Lupus Anticoagulant and Anticardiolipin Antibodies in Serum of Patients Treated With Risperidone

Abstract

Stahl 1 reviews L-methylfolate as a possibly helpful adjunctive antidepressant agent, 1 and Mischoulon and Fava 2 briefly review the evidence that folates, including folic acid, a stable synthetic substance, could be useful augmenting antidepressant agents. However, there is some evidence of possibly harmful or, at the least, disappointing effects of folate supplementation. 1. There has long been a concern that folate supplementation might mask, or even worsen, the manifestations of B 12-deficiency anemia. L-Methylfolate may be less likely to do this than folic acid. 3 2. Folates are growth-promoting substances and therefore may in fact be dangerous at the early stage of tumor growth in colon cancer. 4-6 3. Since folate deficiency has been linked with elevated homocysteine levels, which in turn are linked to vascular pathology, there was hope that folate supplementation might be beneficial in promoting vascular health and slowing the rate of cognitive decline. Folate supplementation has been disappointing in prevention of cardiovascular morbidity in recent studies. 7,8 In one community study, 9 higher intake of folate was associated with a decline in cognition, and B vitamin administration has not been associated with a decrease in dementia. 10,11 4. A recent study 12 showed that administration of B vitamins, including B 12 and folic acid, led to a decrease in homocysteine levels without decreasing depression severity or incidence. 5. The use of synthetic folic acid may result in unmetabolized folic acid in the serum. The consequences of this are unknown. 3,4 It is not yet clear that folates will be safe and effective adjunctive agents in treating depression, particularly if the patient is B 12 deficient.

Risk of venous thromboembolism during treatment with antipsychotic agents

“…demonstrated a relation between clozapine serum levels and increased APA titers in patients with schizophrenia. Therapy with risperidone in schizophrenic patients was also associated with increased APA levels, compared to the normal population . Halacheva et al .…”

Antiphospholipid Antibodies in Mental Disorders

“…After studying 50 patients with schizophrenia on chronic neuroleptic treatment, they then described positive aPL in half of them and supposed that the molecules used to treat these patients may interact with cell membranes, leading to an increased bioavailability of phospholipids to circulating antibodies. 40 A Brazilian case-control study in 70 schizophrenia adults and 98 age-matched controls evidenced any persistent aPL in medium or high titer in 21 patients (30%), but in no controls, a positive LA in 16 patients (a strong 1 in 7). 41 Those with multiple or high-titer antibodies were refractory to therapy, including electroconvulsive therapy.…”

Prevalence of antiphospholipid antibodies in psychiatric patients users and non‐users of antipsychotics

“…The known frequency of aCL antibodies in these patients varies between 10 and 100% (Canoso & Sise, 1982;Canoso & de Oliveira, 1988;Canoso et al, 1990;Lillicrap et al, 1990;Davis et al, 1994;Vargas-Alarcon et al, 1997;Schwartz et al, 1998Schwartz et al, , 1999Schwartz et al, , 2009. A prevalence of LA and aCL antibodies of 24Á4% and 21Á7% respectively, was found in a study of 184 patients with chronic psychosis on long-term neuroleptic therapy (Canoso et al, 1990).…”

“…This suggestion was initially proposed in the 1980's, in response to a high prevalence of aPL antibodies in antipsychotics users (Zarrabi et al, 1979;Canoso & Sise, 1982;Canoso & de Oliveira, 1988;Canoso et al, 1990;Lillicrap et al, 1990;Davis et al, 1994;Kanjolia et al, 1997;Vargas-Alarcon et al, 1997;Schwartz et al, 1998Schwartz et al, , 1999Schwartz et al, , 2009. Then it was speculated that this association could depend on antipsychotics type, asother observational series showed an increase in the prevalence of aPL antibodies in chlorpromazine users compared with users of other antipsychotics (Zarrabi et al, 1979;Canoso & de Oliveira, 1988).…”