July 2010

Omega-3 Fatty Acids and Exercise for Psychosis?
Omega-3 fatty acid supplementation and exercise are relatively benign interventions that might prevent symptoms and improve outcome in patients with or at high risk of developing chronic psychotic disorders.

Long-Acting Injectable Risperidone Often Discontinued
In a study of patients with schizophrenia in the US Department of Veterans Affairs health care system, clozapine (Clozaril and others) had the highest continuation rate over 1 to 2 years, while long-acting injectable risperidone (Risperdal Consta) was discontinued by over half of patients for whom it was prescribed.

Can Molindone Help with Weight Loss?
Molindone (Moban) may produce modest benefits for weight loss in patients taking antipsychotics but carries the risk of long-term movement disorders and is no longer available in the United States.

In Brief
Depression Care Initiative Reduces Suicide Rate to Zero; Ecstasy Decreases Serotonin Transporter Binding in Brain Regions Associated with Memory

Adjunctive Aspirin Reduces Schizophrenia Symptoms
Preliminary data suggest aspirin might reduce schizophrenia symptoms through its anti-inflammatory properties.

Torsade de Pointes and Ziprasidone
The second case of torsade de pointes following ziprasidone (Geodon) overdose reported in the medical literature involved multiple risk factors for triggering the life-threatening ventricular arrhythmia.

Adjunctive Aspirin Reduces Schizophrenia Symptoms

July 2010

Inflammatory processes are being seen increasingly as culprits in a wide range of illnesses—from cardiovascular through neuropsychiatric disorders. Several lines of evidence suggest that inflammation might contribute to the pathology of schizophrenia and, working on this hypothesis, investigators have tried anti-inflammatory agents as treatments (BTP 2009;32:16). Several studies with the selective cyclooxygenase-2 (COX-2) inhibitor celecoxib (Celebrex and others) have yielded mixed results.1 Now come data from a randomized, double-blind, placebo-controlled trial of adjunctive aspirin in schizophrenia.

Laan and others in the Netherlands treated 70 inpatients and outpatients with schizophrenia spectrum disorders with standard antipsychotic drugs and either aspirin, 1000 mg/day, or placebo.1 Patients were continued on their antipsychotics—olanzapine (Zyprexa), clozapine (Clozaril and others), or risperidone (Risperdal and others)—for the 3 months of this protocol. The total and positive subtotal scores on the Positive and Negative Syndrome Scale (PANSS) were significantly higher in patients assigned to aspirin compared with those who took placebo. Moreover, patients who showed a greater anti-inflammatory immune response to aspirin benefited more from it symptomatically.

In some ways, the effects of aspirin, which unselectively inhibits both COX-1 and COX-2 enzymes, are more benign than those of COX-2 inhibitors, which can elevate cardiovascular risk. The authors note, however, that aspirin can lead to gastric side effects, such as bleeding. The risk of gastric effects can be lowered by the concomitant use of proton pump inhibitors.

These findings call for replication, and it would be premature now to begin administering aspirin specifically to benefit schizophrenia symptoms. Nonetheless, the data are encouraging, and we will watch future developments with interest.

1Laan W, Grobbee DE, Selten JP, Heijnen CJ, Kahn RS, Burger H: Adjuvant aspirin therapy reduces symptoms of schizophrenia spectrum disorders: Results from a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 2010;71:520-527.