Cannabidiol (CBD), one of the major products of the marijuana plant, is devoid of marijuana's typical psychological effects. In contrast, potential antipsychotic efficacy has been suggested based on preclinical and clinical data (Zuardi et al., 2002). In this report, we further investigated the efficacy and safety of CBD monotherapy in three patients with treatment-resistant schizophrenia (TRS). This was an in-patient study. All patients were given placebo for the initial 5 days, and from the 6th to 35th day (inclusive) they received CBD (initial oral dose of 40 mg reaching 1280 mg/day). On the 36th day, CBD treatment was discontinued and replaced by placebo for 5 days, which was subsequently switched to olanzapine for over 15 days. Efficacy, tolerability and side effects were assessed. One patient showed mild improvement, but two patients didn't show any improvement during CBD monotherapy. All patients tolerated CBD very well and no side effects were reported. These preliminary data suggest that CBD monotherapy may not be effective for TRS.

The pharmacological profile of cannabidiol (CBD) has several characteristics in common with drugs known to benefit bipolar affective disorder (BAD), leading to the hypothesis that CBD may have therapeutic properties in BAD. Therefore, the aim of the present report was to directly investigate for the first time the efficacy and safety of CBD in two patients with BAD. Both patients met DSM IV criteria for bipolar I disorder experiencing a manic episode without comorbid conditions. This was an inpatient study, and the efficacy, tolerability and side effects were assessed. Both patients received placebo for the initial 5 days and CBD from the 6th to 30th day (initial oral dose of 600 mg reaching 1200 mg/ day). From the 6th to the 20th day, the first patient (a 34-year-old woman) received adjunctive olanzapine (oral dose of 10-15 mg). On day 31, CBD treatment was discontinued and replaced by placebo for 5 days. The first patient showed symptoms improvement while on olanzapine plus CBD, but showed no additional improvement during CBD monotherapy. The second patient (a 36-year-old woman) had no symptoms improvement with any dose of CBD during the trial. Both patients tolerated CBD very well and no side-effects were reported. These preliminary data suggest that CBD may not be effective for the manic episode of BAD.

We report the case of an adult male patient with Tourette syndrome, self-injurious behavior and depression, refractory to conventional treatment, and whose symptoms remitted after electroconvulsive therapy. Serial Technetium 99m-Ethyl-Cysteinate-Dimer single photon emission tomographies were applied, before, during, and after electroconvulsive therapy. The neural substrates of this treatment process were further analyzed by woxel-wise subtracted single photon emission tomography images.

Sir: While alcohol dependence is highly prevalent, pharmacotherapy options for its management remain relatively limited 1 or underutilized.2 Mirtazapine is indicated for the symptomatic treatment of depression. We report a case in which mirtazapine aided the treatment of a depressed alcoholic man, speculating that its 5-HT 3 antagonism may have contributed to its beneficial effect on his alcoholism. Case report. Mr. A was a 59-year-old married white man with early-onset (prior to 25 years of age) 3 DSM-IV-TR alcohol dependence, consuming 26 ounces of Scotch daily over the past 5 years. He previously had experienced delirium tremens. His alcohol use was characterized by loss of control with legal charges and serious impairment in his work and marriage due to his drinking.Mr. A was hospitalized in July 2004 after a suicide attempt following 6 months of daily depressed mood associated with anhedonia, decreased appetite, insomnia, poor concentration, and anergia. He also described ongoing uncontrollable worry and daily panic attacks and was using alprazolam at a dose of 0.5 mg/day. Prior trials of citalopram, paroxetine, sertraline, and fluoxetine adequate in dose and duration were ineffective in treating his mood and anxiety or altering his alcohol use. Prior residential addiction treatment resulted in only brief periods of abstinence. Liver function test results at admission were abnormal with a γ-glutamyl transpeptidase (GGT) level of 417 U/L (normal level, < 63 U/L), an aspartate aminotransferase (AST) level of 124 U/L (normal level, < 40 U/L), and an alanine aminotransferase (ALT) level of 184 U/L (normal level, < 60 U/L).The patient was admitted to the hospital and detoxified via chlordiazepoxide taper (initially 50 mg/day) over 5 days. Motivational interviewing promoted further addiction treatment and abstinence. His suicidality resolved, but he remained overtly depressed with marked anxiety and sleep disturbance. Mirtazapine was introduced on day 4 of his hospitalization and titrated to 30 mg/day for management of his depression. Based on clinical observation and patient report, his mood improved and sleep normalized after 9 days in the hospital, allowing him to be followed thereafter as an outpatient.At 3 months, Mr. A reported an absence of depression and insomnia, decreased anxiety, and continuous abstinence from alcohol and benzodiazepines with resolution of his liver function test abnormalities (GGT = 48 U/L, AST = 23 U/L, ALT = 22 U/L).

This case report describes a patient with manic and psychotic symptoms who had a history of neurocysticercosis and presented with an episode of hypertensive hydrocephalus in 2003. Despite her history, she was initially treated for primary psychiatric disease.