Coexisting Diogenes and Capgras syndromes

The co-occurrence of Diogenes and Capgras syndromes, both unusual in themselves, would be expected to be rare. A MEDLINE search using the terms Diogenes, Capgras, self-neglect and domestic squalor revealed no previous reports of this combination of disorders. Both conditions are somewhat dubiously named as &#164 syndromes' when in fact they are probably no more than symptoms with different causes. Of particular interest in this case is the exacerbation of the self-neglect, characteristic of the Diogenes syndrome, by the delusional misidentification which marks the Capgras syndrome; as well as the reinforcement of the previously recognised association with frontal lobe pathology. The role of medication, though limited, is described. ( Int J Psych Clin Pract 2001; 5:75-76)     

法莫替丁预防奥氮平引起体质量增加的研究

目的 探讨H2受体拮抗剂法莫替丁在预防奥氮平引起的体质量增加中的疗效.方法 选择40例符合中国精神障碍分类与诊断标准的首发精神分裂症患者,随机分为奥氮平合用法莫替丁组和奥氮平合用安慰剂组,均治疗观察8周.于治疗前和治疗后2周、4周、8周测身高、体质量,计算体重指数(BMI)及8周内体质量增加超过自身基线体质量7%的患者比例.采用阳性症状评定量表(SAPS)和阴性症状评定量表(SANS)评定疗效.结果 两组患者的体质量、BMI:治疗后各时点均有增加,与治疗前比较差异有统计学意义(P＜0.05).奥氮平加法莫替丁组和奥氮平组治疗8周末体质量分别增加了3.7 kg,BMI各增加了2.5 kg/cm2和2.6 kg/cm2.治疗后各时点,两组患者的体质量、BMI增加程度比较差异无统计学意义(P＞0.05).治疗8周末,体质量增加超过基线体质量7%的患者比例两组差异无统计学意义(P＞0.05).治疗8周末,SAPS、SANS评分显著下降(P＜0.05);SAPS与SANS分值与基线的差值无组间差异(P＞0.05).结论 合用H2-拮抗剂法莫替丁不能减轻奥氮平引起的体质量增加.     

奥氮平和氯氮平对慢性精神分裂症的认知功能的疗效

目的：了解奥氮平和氯氮平对慢性精神分裂症患者的认知功能的改善，以及二者对认知功能改善是否相同。方法：78例经典抗精神病药物治疗疗效不显著或不能耐受不良反应的慢性精神分裂症患者随机分配替换为奥氮平及氯氮平治疗，分别在人组前、12周、6月进行PANSS量表评定，以及认知功能的测定，包括言语学习、记忆、注意、执行功能、精神运动。结果：奥氮平组32例和氯氮平组34例完成了6月的治疗，这些患者从基线到6月均显示精神症状显著改善，6月时认知功能显著提高，表现为言语流畅性、言语学习、言语视觉记忆、执行功能方面。但二者之间无显著性差异。结论：奥氮平和氯氮平改善认知功能，且二者的疗效相似。     

奥氮平与舒必利治疗急性脑血管疾病后妄想综合征比较

目的:观察奥氮平治疗急性脑血管疾病后妄想综合征的疗效.方法:急性脑血管疾病后妄想综合征病人100例,分为2组奥氮平组50例,男性28例,女性22例,年龄(60±S11)岁,给予奥氮平2.5mg/d逐渐加至5～10㎎mg/d、PO×4周;舒必利组50例,男性26例,女性24例,年龄(62±S13)岁,给予舒必利0.3g/d逐渐加至0.4～0.6g/d、PO×4周.结果:奥氮平组和舒必利组经过4WK的治疗后总有效率分别为88%和83%(P＞0.05)、两组在2周末有效率分别为78%和26%(P＜0.05).结论:奥氮平治疗急性脑血管疾病后妄想综合征与舒必利对比显效早、药物不良反应少且轻.     

Olanzapine in severe Gilles de la Tourette syndrome: a 52-week double-blind cross-over study vs. low-dose pimozide

We selected four patients with severe Gilles de la Tourette syndrome, high frequency of tics (two to ten per minute), vocalizations, and lack of comorbidity. These patients (aged 19–40 years) underwent a 52-week double-blind cross-over study with olanzapine (5 and 10 mg daily) vs. low-dose pimozide (2 and 4 mg daily). The reduction in rating scale scores for the syndrome was highly significant with 10 mg olanzapine vs. basal and vs. 2 mg pimozide, and was significant for 5 mg olanzapine vs. 4 mg pimozide. Only moderate sedation was reported by one patient during olanzapine treatment while three complained of minor motor side effects and sedation during pimozide treatment. At the end of the study all patients opted for olanzapine treatment. Received: 23 July 1999, Received in revised form: 30 November 1999, Accepted: 22 January 2000     

HPLC法测定人血浆中奥氮平浓度

目的建立测定人血浆中奥氮平浓度的反相高效液相色谱法。方法以C18反相柱(150mm×4.6mm,5μm)为色谱柱,流动相0.03m o l.L-1醋酸铵-甲醇(35:65);流速:0.8 m l.m in-1;柱温:40°C;检测波长:275nm。以乙酸乙酯与二氯甲烷(80:20)为提取剂。结果奥氮平320.0,80.0,10.0μg.L-13种浓度平均回收率分别为102.92%,97.11%,98.20%,日内、日间差RSD均低于6%(n=5);最低检测浓度为5.0μg.L-1;线性范围为5.0~320.0μg.L-1。回归方程为:C=264.03F-1.21,r=0.9996(n=9)。结论本法灵敏、准确、简单、快速,可用于临床血药浓度监测和药动学研究。     

Atypical antipsychotic drugs: Part II

This is the second of two columns on atypical antipsychotic drugs. Part II discusses olanzapine, quetiapine, and ziprasidone.     

Effects of sub-chronic antipsychotic drug treatment on body weight and reproductive function in juvenile female rats

Rationale Weight gain caused by some antipsychotics is not only confined to adults but can also adversely affect both children and adolescents. Indeed, olanzapine and risperidone have been associated with extreme weight gain in adolescents even greater than that reported in adults. We have recently shown substantial weight gain in adult female rats following treatment with olanzapine and risperidone but not ziprasidone. Objectives The aim of the present study was to compare the effects of several antipsychotics on weight gain and reproductive function in juvenile (aged 7 weeks) female hooded Lister rats. Methods Olanzapine (4 mg/kg), risperidone (0.5 mg/kg), ziprasidone (2.5 mg/kg), sulpiride (10 mg/kg), haloperidol (0.5 mg/kg) or vehicle was administered i.p. once per day for 21 days. Body weight, food and water intake were measured daily, in addition to the determination of stage of the oestrous cycle. Results Sub-chronic administration of olanzapine, risperidone, sulpiride and haloperidol, but not ziprasidone, significantly increased body weight compared to vehicle-treated animals during weeks 1–3. Sulpiride significantly increased food and water intake. Significantly increased percentage intra-abdominal fat weight was observed in olanzapine, risperidone, sulpiride and haloperidol, but not ziprasidone-treated animals. Marked disruption of the oestrous cycle was observed in all but the ziprasidone-treated group, which continued to have regular 4-day oestrous cycles. Conclusions Weight gain observed in these juvenile animals was 1.5–2 times greater than that previously observed in adult rats. These findings have important implications for the use of antipsychotics in children and adolescent patients.     

Randomized,controlled, double-blind,multicenter comparison of the cognitive effects of ziprasidone versus olanzapine in acutely ill inpatients with schizophrenia or schizoaffective disorder

Background Newer antipsychotic medications have been reported to enhance cognitive functioning in schizophrenia. Head to head studies with double-blind methods are still relatively few in number.Objectives To compare the relative cognitive enhancing effects of ziprasidone and olanzapine in the treatment of acutely ill inpatients with schizophrenia or schizoaffective disorder.Procedures In this 6-week, multicenter, double-blind, parallel-designed trial, patients were randomized to ziprasidone or olanzapine. No patient who had ever received a complete treatment trial with either of these medications previously was entered into the study. Cognitive testing measuring attention, motor speed, memory, executive functioning, and verbal skills were performed on all patients at baseline and endpoint.Results Treatment with either ziprasidone or olanzapine was associated with statistically significant improvements from baseline in attention, memory, working memory, motor speed, and executive functions. Treatment with olanzapine was also associated with a statistically significant improvement in verbal fluency. No statistically significant differences between these medications were found in the magnitude of improvement from baseline on any of the cognitive measures (other than verbal fluency in an exploratory analysis). Observed changes were not associated with changes in clinical symptoms measured using the PANSS or changes in movement disorders.Conclusions During 6 weeks of treatment, ziprasidone and olanzapine demonstrated substantial and comparable cognitive-enhancing effects relative to previous treatment. These effects were noted in all aspects of cognitive functioning previously proven to predict functional outcome in schizophrenia. No overall differences were detected between the medications in terms of the extent of cognitive enhancement.     

A neurobehavioral screening of the ckr mouse mutant: implications for an animal model of schizophrenia

A model of schizophrenia, the chakragati (ckr) mouse was serendipitously created as a result of a transgenic insertional mutation. The apparent loss-of-function of an endogenous gene produced mice that, when homozygous, displayed an abnormal circling behavior phenotype. To determine whether this phenotype could be corrected by atypical antipsychotics, we compared the effects of clozapine and olanzapine on rotational turns and hyperactivity. Both of these drugs successfully ameliorated circling behavior and hyperactivity in homozygous mice. The increased motor activity of these mutant mice was both qualitatively and quantitatively similar to that observed in wild-type animals treated with dizocilpine, an N-methyl-D-aspartate receptor antagonist that produces behaviors resembling positive symptoms of schizophrenia. Mice either homozygous or heterozygous for the mutation also displayed enlargement of the lateral ventricles, which was accompanied only in the homozygous genotype by a loss of individual myelinated axons in the striatum and agenesis of the corpus callosum. These structural brain deficits were selective in that the nigro-striatal dopamine system was normal in these homozygous mice. In addition, two types of interneurons in the neostriatum, namely those producing acetylcholine or nitric-oxide synthase were also devoid of significant structural abnormalities. These results indicate that the ckr mouse mutant could be used as a possible animal model to study the pathophysiology of schizophrenia and suggest possible strategies for treating the behavioral aspects of this brain disease.