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Case Report: Augmentation with Blonanserin for a Schizophrenia Patient with Insufficient Response to Clozapine

Open Journal of Psychiatry 2018年第2期8卷 131-136页

作者： Manabu Takaki Shigeru Takahashi Yuji Yada Kohei Kitagawa yoshiki kishi Norihito Yamada Department of Neuropsychiatry Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama Japan Sekizen Hospital Okayama Japan Department of Psychiatry Okayama Psychiatric Medical Center Okayama Japan

Background: Clozapine is the most efficacious among antipsychotics for patients with schizophrenia. Nevertheless, clozapine is not effective in more than about 50% of treatment refractory schizophrenia patients, and several pharmacological strategies are used to augment it. Several reviews including meta-analyses have been published, but the efficacy of augmentation therapy for clozapine-resistant patients is not adequately supported. Though there is a weak connection between the oral dose and plasma concentration of clozapine, there is no report of augmentation therapy considering the plasma concentration of clozapine. Blonanserin is reported to be effective in treatment of both positive and negative symptoms of schizophrenia and well tolerated. Methods: We obtained consent to evaluate clinical presentations and clozapine plasma concentrations at the Okayama Psychiatric Medical Center and had not identified the individual for ethical reasons. This is a case report. Results: This case fulfilled the diagnostic criteria of neuroleptic-induced dopamine supersensitivity psychosis. Monotherapy with blonanserin was not effective, but augmentation of blonanserin with clozapine was effective and well tolerated by a clozapine-resistant schizophrenia patient. Conclusion: Because clozapine may ameliorate dopamine supersensitivity psychosis, the addition of blonanserin to clozapine may be effective even if monotherapy with blonanserin was not.

关键词： Treatment Refractory Schizophrenia Clozapine Blonanserin Clozapine Concentration Dopamine Supersensitivity Psychosis

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Detection accuracy for epithelial dysplasia using an objective autofluorescence visualization method based on the luminance ratio

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International Journal of Oral Science 2017年第4期9卷 200-209页

作者： nanami yamamoto koji kawaguchi hisako fujihara mitsuhiko hasebe yuta kishi masaaki yasukawa kenichi kumagai yoshiki hamada department of oral and maxillofacial surgery school of dental medicinetsurumi universityYokohamaJapan department of oral hygiene tsurumi junior collegeYokohamaJapan

The autofluorescence visualization method （AVM） uses blue excitation light to assist in the diagnosis of epithelial dysplasia. It detects epithelial dysplasia as a black area, which is known as fluorescence visualization loss （FVL）. In this study, we evaluated the detection accuracy for epithelial dysplasia of the tongue using the objective AVM and assessed its possible clinical utility. Seventy-nine tongue specimens clinically suspected to have leukoplakia or squamous cell carcinoma （SCC） were analyzed. First, the AVM was subjectively performed using the Visually Enhanced Lesion scope （VELscope）, and the iodine-staining method was then performed. After biopsy, the histopathological results and the luminance ratio between the lesion and healthy tissue were compared, and a receiver operating characteristic curve was created. The cutoff value for the objective AVM was determined; the lesion was considered FVL-positive or -negative when the luminance ratio was higher or lower than the cutoff value, respectively. The histopathological diagnoses among the 79 specimens were SCC （n = 30）, leukoplakia with dysplasia （n = 34）, and leukoplakia without dysplasia （n= 15）. The cutoff value of the luminance ratio was 1.62, resulting in 66 FVL-positive and 13 FVL-negative specimens. The luminance ratio was significantly higher in the epithelial dysplasia-positive than -negative group （P〈O.O00 1）. The objective AVM showed much higher consistency between histopathological results than did the two methods （kappa statistic = 0.656）. In conclusion, objective autofluorescence visualization has a potential as an auxiliary method for diagnosis of epithelial dysplasia.

关键词： autofluorescence epithelial dysplasia oral cancer Visually Enhanced Lesion scope

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