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Objective: We aimed at exploring predictors of improvement in clinical and functional outcomes of patients on clozapine with chronic treatment-resistant schizophrenia admitted into rehabilitation wards. Method In a cross-sectional study of 62 patients on clozapine augmented with oral and parenteral antipsychotics, predictors of HoNOS (Health of the Nation Outcome Scales) scores were analysed using ordinal logistic regression. Result: Augmentation with parenteral antipsychotics was associated with lower psychotic symptom scores (OR 0.38 [95%CI 0.15, 0.99]) and activity of daily living scores (OR 0.36 [95%CI, 0.13, 0.96]) compared with oral antipsychotics. Increased age was a predictor of behavioural disturbances, physical illness and cognitive problems for all clozapine patients, and female gender was associated with the increase in depression scores. Conclusion: The addition of parental antipsychotics to clozapine in patients with treatment-resistant schizophrenia might have potential benefits for clinical and functional outcomes and needs a further investigation.

Quetiapine is known to have virtually no risk of extrapyramidal symptoms (EPS) and tardive dyskinesia (TD) [1]. I am aware of one published case report of EPS associated with quetiapine [2]. I now present three further cases of EPS associated with quetiapine.Mr A, a 31-year-old with chronic paranoid schizophrenia, had been stable on 20 mg/day of olanzapine and 300 mg/day of bupropion sustained release. As a response to weight gain, olanzapine was tapered off, and 50 mg twice a day of quetiapine was started and raised to 300 mg/day; 300 mg/day of bupropion sustained release was maintained as before. Two weeks after taking 300 mg/ day quetiapine, Mr A complained that his arms and legs were stiff, his jaw became tight, and his tongue felt thick. He showed cogwheel rigidity of both elbows. Benzatropine 2 mg intramuscular relieved these symptoms.Ms B, a 46-year-old with chronic paranoid schizophrenia, had been stable on 10 mg/day of olanzapine. Recently, she manifested cogwheel rigidity and resting tremor of both hands. Olanzapine was discontinued, and the rigidity and tremor abated. Quetiapine 50 mg twice a day was initiated and raised to 200 mg daily. After 2 weeks, she showed mild cogwheel rigidity of both elbows and wrists and resting tremor of both hands. Benztropine 1 mg twice daily resulted in a reduction of these symptoms.Mr C, a 37-year-old with schizoaffective disorder, had been stable for 2 years on 100 mg/day of quetiapine, 50 mg/day of thioridazine, 2 mg/day of trihexyphenidyl and 500 mg/day of diavalproex. Thioridazine and trihexyhenidyl were discontinued, quetiapine was raised to 200 mg daily; diavalproex was maintained as before. After 3 weeks, Mr C showed typical parkinsonian tremor of both hands and cogwheel rigidity of both elbows and wrists. As trihexyphenidyl produced dry mouth, 200 mg of amantadine twice daily was initiated with reduction of the tremor and rigidity.Attention should be paid to the potential occurrence of EPS in patients on quetiapine. Of course, association in these cases does not necessarily mean cause.

Objectives: Constipation, a clinical manifestation of gastrointestinal hypomotility, is a common and potentially serious complication of clozapine therapy, requiring laxatives for its prevention and treatment. We explored the predictive factors of the increased laxative use in inpatients receiving a long-term clozapine therapy. Methods: In the cross-sectional study of 93 patients in a psychiatric rehabilitation hospital, we examined a four-week prevalence of laxative use and a range of demographic and clinical factors associated with the number of prescribed laxatives. Results: Seventy-four percent of inpatients with schizophrenia were prescribed laxatives, and they were statistically significant older and taking higher daily doses of clozapine. In generalized Poisson regression analysis, the clozapine dose, age, and comorbid diabetes mellitus and hypothyroidism were independently associated with the number of concurrently used laxatives. No association was found between the laxatives and gender, duration of clozapine treatment, and the number of other medications with a potential to cause constipation. Conclusion: The clozapine dose, age, diabetes mellitus, and hypothyroidism were shown to be the independent predictors of the increased laxative use among inpatients on clozapine and might be associated with the increased risk of clozapine-induced constipation and gastrointestinal hypomotility.

Abstract. Psychiatric hospitalization can cause significant distress for patients. Research has shown that to cope with the stress, patients sometimes resort to self-harm. Given the paucity of research on self-harm among psychiatric inpatients, a better understanding of transdiagnostic processes as predictors of self-harm during psychiatric hospitalization is needed. The current study examined whether coping styles predicted self-harm after controlling for commonly associated factors, such as age, gender, and borderline personality disorder. Participants were 72 patients (mean age = 39.32 years, SD = 12.29, 64% male) admitted for inpatient treatment at a public psychiatric hospital in Sydney, Australia. Participants completed self-report measures of coping styles and ward-specific coping behaviors, including self-harm, in relation to coping with the stress of acute hospitalization. Results showed that younger age, diagnosis of borderline personality disorder, and higher emotion-oriented coping were associated with self-harm. After controlling for age and borderline personality disorder, higher levels of emotion-oriented coping were found to be a significant predictor of self-harm. Findings were partially consistent with hypotheses; emotion-oriented but not avoidance-oriented coping significantly predicted self-harm. This finding may help to identify and provide psychiatric inpatients who are at risk of self-harm with appropriate therapeutic interventions.