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Fulltext Marked junctional bradycardia, prolonged QT interval and torsade de pointes in acute phenothiazine intoxication in a schizophrenic patient. A case report

Quek DK, Ong SB, Chan PY

Med J Malaysia, 1988 Jun;43(2):173-7.
PMID: 2907093
Matched MeSH terms: Antipsychotic Agents/poisoning*
Failure of clonidine in tardive dystonia: implications for nosology

Adityanjee, Singh S, Subramaniam M

Biol Psychiatry, 1989 Jun;26(2):199-202.
PMID: 2567611
Matched MeSH terms: Antipsychotic Agents/administration & dosage; Antipsychotic Agents/adverse effects*
Fulltext Neuroleptic malignant syndrome with renal and respiratory complications--a case report

Liam CK, Ong SB

Singapore Med J, 1990 Apr;31(2):182-4.
PMID: 1973548

The neuroleptic malignant syndrome is an idiosyncratic reaction to neuroleptic therapy which sometimes can be fatal because of the various associated complications. We describe a schizophrenic patient who, after commencement of haloperidol, developed this reaction which was complicated by acute oliguric renal failure and aspiration pneumonia. It is mandatory that the patient is treated in a medical intensive care unit once the syndrome is recognised. The management of the neuroleptic malignant syndrome and its complications is discussed.

Matched MeSH terms: Antipsychotic Agents/adverse effects
Fulltext Neuroleptic malignant syndrome in Malaysia: a university hospital experience

Lee MK, Ong SB, Tan CT, Loh TG

Med J Malaysia, 1992 Sep;47(3):200-7.
PMID: 1362794

The neuroleptic malignant syndrome (NMS) is a potentially fatal complication of antipsychotic therapy. A retrospective study of nine patients seen over six years at the University Hospital, Kuala Lumpur (UHKL), is described. The estimated annualised incidence was 1.2 per 1000 in-patients with psychosis. No ethnic difference was detected. Clinical features were similar to experiences elsewhere, with wide variability seen in the severity of illness. The neuroleptic drugs implicated were haloperidol, trifluoperazine, chlorpromazine, fluphenazine and clopenthixol. Treatment consisted of withdrawal of offending drugs and supportive measures. Specific therapy was given to five patients. There was one death. At follow-up no deterioration was detected. A different neuroleptic drug was successfully re-introduced in four patients. In view of the wide usage of major tranquillizers, a high degree of clinical awareness of this serious complication is necessary for early diagnosis to reduce morbidity and mortality.

Matched MeSH terms: Antipsychotic Agents/adverse effects
Clinical evaluation and serum concentration of zuclopenthixol acetate in psychotic Asian patients: a single-dose preliminary study

Tan CH, Low BL, Ng LL, Khoo YM, Lee HS

Ther Drug Monit, 1993 Apr;15(2):108-12.
PMID: 8099240

Nineteen acutely disturbed psychotic Asian patients were treated with a single intramuscular injection of 50 mg of zuclopenthixol acetate in Viscoleo. Patients were assessed clinically before and after treatment using the Brief Psychiatric Rating Scale (BPRS). Serum zuclopenthixol and the inactive geometric isomer trans(E)-clopenthixol were determined by high-performance liquid chromatography after intramuscular injection. All patients improved, with the BPRS being significantly reduced (p < 0.001) at 72 h after injection. Adverse effects were generally few. The mean +/- SEM serum zuclopenthixol concentrations at 24, 48, and 72 h were 19.9 +/- 2.8, 31.5 +/- 4.5, and 17.8 +/- 2.9 micrograms/L, respectively. trans(E)-Clopenthixol concentrations ranged from negligible to 39.5 micrograms/L. This study confirms that a single intramuscular injection of 50 mg is adequate for managing severely disturbed psychotic patients for the first 3 days. The serum zuclopenthixol concentrations attained in the Asian patients were higher than those reported in Caucasian psychiatric patients. In some patients, a considerable amount of zuclopenthixol had been transformed to trans(E)-clopenthixol.

Matched MeSH terms: Antipsychotic Agents/administration & dosage; Antipsychotic Agents/blood*; Antipsychotic Agents/therapeutic use
Oculogyric spasm in Asian psychiatric in-patients on maintenance medication

Tan CH, Chiang PC, Ng LL, Chee KT

Br J Psychiatry, 1994 Sep;165(3):381-3.
PMID: 7994510

BACKGROUND: The objective was to investigate the occurrence and characteristics of oculogyric spasm (OGS) in an Asian country.
METHOD: All 2035 Asian (88% Chinese, 7% Malays and 5% Indonesians) psychiatric in-patients in the state psychiatric hospital in Singapore were surveyed for occurrence of oculogyric spasm (OGS) over a two-month period.
RESULTS: Thirty-four patients (1.7%) developed OGS (53% male and 47% female). All the 34 patients had been on maintenance antipsychotic drugs for more than five months. Eighteen patients had recurrent attacks. The mean chlorpromazine equivalent daily dose for those patients with recurrent OGS was 511 mg. This was significantly higher (P < 0.05) than the 277 mg daily dose received by those without recurrent OGS. Most (68%) of the attacks occurred between 1400-2000 h suggesting that OGS may have a diurnal variation.
CONCLUSIONS: OGS presenting as tardive dystonia may be due to a relative increase in cholinergic activity.

Matched MeSH terms: Antipsychotic Agents/administration & dosage; Antipsychotic Agents/adverse effects*
Fulltext All elevated creatine kinase is not neuroleptic malignant syndrome

Maniam T, Rahman MA

Med J Malaysia, 1994 Sep;49(3):252-4.
PMID: 7845275

Creatine kinase (CK) is an enzyme that is found widely in muscle tissues. Raised levels would occur when there is muscle damage. Raised levels are used as one of the diagnostic criteria for Neuroleptic Malignant Syndrome (NMS). This study looks at CK levels in 30 psychotic inpatients without NMS and compares them with 10 patients with NMS. It was found that 67% of the patients without NMS had raised CK levels, 20% of whom had levels in excess of 1000 IU/L. The rest had a two to five-fold increase over normal limits. Raised levels were associated with the use of intramuscular injections and physical restraints, situations which are well known to result in muscle injury. All the NMS patients had raised CK levels but 40% had levels below 1000 IU/L. Our findings support the idea that CK levels, though helpful, should be interpreted with care as raised levels are nonspecific.

Matched MeSH terms: Antipsychotic Agents/administration & dosage*; Antipsychotic Agents/adverse effects
Fulltext Neuroleptic drug utilisation for acute schizophrenia

Razali MS, Hasanah CI

Singapore Med J, 1996 Dec;37(6):611-3.
PMID: 9104062

The aim of this study was to find the dosage and pattern of neuroleptic drug utilisation for the treatment of acute schizophrenia in a general psychiatry ward. This is an uncontrolled study involving 112 schizophrenic inpatients. Patients' socio-demographic variables, the type and peak daily doses of neuroleptics prescribed to them were analysed. Chlorpromazine was the most commonly prescribed drug. The peak mean daily dose required by the patients was equivalent to 537 mg of chlorpromazine; and 400 to 600 mg/ day of chlorpromazine or its equivalent was generally sufficient to treat acute psychosis. The majority of the patients received neuroleptics within this dose range. Low potency drugs were prescribed in lower doses than high potency drugs. Patients treated with depot preparation tended to receive higher doses of medication than those prescribed oral medication alone. The doses of neuroleptics were significantly correlated with duration of admission.

Matched MeSH terms: Antipsychotic Agents/administration & dosage*
Fulltext A 3 year case study of alcohol related psychotic disorders at Hospital Seremban

George S, Chin CN

Med J Malaysia, 1998 Sep;53(3):223-6.
PMID: 10968157

This paper reports the characteristics and psychopathology of alcohol dependents with alcohol induced psychotic disorder admitted to the Seremban Hospital. The method is that of a case study of all alcohol dependents with alcohol induced psychotic disorder admitted to the Psychiatric Ward, Hospital Seremban over 3 years (1993-1995). There were 34 subjects, 30 Indians, 3 Chinese and 1 Malay with a mean age of 43 years. 32 were men and predominantly of Social Class IV and V (91%). They had a mean duration of drinking of 14.2 years and had a mean weekly consumption of 69.5 units of alcohol. There was a family history of alcohol dependence in (44%). The majority (68%) consumed samsu with beer the second choice. Auditory hallucinations (26) and delusions (16) were common while visual hallucinations (3) and depression (2) were less frequent. Speech disorder occurred in 4 subjects. 2 developed delirium tremens and 1 died. Liver function test was normal in 55%. All except the death from delirium tremens responded to treatment with a combination of anxiolytics, thiamine and antipsychotics and were rapidly discharged. The mean stay was 7 days. However, (68%) did not return for follow up and only 4 were abstinent from alcohol at the time of follow up.

Matched MeSH terms: Antipsychotic Agents/therapeutic use
Fulltext A double blind comparison of zuclopenthixol acetate with haloperidol in the management of acutely disturbed schizophrenics

Chin CN, Hamid AR, Philip G, Ramlee T, Mahmud M, Zulkifli G, et al.

Med J Malaysia, 1998 Dec;53(4):365-71.
PMID: 10971979

The aim of this study was to evaluate the efficacy and side effects of zuclopenthixol acetate compared with haloperidol in the management of the acutely disturbed schizophrenic patient. Suitable subjects diagnosed as having schizophreniform disorder or acute exacerbation of schizophrenia admitted to the psychiatric wards Hospital Kuala Lumpur were randomised to receive either zuclopenthixol acetate or haloperidol. They were rated blind for three consecutive days using the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) and UKU Side Effects Scale. Apart from repeat injections of the same medication, no other anti-psychotic was given for the duration of the study. 50 subjects entered the study of which 44 completed. 23 were given zuclopenthixol acetate and 21 haloperidol. Both groups significantly reduced BPRS and CGI scores on all 3 days compared to the initial rating (p < 0.001). There was however no difference between the zuclopenthixol acetate and haloperidol group scores on all days (p > 0.05). More subjects on haloperidol than zuclopenthixol required more than 1 injection during the study. Both groups had minimal side effects. Zuclopenthixol acetate was effective in the management of the acutely disturbed schizophrenic.

Matched MeSH terms: Antipsychotic Agents/adverse effects; Antipsychotic Agents/therapeutic use*
Fulltext Comparison of risperidone and other neuroleptics in the management of chronic schizophrenia using cognitive therapy

Azhar MZ

Med J Malaysia, 2000 Mar;55(1):7-13.
PMID: 11072484

A number of psychological approaches to alleviating psychotic symptoms have been reported in the literature. The latest technique among them is cognitive therapy (CT). This paper describes an open trial that makes use of cognitive psychotherapy to treat chronic drug resistant delusions (more than 2 years duration) in 20 patients with schizophrenia. The positive response of all patients with the absence of symptom replacement and maintenance of response at 3 months follow-up, seem to imply that this technique is useful and more effort needs to be invested into this new area of psychotherapy for psychosis. This paper also shows that those patients on risperidone maintenance respond better to CT than those on other neuroleptics.

Matched MeSH terms: Antipsychotic Agents/therapeutic use*
Fulltext Brief acute psychosis following hysterectomy in ethnopsychiatric context

Tsoh JM, Leung HC, Ungvari GS, Lee DT

Singapore Med J, 2000 Jul;41(7):359-62.
PMID: 11026805

The psychiatric morbidity following hysterectomy has received increasing attention. One of the sequelae of hysterectomy has been a brief, acute psychosis with excellent outcome, the etiology and pathomechanism of which is still unclear. Two Chinese patients born of Southeast Asian origin who manifested brief, acute psychosis following hysterectomy are presented. Therapy comprised drug treatment with low dose antipsychotics and benzodiazepines coupled with hypnosis and marital therapy to explore and treat the underlying pathology. Both psychotic states resolved. Follow-up at 12 months revealed stable mental condition in one subject; however, the second patient was lost to follow up. The impact of the womb's removal is explored in the context of the ethnicity of the patients and their sociocultural background.

Matched MeSH terms: Antipsychotic Agents/therapeutic use
Caspase-dependent and -independent mechanisms in apoptosis induced by hydroquinone and catechol metabolites of remoxipride in HL-60 cells

Inayat-Hussain SH, McGuinness SM, Johansson R, Lundstrom J, Ross D

Chem Biol Interact, 2000 Aug 15;128(1):51-63.
PMID: 10996300

The hydroquinone and catechol like metabolites, NCQ344 and NCQ436 respectively, of the antipsychotic remoxipride have recently been demonstrated to induce apoptosis in myeloperoxidase (MPO)-rich human bone marrow progenitor and HL-60 cells [S.M. McGuinness, R. Johansson, J. Lundstrom, D. Ross, Induction of apoptosis by remoxipride metabolites in HL-60 and CD34+/CD19- human bone marrow progenitor cells: potential relevance to remoxipride-induced aplastic anemia, Chem. Biol. Interact. 121 (1999) 253-265]. In the present study, we determined the molecular mechanisms of apoptosis induced by these remoxipride metabolites in HL-60 cells. Our results show that apoptosis was accompanied by phosphatidylserine (PS) exposure, activation of caspases-9, -3, -7 and DNA cleavage. In HL-60 cells treated with the hydroquinone NCQ344 and catechol NCQ436, the general caspase inhibitor benzyloxycarbonyl-Val-Ala-Asp. fluoromethyl ketone (Z-VAD.FMK) blocked DNA cleavage and activation of caspases-9, -3/-7. In addition, PS exposure was significantly but not completely inhibited by Z-VAD.FMK. These results demonstrate that although Z-VAD.FMK inhibitable caspases are necessary for maximal apoptosis induced by NCQ344 and NCQ436, additional caspase-independent processes may orchestrate changes leading to PS exposure during apoptosis induced by the remoxipride polyphenolic metabolites.

Matched MeSH terms: Antipsychotic Agents/metabolism; Antipsychotic Agents/toxicity*
Tardive dyskinesia among Chinese and Malay patients with schizophrenia

Chong SA, Mahendran R, Machin D, Chua HC, Parker G, Kane J

J Clin Psychopharmacol, 2002 Feb;22(1):26-30.
PMID: 11799339

The prevalence of tardive dyskinesia (TD) was studied with the Abnormal Involuntary Movements Scale in Chinese and Malay patients with schizophrenia who were hospitalized in a Singapore state psychiatric institute. We also studied the relationship of neuroleptic-induced extrapyramidal side effects to TD. By using established criteria, the rates of TD were 40.6% for Chinese and 29.0% for Malays, higher than previously reported for Chinese subjects. Older age and lower current neuroleptic dose were significantly associated with TD. Multivariate analysis, after controlling for other salient risk variables, did not show a significant difference in TD prevalence rates between the two races. We conclude that suggested differences in interethnic rates of TD among Chinese, Malays, and Westerners are unlikely to exist and that any variation in prevalence is more likely to be determined by differences in duration of exposure and dose levels of neuroleptic drugs.

Matched MeSH terms: Antipsychotic Agents/adverse effects*; Antipsychotic Agents/therapeutic use
Fulltext Involvement of cytochromes p450 in drug-drug interactions: an overview

Ong CE, Teh LK, Ismail R

Med J Malaysia, 2002 Jun;57(2):251-60.
PMID: 24326665

Drug interactions can cause iatrogenic disease. If concurrent medications are taken, the potential exists for a drug interaction to occur. Renewed interest in the topic interactions has been generated by the fatal interactions involving non-sedating histamine H-1 antagonists and the recent intriduction of two therapeutic agents, the selective serotonin reuptake inhibitors (SSRIs) and HIV protease inhibitors, for the treatment of depression and AIDS, respectively. These three therapeutic agents have been implicated in clinically significant drug interactions. The consequences of these interactions vary in clinical significance, extent, and effect. Some interactions are theoretical whereas others may lead to severe iatrogenic adverse experiences including lethal consequences.The purpose of this review is to alert the medical practioner to potential drug interactions that may occur when these drugs are prescribed to patients. The pharmacological basis and clinical signficance of these interactions are reviewed. The pharmacological mechanisms underlying these interactions are illustrative of those that may be involved for many other medications. Doctors should be aware of the potential pitfall that may occur when certain groups of drugs are prescribed with concurrent medications.

Matched MeSH terms: Antipsychotic Agents
Quality of life: an assessment of the state of psychosocial rehabilitation of patients with schizophrenia in the community

Hasanah CI, Razali MS

J R Soc Promot Health, 2002 Dec;122(4):251-5.
PMID: 12557735

The subjective quality of life (QOL) of diabetic patients on oral hypoglycaemics was compared to schizophrenic patients who were well controlled with their antipsychotic medications. This comparison was made using the generic quality of life questionnaire produced by the World Health Organization QOL (WHOQOL) group, namely the WHOQOL-100. Statistical analysis showed that there was no significant difference in the psychological well-being and level of independence between the two groups. However, such measures revealed that the most impaired aspect of well-being in the schizophrenic group was the social relationship. Subjective QOL assessment is able to reveal deficits or handicaps that are obscure and probably difficult to appreciate on objective social and clinical evaluation. Such findings are valuable in planning the rehabilitative need of schizophrenic patients in the community.

Matched MeSH terms: Antipsychotic Agents/therapeutic use*
Fulltext Atypical antipsychotic induced obsessive-compulsive symptoms

Teh EE, Najib MAM

Med J Malaysia, 2004 Dec;59(5):690-1.
PMID: 15889578
Matched MeSH terms: Antipsychotic Agents/administration & dosage*; Antipsychotic Agents/adverse effects*
Characteristics of patients with organic brain syndromes : A cross-sectional 2-year follow-up study in Kuala Lumpur, Malaysia

Chandrasekaran PK, Jambunathan ST, Zainal NZ

Ann Gen Psychiatry, 2005 Apr 15;4(1):9.
PMID: 15876360

BACKGROUND: Organic Brain Syndromes (OBS) are often missed in clinical practice. Determining their varied presentations may help in earlier detection, better management, and, assessing prognosis and outcome. We described the in-patient referrals of patients suffering from the psychiatric effects of organic states and compared the symptomatology and mortality between those with the Acute and Chronic varieties. METHODS: 59 patients referred to our Consultation-Liaison (C-L) Psychiatry services and given a clinical diagnosis of OBS were selected over a 6-month period. Psychiatric and cognitive abnormalities and treatment regimes were recorded and fatality rates determined. Information regarding their condition 24 months after their index hospitalization was recorded. All data were entered into a proforma and analyzed after exclusion. RESULTS: The mean duration of detecting the symptoms by the physician was 3.52 days. The presence of a premorbid psychiatric illness had no influence on the clinical presentation but did on the mortality of patients with OBS (p = 0.029).Patients with the Acute syndrome had significantly more symptom resolution as compared to those with the Chronic syndrome (p = 0.001) but mortalityrates did not differ. Elderly patients and those with symptom resolution upon discharge did not show statistically significant higher mortality rates. The most popular combination of treatment was that of a low-dose neuroleptic and a benzodiazepine (34.7%). The need for maintenance treatment was not significantly different in any group, even in those with a past history of a functional disorder. CONCLUSION: Other than the Acute group having a significantly better outcome in terms of symptom resolution, our findings suggest that there was no significant difference in the clinical presentation between those with Acute or Chronic OBS. Mortality-wise, there was also no difference between the Acute and Chronic syndromes, nor was there any difference between the elderly and the younger group. There was also no significant difference in the need for continued treatment in both groups.

Matched MeSH terms: Antipsychotic Agents
Treatment with olanzapine, risperidone or typical antipsychotic drugs in Asian patients with schizophrenia

Lee C, Wu KH, Habil H, Dyachkova Y, Lee P

Aust N Z J Psychiatry, 2006 May;40(5):437-45.
PMID: 16683970

To examine clinical outcomes in Asian patients with schizophrenia receiving monotherapy with olanzapine, risperidone or typical antipsychotics in naturalistic settings.

Matched MeSH terms: Antipsychotic Agents/adverse effects; Antipsychotic Agents/therapeutic use*
Safety and efficacy of rapid dose administration of quetiapine in bipolar mania

Hatim A, Habil H, Jesjeet SG, Low CC, Joseph J, Jambunathan ST, et al.

Hum Psychopharmacol, 2006 Jul;21(5):313-8.
PMID: 16856220

In this open-label pilot study, 20 adult patients hospitalized for acute bipolar mania received oral quetiapine as a single evening dose of 200 mg on day 1, increased by 200 mg/day on days 2, 3, and 4 until 800 mg/day taken in 2 divided doses on day 4. From day 5 onward, patients received a flexible total dose of 400-800 mg/day until completion of 3 weeks of treatment. Safety and tolerability were assessed by adverse-event (AE)-related dropouts in week 1, incidence of AEs including EPS, changes in electrocardiogram, and vital signs. Efficacy was assessed using the YMRS, PANSS, and CGI scales. Nineteen of 20 patients (95%) completed the quetiapine rapid titration during week 1. Significant improvement was observed in YMRS, PANSS, and CGI Severity of Illness scores by day 5, and was maintained throughout the study. A reduction of > or = 50% in YMRS score was achieved by 75% of patients by day 7, and maintained to day 21. Overall, 20% of patients discontinued due to AEs. Agitation was the most common cause of AE-related study discontinuation. Thirty-five per cent of patients required dose adjustment due to AEs after rapid dose administration was completed. Most patients tolerated rapid titration of quetiapine to 800 mg/day by day 4 of therapy, with a significant improvement in manic symptoms by day 7 of treatment.

Matched MeSH terms: Antipsychotic Agents/administration & dosage*; Antipsychotic Agents/adverse effects

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