We report a case of thoracic post-herpetic neuralgia which was improved by dorsal root ganglionectomy. The patient had failed to obtain adequate pain relief from conservative therapy such as carbamazepine, amitriptyline, thioridazine, gabapentin, and transcutaneous lidocaine infiltration. Thoracic dorsal root ganglionectomy from T5 to T7 on left side was performed and satisfactory pain relief without significant postoperative neurologic deficit was achieved. Although dorsal root entry zone operation for refractory pain was the most commonly performed procedure in past, dorsal root ganglionectomy is an alternative anatomically and technically safe procedure for the pain in the thoracic lesion. The clinical feature, operative technique and clinical result are presented with review of the literatures.
Amitriptyline ; Carbamazepine ; Ganglionectomy* ; Humans ; Lidocaine ; Neuralgia* ; Neurologic Manifestations ; Pain, Intractable ; Spinal Nerve Roots ; Thioridazine

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 METHODS: Twenty-three patients with schizophrenia who had been administered clozapine were withdrawn from clozapine by tapering it over 1-2 weeks, depending on clozapine maintenance dose and subsequently switched to sulpiride or thioridazine randomly.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*

We experienced 6 cases of risperidone-induced hyperprolactinemia. Their mean age were 31.2+/- 7.1 years and 1 case was male and 5 cases were females. The reported neuroendocrine side effects were amenorrhea, galactorrhea and gynecomastia. The prolactin levels checked at the reported time of side effects or early stage of drug trial were more than 10 fold of normal level (male : 7.3-16.1 ng/ml, female 7.8-19.6 ng/ml). In male patient with the side effect of gynecomastia, we reduced the dose of risperidone from 6 to 3mg/day which eliminated the symptom 3 month later. As far female patients, risperidone was replaced with the equivalent doses of thioridazine or haloperidol except one female patient to whom risperione was stopped and benzodiazepine was only given. Follow-up results of them were : 1) one female patient was dropped out and 2) the others were all recovered from their neuroendocrine side effects after 3-4 months later.
Amenorrhea ; Benzodiazepines ; Female ; Follow-Up Studies ; Galactorrhea ; Gynecomastia ; Haloperidol ; Humans ; Hyperprolactinemia* ; Male ; Pregnancy ; Prolactin ; Risperidone ; Thioridazine

The mechanism of erectile dysfunction associated with psychotherapeutic medication is not well defined. To determine whether psychotherapeutic drugs have a direct effect on penile cavernosal smooth muscle, the activity of 4 drugs from 4 major classes of psychotherapeutic agents, chlorpromazine, thioridazine, haloperidol and amitriptyline, was examined in vitro on isolated rabbit corpus cavernosum. Strips of corpus cavernosum were mounted in organ baths for isometric tension studies. The effect of the drugs on resting tension, their relaxant effect on norepinephrine (NE) precontracted tissue, and their effect on electrical field stimulated (EFS) relaxation of NE precontracted tissue were determined. Incubation with any of the drugs did not affect resting tension compared to a control. All drugs produced a dose-dependent relaxation in NE precontracted tissue which were significantly greater than the water treated control (p<0.0001). None of the drugs inhibited EFS relaxation. These result show that these classes of drugs do not affect the basal tone of the corpus cavernosum. All have intrinsic relaxant properties and none interfere with neurally stimulated relaxation. This study suggests that drugs from these 4 major classes of psychotherapeutic agents do not adversely affect penile cavernosal smooth muscle relaxation at the level of the penis and its associated neural elements. It may be inferred that reports of impotence in patients treated with these classes of drugs more likely reflect a central or primary psychopathologic process rather than a local corpus cavernosum effect.
Amitriptyline ; Baths ; Chlorpromazine ; Erectile Dysfunction ; Haloperidol ; Humans ; Male ; Muscle, Smooth ; Norepinephrine ; Penis ; Relaxation ; Thioridazine ; Water

A 51-year-old woman with schizophrenia and depression brought to our emergency room after thioridazine overdose. Her mental state was semicomatous. The initial electrocardiogram showed bradycardia, atrial premature contractions, prolonged PR interval, wide QRS complexes and U waves. She was admitted to the intensive care unit. Continuous electrocardiographic monitoring and artificial ventilation was performed. The treatment included fluids hydration, administration of inotropic agents, alkalization and replacement of electrolytes. On day 2, torsades de pointes on the electrocardiogram was occurred. The rhythms were resolved with isoproterenol infusion. Her hemodynamic state became stable. On day 6, electrocardiographic finding was normalized. She was recovered without any neurologic or cardiac complications. Herein, a rare case is reported, with the review of the literature.
Arrhythmias, Cardiac* ; Bradycardia ; Depression ; Electrocardiography ; Electrolytes ; Emergency Service, Hospital ; Female ; Hemodynamics ; Humans ; Intensive Care Units ; Isoproterenol ; Middle Aged ; Poisoning* ; Schizophrenia ; Thioridazine* ; Torsades de Pointes ; Ventilation

OBJECTIVE: Several cell line studies have demonstrated thioridazine’s anticancer, multidrug resistance-reversing and apoptosis-inducing properties in various tumors. We conducted this nationwide population-based study to investigate the association between thioridazine use and cancer risk among adult patients with schizophrenia. METHODS: Based on the Psychiatric Inpatient Medical Claim of the National Health Insurance Research Database of Taiwan, a total of 185,689 insured psychiatric patients during 2000 to 2005 were identified. After excluding patients with prior history of schizophrenia, only 42,273 newly diagnosed patients were included. Among them, 1,631 patients ever receiving thioridazine for more than 30 days within 6 months were selected and paired with 6,256 randomly selected non-thioridazine controls. These patients were traced till 2012/12/31 to see if they have any malignancy. RESULTS: The incidence rates of hypertension and cerebrovascular disease were higher among cases than among matched controls. The incidence of hyperlipidemia, coronary artery disease and chronic pulmonary disease did not differ between the two groups. By using Cox proportional hazard model for cancer incidence, the crude hazard ratio was significantly higher in age, hypertension, hyperlipidemia, cerebrovascular disease, coronary artery disease and chronic pulmornary disease. However, after adjusting for other covariates, only age and hypertension remained significant. Thioridazine use in adult patients with schizophrenia had no significant association with cancer. CONCLUSION: Despite our finding that thioridazine use had no prevention in cancer in adult patients with schizophrenia. Based on the biological activity, thioridazine is a potential anticancer drug and further investigation in human with cancer is warranted.
Adult* ; Cell Line ; Cerebrovascular Disorders ; Coronary Artery Disease ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Inpatients ; Lung Diseases ; National Health Programs ; Proportional Hazards Models ; Schizophrenia ; Taiwan ; Thioridazine*

OBJECTIVETo study the effect of thioridazine on the proliferation and apoptosis of human colorectal cancer SW480 cells.

METHODSSW480 cells were treated with different concentrations of thioridazine, and MTT assay was used to evaluate the cell inhibition rate. Hoechst 33342 staining was performed to demonstrate the cell morphology changes. Flow cytometry was used to determine the cell apoptosis and cell cycle changes. RT-qPCR was used to detect PDCD4, c-MYC, BCL2, CCND1, CASPASE3, PARP1, CDK4 and EIF4A mRNA expressions, and Western blotting was employed to assay AKT, p-AKT, and PDCD4 protein expression levels.

RESULTSMTT results showed that thioridazine inhibits the proliferation of SW480 cells. SW480 cells treated with thioridazine presented with such typical features of apoptosis of karyopyknosis, chromatin condensation and nuclear fragmentation. Flow cytometry showed that thioridazine was a cell cycle-specific drug and caused cell cycle arrest at G(1)/G(0) phase and an increased cell apoptosis rate. Thioridazine treatment of the cells resulted in up-regulated PDCD4 mRNA expression and down-regulated mRNA expressions of CCND1, CDK4, c-MYC, BCL2, CASPASE3, PARP1 and EIF4A, increased PDCD4 protein expression and reduced p-AKT protein expression.

CONCLUSIONThioridazine inhibits the proliferation and induces apoptosis of SW480 cells by up-regulating PDCD4 and inhibiting PI3K/Akt pathway.

Apoptosis ; Apoptosis Regulatory Proteins ; metabolism ; Cell Cycle Checkpoints ; Cell Line, Tumor ; drug effects ; Cell Proliferation ; Colorectal Neoplasms ; pathology ; Down-Regulation ; Humans ; RNA-Binding Proteins ; metabolism ; Signal Transduction ; drug effects ; Thioridazine ; pharmacology