Clozapine (Clozaril, Novartis) is classified as a prolactin-sparing antipsychotic, so clozapine-induced hyperprolactinemia is rare. Herein, however, we present a case of severe hyperprolactinemia with delusion of pregnancy during the use of clozapine. We discuss various factors involved in the background of hyperprolactinemia and delusion of pregnancy. While clozapine-induced hyperprolactinemia is rare, the adverse events of this condition can be clinically important in the short- and long-term. In Japan, the measurement of prolactin levels is not a required item in the Clozaril Patient Monitoring Service (CPMS, Novartis), so the risk of hyperprolactinemia tends to be easily overlooked. We hope this case report will help to alert colleagues to the risk of hyperprolactinemia during clozapine use.
Novel interventions are needed to manage treatment-resistant depression (TRD), defined as patients who do not respond to two or more antidepressant trials of adequate dose and duration. We report on a 28-year-old female with TRD with nonresponse to several adequate trials of antidepressants who experienced full symptomatic remission after participating in the heated hatha yoga (HY) arm of a randomized controlled trial (RCT) for depression. Patients, including the one of interest, were randomized to 8 weeks of at least twice weekly HY or an 8-week waitlist followed by 8 weeks of HY. HY incorporates yoga plus heat through a series of standardized poses performed in a heated room (105°F). The 30-item Inventory of Depressive Symptoms, Clinician-Rated (IDS-C30) and 28-item Hamilton Depression Rating Scale (HAM-D28) were assessed at key time points throughout the study. The patient attended 16 classes over 8 weeks. Her baseline IDS-C30 score of 42 decreased to 26 following 2 weeks of HY, and continued declining throughout the intervention, with a final score of 6 (remission) after 8 weeks. HAM-D28 scores decreased from 26 at baseline to 4 (remission) after 8 weeks. At the 1-month follow-up, the patient's scores remained stable at 4 on IDS-C30 and 7 on HAM-D28, respectively. HY may serve as a potential intervention for TRD in patients who have not previously responded to conventional antidepressants. The rigorousness of the intervention must be considered regarding recommendations for use in the general population.
Patients with schizophrenia have a higher prevalence of dysbiosis and metabolic disorders. Some probiotics significantly relieve constipation and improve insulin resistance in patients with schizophrenia, with concomitant improvement in psychiatric symptoms. Schizophrenic patients whose psychiatric symptoms are improved by probiotics have characteristics that begin with the three D's: Dysbiosis; Decreased barrier function in intestinal tract; and Dopamine dysfunction in the prefrontal cortex such as negative symptoms. The effects of probiotics on the central nervous system are nowadays referred to as psychobiotics. However, the underlying mechanism of psychobiotics has not been fully elucidated. In this manuscript, the potential of probiotics in psychiatric practice is discussed based mainly on the author's clinical studies. Modulation of the composition of intestinal microbiota with probiotics may be a new therapeutic target for the treatment of schizophrenia and comorbid insulin resistance.