ÖZETKlozapin tedavisi kullanan şizofreni hastalarının önemli bir oranı tedaviye kısmi yanıt vermektedir. Bu grup hastalarda klozapin tedavisine değişik psikotropların eklendiği güçlendirme yöntemleri ile ilgili bulgular çelişkilidir. Bu derlemede klozapin tedavisine dirençli şizofre-ni hastalarında güçlendirme ajanlarının etkinliği ve güvenliği ile ilgili yazın verileri gözden geçirilmiştir. Klozapini tedaviye dirençli şizofreni hastalarında güçlendirmek için kullanılan ek tedaviler antipsikotikler, antidepresanlar, duygudurum düzenleyicileri, diğer farmakolojik ajanlar (örneğin omega 3 yağ asitleri ve glutamaterjik tedaviler) ve elektrokonvulzif tedavi (EKT) olarak gruplanmıştır. Klozapinin tedaviye dirençli şizofreni hastalarında güçlendirilmesi ile ilgili en çok kontrollü çalışma-nın lamotrijin ve risperidon ile yapılmış olduğu görülmektedir. Ancak, meta analizler iki ajanın da klozapine eklenmesinin yararını desteklememektedir. Klozapinin amisülprid, aripiprazol, mirtazapin, omega 3 yağ asitleri ve EKT ile güçlendirilmesinin olumlu sonuç verdiğini destekleyen çalışmalar olsa da, delil/kanıt yeterli değildir ve ek araştırma-lara gereksinim vardır. Güncel çalışmalarda başlıca kısıtlılık, örneklem küçüklüğü, klozapine direnç tanımının sabit olmaması ve tanımlanmış sonlanım ölçütleri ile çalışma desenlerinin farklılık göstermesidir. Sonuç olarak, klozapin tedavisine dirençli şizofreni hastalarında tedavinin güç-lendirilmesi yöntemlerinin başarısı ile ilgili henüz yeterli kanıt yoktur.Anahtar Sözcükler: Şizofreni, klozapin, tedaviye direnç, güçlendirme tedavisi SUMMARY Augmentation Strategies in Patients with Schizophrenia Who Show Partial Response to Clozapine TreatmentA significant proportion of patients with schizophrenia receiving clozapine remain with partial response. In this group of patients findings regarding addition of various psychotropics to ongoing clozapine treatment for augmentation are controversial. In this review, literature regarding the efficacy and safety of adjunctive agents in clozapine resistant schizophrenic patients is examined. Augmentation agents added to clozapine in treatment resistant schizophrenic patients consist of antipsychotics, antidepressants, mood stabilizers, other agents (eg. omega 3 fatty acids and glutamatergic agents) and electroconvulsive therapy (ECT) in this review. The number of controlled studies evaluating augmentation of clozapine in schizophrenia patients are highest for risperidone and lamotrigine add on treatments. However, the results of recent meta-analyses studies do not support any benefit of either agent as adjunct to clozapine treatment. Some evidence regarding the success of clozapine augmentation with amisulpride, aripiprazole, mirtazapine, omega 3 fatty acids and ECT have been obtained which needs further clinical investigation. Current findings from relevant clinical studies point that theses studies have limitations of small sample size, variable definitions of clozapine resistance, heterogenity of outcome measures and methodological designs and th...

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Exhibitionistic Disorder, one of the paraphilic disorders, is a disease with an unknown etiology and causes significant distress and loss of function in the patient's life. Serotonergic antidepressants are generally preferred in the treatment of this Disorder. However, in this case, we report a patient who did not respond to serotonergic antidepressants but bupropion, an antidepressant with dopaminergic and noradrenergic activity. Therefore, bupropion should be considered a medical treatment alternative in case serotonergic antidepressants do not work efficiently in the treatment of Exhibitionism.

In a study in which 72 non-demented idiopathic Parkinson's patients with Parkinson's disease were investigated using MOCI (Maudsley

Schizophrenia is an illness which is chronic that leads to disability. Particularly obtaining sufficient treatment response in patients with first episode schizophrenia is important in determining the course of the illness. Predicting treatment response with antipsychotic drugs would allow to obtain efficient clinical response by reducing unnecessary drug use and enhance the adherence to treatment. In this context, considering the importance of topic, this review is written out relevant to predictive factors of antipsychotic treatment response in patients with first episode schizophrenia. Electronic search was conducted for this review in Pubmed database. Although there are varied links between drug response and both biological, including pharmacological, neuroimaging and electroencephalography (EEG) findings, and clinical, including duration of untreated psychosis, antipsychotic agents which are used in treatment, soft neurological signs, kind and severity of psychotic symptoms and neurophysiologic indicator of frontal lobe function (NoGo Anteriorization, NGA), variables in studies which are conducted in this field, there is a need for further studies as a conclusion.