No abstract

MOST ANTIPSYCHOTICS ARE metabolized by the cytochrome P450 (CYP) enzymes. Thus concurrent use of drugs inducing hepatic CYP enzymes may reduce plasma level and therapeutic efficacy of antipsychotics.1 Rifampin, an antituberculosis (anti-TB) agent, is known to be a potent inducer of CYP enzymes.2 When rifampin is given concomitantly with antipsychotics, decreased plasma concentration and attenuated antipsychotic therapeutic effect may occur. 2 We herein report a chronic and stable schizophrenia patient who developed sudden worsening psychosis associated with rifampin treatment for her pulmonary TB infection.A 56-year-old woman had been diagnosed with schizophrenia for 33 years. In the last 4 years she had been hospitalized in the chronic psychiatric ward at Taoyuan Armed Forces General Hospital with negative symptoms of blunted affect, poverty of speech, and social withdrawal. The patient has been psychiatrically stable on the regimen including zotepine 50 mg three times daily and estazolam 2 mg at bedtime for a period of 4 years. Antihypertensive agents including amlodipine 5 mg (one tablet per day) and propranolol 10 mg (one tablet three times a day) were taken concurrently in addition to the psychotropic medications.On 13 August 2011 the patient had productive cough, night sweating and high fever. On laboratory tests white blood cell count was 14850/mL (normal range, 3000-10000/mL) and C-reactive protein was 5.3 mg/dL (normal range, <0.5 mg/dL). Chest radiography showed bilateral lower lobes infiltration. Microbiology including blood culture, sputum culture, acidfast stain and influenza antibody were all negative. Of note, the sputum TB culture was reactive. Therefore the patient was given anti-TB drugs including rifampin 450 mg/day, isoniazid 300 mg/day, and pyrazinamide 200 mg/day.Three weeks after the use of anti-TB medications, the patient became actively psychotic. She presented with persecutory delusion, reference delusion, delusion of being known, auditory hallucination, and violent tendency. We thus increased the dose of zotepine gradually from 150 mg/day to 300 mg/ day, and the patient showed progressive improvement in psychotic symptoms. After 6 months of treatment for pulmonary TB, the anti-TB regimens were discontinued. We also gradually tapered the zotepine dosage down to 150 mg/day. So far the patient has been psychiatrically stable on zotepine.Zotepine is an antipsychotic drug and has a broad therapeutic effect in the treatment of schizophrenia. This antipsychotic is primarily metabolized by CYP3A4 and partially by CYP1A2 and 2D6.3 Of the three anti-TB agents, only rifampin is an inducer of hepatic CYP enzymes.2 Furthermore, rifampin mainly induces the expression of CYP3A4 and other isoenzymes including CYP1A2.2 There is no known drug interaction between amlodipine or propranolol and zotepine. Therefore, a rifampin-zotepine drug interaction exacerbating psychotic symptoms should be considered in the present case. Although zotepine concentration was not measured during the treatment period, the p...

Aims: Patients with attention deficit hyperactivity disorder (ADHD) are prone to injury and frequently require treatment with hospital admission. This study aimed to evaluate the risk of injuries requiring hospitalization among children and adolescents with and without ADHD and assess the effects of medication on the risk reduction in patients with ADHD.Methods: This is a retrospective population-based cohort study by using data from the Taiwan National Health Insurance Research Database. We compared 4658 6-18 year-old ADHD patients with 18 632 sex-, age-, and index daymatched non-ADHD controls between 2005 and 2012. Both groups were followed until the end of 2013 to compare the risk of injuries requiring hospitalization. Cox regression analysis was performed to determine the hazard ratio (HR) with 95% confidence intervals (CI) after adjusting for confounders.Results: Children and adolescents with ADHD had a significantly higher risk of injuries requiring hospitalization than the non-ADHD controls (HR = 1.39, 95% CI = 1.12-1.72), and a higher risk was especially observed in the male and adolescent subgroups. In ADHD patients, long-term users of ADHD medication were associated with a lower risk of injuries requiring hospitalization than nonusers (HR = 0.51, 95% CI = 0.30-0.85). Conclusion:Healthcare providers should be aware of the potential risk of injury in patients with ADHD and highlight the importance of the duration and compliance with medication treatment.

without PTSD, 3650.6 Ϯ 1648.2 pg/mL; controls, 6172.9 Ϯ 3899.3 pg/mL. Kruskal-Wallis test indicated significant difference (c 2 = 17.20, d.f. = 3, P < 0.001); post-hoc planned Mann-Whitney test indicated lower BDNF for subjects with full-blown or no PTSD than subjects with partial PTSD (Z = 3.51, P < 0.0005 and Z = 3.10, P < 0.005) and controls (Z = 2.56, P < 0.01 and Z = 2.29, P < 0.05) and no difference between partial PTSD and controls.Reduced BDNF in full PTSD is in agreement with Dell'Osso et al. 1 The BDNF finding in patients with partial PTSD is in line with Bonne et al., who found no difference between patients with moderate PTSD severity and controls.2 Hauck et al. reported that BDNF was elevated in subjects at early stages of trauma showing less severe symptoms.3 Together with the current finding that patients with partial PTSD had higher BDNF levels, we can hypothesize that the higher plasma level of BDNF would somehow have a neuroprotective role against the expression of full PTSD.The sample size was relatively small, but all patients were triggered by a unique trauma, had a similar low drug dosage and none presented comorbid psychiatric diagnoses. releasing factor, interleukin-6, brain derived neurotrophic factor, insulin-like growth factor-1, and substance P in the cerebrospinal fluid of civilians with posttraumatic stress disorder before and after treatment with paroxetine.