The effect of paliperidone extended release on subjective well-being and responses in patients with schizophrenia

Objective

This study aimed to evaluate the subjective well-being and attitudes toward antipsychotic medication of patients with schizophrenia who had switched to paliperidone extended release (ER).

Methods

A total of 291 patients with schizophrenia treated with antipsychotics participated in this open-label, 24-week switching study. The primary outcome measures were the Subjective Well-Being under Neuroleptic Treatment Scale-short version (SWN-K) and the Drug Attitude Inventory (DAI). The Krawiecka scale, Clinical Global Impression-Schizophrenia (CGI-SCH), Personal and Social Performance scale (PSP) were used to evaluate psychopathology and psychosocial functioning, respectively.

Results

Data from a total of 243 subjects who received the study medication and had at least one follow-up assessment without a major protocol violation were analyzed. Scores on the DAI and SWN-K showed significant improvement between baseline and end-point measurements beginning during the second week. Scores on the Krawiecka scale, all five subscales of the CGI-SCH scale, and the PSP scale were also significantly improved at the end point compared with the baseline. Significant predictors of improvements in the SWN-K and DAI after a switch to paliperidone ER were baseline scores, reductions in scores on the Krawiecka scale, and previous risperidone use. A clinically relevant increase in body weight (≥ 7% weight gain) occurred in one-fourth of the participants who completed the 24-week study.

Conclusion

Switching to paliperidone ER improved the subjective well-being and attitudes towards antipsychotic medication in patients with schizophrenia. Exploratory analyses revealed that these improvements were particularly pronounced in patients who had been treated with risperidone before treatment with paliperidone ER.     

Relationship between inflammation and metabolic syndrome following treatment with paliperidone for schizophrenia

Objective

Metabolic syndrome and antipsychotic medications are associated with inflammation. This study investigated the relationship between inflammation and metabolic syndrome in patients with schizophrenia. It also examined the effects of paliperidone extended release (ER) treatment on metabolic parameters.

Methods

Data were analyzed from schizophrenic patients who participated in a multi-center, open-label, non-comparative clinical trial. Anthropomorphic measurements (i.e., weight, waist circumference, and blood pressure) were assessed along with fasting laboratory values, including white blood cell (WBC) count, glucose, high-density lipoprotein, and triglycerides.

Results

Among the 225 patients at baseline, the group with the highest WBC count displayed a 5.9-fold risk for metabolic syndrome compared with that of the lowest group. An increase of 10³ WBCs/μL was associated with a 1.4-fold increased risk for metabolic syndrome. After 24 weeks of treatment with paliperidone ER, significant increases were observed in waist circumference and body weight. Changes in WBC count were positively correlated with changes in waist circumference.

Conclusions

Schizophrenic patients with high levels of inflammation should be carefully monitored for metabolic syndrome. Moreover, strategies to reduce inflammation and obesity may prevent metabolic syndrome in patients with schizophrenia who take atypical antipsychotic medication.     

Enfermedad de Parkinson avanzada. Características clínicas y tratamiento (parte I)

Introduction

A large percentage of patients with Parkinson's disease (PD) develop motor fluctuations, dyskinesias, and severe non-motor symptoms within 3 to 5 years of starting dopaminergic therapy, and these motor complications are refractory to treatment. Several authors refer to this stage of the disease as advanced Parkinson's disease.

Objective

To define the clinical manifestations of advanced PD and the risk factors for reaching this stage of the disease.

Development

This consensus document has been prepared by using an exhaustive literature search and by discussion of the contents by an expert group on movement disorders of the Sociedad Española de Neurología (Spanish Neurology Society), coordinated by two of the authors (JK and MRL).

Conclusions

Severe motor fluctuations and dyskinesias, axial motor symptoms resistant to levodopa, and cognitive decline are the main signs in the clinical phenotype of advanced PD.     

La rééducation du membre supérieur assistée par robot contribue-t-elle à améliorer le pronostic de l’hémiparésie vasculaire ?

Introduction

Upper limb robot-assisted rehabilitation is a novel physical treatment for neurological motor impairments. During the last decade, this rehabilitation option utilizing technological tools has been evaluated in hemiparetic patients, mostly after stroke.

State of art

Studies at acute and chronic stages suggested good tolerance and a significant and persistent reduction of motor impairment; a real impact on disability has been shown in acute/sub acute patients.

Perspectives

Improved access to rehabilitation robots and an optimal use will probably be associated with higher efficiency of rehabilitative work in the paretic upper limb.

Conclusions

Even if this treatment is still confined to a narrow circle of users, the device's biomechanical properties and clinical suggestions from the literature may show promise for the future of rehabilitation.     

Aquagenic pruritus induced by clomipramine

Objective

Aquagenic pruritus is the development of severe, prickling-like skin discomfort without observable skin lesions that is evoked by contact with water at any temperature.

Method

This is a case report of a man presenting with aquagenic pruritus after starting clomipramine treatment for anxiety and depression.

Results

The patient's aquagenic pruritus resolved after discontinuing the clomipramine but reemerged when treatment was restarted.

Conclusions

A greater awareness and knowledge about aquagenic pruritus among physicians could help improve the clinical recognition and management of this clinical entity.     

Syndrome of inappropriate secretion of antidiuretic hormone due to desvenlafaxine

Objective

Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is not uncommon in patients receiving treatment of selective serotonin reuptake inhibitors or venlafaxine.

Method

This is a case report of a 47-year-old man with depression, who developed hyponatremia after commencing treatment with desvenlafaxine.

Results

To our knowledge, this is the first case in which desvenlafaxine-associated SIADH was reported since the introduction of the drug.

Conclusion

Physicians should be aware of the possibility of desvenlafaxine-associated hyponatremia in patients under age of 65.     

Somatosensory-motor bodily representation cortical thinning in Tourette: Effects of tic severity, age and gender

Introduction

Tourette syndrome (TS) implicates the disinhibition of the cortico-striatal-thalamic-cortical circuitry (CSTC). Previous studies used a volumetric approach to investigate this circuitry with inconsistent findings. Cortical thickness may represent a more reliable measure than volume due to the low variability in the cytoarchitectural structure of the grey matter.

Methods

66 magnetic resonance imaging scans were acquired from 34 TS subjects (age range 10-25, mean 17.19 ± 4.1) and 32 normal controls (NC) (age range 10-20, mean 16.33 ± 3.56). Brain morphology was assessed using the fully automated CIVET pipeline at the Montreal Neurological Institute.

Results

We report (1) significant cortical thinning in the fronto-parietal and somatosensory-motor cortices in TS relative to NC (p < .05); (2) TS boys showed thinner cortex relative to TS girls in the fronto-parietal cortical regions (p < .05); (3) significant decrease in the fronto-parietal mean cortical thickness in TS subjects with age relative to NC and in the pre-central cortex in TS boys relative to TS girls; (4) significant negative correlations between tic severity and the somatosensory-motor cortical thickness.

Conclusions

TS revealed important thinning in brain regions particularly involved in the somatosensory/motor bodily representations which may play an important role in tics. Our findings are in agreement with Leckman et al. (1991) hypothesis stating that facial tics would be associated with dysfunction in an orofacial subset of the motor circuit, eye blinking with the occulo-motor circuit, whereas lack of inhibition to a dysfunction in the prefrontal cortex. Gender and age differences may reflect differential etiological factors, which have significant clinical relevance in TS and should be considered in developing and using diagnostic and therapeutic interventions.     

A case of bupropion-induced stuttering

Objective

Stuttering is a frequent side effect of many psychotropic drugs, particularly antidepressants.

Method

This is a case report of a woman presenting with stuttering after starting bupropion treatment for her depression.

Results

The patient's stuttering resolved after discontinuing the bupropion.

Conclusion

Neuroimaging and pharmacological studies have implicated dopamine in the pathophysiology of stuttering. Bupropion's ability to increase dopamine in the frontal cortex was suspected to have been involved in this patient's stuttering. However, further research is needed before causality can be assured.     

Therapeutic extradural cortical stimulation for Parkinson's Disease: Report of six cases and review of the literature

Objectives

We report our experience and results with extradural cortical stimulation (ECS) in the surgical treatment of Parkinson's Disease (PD). Besides, we review the literature supporting the use of this technique.

Materials and methods

Six patients with advanced PD and exclusion criteria for Deep Brain Stimulation (DBS) were included in our ECS protocol. With the aid of functional MRI and somato-sensory evoked potentials monitoring, the motor cortex projection over the scalp was drawn. Finally, under local anesthesia a stimulation lead was placed in the epidural space overlying the central sulcus.

Results

Patients showed mild daily life activities improvement with a slightly lower levodopa equivalent dose, but UPDRS part III scores showed no significant modification.

Conclusions

Despite ECS is a minimally invasive surgical technique, our results only support its use in selected patients with advanced PD, in whom this therapy may be modestly effective. More experimental studies regarding the neuromodulation of the basal ganglia-cortex loops are required to optimize its clinical application.     

Effect of afferent input on motor cortex excitability during stroke recovery

Objective

Afferent input is proposed to mediate its effect on motor functions by modulating the excitability of the motor cortex. We aimed to clarify – in a longitudinal study – how afferent input affects motor cortex excitability after stroke and how it is associated with recovery of hand function.

Methods

The motor cortex excitability was studied by measuring the reactivity of the motor cortex beta rhythm to somatosensory stimulation. We recorded the amplitude of the suppression and subsequent rebound of the beta oscillations during tactile finger stimulation with MEG in 23 first-ever stroke patients within one week and at 1 and 3 months after stroke, with concomitant evaluation of hand function.

Results

The strength of the beta rhythm rebound, suggested to reflect decreased motor cortex excitability, was weak in the affected hemisphere after stroke and it was subsequently increased during recovery. The rebound strength correlated with hand function tests in all recordings.

Conclusion

Motor cortex excitability is modulated by afferent input after stroke. The motor cortex excitability is increased in the AH acutely after stroke and decreases in parallel with recovery of hand function.

Significance

The results implicate the importance of parallel recovery of both sensory and motor systems in functional recovery after stroke.