustration of certain principles which, when understood, may be found to lead in turn to a deeper knowledge of the psychopathology of other more commonplace conditions.
Abstract: Polypharmacy, or the use of multiple drugs in the therapy of psychiatric disorders, is not recommended. However, appropriate combinations of pharmacologic mechanisms may enhance the efficacy of antipsychotic drugs and alter the course of schizophrenia. In recent years, some articles have been published about the successful use of clozapine and risperidone in combination for the treatment of patients with resistant schizophrenic and schizoaffective disorders. However, safety of this drug combination is open to discussion. This report presents the results of a preliminary study of five patients with resistant schizophrenia successfully treated with risperidone-olanzapine combination. The results suggest that this combination may be useful. In the future, the efficacy of risperidone-olanzapine combination should be confirmed in larger study populations before its clinical application is considered.
Abstract: There are several reports regarding the efficacy of vitamin B6 in the treatment of tardive dyskinesia (TD). Vitamin B6 plays a key role in the synthesis of several neurotransmitters, including serotonin, dopamine, norepinephrine, and gamma-aminobutyric acid, all of which have been proposed to be involved in the development of TD. The purpose of this study was to examine whether there are special markers to distinguish long-term neuroleptic exposure patients who have TD from those patients who do not develop this side effect. In view of the pivotal role of vitamin B6 in the synthesis of all neurotransmitters believed to take part in the pathogenesis of TD, we decided to examine whether basal levels of vitamin B6 might explain the difference between these two groups. Such a finding could provide a predictive marker for vulnerable patients. The active metabolite of vitamin B6 is pyridoxal phosphate (PP). Pyridoxal phosphate blood levels were measured in 15 schizophrenic and schizoaffective patients with TD and compared with 15 patients without evidence of TD (matched by sex, age, smoking, and diagnosis). We found that, although patients in the TD group were exposed to neuroleptic drugs for significantly longer periods of time, there were no differences in serum PP levels between the groups. The reports of the effectiveness of vitamin B6 supplementation in the treatment of TD could therefore be explained by the assumption that central nervous system or intracellular vitamin B6 levels, which are involved in the pathogenesis of TD, are not the same as vitamin B6 peripheral serum levels. There is need for further studies, which will clarify the relationship between vitamin B6 and TD.
Abstract: Lately an increasing number of physicians are asked to diagnose and treat physical and mental disorders caused by alcohol abuse, a phenomena which had been quite rare in Israel until recently. Early diagnosis and efficient treatment are essential for the management of alcohol-dependent patients. Primary care physicians and hospital personnel should be more alert to the growing numbers of alcohol abusers and to their appropriate diagnosis and treatment. This article describes and summarizes the symptoms of alcohol withdrawal in general, and alcoholic delirium in particular. Problems in diagnosis and treatment are illustrated by typical cases, pointing out early clinical warning signs and suggesting some treatment guidelines.
Abstract: Tardive dyskinesia (TD) remains a significant problem for patients and physicians. Several reports have suggested that vitamin B6 (pyridoxine) can be helpful in the treatment of some neuroleptic-induced movement disorders, including parkinsonism and TD. This report presents the results of a preliminary study of five patients with TD who underwent a four week open-label clinical trial of vitamin B6 (100 mg/d) in addition to their regular medications. The severity of the involuntary movements was assessed using the Abnormal Involuntary Movement Scale (AIMS), Barnes Akathisia Rating Scale (BARS) and the Simpson-Angus Scale (SAS). The patients' clinical status was assessed with the Brief Psychiatric Rating Scale (BPRS). With the addition of vitamin B6 to their treatment, four patients had clinically significant (greater than 30%) improvement on the measures of involuntary movement and, in three cases, there was also clinically significant improvement on the BPRS. None of the patients had side effects attributable to vitamin B6. The results suggest that vitamin B6 may alleviate TD, but it will need to be further tested in controlled double-blind trials.
Abstract: A case is presented of a 65-year-old man with chronic schizophrenia who, after four years of remission, developed psychotic symptoms after pneumonia. The patient was found to be deficient in vitamin B12. His psychosis remitted within 5 days of administration of vitamin B12 and folic acid. This case emphasizes the need to measure vitamin B12 in psychogeriatric patients, especially when they present with a severe infection and organic mental symptoms.
Abstract: BACKGROUND: The aim of this present study was to compare the characteristics of suicidal attempts of patients with major depression (MD) and adjustment reaction (AR). METHOD: Sixty-nine patients with MD and 86 with AR admitted to the Moscow Institute of Emergency Help after the first suicide attempts were studied. All the attempters were interviewed by at least by two psychiatrists and the diagnosis was made according to agreement and to ICD-9CM criteria. RESULTS: Differences between the two groups were found with regard to social-demographic, clinical-psychological and suicidal characteristics: the AR patients were less educated, had lower social status and in most cases were unmarried, compared with the MD patients. A large number (51.2% of the attempters in the AR group and 34.8% in the MD group) had an unstable parental family, early orphanhood or an emotionally deprived childhood. No differences were found in the methods of the suicidal attempts between the groups. Suicidal attempts under alcohol abuse occurred more often among the AR group (34.9 vs. 10.1%). The interval from the beginning of the disorder until the suicidal attempt was significantly shorter within the AR group. In this group the suicidal attempts were not planned, in comparison with the MD group. LIMITATION: The sample is a selected study, because the research included only inpatients with AR and MD after their first suicidal attempt. CONCLUSION: We believe that our data may be important for improving the assessment of suicidal risk and in planning treatment strategies for prevention of repeated suicidal attempts.
Abstract: Changes in serum creatine phosphokinase have been associated with exacerbation of tardive dyskinesia. Vitamin E, a drug suggested to be effective in the treatment of tardive dyskinesia, has been implicated as a possible cause of increased creatine phosphokinase levels. Ten patients with long-term tardive dyskinesia were treated with vitamin E in a double-blind, placebo-controlled crossover study. Vitamin E blood levels and creatine phosphokinase serum levels were monitored at various phases during the study. There were no significant differences between vitamin E and placebo treated patients in their abilities to affect tardive dyskinesia or to influence creatine phosphokinase levels. These data do not support the hypothesis that administration of vitamin E may alter creatine phosphokinase levels in patients with long-term tardive dyskinesia.
Abstract: We present a case of folie à deux in immigrants, for whom the process of immigration changed the intrafamilial dependencies. Folie à deux only appeared in the previously dominant member once she became the dependent member. Follow-up showed resolution of the folie à deux with no change in the recent reversal of roles.
Abstract: This study assesses the different approaches to treating patients with schizoaffective and paranoid schizophrenia in remission. Individualized treatment of 220 outpatient schizophrenia patients was conducted for 4 years. The choice of treatment was based on the course of the disease and the frequency of relapses. The influence of changes in treatment on the patterns of relapses is presented. The results of this prospective followup open study were evaluated by comparing data received during our research with data from the two preceding 4-year periods and with data from the control group. Compared with routine methods, special treatment tactics led to a significantly decreased frequency of relapses in patients with frequent relapses (p < 0.001). In patients with rare relapses, full cessation of treatment did not lead to increasing mean frequency of relapses. Treatment in remission should be based on the peculiarities of the course of disease, specifically, frequency of relapses, type of schizophrenia, and presence or absence of positive psychopathological signs in remission.
Abstract: Laurence-Moon-Bardet-Biedl (LMBB) syndrome is a symptom complex that usually presents with retinitis pigmentosa, poly- or syndactyly, mental retardation, obesity and hypogenitalism. Cotard's syndrome is a state in which the central symptom is a delusion of negation. The case reported here is a combination of these two rare conditions.
