Clozapine-induced sialorrhea (CIS) is a common, treatment-limiting and stigmatizing side effect. All systemic agents that are used for hypersalivation may increase clozapine side effects such as blood pressure changes, constipation, or arrythmias. Oral application of topical anti-muscarinic agents may be a low side effect option for treatment of CIS.

The aim of this case report was to propose an off-label treatment of tropicamide drops to CIS and to stimulate further investigation.

A 33-year-old male inpatient with schizophrenia has been on clozapine 800 mg and amisulpride 600 mg/day. His drooling was occasional and severe as drool drips off his chin during the day and night. Wet area over the pillow, visual analog scale (VAS), the short form of health survey (SF-36), UKU side effect rating scale, scale for the assessment of negative symptoms (SANS), scale for the assessment of positive symptoms (SAPS) were applied at baseline and in one-week intervals. Oral application of one drop of tropicamide % 0.5 (5 mg/mL) to left and one drop to right side before going to bed in the first week and two drops to each side were administered subsequently. Informed consent was given by the patient.

No psychological, neurological, autonomic and other side effects were observed associated with tropicamide. On VAS, the patient rated hypersalivation 5/7 at baseline, 4/7 after one drop each, 3/7 after two drops each.

The reduction of CIS by oral use of tropicamide eye drops is promising and should be explored with randomized controlled trials.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

There is a lack of pharmacological trials studying drug response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available reviews of retrospective data indicate good response to second-generation antipsychotics, but even such data from India is sparse.

We aimed to compare the response of acute PDD to risperidone and olanzapine in our retrospective review.

We conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455) at our Center. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about dose, drug compliance and response, adverse effects, number of follow-up visits and hospitalizations. The study was approved by the Institute Ethics Committee.

A total of 280/455 (61%) were prescribed risperidone and 86/455 (19%) olanzapine. The remaining (n = 89; 20%) had received other antipsychotics. The two groups were comparable in socio-demographic and clinical characteristics of PDD. Compliance was good and comparable in both groups (> 80%, P = 0.2). Response to treatment was comparable in both groups (85% partial response and > 52% good response, all P > 0.3). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone (240 vs. 391, P < 0.05).

Our study indicates a good response to both risperidone and olanzapine, if compliance to treatment can be ensured. In the absence of specific treatment guidelines for PDD, second-generation antipsychotics like risperidone and olanzapine offer good treatment options for this infrequently encountered and difficult to treat psychiatric disorder.

The authors have not supplied their declaration of competing interest.

Microelectrode arrays (MEAs) with cultured neuronal networks are highly suitable to quantify neuroactive activity and neurotoxicity of applied substances.

Multiparametric characterization of functional alterations of in vitro-neuronal network activity by different typical and atypical antipsychotics.

To identify differential effects of antipsychotics on spontaneous neuronal network activity as a functional readout.

Cultured networks of dissociated cortical cells of postpartal mice coupled to MEAs were exposed to increasing doses of aripiprazole, clozapine, haloperidol, olanzapine, raclopride, and risperidone.

We found a concentration-dependent inhibition of firing patterns for all substances except olanzapine. All other substances mediated a concomitant irreversible suppression of burst and spike rates, a decrease of the burst duration and the number of spikes in bursts as well as dose-dependent network desynchronization (decrease of Cohen's kappa). The comparison of the different antipsychotics with regard to their half-maximal effective dose values (EC-50) for inhibiting the spike rate yielded an increasing order of EC50 values, i.e. a declining order of toxic potency, of aripiprazole (8.77 μM) < clozapine (9.36 μM) < haloperidol (9.77 μM) < risperidone (15.9 μM) < raclopride (22.7 μM). No significant correlations were identified between EC50 values of the distinct antipsychotics and their binding affinity to the dopamine D(2), the serotonin 5-HT(1A), 5-HT(2A), 5-HT(2C), and the M(1) and M(2) muscarinic acetylcholine receptors.

In MEAs, a dose-dependent neurotoxic effect of typical and atypical antipsychotics alike occurred at supratherapeutic doses via a yet unknown mechanism that did not involve actions on major receptor targets of these compounds.

The authors have not supplied their declaration of competing interest.

Bupropion is a dual antidepressant, a norepinephrine and dopamine reuptake inhibitor. Its main use is in affective disorders as major depression. Antidepressants have been commonly associated with sexual side effects in the libido, sexual arousal, orgasm and erectile function. Bupropion has negative influence in sexual function, even it could increase the libido. Due to this, it could be a good option in patients with active sexual life and affective disorder.

A 58-year-old female with a long history of depression disorder for 5 years. History of lots of side effects with different treatments, sexual dysfunction with serotonin-antidepressants. Treated with bupropion SR 150 mg/day and alprazolam, she suffered a relapse. The bupropion was increased to 300 mg/day. Three days later she appeared in the consultation room, presented a sense of pre-orgasmic of 72 hours of evolution, high increased libido, tiredness, muscle tension and insomnia. This sense did not improve after the sexual act. It had never happened previously. The side effect improved when the bupropion was reduced to 150 mg/day and disappeared with its withdrawal.

The case made a relationship between the increased of bupropion's dose and the appearance of unusual sexual side effects (increased of libido and pre-orgasmic sense). Not only bupropion is one of the antidepressants that do not cause sexual dysfunction, if not it was reported in some trials that could be a treatment against this dysfunction due to its prosexual effects. The mechanism is unknown but could be related with norepinephrine or dopamine transmission.

The authors have not supplied their declaration of competing interest.

Lithium is among the most effective therapies for bipolar disorder. Lithium treatment may cause hypothyroidism, goiter or to a lesser extent hyperthyroidism, since it can affect several aspects of thyroid functioning. The prevalence of lithium-associated hypothyroidism varies extensively between studies, reaching up to 47%, and affecting more females than males (5:1).

Determine the prevalence of thyroid dysfunction in an acute inpatient psychiatric department dedicated to affective disorders and its association with lithium therapy.

To review the relation between lithium treatment and thyroid dysfunction.

Observational, descriptive and retrospective study with clinical and laboratorial data concerning all inpatient episodes of 2015 in our Psychiatric Department. A non-systematic literature search was performed in PubMed.

The present study documented a high prevalence of thyroid dysfunction, particularly in women. Most cases were due to either hypothyroidism or subclinical hypothyroidism. Patients treated with lithium were more often under thyroid hormone replacement therapy (levothyroxine).

The evidence that lithium treatment is associated with hypothyroidism is well established and this condition is easily treatable with levothyroxine. This study highlights the importance of baseline screening of thyroid function and regular long-term monitoring in patients treated with lithium.

The authors have not supplied their declaration of competing interest.

The use of antipsychotics represents an integral part of the psychiatric practice, unfortunately the use seems to be associated with an elevated frequency of metabolic alterations causing an important weight disorder and glucose and lipid homeostasis, diminishing life expectations for these patients, likely to develop metabolic syndrome without proper control.

This study intended to find the association between metabolic syndrome in patients with psychotropic treatments used in the Guatemalan Institute of Social Security (IGSS).

Cohort Study (n = 43 patients) who were treated combined with antipsychotics and mood stabilizers or antidepressants, conducting checkups at the beginning, then two to four months after, evaluating diagnosis of metabolic syndrome according to the criteria stated by the International Diabetes Federation (IDF).

Risk factor with the use of clozapine and valproic acid was revealed after four months of exposure (RR = 2.32). With the use of clozapine and mood stabilizers a risk factor was prevalent with exposure after four months (RR = 2.67), and with the use of antidepressants a protective factor for the development of metabolic syndrome was revealed at four months of exposure (RR = 0.3741).

the use of antipsychotics in combination with mood stabilizers represents a risk factor for developing metabolic syndrome, especially the association with valproic acid.

The author has not supplied his declaration of competing interest.

Antipsychotic drugs effectively control psychotic symptoms, but may cause important side effects, significantly increasing morbidity and mortality. Hematologic abnormalities are frequent and may be life-threatening in some patients. Many prospective investigations confirmed neutropenia as a frequent occurrence with virtually all atypical antipsychotics.

Define epidemiological, clinical and therapeutic characteristics of antipsychotics – induced leukopenia and neutropenia through a case report and a review of literature.

Patient 28 years old native of Tunis, with family history: brother who suffer of undifferentiated schizophrenia. Since the age of 16 years he has been followed for disorganized schizophrenia (DSM IV). He was initially put under Haldol Decanoate (2 months), fluphenazine (2 months), amisulpride (3 months), sulpride (2 months), olanzapine (3 months), Rispreridone (1 month), aripiprazole (5 months) leukopenia/neutropenia is occurring during treatment with each molecule and which promptly resolved after discontinuation. Reduced white blood cell count has also been reported after addition of lithium. Actually an ECT is proposed for this patient.

This case report shows the importance of hematological monitoring during the course of typical or atypical treatment.

The authors have not supplied their declaration of competing interest.

Psychotic disorders are serious mental illnesses that compromise the quality of life of patients. It is important to know the characteristics of the affected population, seek to improve the adhesion and functionality.

To describe the sociodemographic characteristics of patients treated with Palmitato Paliperidona (PP). Analyze the efficacy variables, adherence to treatment.

Cross-sectional study of 15 patients in outpatient follow-up after 12 months of treatment with PP. Sociodemographic characteristics are collected, mean dose of PP, through a mirror study. Scales to measure the functionality, clinical status and attitude towards medication apply: Scale of personal and social functioning (PSP), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression Scale (CGI-SI) and attitudes toward Inventory Medication (DAI).

The sample consists of 15 patients (54% male). 81% are single; 77% live alone and 94% not working. The mean dose of PP is 147 mg/month. DAI shows a good attitude to the treatment (80%). The PSP shows that 22% of patients have serious difficulties in its development. The CGI-SI shows that 67% are moderately sick and the BPRS that 33% of patients have a serious disorder.

The demographic profile of patients after 12 months of treatment with PP coincides with male, unmarried, unemployed, living alone. Most have good adherence. The variables measured by the CGI-SI, BPRS and PSP, displayed moderately ill patients with severe difficulties or marked on their autonomy.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Ischemic (veno-occlusive, low flow) priapism is a painful and persistent penile erection unrelated to sexual desire or stimulation. In some cases, it is an adverse event of antipsychotic medications.

An Internet search was initiated using the search engines: Direct Sciences; Medline and keywords “Penile erection; priapism; Antipsychotic agents; Side effects” and we illustrated our literature review by a clinical vignette of a man aged 38 years followed for schizophrenia placed under Fluphenazine 125 mg/month from 5 years who consulted us in may 2015 because of priapism and he described painful and prolonged erection episodes evolving for approximately 5 days.

Medical literature mentions many cases of venous priapism in patients treated by conventional or atypical neuroleptics. About 30% of venous priapisms could be related to drugs of which approximately 50% to neuroleptics. This side effect is related to alpha1-adrenergic blocking properties of these treatments, more or less important depending on the drugs in this class. After emergency treatment, the priapism is the problem of the continued neuroleptic treatment. The substitution of one molecule by another alpha-1 blocking properties to the less marked is recommended.

The venous priapism is a uro-andrological emergency requiring prompt treatment to prevent erectile sequelae.

The authors have not supplied their declaration of competing interest.

Valerian officinalis roots extract is a popular medication for insomnia and anxiety treatment. Sedative effect of Valerian is mainly attributed to the modulation of gabaergic transmission, but its pharmacodynamics has not been fully elucidated.

To investigate the acute effects of Valerian Officinalis extracts intake on corticoexcitability as measured by TMS.

To obtain further data on Valerian pharmacodynamics.

Twelve healthy volunteers participated in a double-blind randomized crossover placebo-controlled study. They were required to take either 900 mg of Valerian officinalis extract (valerenic acid 0.8%) or placebo. Focal TMS of the hand area of left motor cortex was used to test Resting motor threshold (RMT), Motor evoked potentials (MEPs) amplitude and silent period duration (SP). We also tested Short-interval Intracortical Inhibition (SICI), Intracortical facilitation (ICF), Short and Long afferent Inhibition (SAI and LAI). All parameters were investigated at baseline, 1 hour and 6 hours after drug intake. After a 3-week washout period the subjects switched to the alternate arm of the study.

A mixed RMANOVA revealed a significant main effect of “time” [F(1,22) = 4.03, P = 0.02] and a significant “treatment × time” interaction [F(1,22) = 6.3, P = 0.003]. Post-hoc analysis indicated that the amount of ICF was significantly reduced 1 hour after Valerian intake (P = 0.01) returning to baseline values after 6 hours. No significant changes between the Valerian and placebo groups were observed for the other parameters investigated.

The modulation of ICF induced by Valerian officinalis is likely due to glutamatergic antagonism and might underlie the anti-anxiety therapeutic effects.

The authors have not supplied their declaration of competing interest.

Desvenlafaxine is a SNRI which presents low affinity for muscarinic, H1 and α1 in vitro receptors and a marginal hepatic metabolism. Different studies have shown effectiveness and a favorable tolerability profile, but only a few of them have been realized independently.

To study the incidence and characteristics of short-term desvenlafaxine side effects (SE) in daily clinical practice.

A total of 123 patients with recently introduced desvenlafaxine treatment are recruited from Barakaldo and Uribe-Kosta Mental Health Centers, and UKU scale is administered to measure SE. Descriptive data are calculated using SPSS v.22.

SE are observed in 30.09%. Among these, 5.69% experimented improvement or disappearance of SE with dose reduction, whereas 16.26% had to stop DVF treatment. The most frequent SE was nausea/vomiting (7.3%), followed by dry mouth (4.9%), blurred vision (4.9%), tachycardia (4.1%), sexual SE (4.1%) and tension/inner unrest (4.1%). Among the patients with anxiety disorders, 27.78% present SE versus 30.47% of patients with other diagnoses.

The characteristics of SE with DVF in daily clinical practice are comparable to those found in previous studies, and the overall profile is more benign than other AD. Aspects such as gender and sexual function must be considered. In patients with anxious symptoms DVF is also effective and ES are presented similarly, opening a new line of research and treatment of conditions with these characteristics.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Cannabis consumption is known to be increased in both schizophrenic and first psychotic episode patients. Contrary to what has been reported in studies with healthy people, all published studies so far have reported no impairments or even beneficial effects on neurocognition associated with cannabis consumption in schizophrenia and first psychotic episode patients. However, these studies did not address the effects of very high cannabis consumption.

Our aim in this study was to assess the effects on neurocognition of regular and heavy cannabis consumption in first psychotic episode patients.

A total of 74 patients were included in the study and assigned to 3 different groups according to their mean cannabis consumption during the last year (non-users, regular users, and heavy users). Participants were administered verbal memory, attention, processing speed, working memory, vocabulary, arithmetic and spatial orientation tasks.

Our results showed the heavy cannabis group of first psychotic episode patients to be significantly impaired in all the verbal memory measures with respect to the non-users group. There were no significant differences between regular users and non-users. Moreover, regular cannabis consumption was associated with an improvement in some attention and processing speed measures.

Our data showed heavy cannabis consumption to impair verbal memory in first psychotic episode patients and suggest a dose-related effect of cannabis consumption, since regular consumption did not impair verbal memory and may be beneficial for other tasks.

The authors have not supplied their declaration of competing interest.

Psychosis with onset in late adulthood already constitutes a challenge on the differential diagnosis and treatment, especially in polypharmacy patients.

We present a case report of a 61-year old woman with a late-onset psychosis and discuss the clinical evolution and the pharmacological treatment.

The patient suffered from obesity, type II diabetes mellitus with poor glycemic control, and hypertension. She had a first psychotic episode at the age of 56, having persecutory delusional ideas and auditory hallucinations with psychomotor agitation and insomnia. She was first medicated with an atypical antipsychotic (olanzapine) with little response and worsening of the glycemic control. A switch was performed to haloperidol with remission of symptomatology with low doses (4 mg/day). Through follow-up the doses of haloperidol was decreased and eventually suspended, but having a relapse a few months later. Haloperidol was again introduced and the symptoms remitted. Stability was maintained, but the patient started to show lower limbs symmetrical rigidity and psychomotor retardation. It was decided to switch haloperidol to risperidone, but the patient reported side effects with its use, and had to stop it. Haloperidol was again introduced, but had to be discontinued after motor symptoms got worse. Again the patient had another recurrence of psychotic symptoms and it was decided to introduce paliperidone (6 mg/day) with good response and tolerability.

The safety and tolerability of antipsychotic medication is variable. When choosing a treatment in a patient with comorbid medical conditions, it can severely influence the desirable outcome.

The authors have not supplied their declaration of competing interest.

Several studies report that Clozapine is more effective in reducing symptoms of schizophrenia, producing clinically meaningful improvements and postponing relapse than other antipsychotic strategies.

To analyze the prescription of Clozapine in a sample of 88 inpatients admitted to a subacute psychiatric hospitalization unit.

This is a transversal study. All patients admitted for a medium-term psychiatric treatment since 01/06/2014 to 30/11/2015 were included. Data about socio-demographical status and clinical situation were obtained and compiled in a database. This study compares patients receiving clozapine treatment with those who receive other psychopharmacologic treatment. Statistics were performed using SPSS Software.

Eighty-eight patients (52% men; mean age: 48.6 years) composed the sample. In 58% of cases, schizophrenia and schizoaffective disorder were the diagnoses motivating the admission. Within the 51 patients with Schizophrenia o Schizoaffective Disorder, 16 of them (31.4%) received Clozapine. Comparing clozapine group vs non-clozapine group, there were no significant differences between the groups in terms of sex, civil state or working state. Instead, Clozapine group patients were older, had a major number of previous hospitalization admissions and had a larger trajectory of their disorder.

Patients requiring treatment with Clozapine had a major number of hospital admissions and had more often committed suicide attempts, suggesting a more severe course of the disorder. They were older than the non-clozapine group. Clozapine is delayed in its use among resistant-treatment patients. It is worth highlighting that only 16 cases of Schizophrenia inpatients received Clozapina. It could mean that Clozapine is underprescribed.

The authors have not supplied their declaration of competing interest.

Adults with autism spectrum disorders (ASD) often have behavioral disorders, like aggression, agitation and self-injury. These problems are frequently severe enough to limit educational and developmental progress. Only risperidone and aripiprazole have so far been approved by the FDA for the treatment of behavioral disturbance associated with autism. These drugs are not very effective in the long term, with little benefits to the social functioning and they are associated with side effects. This case report describes the use of pipamperone, in treating behavioral disorders of a patient with autism spectrum disorder and severe mental retardation.

Here is presented the case of a 32-year-old man with autism spectrum disorder, severe mental retardation (caused by undiagnosed phenylketonuria for the first 3 years of life) treated with antipsychotics since childhood. He showed numerous episodes of psychomotor agitation, hetero-direct physical aggression and self-injury, and movement disorders induced by drugs. Treatment with pipamperone reduced drastically crises of psychomotor agitation, and behavioral disorders, without extrapyramidal side effects, and led to an improvement in social functioning. The control of behavioral symptoms associated with adherence to treatment was maintained for 6-month follow up. These clinical observations are supported by ratings using: ABC, CGI-S and CGI-I, VABS, SAS, AIMS.

This case report provides the first potential evidence that pipamperone may be effective in treating behavioral problems associated with autism spectrum disorders. Moreover, the improvement of social functioning and the lack of extrapyramidal side effects make this drug notable for its effectiveness and tolerability.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.