Abstract: Myocarditis is a rare but life threatening adverse effect of clozapine. Some symptoms of myocarditis--elevated temperature, tachycardia and fatigue--appear commonly during the onset of treatment with clozapine and during the dose titration. We present a case of a patient with concurrent schizoaffective disorder and Parkinson's disease, who twice developed clozapine-induced myocarditis. All symptoms disappeared after the discontinuation of the drug. Early diagnosis, discontinuation of clozapine and supportive therapy of myocarditis lower the risk of a fatal outcome.
Abstract: AIMS: Psychiatric disorders and treatment with conventional antipsychotic medications have been associated with venous thromboembolism, but only a few data on recent antipsychotics such as olanzapine are available. METHODS: We describe four subjects treated with olanzapine who developed venous thromboembolism, and were hospitalized at the University Hospital in Hradec Kralove during the period 2004-2006. RESULTS: We found a combination of several clinical and laboratory risk factors in our patients. CONCLUSIONS: A cohort study or case-control studies are needed to better elucidate the possible role of olanzapine in etiopathogenesis of venous thromboembolism.
Abstract: AIMS: The aim of the present study was to compile a specific algorithm of prevention of venous thromboembolism in hospitalized psychiatric patients because this specific issue has not been addressed sufficiently in the literature. METHODS: The computer database MEDLINE was searched using key words (schizophrenia OR depression OR bipolar) AND (antipsychotic OR antidepressant) AND (venous thromboembolism OR pulmonary embolism) AND (prevention OR prophylaxis) in 2006. RESULTS: Based on the literature regarding non-surgical and surgical patients with respect to specificities in mental disorders (obesity induced with psychotropic drugs, possible catatonia, physical restraint, potential dehydration, antipsychotic treatment), a scoring system and a synoptic algorithm of prevention of venous thromboembolism modified for hospitalized psychiatric patients, were suggested. CONCLUSIONS: According to the authors' knowledge this is the first attempt to establish such guidelines exclusively in psychiatry. Individual preventative clinical measures are suggested, ranging from regular physical exercise of lower extremities to repeated parenteral application of high doses of heparin tailored to every patient's risk for venous thromboembolism. Economic data support implementation of a proposed decision procedure into psychiatric clinical practice. Prospective discussion of its international applicability would be beneficial from both the clinical and the scientific points of view.
Abstract: Event related potentials (ERPs) provide an insight into sensory and cognitive processes in health and disease. Studies of an ERP negative amplitude deflection elicited by a change in a series of auditory stimuli is known as mismatch negativity (MMN). The generation of MMN is impaired in schizophrenia. Its deficit is associated with lower everyday functioning and may be also interpreted as the marker of progression in schizophrenia. MMN elicited by visual stimuli (vMMN) was described by several research teams, but it has not been investigated in schizophrenia as yet. Using a motion-direction paradigm, we elicited visual MMN in 24 patients with schizophrenia and schizoaffective disorder. The vMMN was computed as differences in areas under curve of visual ERPs to standard and deviant motion-direction stimuli recorded from midline derivations at the interval of 100-200 ms. They were compared between groups of patients with schizophrenia and healthy controls. The significantly smaller vMMN indicated an impaired generation of mismatch negativity in patients with schizophrenia. In secondary analyses there was an association of vMMN impairment among patients with higher dose of medication, lower level of functioning and the presence of deficit syndrome. This impairment appears analogous to the impairment of MMN in the auditory domain and is probably related to early visual information processing. Its relationship to cognitive functioning of patients with schizophrenia deserves further attention.
Abstract: BACKGROUND: The diagnosis of Creutzfeldt-Jakob disease (CJD) is based on typical clinical features and can be supported by detection of 14-3-3 protein in the CSF. The present study suggests the importance of investigating this ratio of total tau protein to phosphorylated tau protein in differentiating CJD from other dementias. Thirty-one patients with Alzheimer's disease (AD) or frontotemporal dementia and four with definitive diagnoses of CJD were included in the study. METHODS AND MATERIAL: Results from baseline investigations were compared with those from an age-matched cognitively controlled group with Bell's palsy. Tau protein, phosphorylated tau protein, and beta amyloid were analyzed using a commercially available enzyme-linked immunosorbent assay; 14-3-3 protein was assessed by Western blotting. RESULTS AND CONCLUSION: A distinctly high proportion of total tau protein to phosphorylated tau protein in CSF was found in all patients diagnosed with CJD, even in those with negative 14-3-3 protein blot results. In contrast, marker analysis in patients with Alzheimer's dementia revealed the highest CSF ratio of beta amyloid to phosphorylated tau protein levels. These proteins are important diagnostic biomarkers for CJD, especially in patients with negative 14-3-3 protein findings.
Abstract: Fahr's disease is characterized by idiopathic calcification of the basal ganglia and other brain regions. Clinically it may be accompanied by extrapyramidal and behavioural disorders. In Fahr's syndrome, the same pathology is due to another well-defined disease. Calcium/phosphate metabolic disorders, e.g. hypoparathyroidism or pseudohyperparathyroidism, may be involved. Here, we report a case of 62-year-old man presenting with severe dementia but only mild movement disorders and mild calcium metabolism abnormalities. Extensive brain calcifications together with unevenly distributed perfusion on single photon emission tomography are documented.
Abstract: Clozapine is an atypical antipsychotic indicated for the treatment of refractory schizophrenia. Clozapine treatment is associated with the metabolic side effects. Weight gain, hyperlipidemia and hyperglycemia are the risk factors for onset of diabetes and cardiovascular disorders. We report a case vignette of a patient in whom the decrease in negative and general psychopathology after adjunctive aripiprazole appeared simultaneously with a reduction of clozapine-induced increase in weight and metabolic measures. Combined application of clozapine and aripiprazole is in accordance with a neurobiological rationale and appears to be a safe and well tolerated.
Abstract: OBJECTIVES: The presented study focuses on the importance of measurement of beta-amyloid42 (Abeta-42) levels, total tau protein, and phosphorylated tau (p-tau) protein in the cerebrospinal fluid (CSF) of cerebrospinal multiple sclerosis (MS) and clinically isolated syndrome (CIS) which represents an early phase of multiple sclerosis. METHODS: A total of 23 patients with clinically isolated syndrome and suspected MS were enrolled into the study. Of this number, 14 patients met the criteria for definitive MS according to McDonald. The control group consisted of 40 patients examined for the possibility of organic damage to the brain, which was not confirmed. We used method of enzyme immunoanalysis to examine concentrations of tau protein, p- tau protein, and beta amyloid42. Differences between the respective groups were examined by test statistics. In addition, dependence of the total tau protein, p-tau protein, and beta-amyloid42 levels on demographic variables, diagnosis and duration of disease was examined by correlation analysis. Correlation of the concentrations obtained in the measurements was evaluated based on the calculated correlation coefficient (r) and level of significance (p). RESULTS: Compared to the control group, no statistically significant difference was found in the levels of tau protein and p-tau protein between the CIS group and definitive MS group. A significant increase was found only for beta-amyloid42 levels in patients with diagnosed MS vs. control group. We demonstrated no correlation between the beta-amyloid42 and tau protein levels, p-tau protein and age of patients and duration of disease in patients with MS, CIS and the control group. CONCLUSION: Results of our study show that use of tau protein, p-tau protein and beta-amyloid42 in the diagnosis of multiple sclerosis seems to be non-beneficial. We confirmed no importance for the differential diagnosis of an early stage MS.
Abstract: Administration of antipsychotics appears to be related to increased risk of venous thromboembolism and cerebrovascular side effects. The biological mechanism responsible for this possible adverse drug reaction is unknown, but there is a growing number of elucidating hypotheses. Treatment with antipsychotics is associated with elevation of prolactin level. Prolactin has recently been recognized as potent platelet aggregation co-activator, and have therefore been postulated as an additional risk factor for both arterial and venous thrombosis. We briefly review the arguments for the role of hyperprolactinemia in pathogenesis of platelet aggregation.
Abstract: The hospitalized patients of the psychiatric wards represent a risk group for the development of venous thromboembolism. Apart from sedative administration, total movement reduction, bad life style and daily routine and increased body weight, there is negative impact of dehydration, prolonged hospitalization and sometimes immobilisation in consequence of mechanical restraints. A large amount of patients are treated with antipsychotics that have a series of adverse effects. Depending of the drug used, the most frequent of them are somnolence, fatigue, extrapyramidal syndrome, hypotension, hepatotoxicity, increased body weight, prolongation of the QT interval of the ECG with a risk of ventricular arrhythmias, hematopoietic disorders, lipid or glycide metabolism disorders or hyperprolactinemia. Another potential adverse effect of these drugs is the heightened risk of venous thromboembolism development (deep vein thrombosis and/or pulmonary embolism). There is the risk of a pathological blood clotting event in psychiatric patients, especially those treated with antipsychotics. Although it is not high, it can have fatal consequences when combined with a relatively frequent pulmonary embolism and difficult diagnostics of thromboembolism. An algorithm for thromboembolism prevention has been developed. It involves important general risk factors of venous thrombosis (VTE history, immobilisation, malignancy, age over 75 years etc.) and also markers (physical restraints, dehydration, obesity, antipsychotics use) that can participate in the pathogenesis of venous thrombosis in the hospitalized psychiatric patients with limited motility. The authors believe that this prophylaxis is indicated, safe, effective and that it improves the quality of life at relatively low costs.
