Mood stabilizers have been conventionally defined as drugs possessing efficacy in both acute and maintenance therapy for any polarity of bipolar disorder. Only lithium has been regarded as the gold standard mood stabilizer, fulfilling all of these conditions. Recently, evidence for the comprehensive mood-stabilizing effects of second-generation antipsychotics such as quetiapine and olanzapine has been found, although their safety in long-term use is still of great concern. Antiepileptic drugs do not appear to be ideal mood stabilizers because of selective effectiveness on a particular polarity -- for example, valproate and carbamazepine are predominantly antimanic, and lamotrigine is predominantly antidepressive. However, the mood-stabilizing effects of combinations of these drugs may be equivalent or even superior to that of lithium alone, especially in pathophysiologies less responsive to lithium, such as dysphoric mania, mixed features and rapid cycling.

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Purpose: To compare the characteristics of outpatients who were initiated on olanzapine or risperidone in the naturalistic treatment of schizophrenia in Japan.
Methods: The Japan Medical Data Centre Database (JMDC) was used to identify patients diagnosed with schizophrenia or schizoaffective disorder using ICD-10 codes. Patients were required to be 20-65 years old, to have initiated olanzapine or risperidone therapy at an outpatient setting between January 2004 and July 2008, and to be continuously enrolled during the 6 months prior and 12 months post initiation date. Treatment groups were compared on demographics, medical and psychiatric comorbidities, prior medication use patterns, and prior health care resource utilization. Chi-square tests and t-tests were employed for univariate comparisons. Multivariate logistic regressions were used to assess the independent contribution of the predictors.
Results: In both the multivariate and univariate models, olanzapine-initiated patients (n=334) were more likely than risperidone-initiated patients (n=502) to have a history of treatment with antidepressants (56.6% vs. 43.8%, p < 0.001) and a history of prior manic episodes (59.3% vs. 51.6%, p = 0.03).
Discussion: Current findings suggest that in Japan, olanzapine and risperidone are not used interchangeably. Olanzapine appears to be used more often for schizophrenia patients with comorbid mood symptoms, as reflected by a prior diagnosis of manic episodes and prior treatment with antidepressants. Previous research has found that schizophrenia patients with depressive symptoms have a worse prognosis across a broad range of outcomes including the use of more relapse-related mental health services, higher rates of arrests, and suicidality, as well as poorer quality of life, mental functioning, family relationships, and medication adherence.

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In the present study, we investigated the effects of atypical antipsychotic drugs on brain NAA and serum BDNF levels in early-stage first-episode schizophrenia patients. Sixteen (8 males, 8 females; mean age: 30 ± 11 yr) of 18 patients were followed for 6 months. All patients were treated with atypical antipsychotic drugs. No changes in NAA concentrations in the three regions were observed from before treatment to 6 months after atypical psychotic treatment. In addition, serum BDNF levels also did not change from before to 6 months after treatment. These preliminary results suggest that relatively short-term treatment with atypical antipsychotic drugs may be unlikely to alter brain NAA concentrations and serum BDNF levels in early-stage first-episode schizophrenia.

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Purpose: To assess the clinical and functional outcomes of olanzapine treatment for schizophrenia in a 1-year naturalistic study of inpatients and outpatients in Japan.
Methods: We used data from a large (N=1850), prospective, observational study of Japanese schizophrenia patients who were initiated on olanzapine. Clinical and functional outcomes of inpatients and outpatients were contrasted using chi-square tests, t-tests, and mixed models for repeated measures controlling for baseline demographics.
Results: At study entry, 43.2% were outpatients and 56.8% were inpatients. The mean (± SD) dosage for olanzapine was 11.4 ± 5.7 mg/day. Outpatients were significantly younger and more likely to be female. The most common reason for switching to olanzapine was poor medication efficacy (outpatients: 71.8%, inpatients: 74.3%), followed by medication intolerability (outpatients: 21.5%, inpatients: 28.0%). Most outpatients (63.8%) and inpatients (71.6%, p=.003) completed the study. Outpatients and inpatients experienced clinically and statistically significant improvements in global symptom severity, positive, negative, depressive, and cognitive symptoms, health-related quality of life, paid work, and social activities. Many outpatients (60.9%) and inpatients (50.5%, p<.001) demonstrated symptomatic response, with 51.0% of outpatients and 32.8% of inpatients (p<.001) experiencing remission. Mean weight gain was 2.06 kg, with 26.5% of patients experiencing clinically significant weight gain (≥ 7%).
Discussion: In this 1-year naturalistic study, inpatients and outpatients who initiated treatment with olanzapine experienced significant improvements in their clinical and functional outcomes. One-fourth of patients experienced clinically significant weight gain. Current findings highlight the favorable benefit to risk profile of olanzapine for the treatment of schizophrenia in Japan.

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Patients with autistic disorders (AD) exhibit irritability, aggression, deliberate self-injury, and tantrums, which often exacerbate social and communication problems and impair family life and/or school adjustments. Risperidone and aripiprazole have been approved by the U.S. Food and Drug Administration for treating irritability in children and adolescents with AD. The efficacy of other second-generation antipsychotics (SGA), such as quetiapine and olanzapine, for AD-associated irritability have been demonstrated in open-label trials. However, no study has yet evaluated the effectiveness and safety of blonanserin (BNS) for treating irritability in patients with AD in Japan. In this case report, we describe an AD patient who exhibited irritability while on standard antipsychotics that was improved by BNS. BNS may be effective and safe for treating AD-associated irritability. Further large-scale controlled studies will be needed to confirm our findings.

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Multiple studies have reported that tobacco smoking, alcohol use, and depression are interrelated. Here we report a case of a 54-year old male depressive patient with comorbid alcohol and nicotine dependence who was successfully treated with sertraline. After treatment with sertraline, the patient's plasma levels of MHPG and HVA were increased, but his serum BDNF level was. Sertraline exhibits more potent efficacy than other SSRIs in inhibiting dopamine reuptake. This unique effect of sertraline on catecholamine systems contributed to the successful outcome in this case.

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We report the case of a 69-year-old woman with malignant lymphoma who suffered from major depressive disorder. A low dose of mirtazapine (15 mg/day) brought about dramatic improvement in her mental status. However, after discontinuation of the mirtazapine, anxiety, restlessness, irritability, nausea, insomnia, imbalance and sensory disturbances occurred. When mirtazapine therapy was restarted, these symptoms resolved completely. These findings suggest that discontinuing even a low dose of mirtazapine might result in discontinuation syndrome, particularly in patients in poor physical condition. To the best of our knowledge, this is the first report describing a discontinuation syndrome due to the discontinuation of a low dose of mirtazapine.

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In this manuscript, we present a case report of a patient suffering from dementia with Lewy bodies who experienced not only visual but also four other sensory hallucinations, which were interdependent and may have influenced the patient's behavior. To the best of our knowledge, based on our search of the literature, this is the first such reported case of dementia with Lewy bodies.In this paper, we review the literature related to drug therapy for dementia with Lewy bodies, and propose, based on our clinical observations, that cholinesterase inhibitors, including donepezil, should be used as first-line drugs for the treatment and management of psychotic symptoms, including all five sensory hallucinations, in dementia with Lewy bodies.

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