April 2007

Paliperidone (Invega)
Paliperidone (Invega), recently approved to treat schizophrenia, is similar to risperidone (Risperidone) in efficacy and adverse effects.

Methylphenidate for ADHD in Preschool Children
Low doses of methylphenidate (Ritalin and others) are effective and safe for preschool children with ADHD but may cause more side effects than in older children.

A Case of Wernicke's Encephalopathy
Wernicke's encephalopathy is caused by thiamine deficiency, usually due to alcoholism or malnutrition.

In Brief
Taste Altered in Mood Disorders; Reduced Gray Matter May Predict Schizophrenia; FDA Issues Methadone Alert

Two Ineffective Adjuncts for Mania
Olanzapine (Zyprexa) and topiramate (Topamax) add no therapeutic benefit as adjunctive treatments for bipolar disorder.

Schizophrenia, Substance Abuse, and Violence
Substance abuse increases the risk of violent behavior in people with schizophrenia.

Schizophrenia, Substance Abuse, and Violence

April 2007

Predicting violence in patients with chronic mental illness is difficult yet important. The risk of aggression in people with schizophrenia appears to be amplified by comorbid substance abuse. Erkiran and coworkers studied 103 adults with schizophrenia or a related disorder consecutively admitted to a psychiatric hospital in Turkey.1

A recent violent incident occurred more frequently in patients with comorbid substance abuse (51.7%) than in those without (6.7%, P < .001). There was also a trend toward a more common history of criminal offenses in substance-abusing patients. Scores on an overt aggression rating scale were more than 50% higher in patients with comorbid substance abuse. Patients with bizarre behavior were more likely to become violent, while patients with avolition or apathy were less likely. Not surprisingly, a history of criminal offenses coupled with substance use disorder made patients much more likely to become violent.

This is important information for people caring for patients with schizophrenia-related disorders. When they are abusing alcohol or drugs, especially when behavior is bizarre, the risk of violence can become substantial.

1Erkiran M, Özünalan H, Evren C, Aytaçlar S, Kirisci L, Tarter R: Substance abuse amplifies the risk for violence in schizophrenia spectrum disorder. Addict Behav 2006;31:1797-1805.