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Associations between Purine Metabolites and Clinical Symptoms in Schizophrenia  [PDF]
Jeffrey K. Yao, Ruth Condray, George G. Dougherty, Matcheri S. Keshavan, Debra M. Montrose, Wayne R. Matson, Joseph McEvoy, Rima Kaddurah-Daouk, Ravinder D. Reddy
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0042165
Abstract: Background The antioxidant defense system, which is known to be dysregulated in schizophrenia, is closely linked to the dynamics of purine pathway. Thus, alterations in the homeostatic balance in the purine pathway may be involved in the pathophysiology of schizophrenia. Methodology/Principal Findings Breakdown products in purine pathway were measured using high-pressure liquid chromatography coupled with a coulometric multi-electrode array system for 25 first-episode neuroleptic-na?ve patients with schizophrenia at baseline and at 4-weeks following initiation of treatment with antipsychotic medication. Associations between these metabolites and clinical and neurological symptoms were examined at both time points. The ratio of uric acid and guanine measured at baseline predicted clinical improvement following four weeks of treatment with antipsychotic medication. Baseline levels of purine metabolites also predicted clinical and neurological symtpoms recorded at baseline; level of guanosine was associated with degree of clinical thought disturbance, and the ratio of xanthosine to guanosine at baseline predicted degree of impairment in the repetition and sequencing of actions. Conclusions/Significance Findings suggest an association between optimal levels of purine byproducts and dynamics in clinical symptoms and adjustment, as well as in the integrity of sensory and motor processing. Taken together, alterations in purine catabolism may have clinical relevance in schizophrenia pathology.
Purine Bases in Blood Plasma of Patients with Chronic Pulmonary Diseases
Larissa E. Muravluyova,Vilen B. Molotov-Luchanskiy,Dmitriy A. Kluyev,Rosa A. Bakenova
European Researcher , 2012,
Abstract: The article is focused on the study of purine bases and intermediates of purine catabolism in plasma of patients with chronic obstructive bronchitis and idiopathic interstitial pneumonia. Decrease of adenine and hypoxantine in plasma of patients with idiopathic interstitial pneumonia was registered. Increase of guanine in plasma of patients with chronic obstructive pulmonary disease was established.
NEUROLEPTIC MALIGNANT SYNDROME
MUHAMMAD SAEED AKHTAR
The Professional Medical Journal , 2006,
Abstract: Neuroleptic malignant syndrome is a rare but life threatening reaction toa neuroleptic medication. Even in state-of-the-art centers, the mortality rate is reported as 5-12%. We present a reportof a successfully managed patient with neuroleptic malignant syndrome, in Faisalabad, Pakistan. This is followed bya brief discussion about the syndrome, with a compilation of latest recommendations about assessment andmanagement.
Three Patients with Neuroleptic Malignant Syndrome: Differential Diagnosis and the Causes of Predisposition  [cached]
Ali Kemal Kadiro?lu,Berat Ebik,?mer Kaya,Serdar Y?ld?r?m
Turkish Journal of Medical and Surgical Intensive Care Medicine , 2011,
Abstract: Neuroleptic malignant syndrome (NMS) is a life-threatening idiosyncratic reaction that occurs after the administration of neuroleptic drugs. It usually appears within the first two weeks of neuroleptic treatment. The tetrad of NMS seen in 50% of patients includes fever, muscle rigidity, altered mental status and evidence of autonomic instability. NMS may be overlooked or its diagnosis may be difficult due to its similarities with some organic and psychiatric disorders. Due to its heterogeneous character, differential diagnosis and supportive treatment are very important when managing these patients. We aimed to present the differential diagnosis and the causes of predisposition in three patients, two with a diagnosis of schizophrenia and one with psychomotor impairment, who were admitted to the medical intensive care unit with a diagnosis of an NMS-like condition related to antipsychotic (olanzapine) treatment.
Dendritic and spine alterations in areas 9 and 17 in schizophrenia and Huntington chorea and the role of neuroleptic exposure  [PDF]
Latchman Somenarain, Liesl B. Jones
Open Journal of Psychiatry (OJPsych) , 2012, DOI: 10.4236/ojpsych.2012.23032
Abstract: Recent morphological studies in schizophrenia suggest atrophic changes in the neuropil of the prefrontal cortex. Most recently, we showed a schizophrenia-associated decrease in MAP2 in schizophrenia, which we believed is not due to neuroleptic exposure. MAP2 is a very important protein in the assembly of micro-tubule in neurons; therefore, it plays a major role in neuronal processes like dendrites, spines and synapses. Additionally, recent studies from our lab showed decreases in dendrites in area 32 and area 9. In this study we examined the dendrites and spines in area 9 and 17 to determine if neuroleptic drugs play a role. Huntington’s patients take neuroleptics similar to schizophrenics; therefore, by comparing the two groups to controls we can determine if neuroleptics play a role in the deficits reported in schizophrenia. Our results showed a significant decrease in both basal dendrites and spines for both layers III and V in area 9 in schizophrenia compared to controls. The Huntington’s brains, on the other hand, showed no significant difference compared to controls. In area 17, there was also no significant difference when comparing the three groups. The data suggest that neuroleptic drugs may not be responsible for the changes observed in schizophrenia.
Amisulpride and Neuroleptic Malignant Syndrome  [PDF]
Ming-Che Tu,Cheng-Cheng Hsiao
Chang Gung Medical Journal , 2011,
Abstract: Neuroleptic malignant syndrome (NMS) is a rare but lethal complication of neuroleptics. Its incidence ranges between 0.02% and 3%. Amisulpride, a second generation neuroleptic, was associated with rhabdomyolysis in one report and NMS in 2 reports. Althoughthe precise pathogenesis is still unclear, dopamine receptor blockade is theorized to play acentral role. Conventional presentations include hyperthermia, muscle rigidity, and elevatedcreatine kinase concentrations. However, similar to other second generation neuroleptics,amisulpride induces an atypical form of NMS, which presents with lower degrees of hyperthermia and elevation of creatine kinase than the typical form. This phenomenon makes itdifficult to identify early signs of NMS. This study describes the first case of amisulprideinduced NMS in Taiwan, together with a review of the current knowledge on NMS. In thiscase, the correlation between NMS and amisulpride was categorized as “probable” on theNaranjo adverse drug reaction probability scale
Neuroleptic Malignant Syndrome and Anaesthesia: A Case Report  [PDF]
Pramendra Agrawal,Abha Agrawal,Ishwar Singh
Indian Anaesthetists' Forum , 2010,
Abstract: Neuroleptic Malignant Syndrome (NMS) is a life threatening, neurological disorder most often caused by an adverse reaction to neuroleptic or anti psychotic drugs. A case of Neuroleptic Malignant Syndrome who was posted for an incidental surgery and its anesthetic management is reported.
Neuroleptic malignant syndrome
Moscovich, Mariana;Nóvak, Felipe T.M.;Fernandes, Artur F.;Bruch, Tatiana;Tomelin, Tabita;Nóvak, Edison M.;Munhoz, Renato P.;Teive, Hélio A.G.;
Arquivos de Neuro-Psiquiatria , 2011, DOI: 10.1590/S0004-282X2011000600005
Abstract: neuroleptic malignant syndrome (nms) is a potentially fatal adverse event associated with the use of antipsychotics (ap). the objective of this study was to investigate the profile of cases of nms and to compare our findings with those published in similar settings. a series of 18 consecutive patients with an established diagnosis of nms was analyzed, gathering data on demography, symptoms and signs. two thirds of all cases involved woman with a past medical history of psychiatric disorder receiving relatively high doses of ap. the signs and symptoms of nms episodes were similar to those reported in other series and only one case had a fatal outcome, the remaining presenting complete recovery. as expected, more than two thirds of our cases were using classic ap (68%), however the clinical profile of these in comparison with those taking newer agent was similar. newer ap also carry the potential for nms.
Neuroleptic-induced movement disorders in a naturalistic schizophrenia population: diagnostic value of actometric movement patterns
Sven Janno, Matti M Holi, Katinka Tuisku, Kristian Wahlbeck
BMC Neurology , 2008, DOI: 10.1186/1471-2377-8-10
Abstract: A naturalistic population of 99 schizophrenia inpatients using conventional antipsychotics and clozapine was evaluated. Subjects with NIMDs were categorized using the criteria for NIMD found in the Diagnostic and Statistical Manual for Mental Disorders – Fourth Edition (DSM-IV).Two blinded raters evaluated the actometric-controlled rest activity data for activity periods, rhythmical activity, frequencies, and highest acceleration peaks. A simple subjective question was formulated to test patient-based evaluation of NIMD.The patterns of neuroleptic-induced akathisia (NIA) and pseudoakathisia (PsA) were identifiable in actometry with excellent inter-rater reliability. The answers to the subjective question about troubles with movements distinguished NIA patients from other patients rather well. Also actometry had rather good screening performances in distinguishing akathisia from other NIMD. Actometry was not able to reliably detect patterns of neuroleptic-induced parkinsonism and tardive dyskinesia.The present study showed that pooled NIA and PsA patients had a different pattern in lower limb descriptive actometry than other patients in a non-selected sample. Careful questioning of patients is a useful method of diagnosing NIA in a clinical setting.Globally, many schizophrenia patients still suffer from neuroleptic-induced movement disorders (NIMDs) [1-3] in spite of the increasing use of second generation antipsychotics, which in general have a lower propensity for NIMDs [4]. Although in earlier years movement adverse effects were even considered to be an indicator of antipsychotic action [5], today they are seen as burdening and stigmatizing phenomena that should be avoided by careful choice of treatment [6]. NIMDs, which are investigated in this study and classified in DSM-IV [7], include neuroleptic-induced akathisia (NIA), neuroleptic-induced parkinsonism (NIP) and tardive dyskinesia (TD). Pseudoakathisia (PsA) is a movement disorder with objective signs of akat
Side effects of antipsychotic agents: Neuroleptic malignant syndrome  [PDF]
Cvjetkovi?-Bo?njak Mina,Soldatovi?-Staji? Branislava
Medicinski Pregled , 2010, DOI: 10.2298/mpns1010705c
Abstract: Neuroleptic malignant syndrome is a rare, potentially life-threatening complication which is an unpredictable, idiosyncratic reaction to antipsychotics. In patients receiving traditional antipsychotics, neuroleptic malignant syndrome occurs with an incidence of 0.2-3.3%. However, neuroleptic malignant syndrome also appears in patients treated with atypical antipsychotics, especially Clozapine. A possible cause of neuroleptic malignant syndrome is blockade of dopamine receptors in the nigrostriatal tracts or hypothalamic nuclei. If signs and symptoms of the Neuroleptic malignant syndrome are identified in time, full recovery is possible. This is a report of a female patient with neuroleptic malignant syndrome treated by traditional antipsychotics. As soon as neuroleptic malignant syndrome symptoms were recognized, the antipsychotic drugs were discontinued, symptomatic therapy was initiated and symptoms of neuroleptic malignant syndrome disappeared. However, the patient's psychotic symptoms persisted and an atypical antipsychotic was administered. During the next few days the psychotic symptoms gradually disappeared and the patient accomplished good recovery.
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