TY - JOUR
T1 - A within-subject consideration of the psychotic spectrum disorder concept in a patient in remission associated with cortical gray matter recovery
AU - Meltzer, Herbert Y.
AU - Sim, Min Young
AU - Anderson, Adam
AU - Cannistraci, Christopher
AU - Jayathilake, Karu
AU - Share, Daniel Barrett
AU - Lee, Myung
N1 - Funding Information:
HYM has received grant support from Janssen Pharmaceuticals, Allergan, Eli Lilly, Lundbeck, Neurocrine, Takeda, Sumitomo Dainippon, Sunovion and by a donation from the Weisman family.
Funding Information:
The clinical trial reported here was supported by a grant from Janssen Pharmaceuticals (2005-2009). The post-trial research received no financial support from Janssen and represents the views of the authors only.
Publisher Copyright:
© 2018 John Wiley & Sons Ltd
PY - 2018/7
Y1 - 2018/7
N2 - Introduction: Psychotic spectrum disorder (PSD) links the syndromes of bipolar disorder, psychotic depression, and schizophrenia, often viewed as unique disorders. Aims: Application of the PSD concept to a single patient rather than across groups of patients and demonstration of a remarkable remission of schizophrenia phenotype with recovery of gray matter in specific brain regions. Results: We report a woman who experienced discrete, nonoverlapping periods of each of the above syndromes, in the order noted, over a 30-year period, followed by abrupt ending of psychosis and full remission lasting at least 7 years. This patient had 2 episodes of Bipolar 1 mania, followed by a 20-year period of psychotic depression. From ages 35-48, she manifested severe, paranoid schizophrenia with marked functional decline. She became refractory to antipsychotic drugs, including oral risperidone and clozapine. At age 48, while participating in a double-blind, 6-month clinical trial of long-acting injectable risperidone (Consta®, 100 mg IM biweekly) for treatment-resistant schizophrenia, at week 23, upon awakening, complete disappearance of psychosis and marked improvement in function was noted, which persisted until the present (approximately 7 years). Remarkably, cognitive test performance in most domains improved beginning at 6 weeks and reached normal levels in executive function, despite minimal improvement in psychosis until week 23. MRI studies before and after remission revealed unique and substantial increases in gray matter of the cingulate and parietal cortex, and subthalamic nucleus, not seen in other patients in this study. Conclusions: The 3 discrete periods of psychopathology support the diagnosis of PSD. The unusual course and outcome, including remarkable improvement, in executive function and enhanced cortical gray matter in selective brain regions may have been the result of unique endogenous genetic and epigenetic factors and effect of medication.
AB - Introduction: Psychotic spectrum disorder (PSD) links the syndromes of bipolar disorder, psychotic depression, and schizophrenia, often viewed as unique disorders. Aims: Application of the PSD concept to a single patient rather than across groups of patients and demonstration of a remarkable remission of schizophrenia phenotype with recovery of gray matter in specific brain regions. Results: We report a woman who experienced discrete, nonoverlapping periods of each of the above syndromes, in the order noted, over a 30-year period, followed by abrupt ending of psychosis and full remission lasting at least 7 years. This patient had 2 episodes of Bipolar 1 mania, followed by a 20-year period of psychotic depression. From ages 35-48, she manifested severe, paranoid schizophrenia with marked functional decline. She became refractory to antipsychotic drugs, including oral risperidone and clozapine. At age 48, while participating in a double-blind, 6-month clinical trial of long-acting injectable risperidone (Consta®, 100 mg IM biweekly) for treatment-resistant schizophrenia, at week 23, upon awakening, complete disappearance of psychosis and marked improvement in function was noted, which persisted until the present (approximately 7 years). Remarkably, cognitive test performance in most domains improved beginning at 6 weeks and reached normal levels in executive function, despite minimal improvement in psychosis until week 23. MRI studies before and after remission revealed unique and substantial increases in gray matter of the cingulate and parietal cortex, and subthalamic nucleus, not seen in other patients in this study. Conclusions: The 3 discrete periods of psychopathology support the diagnosis of PSD. The unusual course and outcome, including remarkable improvement, in executive function and enhanced cortical gray matter in selective brain regions may have been the result of unique endogenous genetic and epigenetic factors and effect of medication.
KW - bipolar
KW - cognition
KW - depression
KW - gray matter
KW - gyrus cingula
KW - paranoid
KW - psychotic disorders
KW - risperidone
KW - schizophrenia
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U2 - 10.1111/cns.12986
DO - 10.1111/cns.12986
M3 - Article
C2 - 29898284
AN - SCOPUS:85048499788
VL - 24
SP - 641
EP - 651
JO - CNS Neuroscience and Therapeutics
JF - CNS Neuroscience and Therapeutics
SN - 1755-5930
IS - 7
ER -