clozapine and Spasm

We report a trial of clozapine (CLO) in patients with spasmodic torticollis (ST). In an open-design trial we treated five patients with adult-onset ST with CLO (300 mg/d) over 12 weeks and one patient over 3 weeks. We videotaped the patients three times (before and at the end of CLO treatment, and 2 weeks after CLO withdrawal) according to a standardized protocol. At the end of the treatment period, CLO plasma concentrations ranged from 67 to 371 ng/ml. In all six patients, analysis of the video ratings and patients' self-assessments failed to reveal any improvement of ST. These preliminary results fail to confirm any therapeutic benefit of CLO in the treatment of ST.

Topics: Adult; Clozapine; Female; Humans; Male; Middle Aged; Spasm; Torticollis

With the advent of atypical antipsychotics, quality of life for patients with schizophrenia has improved significantly. The positive effects are based not only on the compliance-enhancing reduction of extrapyramidal side effects but also due to improved cognitive function and social integration, shorter duration, and overall reduction of hospital treatment. Numerous controlled studies have addressed the issue of switching patients from typical to atypical antipsychotics. However, published data on substituting one atypical antipsychotic for another are preliminary and very limited. This case report describes acute side effects which occurred when switching from clozapine to amisulpride and discusses mechanisms on the receptor level. Regarding these two agents, the clinical relevance of the knowledge of receptor profiles is outlined.

Topics: Acute Disease; Adult; Amisulpride; Antipsychotic Agents; Clozapine; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Pharyngeal Diseases; Psychotic Disorders; Receptors, Dopamine; Spasm; Sulpiride; Tongue Diseases