Tardive dyskinesia (TD) is a severe side effect of antipsychotic treatment. Factors considered as predisposing include age, gender, emotional disorders, diabetes, development of EPS during early treatment, prolonged administration and use of high doses of conventional antipsychotics. The second generation antipsychotics are of significantly lower risk. Furthermore, there is evidence that they may have a therapeutic effect on TD. This is well established for clozapine and there are reports also for risperidone, olanzapine, quetiapine and amilsulpride. Aripiprazole inhibits central dopaminergic neuron activity by a partial agonistic effect on the presynaptic D2 dopamine autoreceptor and also acts as an antagonist at postsynaptic D2 dopamine receptors. Through this mechanism, aripiprazole exerts activity as a dopamine agonist in hypodopaminergic states, while acting as a dopamine antagonist when dopaminergic activity is increased. There is also evidence from basic science studies that aripiprazole causes little D2 receptor up-regulation.Case report:We report a case of an 84 year old woman with lingual-facial-buccal TD, due to treament for 10 years with Haloperidol 2 mg/day, after a single psychotic episode. A decision to switch to aripiprazole 10 mg/day was made. Over the next month, her TD gradually disappeared, and re-emerged after three months when the patient gave up treatment against our advice. We also review four other cases reported in the last two years with similar findings. These properties may play a role in both prevention of the emergence of TD and the treatment of TD. Aripiprazole may provide alternate pharmacotherapy to treat psychoses and TD.
Introduction: Recent studies have suggested an association between elevated levels of bilirubin and psychotic spectrum disorders. The aim of our study was to compare the levels of bilirubin in the different psychotic disorders among themselves and with other mental disorders. Method: Observational, retrospective, in a sample of patients admitted to the Acute Psychiatric Unit between January 2007 and December 2009. We included all patients with plasma concentrations of bilirubin in the blood analysis. We excluded patients with toxic abuse and alterations in the liver reflected in increased transaminases. Results: The final sample of 523 patients. Patients with psychotic disorder had bilirubin levels significantly higher than patients with other diagnosis (p < 001). Psychotic disorders were subdivided into 5 groups: schizophrenia (N = 76), schizoaffective disorder (N = 53), delusional disorder (N = 21), brief psychotic disorder (N = 29) and other unspecified psychotic disorders (N = 34). The brief psychotic disorder patients had bilirubin levels significantly higher than other categories of the same spectrum (p < 0.001). Conclusions: The psychotic spectrum patients have higher bilirubin levels at admission than other diagnostic entities, and this increase is mainly explained by Brief Psychotic Disorder. Bilirubin figures correlate negatively with psychotic symptoms days, so the brief psychotic disorder, is proclaimed as an ideal model for the llaboratory studies about psychotic spectrum disorders.
Introduction: Brief Psychotic Disorder (BPD) is a disease characterized by sudden onset of psychotic symptoms. This disturbance lasts at least 1 day but less than 1 month, and the subject fully recovered premorbid level. In the literature there are few data on its prevalence, established between 4-10% of all psychotic disorders. Although a female preponderance has been postuled, gender differences have not been well studied. Therefore, the aim of the present study is to examined sex differences in brief psychotic disorder. Method: We conducted a retrospective study to estimate the gender differences in an inpatient psychiatric sample. This sample (n=39) included acute patients admitted in a psychiatry ward with diagnosis of brief psychotic disorder. The clinical and socio-demographic characteristics were analysed for males and females separately. Results: Of a total of 39 patients with BPD, 74.4% were women (n = 29) and 25.6% male (n = 10). Mean age at diagnosis was 33 +/-8.65 years. Of the clinical variables studied, none was significantly different between male and female. Men had a higher consumption of alcohol (p< 0´05); there were no differences in axis II. Males had more psychiatric family history (70% vs 48.3%), although not statistically significant. Women had more frequent family history of mood disorders and men of psychotic disorders (p < 0.05). Conclusion: We found higher prevalence of BPD in women. Males had more family history (mostly psychotic) and more toxic dependence. Further studies are needed with larger samples to determine the existence of sex differences.
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