No abstract available.
Sulpiride*

Tardive blepharospam is characterized by repetitive, forceful, and sustained involuntary contractions of the orbicularis oculi. We report here one case of neuroleptic-induced tardive blepharospasm that developed during high-dose amisulpride treatment and was treated with clozapine. The patient was a 29-year-old man with a 6-year history of schizophrenia. After 33 months of amisulpride treatment (1200 mg/day), involuntary eye-blinking had developed. Following exclusion of all other possible etiopathological causes of the blepharospasm, we decided to switch the drug treatment from amisulpride to clozapine. On the fourteenth day of clozapine (250 mg/day) treatment, we observed significant improvements in eye-blinking and psychotic symptoms. Four months later, the eye-blinking had remitted completely. We suggest that amisulpride may cause blepharospasm and lead to an impaired ability to perform daily activities. Therefore, we recommend that clinicians regularly monitor involuntary movements in patients receiving antipsychotic treatment, especially when high doses of amisulpride are involved.
Adult ; Blepharospasm ; Clozapine ; Contracts ; Dyskinesias ; Humans ; Organothiophosphorus Compounds ; Schizophrenia ; Sulpiride

Humans ; Serum ; chemistry ; Spectrophotometry, Ultraviolet ; methods ; Sulpiride ; blood

OBJECTIVES: Levosulpiride is the levo-enantiomer of sulpiride, a well-known antiemetic, antidyspeptic and antipsychotic drug. This study was undertaken to investigate the effects of levosulpiride on dyspeptic symptoms and gastric motor function in a group of patients with functional dyspepsia showing delayed gastric emptying. METHOD: Forty two eligible patients were entered into a 3 week, double-blind randomized comparison of 25mg of levosulpiride or placebo t.i.d.. Symptom assessment and gastric scintigraphy following the intake of scrambled egg sandwich, were performed in each patient before and after treatment. RESULTS: The improvement of symptom score in levosulpiride group was higher than the placebo group (p < 0.05). We assessed global efficacy, which was excellent in 1 (6%), good 11 (65%), fair 4 (24%), nil 1 (6%) of those receiving levosulpiride, and fair 9 (60%), nil 5 (33%), poor 1 (6%) of those receiving placebo. Levosulpiride tended to be more effective than placebo in relieving the dyspeptic symptoms especially in the subgroups of dysmotility-like (p < 0.05) and nonspecific (p < 0.05) as compared to other subgroups (p = 0.16). The reduction of gastric emptying time after levosulpiride treatment was more marked than Placebo group (p < 0.05). We found a significant correlation between changes of symptom score and gastric emptying time (r = 0.47, p = 0.01). No serious adverse effects were reported after administration of either levosulpiride or placebo. Only two patients reported mild somnolence during levosulpiride administration. CONCLUSIONS: Levosulpiride is effective and well tolerated in patients with functional dyspepsia accompanied by delayed gastric emptying. Its efficacy may be related to its action on the gastric motor function by improving the delayed gastric emptying.
Adolescence ; Adult ; Double-Blind Method ; Dyspepsia/drug therapy* ; Female ; Gastric Emptying/drug effects* ; Gastrointestinal Agents/therapeutic use* ; Human ; Male ; Middle Age ; Sulpiride/therapeutic use ; Sulpiride/analogs & derivatives*

This paper presents the case of a 67-year-old woman who visited the Psychiatry Department complaining of persecutory ideas and auditory hallucinations after a buccal cancer operation. On neuropsychological testing, she demonstrated paranoid psychosis and bizarre thoughts. Hospital admission was recommended for supportive care and treatment with antipsychotics. She was initially treated with olanzapine, but this medication had little effect and was replaced with amisulpride, which reduced the residual symptoms. The aim of this report was to discuss the diagnostic process and treatment of very late-onset schizophrenia-like psychosis.
Aged ; Antipsychotic Agents ; Benzodiazepines ; Female ; Hallucinations ; Humans ; Neuropsychological Tests ; Psychotic Disorders ; Sulpiride

OBJECTIVE: Several reports have found that withdrawal symptoms of clozapine are more severe and common than that of the typical antipsychotics. The objective of this study was to report the clinical experiences of relatively rapid withdrawal of clozapine in the patients with schizophrenia at the end of over a year clinical trial of clozapine. METHODS: Twenty-three patients with schizophrenia who had been administered clozapine were withdrawn from clozapine by tapering it over 1-2 weeks, depending on clozapine maintenance dose and subsequently switched to sulpiride or thioridazine randomly. Patients were assessed using PANSS, CGI, and Sympson-Augus Rating Scale on the first, third, and last day of clozapine tapering as well as on the first, second, and fourth week of sulpiride or thioridazine. RESULTS: Fifteen of the 23 patients (65%) relapsed: 5 patients relapsed during the clozapine tapering period and 10 patients relapsed during the switching period to sulpiride or thioridazine. Six of the 9 patients (67%) in the sulpiride switch group relapsed and 4 of the 10 patients (40%) in the thioridazine switch group relapsed. The withdrawal symptoms of clozapine appear faster with a higher relapse rate than the typical antipsychotic drugs. CONCLUSIONS: Our data suggests that if at all possible clozapine should not be discontinued and for patients who need to be switched to a different antipsychotics for a specific reason, at least 2 weeks of clozapine tapering are recommended. The possibility of cross tapering with another drug should also be considered.
Antipsychotic Agents ; Clozapine* ; Humans ; Recurrence ; Schizophrenia ; Substance Withdrawal Syndrome ; Sulpiride* ; Thioridazine*

OBJECTIVE: Hyperprolactinemia is common side effect associated with antipsychotics use. Nevertheless, hyperprolactinemia is relatively neglected by clinician. Especially, there is no study related to amisulpride-induced hyperprolactinemia in korea. This study aimed to determine whether amisulpride can be induced hyperprolactinemia in Korean psychiatric patients. METHODS: This study methodology consisted of a retrospective review of medical charts and prolactin levels. Serum prolactin levels were measured in 24 Korean patients(12 males and 12 females) with psychosis who were treated over 400mg of amisulpride per day. RESULTS: All patients had hyperprolactinemia. Prolactin levels significantly increased after receiving amisulpride(z=-3.702, p=0.000). The prolactin level was significantly higher in females(156.29+/-63.75ng/mL) than in males(69.04+/-39.91ng/mL) after administering amisulpride(p=0.000). There was a correlation between dosage and prolactin levels(r=0.61, p=0.002). However, there was no correlation between duration of treatment and prolactin levels. CONCLUSIONS: Antipsychotics, especially amisulpride can increase serum prolactin levels and may results in short and long term side effects. Routine clinical assessment of initial and additional prolactin level and associated symptoms should be done.
Antipsychotic Agents ; Humans ; Hyperprolactinemia ; Korea ; Male ; Prolactin ; Psychotic Disorders ; Retrospective Studies ; Sulpiride

Striatum has important roles in motor control, habitual learning and memory. It receives glutamatergic inputs from neocortex and thalamus, and dopaminergic inputs from substantia nigra. We examined effects of dopamine (DA) on the corticostriatal synaptic transmission using in vitro extracellular recording technique in rat brain corticostriatal slices. Synaptic responses were elicited by stimulation of cortical glutamatergic inputs on the corpus callosum and recorded in the dorsal striatum. Corticostriatal population spike (PS) amplitudes were decreased (39.4+/-7.9%) by the application of 100microM DA. We applied receptor subtype specific agonists and antagonists and characterized the modulation of corticostriatal synaptic transmission by different DA receptor subtypes. D2 receptor agonist (quinpirole), antagonist (sulpiride), and D1 receptor antagonist (SKF 83566), but not D1 receptor agonist (SKF 38393), induced significantly the reduction of striatal PS. Pretreatment neither with SKF 83566 nor sulpiride significantly affected corticostriatal synaptic inhibition by DA. However, the inhibition of DA was completely blocked by pretreatment with mixed solution of both SKF 83566 and sulpiride. These results suggest that DA inhibits corticostriatal synaptic transmission through both D1 and D2 receptors in concert with each other.
Animals ; Brain* ; Corpus Callosum ; Dopamine* ; Learning ; Memory ; Neocortex ; Rats* ; Substantia Nigra ; Sulpiride ; Synaptic Transmission* ; Thalamus

Dopamine has been generally known to exert antinociceptive action in behavioral pain test, such as tail flick and hot plate test, but there appears to be a great variance in the reports on the antinociceptive effect of dopamine depending on the dosage and route of drug administration and type of animal preparation. In the present study, the effects of dopamine on the responses of wide dynamic range (WDR) cells to mechanical, thermal and graded electrical stimuli were investigated, and the dopamine-induced changes in WDR cell responses were compared between animals with an intact spinal cord and the spinal animals. Spinal application of dopamine (1.3 & 2.6 mM) produced a dose-dependent inhibiton of WDR cell responses to afferent inputs, the pinch-induced or the C-fiber evoked responses being more strongly depressed than the brush-induced or the A-fiber evoked responses. The dopamine-induced inhibition was more pronounced in the spinal cat than in the cat with intact spinal cord. The responses of WDR cell to thermal stimulation were also strongly inhibited. Dopamine D2 receptor antagonist, sulpiride, but not D1 receptor antagonist, significantly blocked the inhibitory action of dopamine on the C-fiber and thermal responses of dorsal horn cells. These findings suggest that dopamine strongly suppresses the responses of WDR cells to afferent signals mainly through spinal dopamine D2 receptors and that spinal dopaminergic processes are under the tonic inhibitory action of the descending supraspinal pathways.
Animals ; Cats* ; Dopamine ; Posterior Horn Cells* ; Receptors, Dopamine D2 ; Spinal Cord ; Sulpiride

BACKGROUND: Nefopam has been known as an inhibitor of the reuptake of monoamines, and the noradrenergic and/or serotonergic system has been focused on as a mechanism of its analgesic action. Here we investigated the role of the spinal dopaminergic neurotransmission in the antinociceptive effect of nefopam administered intravenously or intrathecally. METHODS: The effects of intravenously and intrathecally administered nefopam were examined using the rat formalin test. Then we performed a microdialysis study to confirm the change of extracellular dopamine concentration in the spinal dorsal horn by nefopam. To determine whether the changes of dopamine level are associated with the nefopam analgesia, its mechanism was investigated pharmacologically via pretreatment with sulpiride, a dopaminergic D2 receptor antagonist. RESULTS: When nefopam was administered intravenously the flinching responses in phase I of the formalin test were decreased, but not those in phase II of the formalin test were decreased. Intrathecally injected nefopam reduced the flinching responses in both phases of the formalin test in a dose dependent manner. Microdialysis study revealed a significant increase of the level of dopamine in the spinal cord by intrathecally administered nefopam (about 3.8 fold the baseline value) but not by that administered intravenously. The analgesic effects of intrathecally injected nefopam were not affected by pretreatment with sulpiride, and neither were those of the intravenous nefopam. CONCLUSIONS: Both the intravenously and intrathecally administered nefopam effectively relieved inflammatory pain in rats. Nefopam may act as an inhibitor of dopamine reuptake when delivered into the spinal cord. However, the analgesic mechanism of nefopam may not involve the dopaminergic transmission at the spinal level.
Analgesia ; Animals ; Dopamine ; Microdialysis ; Nefopam* ; Pain Measurement ; Rats* ; Spinal Cord ; Spinal Cord Dorsal Horn ; Sulpiride ; Synaptic Transmission