The treatment of refractory schizophrenia has been a clinical challenge for most psychiatrists; the possible reasons include diagnostic errors, medical conditions and brain dysgenesis. Here, we described a patient with childhood-onset schizophrenia who had severe psychiatric symptoms such as auditory hallucinations and persecutory delusions, and etc. We reexamined all his possible medical conditions and found that the patient had an abnormally enlarged cavus septum pellucidum (CSP) combined with cavum vergae (CV) (maximum length >30 mm). Some reports suggested that abnormal CSP (length >6 mm) has a significant association with schizophrenia. However, abnormally large CSP or CSP/CV and related prognosis were reported rarely. This case suggested that abnormally enlarged CSP or CSP/CV may worsen the prognosis.
Adolescent ; Antipsychotic Agents ; therapeutic use ; Benzodiazepines ; therapeutic use ; Clozapine ; therapeutic use ; Dibenzothiazepines ; therapeutic use ; Humans ; Male ; Quetiapine Fumarate ; Schizophrenia, Childhood ; diagnosis ; drug therapy ; pathology ; Septum Pellucidum ; pathology

Objective To systematically evaluate the efficacy of clozapine combined with other antipsychotic drugs in the treatment of refractory schizophrenia. Methods We searched Medline, EMBASE, and China Biology Medicine databases in both English and Chinese for randomized controlled trials, quasi-randomization controlled trials, and clinical controlled trials concerning the combinations of clozapine with other antipsychotic drugs for refractory schizophrenia. Quality assessment and data extraction were conducted with the Cochrane collaboration's RevMan 5.3 software. Results Totally 47 trials met the inclusion criteria, in which clozapine was combined with risperidone, aripiprazole, sulpiride, ziprasidone, modified electroconvulsive therapy, valproate, or lithium carbonate, respectively. Analysis showed that most combination strategies were superior to clozapoine alone (P<0.05), except for the combination with lithium carbonate(8 weeks: RR=1.27, 95%CI=0.82-1.97,P=0.28; 12 weeks: RR=1.53, 95% CI=0.45-5.13, P=0.49). Conclusion Reasonable combination of clozapine with other drugs may improve the therapeutic effectiveness and reduce adverse reactions and thus can be effectively used for treating refractory schizophrenia.
Antipsychotic Agents ; therapeutic use ; Benzodiazepines ; China ; Clozapine ; therapeutic use ; Drug Therapy, Combination ; Humans ; Randomized Controlled Trials as Topic ; Schizophrenia ; drug therapy

OBJECTIVETo compare the short-term curative effect of clozapine (CZ) and its combination with electroacupuncture (EA) in treating schizophrenia.

METHODSNinety schizophrenia patients were randomly divided into two groups equally: the EA group treated with combination of CZ (200 - 300 mg/d in mean) and EA, and the CZ group treated with CZ alone. The effects of treatment were evaluated with PANSS, CGI and TESS before and at the 2th, 4th, 6th and 8th weekend of the treatment.

RESULTSThe initiation of effect in the two groups was the same, the total effective rate was 75% in the EA group and 73% in the CZ group. However, somatic complaint was lower and compliance was higher in the EA group than that in the CZ group respectively.

CONCLUSIONWith the effect equal to CZ, combination of CZ and EA shows higher compliance in treating schizophrenia, which would be beneficial in the later stage treatment for consolidation.

Acupuncture Therapy ; Adolescent ; Adult ; Clozapine ; adverse effects ; therapeutic use ; Combined Modality Therapy ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Schizophrenia ; therapy

This report describes the efficacy of combined use of aripiprazole in the treatment of a patient with clozapine induced enuresis. Aripiprazole acts as a potential dopamine partial agonist and the dopamine blockade in the basal ganglia might be one of the causes of urinary incontinence and enuresis. We speculate that aripiprazole functioned as a D2 agonist in hypodopaminergic state of basal ganglia caused by clozapine and maintained dopamine level that would improve enuresis ultimately.
Adult ; Antipsychotic Agents/*adverse effects ; Clozapine/*adverse effects ; Dopamine/metabolism ; Dopamine Agonists/*therapeutic use ; Drug Therapy, Combination ; Enuresis/chemically induced/*drug therapy ; Humans ; Male ; Middle Aged ; Piperazines/*therapeutic use ; Quinolones/*therapeutic use ; Schizophrenia, Paranoid/drug therapy

INTRODUCTIONA bibliometric study was carried out to ascertain the volume and impact of scientific literature published on second-generation antipsychotic drugs (SGAs) in Singapore from 1997 to 2011.

METHODSA search of the EMBASE and MEDLINE databases was performed to identify articles originating from Singapore that included the descriptors 'atypic* antipsychotic*', 'second-generation antipsychotic*', 'clozapine', 'risperidone', 'olanzapine', 'ziprasidone', 'quetiapine', 'sertindole', 'aripiprazole', 'paliperidone', 'amisulpride', 'zotepine', 'asenapine', 'iloperidone', 'lurasidone', 'perospirone' and 'blonanserin' in the article titles. Certain bibliometric indicators of production and dispersion (e.g. Price's Law on the increase of scientific literature, and Bradford's Law) were applied, and the participation index of various countries was calculated. The bibliometric data was also correlated with some social and health data from Singapore, such as the total per capita expenditure on health and gross domestic expenditure on research and development.

RESULTSFrom 1997 to 2011, a total of 51 articles on SGAs in Singapore were published. Our results suggested non-fulfilment of Price's Law (r = 0.0648 after exponential adjustment vs. r = 0.2140 after linear adjustment). The most widely studied drugs were clozapine (21 articles), risperidone (16 articles) and olanzapine (8 articles). Division into Bradford zones yielded a nucleus occupied by the Journal of Clinical Psychopharmacology (6 articles) and the Singapore Medical Journal(4 articles). The analysed material was published in a total of 30 journals, with the majority from six journals. Four of these six journals have an impact factor greater than 2.

CONCLUSIONPublications on SGAs in Singapore are still too few to confirm an exponential growth of scientific literature.

Antipsychotic Agents ; therapeutic use ; Benzodiazepines ; administration & dosage ; Bibliometrics ; Biomedical Research ; methods ; Clozapine ; administration & dosage ; Humans ; Journal Impact Factor ; Publications ; Risperidone ; administration & dosage ; Singapore

This study aimed to analyze the patterns of antipsychotic prescription to patients with schizophrenia in Korea. Using the Health Insurance Review & Assessment Service-National Patients Sample (HIRA-NPS), which was a stratified sampling from the entire population under the Korean national health security system (2009), descriptive statistics for the patterns of the monopharmacy and polypharmacy, neuropsychiatric co-medications, and prescribed individual antipsychotic for patients with schizophrenia were performed. Comparisons of socioeconomic and clinical factors were performed among patients prescribed only with first- and second-generation antipsychotics. Of 126,961 patients with schizophrenia (age 18-80 yr), 13,369 were prescribed with antipsychotic monopharmacy and the rest 113,592 with polypharmacy. Two or more antipsychotics were prescribed to 31.34% of the patients. Antiparkinson medications (66.60%), anxiolytics (65.42%), mood stabilizers (36.74%), and antidepressants (25.90%) were co-medicated. Patients who were prescribed only with first-generation antipsychotics (n=26,254) were characterized by significantly older age, greater proportion of male, higher proportion of medicaid, higher total medical cost, lower self-payment cost, and higher co-medication rates of antiparkinson agents and anxiolytics than those who were prescribed only with second-generation antipsychotics (n=67,361). In this study, it has been reported substantial prescription rates of first-generation antipsychotics and antipsychotic polypharmacy and relatively small prescription rate of clozapine to patients with schizophrenia. Since this study has firstly presented the patterns of antipsychotic prescription to schizophrenic patients in Korean national population, the findings of this study can be compared with those of later investigations about this theme.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Anxiety Agents/therapeutic use ; Antidepressive Agents/therapeutic use ; Antiparkinson Agents/therapeutic use ; Antipsychotic Agents/*therapeutic use ; Clozapine/therapeutic use ; Drug Therapy, Combination ; Female ; Humans ; Insurance, Health ; Male ; Middle Aged ; *Physician's Practice Patterns ; Polypharmacy ; Republic of Korea ; Schizophrenia/*drug therapy ; Young Adult

OBJECTIVE: To explore the correlation between signs similar to schizophrenia in mice after ketamine administration and the expressions of NRG1 and ErbB4 mRNA in order to explain the possible pathogenesis of schizophrenia. METHODS: Fifty KM mice were randomly divided into 5 groups which were administered intraperitoneally with saline, clozapine and different dosages ketamine. The ketamine groups were administered intraperitoneally with low dosage (25 mg/kg), middle dosage (50 mg/kg) and high dosage (100 mg/kg) one time every day for 7 days. After administration of 100 mg/kg ketamine for 7 days, the clozapine group was introgastrically administered 20 mg/kg with clozapine one time every day for 7 days. The pathological changes of hippocampus neurons were observed by HE stain. The expressions of the NRG1 and ErbB4 mRNA in hippocampus were detected by reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: In the group with high dosage of ketamine, the levels of NRG1 and ErbB4 mRNA were significantly lower than that of the group with saline. CONCLUSION Ketamine may induce signs similar to schizophrenia in KM mice. The mechanism may be involved in the reduction of NRG1 and ErbB4 mRNA expression.
Animals ; Clozapine/therapeutic use* ; Disease Models, Animal ; Dose-Response Relationship, Drug ; ErbB Receptors/metabolism* ; Hippocampus/pathology* ; Ketamine/adverse effects* ; Male ; Mice ; Neuregulin-1/metabolism* ; Neurons/metabolism* ; RNA, Messenger/metabolism* ; Random Allocation ; Receptor, ErbB-4 ; Reverse Transcriptase Polymerase Chain Reaction ; Schizophrenia/genetics*