clozapine and Syndrome

The term "frontal lobe syndrome" comprises a variety of different clinical syndromes produced by focal lesions involving the prefrontal cortex. However, similar syndromes can be observed after lesions involving subcortical structures connected with the prefrontal cortex in neuronal networks. With respect to the different clinical pictures and underlying brain lesions, prefrontal lobe dysfunction may be divided into a disorganized type, caused by lesion of the dorsolateral prefrontal lobe and its connections, a disinhibited type that can be observed following lesions of the orbitofrontal cortex, and an apathetic type following lesions affecting the functional balance between the cingulum and the supplementary motor area. As intracerebral lesions are rarely limited to the brain regions described, in the majority of patients various degrees of behavioural dysfunction can be observed. The case reports of four patients illustrating the three major prefrontal syndromes following severe head injury (n = 2) or cerebrovascular disease (n = 2) are presented and diagnostic implications as well as possible treatment strategies are discussed.

Topics: Aged; Brain Concussion; Cerebral Arterial Diseases; Cerebrovascular Disorders; Clozapine; Craniocerebral Trauma; Female; Frontal Lobe; Humans; Male; Middle Aged; Nerve Net; Neurocognitive Disorders; Prefrontal Cortex; Syndrome

Negative symptoms in schizophrenia comprise a psychopathologic and pathophysiologic syndrome which is absent from normal mental function. Renewed interest in negative symptoms has led to the development of better measuring instruments, among which is the Positive And Negative Syndrome Scale (PANSS), which provides a way of measuring and reporting positive and negative symptoms in a balanced and convenient form. A number of strategies are being investigated for treating negative symptoms. Dopamine agonists such as levodopa, amphetamines and bromocriptine have been shown to produce improvements in negative symptoms, although good, well-controlled clinical trials are lacking. Partial dopamine agonists, such as MAR 327, are also currently under investigation and results are expected soon. Tricyclic, selective serotonin reuptake inhibitors and monoamine oxidase antidepressants appear to be able to modify negative symptoms in schizophrenia, although, once again, carefully designed trials are needed. Modification of GABAergic transmission has shown little promise, but the use of glycine to augment transmission at N-methyl-D-aspartate (NMDA) synapses suggests that the strategy may be beneficial. These results also imply that altered glutamate receptor function may be partly responsible for negative symptoms. One strategy that has been shown to have a beneficial effect against negative symptoms is combined serotonin/dopamine antagonism. Clozapine was found to have this profile after its introduction, and the recently introduced antipsychotic, risperidone was developed intentionally to be a combined 5-HT2/D2 antagonist. Both risperidone and clozapine have been shown to be effective against negative symptoms. One problem associated with the assessment of drug effects on negative symptoms, however, is that drugs can act on both primary and secondary negative symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Affective Symptoms; Antipsychotic Agents; Clozapine; Humans; Isoxazoles; Piperidines; Psychiatric Status Rating Scales; Psychometrics; Risperidone; Schizophrenia; Schizophrenic Psychology; Syndrome

Negative symptoms in schizophrenia comprise a psychopathologic and pathophysiologic syndrome which is absent from normal mental function. Renewed interest in negative symptoms has led to the development of better measuring instruments, among which is the Positive And Negative Syndrome Scale (PANSS), which provides a way of measuring and reporting positive and negative symptoms in a balanced and convenient form. A number of strategies are being investigated for treating negative symptoms. Dopamine agonists such as levodopa, amphetamines and bromocriptine have been shown to produce improvements in negative symptoms, although good, well-controlled clinical trials are lacking. Partial dopamine agonists, such as MAR 327, are also currently under investigation and results are expected soon. Tricyclic, selective serotonin reuptake inhibitors and monoamine oxidase antidepressants appear to be able to modify negative symptoms in schizophrenia, although, once again, carefully designed trials are needed. Modification of GABAergic transmission has shown little promise, but the use of glycine to augment transmission at N-methyl-D-aspartate (NMDA) synapses suggests that the strategy may be beneficial. These results also imply that altered glutamate receptor function may be partly responsible for negative symptoms. One strategy that has been shown to have a beneficial effect against negative symptoms is combined serotonin/dopamine antagonism. Clozapine was found to have this profile after its introduction, and the recently introduced antipsychotic, risperidone was developed intentionally to be a combined 5-HT2/D2 antagonist. Both risperidone and clozapine have been shown to be effective against negative symptoms. One problem associated with the assessment of drug effects on negative symptoms, however, is that drugs can act on both primary and secondary negative symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Affective Symptoms; Antipsychotic Agents; Clozapine; Humans; Isoxazoles; Piperidines; Psychiatric Status Rating Scales; Psychometrics; Risperidone; Schizophrenia; Schizophrenic Psychology; Syndrome

This report highlights a rare single-gene cause of early-onset, treatment-resistant schizophrenia, and its unique responsiveness to clozapine therapy. This case describes a pediatric female who was diagnosed with early-onset schizophrenia and catatonia in her early adolescence, and was later found to have DLG4-related synaptopathy, also known as SHINE syndrome. SHINE syndrome is a rare neurodevelopmental disorder caused by dysfunction of the postsynaptic density protein-95 (PSD-95), encoded by the DLG4 gene. After failing three antipsychotic drug treatments, the patient was started on clozapine, which resulted in significant improvements in positive and negative symptoms. This case illustrates the impact of clozapine in treatment-resistant early-onset psychosis and exemplifies practical implications for genetic testing in early-onset schizophrenia.

Topics: Adolescent; Antipsychotic Agents; Child; Clozapine; Female; Humans; Psychotic Disorders; Schizophrenia; Schizophrenia, Treatment-Resistant; Syndrome

Treatment-Resistant Schizophrenia (TRS) and Non-Treatment-Resistant Schizophrenia (NTRS) may represent different subtypes of schizophrenia. However, few studies have investigated their PANSS symptom dimensions by Exploratory (EFA) or Confirmatory (CFA). Data from the present study are derived from 1429 patients of the Pattern study. TRS was defined by the use of clozapine in the previous year whereas NTRS by the use of non-clozapine antipsychotics ("by proxy"). Factors were chosen based on the Kaiser criterion and considered valid when loadings were greater than or equal to 0.5. The fit to the data was evaluated by CFA in comparison with well-established PANSS models, using fit indexes. The EFA yielded similar five-factor model in both groups: Negative, Positive, Anxiety/Depression, Cognitive and Excited. CFA showed a satisfactory, but not perfect, fit to the data, as compared with the previous PANSS factor analytic models. Despite the limitations regarding the 'by proxy' definition of TRS, the results of the present study show that there are no differences in the factorial structure of PANSS in patients with TRS and NTRS.

Topics: Adult; Antipsychotic Agents; Clozapine; Cohort Studies; Diagnosis, Differential; Factor Analysis, Statistical; Female; Humans; Male; Middle Aged; Psychiatric Status Rating Scales; Schizophrenia; Syndrome

Topics: Adult; Antipsychotic Agents; Clozapine; Colitis; Delirium; Female; Humans; Syndrome; Treatment Outcome

Topics: Adrenal Gland Neoplasms; Antipsychotic Agents; Catecholamines; Clozapine; Female; Humans; Hypertension; Middle Aged; Pheochromocytoma; Syndrome; Tachycardia

Dyke-Davidoff-Masson syndrome, or cerebral hemiatrophy, is a pre- or perinatally acquired entity characterized by predominantly neurologic symptoms, such as seizures, facial asymmetry, contralateral hemiplegia, and mental retardation. Psychiatric symptoms are rarely reported. We report the first case of left cerebral hemiatrophy and a late onset of treatment-resistant schizoaffective disorder after a stressful life event. The patient finally responded well to clozapine. The clinical history and results from structural neuroimaging are highlighted to discuss the possible developmental bias for psychotic disorders.

Topics: Adult; Antipsychotic Agents; Atrophy; Brain; Brain Diseases; Clozapine; Facial Asymmetry; Hemiplegia; Humans; Magnetic Resonance Imaging; Male; Psychotic Disorders; Syndrome; Treatment Outcome

To report a case of olanzapine-induced Pisa syndrome that improved after treatment with clozapine.. A 22-year-old male with paranoid schizophrenia presented with insidious onset tonic truncal flexion with axial rotation and difficulty in walking after exposure to olanzapine in doses up to 15 mg/day for 9 months. An objective causality assessment suggested that Pisa syndrome was probably related to olanzapine. There was improvement in his symptoms after 6 weeks of treatment with clozapine in doses gradually titrated to 350 mg/day.. Pisa syndrome is a type of dystonia that has been associated with both typical and atypical antipsychotics. Both acute and insidious onset cases have been described in the literature, which have different course and treatment response. Clozapine was found to be effective in reducing the severity of olanzapine-induced Pisa syndrome.. Clozapine may be a useful treatment option for Pisa syndrome that has been caused by olanzapine.

Topics: Adult; Benzodiazepines; Clozapine; Dyskinesia, Drug-Induced; Dystonia; Humans; Male; Olanzapine; Schizophrenia, Paranoid; Syndrome

Clozapine is licensed for the treatment of psychotic illnesses resistant to other antipsychotic medications. Velo-cardio-facial syndrome (VCFS) is associated with a vulnerability to psychotic illness that may be resistant to treatment with conventional typical and atypical antipsychotics.. A 32-year-old man with intellectual disability (ID) and a long history of treatment-resistant psychosis was found to have VCFS. Treatment with typical antipsychotic drugs and with one atypical olanzapine produced no improvement.. Treatment with clozapine produced an improvement in psychotic symptoms and associated behavioural abnormalities, but caused hypersalivation, constipation and a seizure disorder. The latter led to two fractures, one requiring surgery. The addition of sodium valproate stopped seizures.. Clozapine may improve psychotic symptoms for people with ID associated with VCFS, but clinicians should be alert for potential adverse effects.

Topics: Abnormalities, Multiple; Adult; Antipsychotic Agents; Cleft Palate; Clozapine; Face; Genetics, Behavioral; Heart Defects, Congenital; Humans; Intellectual Disability; Male; Psychotic Disorders; Syndrome

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Basal Ganglia Diseases; Clozapine; Depressive Disorder, Major; Dystonia; Female; Humans; Syndrome

Topics: Adrenal Gland Neoplasms; Adult; Antipsychotic Agents; Catecholamines; Clozapine; Female; Humans; Hypertension; Male; Obesity; Pheochromocytoma; Schizophrenia; Sweating; Syndrome; Tachycardia; Time Factors

Topics: Clozapine; Dopamine Antagonists; Dyskinesia, Drug-Induced; Female; Humans; Metoclopramide; Middle Aged; Nausea; Schizophrenia; Syndrome

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Dyskinesia, Drug-Induced; Female; Humans; Middle Aged; Olanzapine; Pirenzepine; Psychotic Disorders; Syndrome

Relationships between symptom profile and clozapine response were studied. Symptom scores on the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms were subjected to principal component analysis (PCA) in a group of 66 treatment-resistant schizophrenic patients, 49 of whom were treated with clozapine. Factor scores were compared among responders, non-responders and partial responders. The PCA yielded a four-factor solution, with positive symptoms, negative symptoms, cognitive disorganization and behavioral disorganization components. Cognitive and behavioral disorganization syndrome scores showed significant differences across groups. Cognitive disorganization was higher in non-responders, while behavioral disorganization was higher in partial responders. The results support the possibility of using clinical profiles to predict therapeutic response to clozapine.

Topics: Adult; Antipsychotic Agents; Clozapine; Dose-Response Relationship, Drug; Dyskinesia, Drug-Induced; Female; Humans; Male; Middle Aged; Neurologic Examination; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology; Syndrome; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Chlorpromazine; Chronic Disease; Clozapine; Female; Humans; Male; Schizophrenia; Sulpiride; Syndrome

To study a correlation between anxiety and delirium, 50 schizophrenic patients with the anxiety-delirious syndrome were treated with anxiolytics (leponex and phenazepam). The results were evaluated with the help of a special graded scale. The first control group consisted of 20 patients with vascular and organic psychoses with the anxiety-delirious syndrome who were treated by phenazepam. The second control group was composed of 20 schizophrenics with analogous symptomatology treated by traditional neuroleptics (haloperidol and tisercin). In many patients reduction of anxiety closely and directly correlated with that of delirium, which evidenced the leading role of anxiety in the structure of the syndrome in those patients. It has been demonstrated that in patients of this group treatment with antianxiety drugs is more effective than that with conventional neuroleptics. The diazepam test is proposed as a method of predicting the effect of anxiolytic therapy.

Topics: Adolescent; Adult; Aged; Anti-Anxiety Agents; Anxiety; Benzodiazepines; Benzodiazepinones; Clozapine; Delusions; Haloperidol; Humans; Male; Middle Aged; Neurocognitive Disorders; Schizophrenia; Syndrome; Trifluoperazine

A group of patients with paranoid schizophrenia treated with aminazine and leponex were examined. Using the component analysis, the integral characteristics of the EEGs--the main components describing principal organizational variants of the background EEG--were obtained. An analysis of the components showed the generalized synchronous and activating effects of the deep cerebral structures to be involved in the formation of these variants of the EEG organization. The components obtained proved to be important for the prognosis of therapy efficacy and the selection of an optimal psychotropic agent.

Topics: Adult; Antipsychotic Agents; Automatism; Chlorpromazine; Clozapine; Dibenzazepines; Drug Evaluation; Electroencephalography; Humans; Schizophrenia, Paranoid; Syndrome

The authors studied a prolonged (3--5 years) use of leponex in 23 patients with the most progressive forms of schizophrenia (hebephrenic, paranoid and close to them attack-like). The study included the influence on the frequency and duration of relapses, on the dynamics of the so-called productive and negative disorders and social adaptation. The achieved data indicate that leponex possesses certain advantages compared to other neuroleptical drugs in prolonged maintenance therapy. Leponex has a rather "universal" psychopharmacological effect which includes a capability of arresting acute psychoses, exerts a psychoregulating influence on the general behaviour, contacts and socio-working adaptation, distinctly alleviates the clinical signs and frequency of relapses. Due to the absence of motor disturbances and minimum of other side-effects leponex is quite convenient for prolonged use and promotes a higher quality of remissions.

Topics: Adult; Chronic Disease; Clozapine; Dibenzazepines; Female; Humans; Male; Middle Aged; Recurrence; Schizophrenia; Schizophrenia, Disorganized; Schizophrenia, Paranoid; Social Adjustment; Syndrome; Time Factors