A case of vascular depression associated with musical hallucinations successfully treated with paroxetine and a low dose of risperidone

Abstract

Herein, we report a case of an 83-year-old man with vascular depression associated with musical hallucinations. Brain magnetic resonance imaging disclosed diffuse brain atrophy with multiple higher-density zones in the white matter and basal ganglia. Single photon emission computed tomography images showed areas of hypoperfusion in the bilateral temporal lobe and basal ganglia. Combination treatment with paroxetine and a low dose of risperidone rapidly improved both the depressive symptoms and musical hallucinations.

Pharmacogenomics of antipsychotics efficacy for schizophrenia

“…The Ser9Gly polymorphism of dopamine receptor D3 (DRD3) could disturb the membrane insertion of Psychiatry and Clinical Neurosciences 2011; 65: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Pharmacogenomics of schizophrenia 7 this receptor molecule with biological consequence. Studies with FGA treatment response showed the Gly allele is more frequent among poor responders, however, recent studies with SGA showed a positive link of the Gly allele with a better response.…”

“…The neurobiology of DISC1 in the normal developing and adult brain and its roles in SCZ are not well understood. The biological role of DISC1 is, however, speculated from the following findings: (i) downregulation of DISC1 accelerates morphological development of adult-born neurons resulting in soma hypertrophy and enhancement of dendritic outgrowth; (ii) inhibition of DISC1 leads to mispo-Psychiatry and Clinical Neurosciences 2011; 65: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Pharmacogenomics of schizophrenia 9 sitioning of new neurons in the molecular layer from overextended migration, suggesting that DISC1 serves as an interpreter that relays positional signals to the intracellular migratory machinery rather than a direct mediator of neuronal migration; (iii) new neurons with DISC1 knockdown exhibit more mature neuronal firing patterns; and (iv) downregulation of DISC1 accelerates synapse formation of newborn neurons. Taken together, these results indicate that DISC1 controls the tempo of the entire process of neuronal integration in the adult brain as a master regulator.…”

“…Genome-wide expression profiling using microarrays, performed to study effects of FGA and SGA in the postmortem liver of SCZ patients, revealed that FGA affected genes associated with nuclear protein, stress responses and phosphorylation, whereas SGA affected genes associated with Golgi/endoplasmic reticulum and cytoplasm transport. Comparison between FGA and SGA further identified genes asso-Psychiatry and Clinical Neurosciences 2011; 65: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Pharmacogenomics of schizophrenia 11 ciated with lipid metabolism and mitochondrial function. Analyses on individual antipsychotics identified a set of genes (151 transcripts) that are differentially regulated by four antipsychotics, particularly by phenothiazines, in the liver of SCZ patients.…”

“…109 Pharmacogenomics offer great potential to improve patients' health in a cost-effective manner; however, pharmacogenomics will not be applied to all drugs available in the market, and careful evaluations should be made prior to investing resources in research and development of pharmacogenomic-based therapeutics and making reimbursement decisions. 110 Despite the effort of the pharmaceutical industry to demonstrate the benefits and cost-effectiveness of available drugs, the general impression in the medical community and in some governments is that some psychotropics and most anti-dementia drugs Psychiatry and Clinical Neurosciences 2011; 65: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Pharmacogenomics of schizophrenia 13 present in the market are not cost-effective. 4 Conventional drugs for neuropsychiatric disorders are relatively simple compounds with unreasonable prices.…”

“…Even though second-generation antipsychotics (SGA) have been introduced to reduce side-effects, 5,6 there are still many cases with SGA-related adverse side-effects, with vulnerable subjects in particular. [7][8][9][10][11][12] SGA are widely used in elderly patients with various diagnosis, such as delirium, [13][14][15] delusion, 16 hallucination, 17 catatonia, 18 and behavioral and psychological problems of many types of dementia. [19][20][21][22][23][24] Due to adverse side-effects, SGA are no longer recommended to elderly subjects.…”