2012, volume 28, issue 2

Review article

Combination treatment with mood-stabilizing drugs in bipolar affective illness

Janusz Rybakowski, Jan Jaracz
Farmakoterapia w Psychiatrii i Neurologii, 2012, 2, 73–80

In this paper, information has been presented on combination therapy with the use of mood-stabilizing drugs in bipolar affective illness, in the context of pharmacokinetic and pharmacodynamic properties of these drugs. A concept of classifi cation of mood-stabilizing drugs into fi rst- and second generation mood stabilizers has been discussed, based on a chronology of introducing these drugs to therapy of bipolar affective illness. The possibilities of employing mood-stabilizing drugs in combination treatment of mania and depression in the course of bipolar affective illness as well as for a prophylaxis of affective recurrences in this illness have been presented. In the further part of the paper, data on pharmacokinetic and pharmacodynamic interactions have been discussed concerning mood-stabilizers of fi rst generation such as lithium, valproates and carbamazepine as well as of second generation including clozapine, olanzapine, quetiapine, aripiprazole, risperidone and lamotrigine.

Original article

Efficacy of single ketamine infusion in bipolar depression not improved after antidepressant treatment

Agnieszka Permoda-Osip, Rafał Adamski, Alicja Bartkowska-Śniatkowska, Maria Chłopocka-Woźniak, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii, 2012, 2, 81–86

Background. The aim of study was to investigate the antidepressant action of single ketamine infusion, in patients with bipolar depression receiving mood-stabilizing drugs which have not improved after treatment with antidepressants.
Methods. The study comprised 25 patients (21 women, 4 men), aged 27 to 67 years with depressive episode in the course of bipolar mood disorder (BD). All patients received at least one mood-stabilizing medication of fi rst or/and second generation and their depression was resistant to antidepressant treatment. After discontinuation of antidepressant drugs for at least 7 days, patients received intravenous infusion of ketamine (0,5 mg/kg body weight). Psychometric assessment was done using 17-item Hamilton Depression Rating Scale (HDRS) before the infusion, after 6, 12, 24 hours and on 3, 7, 10 and 14 day after ketamine.
Results. The mean intensity of depression before ketamine infusion on HDRS was 21±5 points, reduced to 19±8 after 6 h, to 16±9 on the second day, to 12±7 on the 7 th day, and to 11±7 points on the 14 th day after ketamine. Response to treatment (reduction of ≥50% on HDRS) in one patient occurred after 6 hours, in ¼ of patients after 24 hours and in 52% of patients after 7 and 14 days. Four patients obtained remission (≤7 points on HDRS) on the second day after infusion, eight were in remission after 7 days, and twelve after 14 days. The infusion was well tolerated.
Conclusion. The results confi rm a rapid antidepressant effect of ketamine infusion, sustained for at least 14 days, in a signifi cant proportion of patients with depression in the course of BD, receiving mood-stabilizing drugs and resistant to previous treatment with antidepressants.

Case report

Combined treatment with sertindole and clozapine for patients with drug-resistant schizophrenia. 4 cases reports

Bożena Śpila
Farmakoterapia w Psychiatrii i Neurologii, 2012, 2, 87–93

We report four cases (2 men and 2 women) of schizophrenia patients resistant to pharmacological treatment, in whom all neuroleptics available in Poland were used without satisfactory effect. Patients were treated in the Department of Psychiatry of Medical University of Lublin between 2008 and 2011. The applied combined therapy consisted of sertindole, 16–20 mg/d and clozapine, 100–600 mg/d. A signifi cant improvement of the mental state was achieved during the first two months of gradually introduced treatment. In all patients, a signifi cant reduction of positive and deficit symptom occurred as well as improvement in functioning. Monitoring of the heart did not reveal prolongation of the QT segment or the QTc, and no arrhythmias were observed. The results obtained show that combined treatment with sertindole and clozapine was found to be effective and safe for patients with drug-resistant schizophrenia.

Case report

Extrapiramidal symptoms presented as „rabbit syndrome” in the course of risperidone treatment

Ewa Ferensztajn, Maria Chłopocka-Woźniak, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii, 2012, 2, 95–99

Rabbit syndrome is a rare extrapiramidal symptom induced by prolonged neuroleptic administration. It is characterized by fi ne, rapid, rhytmic movements of the perioral muscles and the masseters along a vertical axis of the mouth, without involvement of the tongue and is often misdiagnosed as a tardive dyskinesia. It shows favourable resonse to anticholinergic agents, and a deterioration after treatment with dopamine agonists. Recent treatment strategies include changing antipsychotic drug to atypical neuroleptic with anticholinergic properties, such as olanzapine or clozapine. We describe a case of a patient with bipolar disorder in the course of treatment with the drug induced rabbit syndrome. The change of treatment from risperidone to clozapine has resulted in a rapid, signifi cant reduction of symptoms.

Case report

Pharmacological treatment of mental disorders in the course of Jadassohn syndrome – case report

Karol Świeca, Jan Jaracz, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii, 2012, 2, 101–106

Jadassohn’s syndrome (linear nevus sebaceus syndrome) is relatively common (1/1000 live births) congenital syndrome among phacomatoses. Characteristic symptoms include syndrome-specifi c sebaceous nevi (nevi of Jadassohn) in Voight or Blaschko lines, mental retardation and epileptic seizures resulting from CNS developmental abnormalities (Solomon, Esterly 1975). The article presents the course and effects of pharmacological therapy of behavioral and mood disorders in 19-years old patient with Jadassohn syndrome, hospitalized twice at the Department of Adult Psychiatry in Poznan University of Medical Sciences.