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Marc Ziegenbein, M.D., Social Psychiatry and Psychotherapy, Medical School Hannover,
Hannover, Germany, Marcel Sieberer, M.D., Social Psychiatry and Psychotherapy,
Medical School Hannover, Hannover, Germany, Stefan Kropp, M.D., Clinical Psychiatry
and Psychotherapy, Medical School Hannover, Hannover, Germany
It has been proposed that low-dose atypical antipsychotic drugs like amisulpride
are beneficial in schizophrenic patients with negative symptoms (1). The second-generation
atypical drug amisulpride is a substituted benzamide derivative with specific
antagonistic properties, which target dopamine D2 and D3 receptors, preferentially
in the limbic system rather than in the striatum (2).
At low doses, amisulpride binds preferentially to presynaptic receptors, increasing dopaminergic transmission, and at high doses the postsynaptic receptor blockade induces a decrease in dopaminergic transmission.
A few studies suggest that the combination of clozapine and amisulpride is useful in patients with treatment-resistant schizophrenia (3). Despite the fact that amisulpride has been licensed in France for more than one decade, there are neither reports nor studies available about the usefulness of this compound in elderly schizophrenic patients or patients with residual schizophrenia.
We describe a 55-year-old female Caucasian patient with paranoid schizophrenia
who was first seen in our department 28 years ago. In 1999 she was admitted
to our psychiatric hospital again. To our knowledge there was no exposure to
classic or atypical antipsychotics for at least 11 years. The patient was alert
but neither oriented towards person, situation, nor time. Speech was reduced
to short answers, without modulation. The affect was emotionless, indifferent
and flat. While answering questions, the face was emotionless, psychomotoric
movements were sparse. Visual contact was absent. There were acoustic hallucinations
(commenting voices without threat but of indifferent character). Suicidal thoughts
were absent.
The physical examination showed a stiff left hip after a pelvis- and hip-fracture
and a scar in the right renal area after renal explantation after a truck-accident
at the age of eigth years. Blood tests, ECG and EEG revealed no abnormal findings,
whereas the MRI revealed an old small ischemic area of the A. cerebri posterior.
An antipsychotic pharmacotherapy with risperidone up to 4mg daily was started,
in combination with 450mg valproate. As a generalized stiffness and slight rigor
appeared, 4mg retarded bipiridine daily was added. As the psychopathological
pattern improved only gradually and with first signs of extrapyramidal side
effects (EPS) risperidone was discontinued. Amisulpride in combination with
valproate was given instead an the dose was increased up to 500mg daily. Hallucinations
disappeared and the patient was beginning to concentrate on reading and took
part in many activities.
It has been proposed that the atypical antipsychotic amisulpride might be beneficial
in case of primary negative schizophrenic symptoms. In this paticcular case
clinical and social symptoms now improved beyond our expectations, neurological
or renal side-effects were absent until discharge. In our case 500mg amisulpride
appeared to be safe and very effective in ameliorating primary negative symptoms
in this patient with residual schizophrenia. In contrast to recent clinical
studies which recommend a much lower dose for chronic patients (4), we found
500mg of amisulpride daily very effective.
We conclude that primary negative symptoms of chronic schizophrenia in elderly patients might be improved substancially with amisulpride in combination with mood stabilizers and controlled studies should further elucidate this therapeutic option.
1. Boyer P, Lecrubier Y, Puech AJ, Dewailly J, Aubin F. Treatment of negative
symptoms in schizophrenia with amisulpride. Br J Psychiat 1995;166(1):68-72
2. Curran MP, Perry CM. Amisulpride: a review of its use in the managent of
schizophrenia. Drugs 2001; 61(14):2123-2150
3. Zink M, Knopf U, Henn FA, Thome J. Combination of clozapine and amisulpride
in treatment-resistant schizophrenia- case reports and review of the literature.
Pharmacopsychiatry 2004; 37(1):26-31
4. Danion JM, Rein W, Fleurot O. Improvement of schizophrenic patients with
primary negative symptoms treated with amisulpride. Amisulpride Study Group.
Am J Psychiat 1999; 156(4): 610-616
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All pages copyright ©Priory Lodge Education Ltd 1994-2005.
First Published April 30 2005