February 2007

Acupuncture for Depression: Missing the Point
Depression-specific acupuncture was no better than nonspecific acupuncture for patients with major depression.

Adjunctive Galantamine in Schizophrenia
Galantamine (formerly Reminyl, currently Razadyne) added to risperidone (Risperdal) treatment for schizophrenia patients offered some benefits.

Adverse Effects of Erectile Dysfunction Drugs
Drugs for erectile dysfunction, such as sildenafil (Viagra) and vardenafil (Levitra), may worsen sleep apnea and can cause seizures.

Deep brain stimulation decreased obsessive compulsive symptoms in 10 patients.

Clozapine for Treatment-Resistant Schizophrenia
Clozapine (Clozaril and others) was superior to other second-generation antipsychotics for treatment-resistant patients with schizophrenia.

In Brief
Rasagiline Approved for Treatment of Parkinson's Disease; Paliperidone Approved for Treatment of Schizophrenia; PCOS Reversed When Valproate Discontinued.

Antipsychotics and New MIs
A large study suggests that antipsychotic drugs do not increase the risk of a new myocardial infarction (heart attack).

Take Ziprasidone with Food
Adequate absorption of ziprasidone is promoted by taking it with a meal that contains at least 30% fat.

Adjunctive Galantamine in Schizophrenia

February 2007

Treating people with schizophrenia is no easy task. Treatment goals are usually modest, with full reversal of symptoms rare.1 Antipsychotics are, of course, the mainstay of treatment.

Some of the greatest functional burden levied by schizophrenia comes not from the symptoms of psychosis as much as from cognitive impairment-—including problems with memory, attention, learning, and executive functioning. Antipsychotics, particularly the second generation, appear to provide some benefit for cognitive symptoms of schizophrenia. Schubert and others studied adjunctive galantamine (formerly Reminyl, currently Razadyne), approved by the US Food and Drug Administration for the treatment of mild to moderate dementia of Alzheimer's disease, for patients with schizophrenia.2

Subjects in this study were 16 men and 1 woman, aged 26 to 55 years, who carried diagnoses of schizophrenia or schizoaffective disorder. The patients had been taking stable doses of risperidone (Risperdal), 4 or 6 mg daily, for at least 4 weeks. In double-blind fashion, patients were randomly assigned to added treatment with either placebo or galantamine, beginning with 4 mg twice daily and progressing up to 24 mg/day, for 8 weeks.

Overall symptoms of schizophrenia improved in both groups. But cognitive improvement, particularly attention and delayed memory, were significantly better in patients who took galantamine (P < .04). Galantamine was well tolerated. Consistent with hypotheses about cholinergic therapies for tardive dyskinesia (BTP 2006;29:47-48), scores on the Abnormal Involuntary Movement Scale improved in patients who took galantamine.

Galantamine is a reversible, competitive acetylcholinesterase inhibitor and also acts on nicotinic acetylcholine receptors. Its most common adverse effects presumably reflect its cholinergic activity and include nausea, vomiting, dizziness, diarrhea, anorexia, and weight loss.

Patients with schizophrenia need all the help they can get. This was an encouraging but preliminary study involving only a small number of patients. Cognitive function was assessed with a neuropsychological test battery. It will be interesting in subsequent studies to see what impact these presumed cognitive benefits have on actual functioning. For now, the work of Dr Schubert's group presents a promising lead worth pursuing.

1Lambert M, Schimmelmann BG, Naber D, Schacht A, Karow A, Wagner T, Czekalla J: Prediction of remission as a combination of symptomatic and functional remission and adequate subjective well-being in 2960 patients with schizophrenia. J Clin Psychiatry 2006;67:1690-1697.

2Schubert MH, Young KA, Hicks PB: Galantamine improves cognition in schizophrenic patients stabilized on risperidone. Biol Psychiatry 2006;60:530-533.