fluvoxamine and Psychotic-Disorders

Topics: Acute Disease; Aged; Alzheimer Disease; Ambulatory Care; Antipsychotic Agents; Brief Psychiatric Rating Scale; Cross-Over Studies; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Perphenazine; Pilot Projects; Placebos; Psychiatric Status Rating Scales; Psychotic Disorders; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

Fluvoxamine (FLUVOX) is an inhibitor of the cytochrome P450 isoenzyme 1 A2 and thereby inhibits clozapine (CLOZ) metabolism. We performed an open clinical study to gather experience in necessary dosages, plasma levels, side effects and clinical efficiency of the coadministration of the two drugs. Eighteen psychotic patients were studied. 50 mg FLUVOX were given throughout the study period, while the CLOZ dosage was increased individually (week 5: 96.9+/-37.2 mg). After 5 weeks the plasma concentrations were as follows: CLOZ 252+/-174 ng/ml, N-desmethylclozapine (DM-CLOZ) 143+/-74 ng/ml and clozapine N-oxide (CLOZ N-OX) 30+/-14 ng/ml. There were no differences in side effects, especially sedation, after 5 weeks compared to the pretreatment condition. Moreover, we found a significant improvement in measures of cognitive speed which might be regarded as a measure of vigilance. The BPRS scores dropped continuously until week 5 (pretreatment: 53.3+/-13.4; week 5: 33.2+/-12.9) and 5 patients were considered treatment responders (BPRS reduction > 50%). Ten patients continued the combination treatment after the study period and 9 of these patients were in clinical remission when discharged. Given strict therapeutic drug monitoring, coadministration of FLUVOX and CLOZ seems to be a safe and efficient treatment strategy with a low occurrence of the side effects associated with CLOZ treatment. This might be due to additive effects of the two drugs and/or metabolic interaction.

Topics: Adult; Anti-Anxiety Agents; Antipsychotic Agents; Clozapine; Depressive Disorder; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Male; Psychotic Disorders; Schizophrenia; Schizophrenia, Paranoid

Topics: Adolescent; Adult; Anti-Anxiety Agents; Clozapine; Female; Fluvoxamine; Humans; Male; Psychopharmacology; Psychotic Disorders; Serotonin Antagonists

Obsessive-compulsive disorder (OCD) is a heterogenous disorder with different clinical presentations. The most common symptoms are those that involve contamination, possible harm, ordering/symmetry, aggressive/sexual/religious concerns and hoarding. A variety of less common symptoms have been described. Unusual OCD symptoms may lead to misdiagnosis, inappropriate treatment with possible serious side effects. In this report we present a case of an adolescent girl in which unusual OCD presentation and symptoms were misinterpreted to represent psychosis and exacerbation of OCD symptoms with risperidone and clozapine treatment. We discuss the possible pathophysiological mechanisms of OCD symptom exacerbation, clinical implications, and successful management of this case, with fluvoxamine therapy. This case may represent the first report of musical obsessions successfully managed with fluvoxamine therapy.

Topics: Adolescent; Antipsychotic Agents; Clozapine; Diagnostic Errors; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Psychotic Disorders; Risperidone

Central pontine and extrapontine myelinolysis (CPEM) are rare conditions usually associated with rapid correction of hyponatremia. Neurologic complications are the usual sequelae although neuropsychiatric features are rare. Described herein are unusual psychotic symptoms following CPEM and discussion of the likely pathogenesis and implications for treatment.

Topics: Antidepressive Agents, Second-Generation; Antiparkinson Agents; Antipsychotic Agents; Baclofen; Female; Fluvoxamine; GABA Agonists; Humans; Magnetic Resonance Imaging; Middle Aged; Movement Disorders; Myelinolysis, Central Pontine; Psychotic Disorders; Quadriplegia; Risperidone; Trihexyphenidyl

The objective of the present study was to investigate the effect of age, gender, and various comedications on the pharmacokinetics of quetiapine in a naturalistic setting.. In total, 2111 serum samples analyzed for quetiapine during the period from June 2001 to December 2004 were included in the study. The samples had been collected for routine therapeutic drug monitoring purposes from 1179 patients treated with quetiapine. A log-linear mixed model was used to identify factors influencing the dose-corrected quetiapine serum concentration, expressed as the quetiapine concentration-to-dose (C/D) ratio. Variables included in the analysis were age, gender, and concomitant treatment with a total of 41 drugs most often used in combination with quetiapine.. Age >or= 70 years (p = .001) and comedication with alimemazine (p = .002), fluvoxamine (p = .001), citalopram/escitalopram (p = .041), or clozapine (p < .001) significantly increased the serum concentrations of quetiapine, while age < 18 years (p = .044) and comedication with lamotrigine (p = .024), levomepromazine (p = .011), oxazepam (p < .001), or carbamazepine (p < .001) significantly decreased the serum concentrations. The effects were most pronounced for fluvoxamine (+159%), clozapine (+82%), age >or= 70 years (+67%), and carbamaze-pine (-86%). In 18% of the samples, the daily dose exceeded the currently recommended maximum of 800 mg/day.. Due to the increased serum levels of quetiapine, a lower dose than usual should be considered when quetiapine is administered to elderly patients and to patients comedicated with clozapine or fluvoxamine. As the inducing effect of carbamazepine on quetiapine metabolism is very potent, cotreatment with carbamazepine cannot be recommended. On the basis of our data and pharmacokinetic considerations, the majority of drugs commonly used in psychiatry can safely be given in combination with quetiapine.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antipsychotic Agents; Carbamazepine; Dibenzothiazepines; Dose-Response Relationship, Drug; Drug Interactions; Drug Monitoring; Female; Fluvoxamine; Humans; Lamotrigine; Male; Methotrimeprazine; Middle Aged; Oxazepam; Psychotic Disorders; Quetiapine Fumarate; Triazines

Hypersalivation has been reported as a side effect of atypical antipsychotics such as clozapine and olanzapine. As it is very common for antipsychotics to cause dry mouth due to anticholinergic effects, hypersalivation seems to be paradoxical. We present the case of a 34-year-old Japanese man with delusional disorder, somatic type (DSM-IV). He had chronic neck pain as well as somatic hallucination with hypochondriacal delusion for 4 years. Since combination therapy with atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs) has been introduced in the treatment of refractory psychiatric disorders such as schizophrenia, olanzapine (10 mg/day) was added to fluvoxamine treatment (200 mg/day) in this case. Subsequently, hypersalivation was induced without any extrapyramidal symptoms. It is suggested that hypersalivation was an adverse effect of olanzapine. Possible interaction olanzapine with fluvoxamine might increase the risk of the adverse effect. When combination therapy of atypical antipsychotics and SSRI is introduced, it should be used cautiously with careful observation. Underlying pharmacological and clinical problems will be discussed.

Topics: Adult; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzodiazepines; Fluvoxamine; Humans; Male; Olanzapine; Psychotic Disorders; Sialorrhea

Despite the advances in antipsychotic pharmacotherapy over the past decade, many atypical antipsychotic agents are not readily accessible by patients with major psychosis or in developing countries where the acquisition costs may be prohibitive. Olanzapine is an efficacious and widely prescribed atypical antipsychotic agent. In theory, olanzapine therapeutic dose requirement may be reduced during concurrent treatment with inhibitors of drug metabolism. In vitro studies suggest that smoking-inducible cytochrome P450 (CYP) 1A2 contributes to formation of the metabolite 4'-N-desmethylolanzapine. The present prospective study tested the hypothesis that olanzapine steady-state doses can be significantly decreased by coadministration of a low subclinical dose of fluvoxamine, a potent inhibitor of cytochrome P450 1A2. The study design followed a targeted "at-risk" population approach with a focus on smokers who were likely to exhibit increased cytochrome P450 1A2 expression. Patients with stable psychotic illness (N = 10 men, all smokers) and receiving chronic olanzapine treatment were evaluated for steady-state plasma concentrations of olanzapine and 4'-N-desmethylolanzapine. Subsequently, olanzapine dose was reduced from 17.5 +/- 4.2 mg/d (mean +/- SD) to 13.0 +/- 3.3 mg/d, and a nontherapeutic dose of fluvoxamine (25 mg/d, PO) was added to regimen. Patients were reevaluated at 2, 4, and 6 weeks during olanzapine-fluvoxamine cotreatment. There was no significant change in olanzapine plasma concentration, antipsychotic response, or metabolic indices (eg, serum glucose and lipids) after dose reduction in the presence of fluvoxamine (P > 0.05). 4'-N-desmethylolanzapine/olanzapine metabolic ratio decreased from 0.45 +/- 0.20 at baseline to 0.25 +/- 0.11 at week 6, suggesting inhibition of the cytochrome P450 1A2-mediated olanzapine 4'-N-demethylation by fluvoxamine (P < 0.05). In conclusion, this prospective pilot study suggests that a 26% reduction in olanzapine therapeutic dose requirement may be achieved by coadministration of a nontherapeutic oral dose of fluvoxamine.

Topics: Benzodiazepines; Drug Interactions; Drug Therapy, Combination; Fluvoxamine; Humans; Middle Aged; Olanzapine; Pilot Projects; Prospective Studies; Psychotic Disorders

Topics: Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzodiazepines; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Fluvoxamine; Humans; Olanzapine; Psychotic Disorders

Topics: Antipsychotic Agents; Citalopram; Delayed-Action Preparations; Depressive Disorder, Major; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Injections, Intramuscular; Middle Aged; Psychotic Disorders; Risperidone

This is the first longitudinal report on possible psychosis resulting from the juvenile onset of hypothyroidism. A 10-year follow-up in the case of a 13-year-old boy published in this journal in 1993 is presented. The patient presented with a diagnostic dilemma. Although psychosis resulting from hypothyroidism was the most parsimonious explanation of his symptoms (new-onset auditory hallucinations, severe obsessions, and severe hypothyroidism), a primary psychiatric disorder (obsessive-compulsive disorder [OCD] or psychotic depression) aggravated by hypothyroidism could not be excluded. The aim of this study was to illustrate that the diagnosis and clinical interrelationships can be clarified by longitudinal data. FOLLOW-UP DATA: The patient's symptoms responded optimally to a combination of fluvoxamine, risperidone, and levothyroxine (LT4, 300 microg daily). He was free from severe symptoms until age 21, when he discontinued all psychotropic medications while continuing with LT4. Over 2 months later, he was hospitalized for thoughts of hurting himself or others. In the hospital, his LT4 was discontinued and propranolol was started. He was discharged on multiple psychotropic medications, and was rehospitalized 6 days later for suicide risk. When LT4 (200 microg daily) was added to his psychotropic regimen, he partially responded and was discharged. The optimal response to treatment occurred only after he was placed on a combination of fluoxetine, risperidone, and LT4 (300 microg daily). The patient remained stable for up to 12 months of follow-up.. This chronology suggests that the optimal treatment in this patient probably required three components: a Selective Serotonin Reuptake Inhibitor, (SSRI) risperidone, and LT4 (300 g daily). Each component was apparently necessary but not sufficient individually for the optimal response. The relapse after the discontinuation of fluvoxamine and risperidone (but not LT4) suggests the presence of a primary psychiatric disorder (OCD with depression). The failure to improve without an adequate dosage of LT4 suggests that hypothyroidism was probably an aggravating factor. This case illustrates the diagnostic difficulty in distinguishing between obsessions, depressive ruminations, and delusions in children and the need to consider hypothyroidism in the differential diagnosis of the sudden worsening of OCD, or in cases of new-onset psychosis in children and adolescents.

Topics: Adolescent; Aggression; Antipsychotic Agents; Fluvoxamine; Hospitalization; Humans; Hypothyroidism; Male; Obsessive Behavior; Psychiatric Status Rating Scales; Psychotic Disorders; Risperidone; Selective Serotonin Reuptake Inhibitors; Suicide; Thyrotropin; Thyroxine

Topics: Aged; Alzheimer Disease; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Fluvoxamine; Humans; Perphenazine; Psychiatric Status Rating Scales; Psychotic Disorders; Treatment Outcome

To inform clinicians of the possibility that seizures due to therapeutic doses of fluvoxamine may not be as rare as previously considered.. A 49-year-old white man with schizoaffective disorder and a past history of seizures secondary to head trauma had been seizure-free for approximately 10 years. Fluvoxamine therapy was begun due to increasing obsessive-compulsive behavior. Despite receiving anticonvulsants for his mood disorder, the patient had a breakthrough seizure. There were no underlying medical conditions that might have induced this seizure. No further seizures occurred after he was placed on a higher dosage of the anticonvulsants. The obsessive-compulsive behavior improved considerably as a result of fluvoxamine treatment.. The patient presented here developed a seizure with a therapeutic dosage of fluvoxamine; seizures associated with this agent have occurred more often with overdose. Multiple factors such as a prior history of seizures, head trauma, and concurrent treatment with other psychotropic agents are considered in this case report.. Despite the relatively safe and benign adverse effect profile of the selective serotonin-reuptake inhibitors such as fluvoxamine, clinicians should be cautious about seizures as an adverse effect, especially when the patient has even a remote history of seizure or head trauma.

Topics: Dose-Response Relationship, Drug; Fluvoxamine; Humans; Male; Middle Aged; Psychotic Disorders; Seizures; Selective Serotonin Reuptake Inhibitors

Topics: Aged; Akathisia, Drug-Induced; Antipsychotic Agents; Detergents; Drug Interactions; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Poisoning; Psychotic Disorders; Selective Serotonin Reuptake Inhibitors; Suicide, Attempted

Lithium is a neurotoxin with a particular affinity for the cerebellum. The risk of permanent neurotoxic sequelae of lithium is increased by the concomitant use of certain conventional neuroleptics. We report two new cases of lithium neurotoxicity; one received lithium alone, not in combination with a neuroleptic. Both cases showed severe cerebellar atrophy on brain CT and MRI. Additional factors such as dehydration, systemic infection, other medications, or rapid correction of frequently-coexisting hyponatremia may contribute to the risk of lithium neurotoxicity. We discuss possible pathophysiologic mechanisms and preventive measures.

Topics: Antipsychotic Agents; Atrophy; Bipolar Disorder; Cerebellum; Drug Interactions; Drug Therapy, Combination; Female; Fluvoxamine; Follow-Up Studies; Humans; Lithium; Magnetic Resonance Imaging; Middle Aged; Nerve Degeneration; Psychotic Disorders; Time Factors

Topics: Adult; Clozapine; Cytochrome P-450 CYP1A2; Cytochrome P-450 CYP1A2 Inhibitors; Cytochrome P-450 Enzyme Inhibitors; Cytochrome P-450 Enzyme System; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Microsomes, Liver; Psychotic Disorders