Cases That Test Your Skills

Unexpected improvement

Current Psychiatry. 2011 August;10(8):55-61

References

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Schizophrenia-ALS comorbidity

Some investigators have suggested²⁰ the relative rarity of ALS in patients with schizophrenia is attributable to the neuroprotective effects of antipsychotics and antidepressants.²¹ If this is true, it is possible resistance to antipsychotics among some schizophrenia patients may be underpinned by the degree of cell injury and therefore of neurodegeneration, which may be the case with Ms. U.

Controlled, randomized, double-blind studies are needed to confirm our team’s assumptions. Our observation is limited by the lack of standardized scale measurements to assess all schizophrenia domains before starting riluzole and Ms. U’s clinical improvement could be associated with other factors such as passage of time or schizophrenia “burning out.” However, clinical observation and description from family members and hospital staff are important to consider in this case.

The improvement in schizophrenia symptoms observed from a drug with no action on dopamine blockade—a quality observed in all antipsychotics²²—reinforces the possibility that targeting different pathways involved in the genesis of schizophrenia is a reasonable topic for future research. The possible use of riluzole and other glutamate-modulating drugs might influence positive, negative, and cognitive symptoms of schizophrenia.

Clinical Point

Use of riluzole and other glutamate-modulating drugs might influence positive, negative, and cognitive symptoms

Related Resources

Kantrowitz JT, Javitt DC. Glutamate: new hope for schizophrenia treatment. Current Psychiatry. 2011;10(4):68-74.
Vinson PN, Conn PJ. Metabotropic glutamate receptors as therapeutic targets for schizophrenia. Neuropharmacology. 2011. Epub ahead of print.

Drug Brand Names

Acamprosate • Campral
Amantadine • Symmetrel
Clozapine • Clozaril
Haloperidol • Haldol
Ketamine • Ketalar
Lamotrigine • Lamictal
Lithium • Eskalith, Lithobid
Loxapine • Loxitane
Methotrimeprazine • Nozinan
Memantine • Namenda
Olanzapine • Zyprexa
Riluzole • Rilutek
Risperidone • Risperdal
Sertindole • Serdolect
Thioridazine • Mellaril
Trazodone • Desyrel, Oleptro
Trifluoperazine • Stelazine
Venlafaxine • Effexor

Disclosures

Dr. Millán-González is a consultant to AstraZeneca CAMCAR. Drs. Loizaga-Arniaz and Zúñiga-Montes report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.