BACKGROUND Tardive dyskinesia(TD)is a serious and disabling movement disorder;it impairs social function and quality of life and increases the mortality rate.TD is usually induced by the use of antipsychotic drugs;how...BACKGROUND Tardive dyskinesia(TD)is a serious and disabling movement disorder;it impairs social function and quality of life and increases the mortality rate.TD is usually induced by the use of antipsychotic drugs;however,the underlying mechanism remains unclear.Pharmacotherapy of TD includes cholinergic drugs,benzodiazepines,ginkgo biloba extract(GBE),antioxidants,amantadine,propanolol,botulinum toxin,valbenazine,and deutetrabenazine,whereas the non-pharmacotherapy approach includes modified electroconvulsive therapy(MECT)and deep brain stimulation.We successfully treated a chronic schizophrenia patient with comorbid long-term severe TD using deutetrabenazine,clozapine,and MECT.CASE SUMMARY A 69-year-old woman who was diagnosed as having schizophrenia 16 years ago developed severe TD after 6-mo prescription of risperidone oral solution.Her TD symptoms did not resolve despite various treatments,such as GBE,vitamin E,trihexyphenidyl,promethazine,benzodiazepines,and switching to quetiapine and olanzapine.After admission,she was given deutetrabenazine 6 mg bid.Her buccal tremor was slightly resolved 3 d later;however,her tongue remained protruded and could not be retracted.Quetiapine was switched to clozapine on day 4,and the buccal tremor remarkably resolved,and the tongue could be retracted into the mouth from day 6 onward.After three sessions of MECT,the buccal tremor resolved further.Since then,she has been able to take a semifluid diet,and her quality of life improved remarkably during 6 mo of follow-up.CONCLUSION TD is a serious condition which could be caused by antipsychotic medications;however,the best strategy against TD is prevention and monitoring during using antipsychotics.For patients with TD caused by antipsychotic medication use,multiple measures should be considered like switching to clozapine,adjunction with deutetrabenazine,or even MECT.展开更多
BACKGROUND Sleep dysfunction is a common problem in people with schizophrenia,and side effects of treatment often exacerbate metabolic and cardiovascular risk and may induce extrapyramidal side effects.Melatonin(N-ace...BACKGROUND Sleep dysfunction is a common problem in people with schizophrenia,and side effects of treatment often exacerbate metabolic and cardiovascular risk and may induce extrapyramidal side effects.Melatonin(N-acetyl-5-methoxytryptamine)is an endogenously produced hormone which has demonstrated direct and indirect antioxidant and neuroprotective effects.Previous studies have explored the use of exogenous melatonin in improving sleep outcomes in the general population,yet indications for use in schizophrenia are unclear.AIM To synthesize the evidence from clinical trials investigating prescribed melatonin as an adjunctive therapy in patients with schizophrenia.METHODS A systematic literature review of MEDLINE(Ovid),Embase,PsychINFO,and PubMed on the 27/08/20;and CINAHL and Cochrane Library databases,was conducted.Inclusion criteria were:a peer-reviewed clinical trial published in English;included a group of patients with schizophrenia;used melatonin as an adjunctive therapy;and reported any outcome of any duration.Exclusion criteria were:neurodegenerative diseases,primary sleep disorders,co-morbid substance use or animal studies.RESULTS Fifteen studies were included in the current review with the following primary outcomes:sleep(n=6),metabolic profile(n=3),tardive dyskinesia(n=3),cognitive function(n=2)and benzodiazepine discontinuation(n=1).CONCLUSION Adjunctive melatonin therapy has some positive outcomes for sleep,metabolic profile and tardive dyskinesia in patients with schizophrenia.No beneficial effect of melatonin was observed on outcomes of cognition or benzodiazepine discontinuation.Future studies utilizing larger samples and investigations specifically comparing the effect of melatonin as adjunctive therapy with different antipsychotics in patients with schizophrenia are required.展开更多
Adjunctive melatonin use in schizophrenia, as supported by a modicum ofevidence, has multiple transcending chronobiotic actions, including fixingconcurrent sleep problems to bona fide augmentative antipsychotic action...Adjunctive melatonin use in schizophrenia, as supported by a modicum ofevidence, has multiple transcending chronobiotic actions, including fixingconcurrent sleep problems to bona fide augmentative antipsychotic actions,mitigating the risk of tardive dyskinesias, curbing the drastic metabolic syndromeand ultimately providing neuroprotective actions. Its use is rather an art thanscience!展开更多
基金Science and Technology Program of Huzhou City,No.2023GYB32.
文摘BACKGROUND Tardive dyskinesia(TD)is a serious and disabling movement disorder;it impairs social function and quality of life and increases the mortality rate.TD is usually induced by the use of antipsychotic drugs;however,the underlying mechanism remains unclear.Pharmacotherapy of TD includes cholinergic drugs,benzodiazepines,ginkgo biloba extract(GBE),antioxidants,amantadine,propanolol,botulinum toxin,valbenazine,and deutetrabenazine,whereas the non-pharmacotherapy approach includes modified electroconvulsive therapy(MECT)and deep brain stimulation.We successfully treated a chronic schizophrenia patient with comorbid long-term severe TD using deutetrabenazine,clozapine,and MECT.CASE SUMMARY A 69-year-old woman who was diagnosed as having schizophrenia 16 years ago developed severe TD after 6-mo prescription of risperidone oral solution.Her TD symptoms did not resolve despite various treatments,such as GBE,vitamin E,trihexyphenidyl,promethazine,benzodiazepines,and switching to quetiapine and olanzapine.After admission,she was given deutetrabenazine 6 mg bid.Her buccal tremor was slightly resolved 3 d later;however,her tongue remained protruded and could not be retracted.Quetiapine was switched to clozapine on day 4,and the buccal tremor remarkably resolved,and the tongue could be retracted into the mouth from day 6 onward.After three sessions of MECT,the buccal tremor resolved further.Since then,she has been able to take a semifluid diet,and her quality of life improved remarkably during 6 mo of follow-up.CONCLUSION TD is a serious condition which could be caused by antipsychotic medications;however,the best strategy against TD is prevention and monitoring during using antipsychotics.For patients with TD caused by antipsychotic medication use,multiple measures should be considered like switching to clozapine,adjunction with deutetrabenazine,or even MECT.
文摘BACKGROUND Sleep dysfunction is a common problem in people with schizophrenia,and side effects of treatment often exacerbate metabolic and cardiovascular risk and may induce extrapyramidal side effects.Melatonin(N-acetyl-5-methoxytryptamine)is an endogenously produced hormone which has demonstrated direct and indirect antioxidant and neuroprotective effects.Previous studies have explored the use of exogenous melatonin in improving sleep outcomes in the general population,yet indications for use in schizophrenia are unclear.AIM To synthesize the evidence from clinical trials investigating prescribed melatonin as an adjunctive therapy in patients with schizophrenia.METHODS A systematic literature review of MEDLINE(Ovid),Embase,PsychINFO,and PubMed on the 27/08/20;and CINAHL and Cochrane Library databases,was conducted.Inclusion criteria were:a peer-reviewed clinical trial published in English;included a group of patients with schizophrenia;used melatonin as an adjunctive therapy;and reported any outcome of any duration.Exclusion criteria were:neurodegenerative diseases,primary sleep disorders,co-morbid substance use or animal studies.RESULTS Fifteen studies were included in the current review with the following primary outcomes:sleep(n=6),metabolic profile(n=3),tardive dyskinesia(n=3),cognitive function(n=2)and benzodiazepine discontinuation(n=1).CONCLUSION Adjunctive melatonin therapy has some positive outcomes for sleep,metabolic profile and tardive dyskinesia in patients with schizophrenia.No beneficial effect of melatonin was observed on outcomes of cognition or benzodiazepine discontinuation.Future studies utilizing larger samples and investigations specifically comparing the effect of melatonin as adjunctive therapy with different antipsychotics in patients with schizophrenia are required.
文摘Adjunctive melatonin use in schizophrenia, as supported by a modicum ofevidence, has multiple transcending chronobiotic actions, including fixingconcurrent sleep problems to bona fide augmentative antipsychotic actions,mitigating the risk of tardive dyskinesias, curbing the drastic metabolic syndromeand ultimately providing neuroprotective actions. Its use is rather an art thanscience!
