Lack of adherence is a common cause of relapse in schizophrenia. Long-acting antipsychotics have shown in recent studies that they improve compliance. However, some randomised controlled trials showed no difference in relapse rates between oral medication and long-acting injections.

To report the use of paliperidone palmitate in an Acute Psychiatrist Unit in Spain.

Retrospective observational study of 42 patients prescribed paliperidone palmitate (PLAI) during an admission at Acute Psychiatric unit in Málaga. In the mirror image analysis, the main outcome measure was the total number of days of psychiatric inpatient care twelve months before and after patients started Paliperidone palmitate.

Most common reason for starting paliperidone palmitate was lack of adherence to oral medication (54%) followed by lack of efficacy on previous medication (31%). Olanzapine (47%) and risperidone (41%) were most commonly antipsychotics prescribed before PLAI. Thirty-four patients continued PLAI over twelve months (80%). Poor compliance was the most common reason of withdrawal. Three patients had a movement disorder adverse effect. Only one was lost because adverse effects. Total admissions and inpatients days were significantly reduced from the previous treatment to PLAI-treatment period (Table 1).

PLAI was associated with a reduction in total inpatient days. The financial saving from reduced admissions stays exceeded the acquisition and administration cost of PLAI. Improved compliance because of PLAI is the most plausible explanation of this result (Fig. 1).

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a chronic, severe, and disabling mental disorder. An evaluation of clinical predictors to clozapine was described.

Identify clinical predicting factors to clozapine.

This is a cross-sectional study including patients diagnosed with schizophrenia or schizoaffective disorder according to the DSM 5 criteria and treated with clozapine.

Of the 33 patients, 78.8% were males and 69.7% of them were single. The mean age was 36 years old. The mean age at the onset of the disorder was 24 years old. The mean number of hospitalizations was 6. The beginning of the mental disorder was acute in 21.2% of the cases. The mean duration of the disease course before starting clozapine treatment was 11 years. The mean duration of treatment was 19 months. The diagnosis according to DSM 5 criteria was schizophrenia in 87.9 and schizoaffective disorder in 12.1% of cases. The outcome was assessed by PANSS and BPRS scales with a symptomatic remission in 63.63% of cases. The analytical study revealed a significant correlation between favorable evolution and the latest onset of the disorder (P = 0.04), the number of previous hospitalizations (P = 0.009), disorder's duration (P = 0.032), male sex (P = 0.0004) and secondary resistance (P < 10−3).

The evaluation of clinical factors is important in our practice in order to improve the response to clozapine. Otherwise, adherence to treatment and quality of insight are determining factors of the treatment response.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The aims of this study were to investigate the new models of research and development in infectious diseases that emerged after the pharmaceutical industry ceased their investments and to model how these can be used in psychiatry.

A systematic review. We searched PubMed, EMBASE and Web of Science for the keywords “infectious diseases”, “research and development” and “pharmaceutical industry”.

The searches gave a total of 248 references. Among the findings, we want to highlight the Drugs for Neglected Diseases initiative (DNDi) and the WHO Research and Development Treaty (R&D Treaty). DNDi is a non-profit organization that has developed six new drugs since 2003. The development costs were €150 millions per drug, which is considerably below the costs for drug development claimed by the pharmaceutical industry. The R&D Treaty will commit member states of the WHO to fund development for neglected health needs using alternative incentives like milestone prizes, patent pools and direct grants. The treaty has not yet been agreed upon.

Though a low priority from the pharmaceutical industry, other funding models have proven able to deliver new treatments. This could also lead to more development of non-patentable treatments, e.g. psychotherapy.

The author has not supplied his/her declaration of competing interest.

There are relatively few studies of Long-acting injectable antipsychotics (LAI), although poor adherence to treatment is one of the main problems in patients with psychotic disorders.

The aim of the study is to describe socio-demographic and clinical characteristics of a sample of outpatients with LAI treatment.

This is a cross-sectional study. A randomized sampling was performed among the outpatients that were receiving LAI in an outpatient clinic in Barcelona (Spain). For each patient, socio-demographic, clinical and pharmacotherapeutic data were collected through interviews and clinical history.

The sample consisted of 30 subjects (50% men, average age 48 years). Most of the patients in the sample have basic education (50%) and are unemployed, receiving permanent disability pension (39.3%). In addition, 44.8% of the subjects were living with family members and were not married (56.7%). Of the patients, 70% were diagnosed with schizophrenia, 13.3% schizoaffective, 10% bipolar and 6.7% delusional disorder. The main reason to initiate LAI treatment was due to non-compliance of the prescribed oral treatment (85.7%). The 40% of patients were also with oral antipsychotic treatment. Average punctuation in the 3 first items of the Scale to Assess Unawareness of Mental Disorder: 11. Average punctuation in the short version of the Simpson-Angus Scale: 1.68.

In our sample, the outpatients with LAI treatment had a low functioning and disease awareness. Although the main reason to start LAI is the non-compliance, 40% of the patients were concurrently treated with oral antipsychotics. The extrapyramidal side effects are mild.

The authors have not supplied their declaration of competing interest.

Dementia with lewy bodies (DLB) is commonly considered the second most common form of dementia. The purpose of this study is to investigate the treatment effects of aripiprazole in patients with DLB.

Eleven patients who had meet the criteria for DLB participated in this study. The presence of psychotic symptoms was confirmed by scores of either the delusions or hallucinations items of the Neuropsychiatric Inventory (NPI) score. Patients who had 25 or more on the Mini-mental State Examination Scale (MMSE) at the entry or having brain damage were excluded. Aripiprazole was initiated at a low dose (3 or 6 mg/day) and titrated to higher doses at 2-weeks intervals or more rapidly based on investigator's judgment. Previous medications prior to aripiprazole administration were not changed through this trial. Patient's clinical status was assessed at baseline, then 2 weeks during the study by using NPI, Clinical Global Impression (CGI) and Brief Psychiatric Rating Scale (BPRS) to measure psychotic behavioral symptoms, and Simpson-Angus Scale (SAS) to measure parkinsonism symptoms. Clinical Dementia Rating (CDR) and MMSE were carried out at screening and end point to evaluate cognitive function.

The mean scores of the SAS and CDR were significantly decreased at the study endpoint compared to baseline. The mean scores of the NPI and BPRS improved up until 4 weeks after having started aripiprazole. After 4 weeks, improvements slowed. The mean score of the CGI-S was decreased up until 8 weeks.

This study shows that aripiprazole may be effective for the treatment of psychotic symptoms in patients with DLB.

The authors have not supplied their declaration of competing interest.

Clozapine-induced sialorrhea (CIS) is a common, treatment-limiting and stigmatizing side effect. All systemic agents that are used for hypersalivation may increase clozapine side effects such as blood pressure changes, constipation, or arrythmias. Oral application of topical anti-muscarinic agents may be a low side effect option for treatment of CIS.

The aim of this case report was to propose an off-label treatment of tropicamide drops to CIS and to stimulate further investigation.

A 33-year-old male inpatient with schizophrenia has been on clozapine 800 mg and amisulpride 600 mg/day. His drooling was occasional and severe as drool drips off his chin during the day and night. Wet area over the pillow, visual analog scale (VAS), the short form of health survey (SF-36), UKU side effect rating scale, scale for the assessment of negative symptoms (SANS), scale for the assessment of positive symptoms (SAPS) were applied at baseline and in one-week intervals. Oral application of one drop of tropicamide % 0.5 (5 mg/mL) to left and one drop to right side before going to bed in the first week and two drops to each side were administered subsequently. Informed consent was given by the patient.

No psychological, neurological, autonomic and other side effects were observed associated with tropicamide. On VAS, the patient rated hypersalivation 5/7 at baseline, 4/7 after one drop each, 3/7 after two drops each.

The reduction of CIS by oral use of tropicamide eye drops is promising and should be explored with randomized controlled trials.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

There is a lack of pharmacological trials studying drug response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available reviews of retrospective data indicate good response to second-generation antipsychotics, but even such data from India is sparse.

We aimed to compare the response of acute PDD to risperidone and olanzapine in our retrospective review.

We conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455) at our Center. We selected the data of patients prescribed either olanzapine or risperidone for the purpose of this analysis. We extracted data about dose, drug compliance and response, adverse effects, number of follow-up visits and hospitalizations. The study was approved by the Institute Ethics Committee.

A total of 280/455 (61%) were prescribed risperidone and 86/455 (19%) olanzapine. The remaining (n = 89; 20%) had received other antipsychotics. The two groups were comparable in socio-demographic and clinical characteristics of PDD. Compliance was good and comparable in both groups (> 80%, P = 0.2). Response to treatment was comparable in both groups (85% partial response and > 52% good response, all P > 0.3). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone (240 vs. 391, P < 0.05).

Our study indicates a good response to both risperidone and olanzapine, if compliance to treatment can be ensured. In the absence of specific treatment guidelines for PDD, second-generation antipsychotics like risperidone and olanzapine offer good treatment options for this infrequently encountered and difficult to treat psychiatric disorder.

The authors have not supplied their declaration of competing interest.

Microelectrode arrays (MEAs) with cultured neuronal networks are highly suitable to quantify neuroactive activity and neurotoxicity of applied substances.

Multiparametric characterization of functional alterations of in vitro-neuronal network activity by different typical and atypical antipsychotics.

To identify differential effects of antipsychotics on spontaneous neuronal network activity as a functional readout.

Cultured networks of dissociated cortical cells of postpartal mice coupled to MEAs were exposed to increasing doses of aripiprazole, clozapine, haloperidol, olanzapine, raclopride, and risperidone.

We found a concentration-dependent inhibition of firing patterns for all substances except olanzapine. All other substances mediated a concomitant irreversible suppression of burst and spike rates, a decrease of the burst duration and the number of spikes in bursts as well as dose-dependent network desynchronization (decrease of Cohen's kappa). The comparison of the different antipsychotics with regard to their half-maximal effective dose values (EC-50) for inhibiting the spike rate yielded an increasing order of EC50 values, i.e. a declining order of toxic potency, of aripiprazole (8.77 μM) < clozapine (9.36 μM) < haloperidol (9.77 μM) < risperidone (15.9 μM) < raclopride (22.7 μM). No significant correlations were identified between EC50 values of the distinct antipsychotics and their binding affinity to the dopamine D(2), the serotonin 5-HT(1A), 5-HT(2A), 5-HT(2C), and the M(1) and M(2) muscarinic acetylcholine receptors.

In MEAs, a dose-dependent neurotoxic effect of typical and atypical antipsychotics alike occurred at supratherapeutic doses via a yet unknown mechanism that did not involve actions on major receptor targets of these compounds.

The authors have not supplied their declaration of competing interest.

Bupropion is a dual antidepressant, a norepinephrine and dopamine reuptake inhibitor. Its main use is in affective disorders as major depression. Antidepressants have been commonly associated with sexual side effects in the libido, sexual arousal, orgasm and erectile function. Bupropion has negative influence in sexual function, even it could increase the libido. Due to this, it could be a good option in patients with active sexual life and affective disorder.

A 58-year-old female with a long history of depression disorder for 5 years. History of lots of side effects with different treatments, sexual dysfunction with serotonin-antidepressants. Treated with bupropion SR 150 mg/day and alprazolam, she suffered a relapse. The bupropion was increased to 300 mg/day. Three days later she appeared in the consultation room, presented a sense of pre-orgasmic of 72 hours of evolution, high increased libido, tiredness, muscle tension and insomnia. This sense did not improve after the sexual act. It had never happened previously. The side effect improved when the bupropion was reduced to 150 mg/day and disappeared with its withdrawal.

The case made a relationship between the increased of bupropion's dose and the appearance of unusual sexual side effects (increased of libido and pre-orgasmic sense). Not only bupropion is one of the antidepressants that do not cause sexual dysfunction, if not it was reported in some trials that could be a treatment against this dysfunction due to its prosexual effects. The mechanism is unknown but could be related with norepinephrine or dopamine transmission.

The authors have not supplied their declaration of competing interest.

Lithium is among the most effective therapies for bipolar disorder. Lithium treatment may cause hypothyroidism, goiter or to a lesser extent hyperthyroidism, since it can affect several aspects of thyroid functioning. The prevalence of lithium-associated hypothyroidism varies extensively between studies, reaching up to 47%, and affecting more females than males (5:1).

Determine the prevalence of thyroid dysfunction in an acute inpatient psychiatric department dedicated to affective disorders and its association with lithium therapy.

To review the relation between lithium treatment and thyroid dysfunction.

Observational, descriptive and retrospective study with clinical and laboratorial data concerning all inpatient episodes of 2015 in our Psychiatric Department. A non-systematic literature search was performed in PubMed.

The present study documented a high prevalence of thyroid dysfunction, particularly in women. Most cases were due to either hypothyroidism or subclinical hypothyroidism. Patients treated with lithium were more often under thyroid hormone replacement therapy (levothyroxine).

The evidence that lithium treatment is associated with hypothyroidism is well established and this condition is easily treatable with levothyroxine. This study highlights the importance of baseline screening of thyroid function and regular long-term monitoring in patients treated with lithium.

The authors have not supplied their declaration of competing interest.

The use of antipsychotics represents an integral part of the psychiatric practice, unfortunately the use seems to be associated with an elevated frequency of metabolic alterations causing an important weight disorder and glucose and lipid homeostasis, diminishing life expectations for these patients, likely to develop metabolic syndrome without proper control.

This study intended to find the association between metabolic syndrome in patients with psychotropic treatments used in the Guatemalan Institute of Social Security (IGSS).

Cohort Study (n = 43 patients) who were treated combined with antipsychotics and mood stabilizers or antidepressants, conducting checkups at the beginning, then two to four months after, evaluating diagnosis of metabolic syndrome according to the criteria stated by the International Diabetes Federation (IDF).

Risk factor with the use of clozapine and valproic acid was revealed after four months of exposure (RR = 2.32). With the use of clozapine and mood stabilizers a risk factor was prevalent with exposure after four months (RR = 2.67), and with the use of antidepressants a protective factor for the development of metabolic syndrome was revealed at four months of exposure (RR = 0.3741).

the use of antipsychotics in combination with mood stabilizers represents a risk factor for developing metabolic syndrome, especially the association with valproic acid.

The author has not supplied his declaration of competing interest.

Antipsychotic drugs effectively control psychotic symptoms, but may cause important side effects, significantly increasing morbidity and mortality. Hematologic abnormalities are frequent and may be life-threatening in some patients. Many prospective investigations confirmed neutropenia as a frequent occurrence with virtually all atypical antipsychotics.

Define epidemiological, clinical and therapeutic characteristics of antipsychotics – induced leukopenia and neutropenia through a case report and a review of literature.

Patient 28 years old native of Tunis, with family history: brother who suffer of undifferentiated schizophrenia. Since the age of 16 years he has been followed for disorganized schizophrenia (DSM IV). He was initially put under Haldol Decanoate (2 months), fluphenazine (2 months), amisulpride (3 months), sulpride (2 months), olanzapine (3 months), Rispreridone (1 month), aripiprazole (5 months) leukopenia/neutropenia is occurring during treatment with each molecule and which promptly resolved after discontinuation. Reduced white blood cell count has also been reported after addition of lithium. Actually an ECT is proposed for this patient.

This case report shows the importance of hematological monitoring during the course of typical or atypical treatment.

The authors have not supplied their declaration of competing interest.

Psychotic disorders are serious mental illnesses that compromise the quality of life of patients. It is important to know the characteristics of the affected population, seek to improve the adhesion and functionality.

To describe the sociodemographic characteristics of patients treated with Palmitato Paliperidona (PP). Analyze the efficacy variables, adherence to treatment.

Cross-sectional study of 15 patients in outpatient follow-up after 12 months of treatment with PP. Sociodemographic characteristics are collected, mean dose of PP, through a mirror study. Scales to measure the functionality, clinical status and attitude towards medication apply: Scale of personal and social functioning (PSP), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression Scale (CGI-SI) and attitudes toward Inventory Medication (DAI).

The sample consists of 15 patients (54% male). 81% are single; 77% live alone and 94% not working. The mean dose of PP is 147 mg/month. DAI shows a good attitude to the treatment (80%). The PSP shows that 22% of patients have serious difficulties in its development. The CGI-SI shows that 67% are moderately sick and the BPRS that 33% of patients have a serious disorder.

The demographic profile of patients after 12 months of treatment with PP coincides with male, unmarried, unemployed, living alone. Most have good adherence. The variables measured by the CGI-SI, BPRS and PSP, displayed moderately ill patients with severe difficulties or marked on their autonomy.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Ischemic (veno-occlusive, low flow) priapism is a painful and persistent penile erection unrelated to sexual desire or stimulation. In some cases, it is an adverse event of antipsychotic medications.

An Internet search was initiated using the search engines: Direct Sciences; Medline and keywords “Penile erection; priapism; Antipsychotic agents; Side effects” and we illustrated our literature review by a clinical vignette of a man aged 38 years followed for schizophrenia placed under Fluphenazine 125 mg/month from 5 years who consulted us in may 2015 because of priapism and he described painful and prolonged erection episodes evolving for approximately 5 days.

Medical literature mentions many cases of venous priapism in patients treated by conventional or atypical neuroleptics. About 30% of venous priapisms could be related to drugs of which approximately 50% to neuroleptics. This side effect is related to alpha1-adrenergic blocking properties of these treatments, more or less important depending on the drugs in this class. After emergency treatment, the priapism is the problem of the continued neuroleptic treatment. The substitution of one molecule by another alpha-1 blocking properties to the less marked is recommended.

The venous priapism is a uro-andrological emergency requiring prompt treatment to prevent erectile sequelae.

The authors have not supplied their declaration of competing interest.

Valerian officinalis roots extract is a popular medication for insomnia and anxiety treatment. Sedative effect of Valerian is mainly attributed to the modulation of gabaergic transmission, but its pharmacodynamics has not been fully elucidated.

To investigate the acute effects of Valerian Officinalis extracts intake on corticoexcitability as measured by TMS.

To obtain further data on Valerian pharmacodynamics.

Twelve healthy volunteers participated in a double-blind randomized crossover placebo-controlled study. They were required to take either 900 mg of Valerian officinalis extract (valerenic acid 0.8%) or placebo. Focal TMS of the hand area of left motor cortex was used to test Resting motor threshold (RMT), Motor evoked potentials (MEPs) amplitude and silent period duration (SP). We also tested Short-interval Intracortical Inhibition (SICI), Intracortical facilitation (ICF), Short and Long afferent Inhibition (SAI and LAI). All parameters were investigated at baseline, 1 hour and 6 hours after drug intake. After a 3-week washout period the subjects switched to the alternate arm of the study.

A mixed RMANOVA revealed a significant main effect of “time” [F(1,22) = 4.03, P = 0.02] and a significant “treatment × time” interaction [F(1,22) = 6.3, P = 0.003]. Post-hoc analysis indicated that the amount of ICF was significantly reduced 1 hour after Valerian intake (P = 0.01) returning to baseline values after 6 hours. No significant changes between the Valerian and placebo groups were observed for the other parameters investigated.

The modulation of ICF induced by Valerian officinalis is likely due to glutamatergic antagonism and might underlie the anti-anxiety therapeutic effects.

The authors have not supplied their declaration of competing interest.

Desvenlafaxine is a SNRI which presents low affinity for muscarinic, H1 and α1 in vitro receptors and a marginal hepatic metabolism. Different studies have shown effectiveness and a favorable tolerability profile, but only a few of them have been realized independently.

To study the incidence and characteristics of short-term desvenlafaxine side effects (SE) in daily clinical practice.

A total of 123 patients with recently introduced desvenlafaxine treatment are recruited from Barakaldo and Uribe-Kosta Mental Health Centers, and UKU scale is administered to measure SE. Descriptive data are calculated using SPSS v.22.

SE are observed in 30.09%. Among these, 5.69% experimented improvement or disappearance of SE with dose reduction, whereas 16.26% had to stop DVF treatment. The most frequent SE was nausea/vomiting (7.3%), followed by dry mouth (4.9%), blurred vision (4.9%), tachycardia (4.1%), sexual SE (4.1%) and tension/inner unrest (4.1%). Among the patients with anxiety disorders, 27.78% present SE versus 30.47% of patients with other diagnoses.

The characteristics of SE with DVF in daily clinical practice are comparable to those found in previous studies, and the overall profile is more benign than other AD. Aspects such as gender and sexual function must be considered. In patients with anxious symptoms DVF is also effective and ES are presented similarly, opening a new line of research and treatment of conditions with these characteristics.

The authors have not supplied their declaration of competing interest.