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August 2008

High-Dose Olanzapine in Treatment-Resistant Schizophrenia
For some treatment-resistant patients with schizophrenia, high-dose olanzapine might be a better option than clozapine.

Increased Stroke Risk in Schizophrenia Patients
Patients with schizophrenia appear to have an increased risk of stroke, and the risk may be higher for women than for men.

Tamoxifen for Mania?
Through inhibition of protein kinase C, tamoxifen may benefit patients with mania and merits further study.

In Brief
Genetic Variations in Patients with Schizophrenia; Zonisamide for Weight Loss in Bipolar Disorder; Music Therapy for Stroke Recovery

NMS in Children and Adolescents
The neuroleptic malignant syndrome is a risk in children and adolescents treated with second-generation antipsychotics.

Options for SSRI-Resistant Depression in Adolescents
In a study by Brent et al, depressed adolescents who did not respond sufficiently to an SSRI benefited from switching to a different antidepressant and cognitive behavioral therapy.

In Brief

August 2008

New research suggests that rare genetic microdeletions and microduplications, also known as structural variants, occur more frequently among people with schizophrenia than among unaffected individuals. Using microarray comparative hybridization of genomic DNA, Walsh and colleagues found novel deletions and duplications of genes in 15% of 150 people with schizophrenia but in only 5% of 268 ancestry-matched controls, a highly significant difference (Science 2008;320:539-543). Among patients with early-onset schizophrenia (the development of symptoms by age 18 years or younger), the incidence was 20%. In addition, the genes disrupted by structural mutations in patients were more likely than those disrupted in controls to encode proteins critical to brain development.

Adjunctive treatment with the anticonvulsant zonisamide (Zonegran and others) helped patients with bipolar disorder lose weight but was poorly tolerated (Wang et al. J Psychiatr Res 2008;42:451-457). Zonisamide was added to treatment as usual in recovered patients with bipolar disorder who had been euthymic for at least two months. There was a significant decrease in mean body mass index (BMI) and an average loss of about 0.25 kg (0.56 lb) per week. However, 18 (72%) of the 25 subjects discontinued treatment early: 11 (44%) due to emergent mood symptoms, 5 (20%) due to physical adverse events (including nausea, paresthesias, and rash), and 2 (8%) due to patient choice. The authors point out that emerging mood symptoms, especially depression, are typical during long-term maintenance treatment of bipolar disorder, and may not have been a result of zonisamide treatment.

In a single-blind, randomized controlled trial, Sarkamo and others studied the effects of music therapy in patients with a left or right hemisphere middle cerebral artery ischemic stroke (Brain 2008;131:866-876). The subjects' mean age was 59 years and 53% were male. For 2 months, 1 hour a day, 20 subjects listened to self-selected music, while 20 listened to audio books. The 20 control subjects received no experimental intervention. Standard medical care and rehabilitation was provided for all patients. On a neuropsychological test battery at 3 and 6 months, verbal memory and focused attention improved significantly more in the music group than in either of the other two groups. The advantage for music was especially evident in patients with left hemisphere stroke.

Heather S. Hopkins