Caniato, R.Gundaberwady, A.Deshmuck, A.Garcia-Alcaraz, M.Baune, B.2011-09-022011-09-022008Acta Neuropsychiatrica, 2008; 20(3):172-1730924-27081601-5215http://hdl.handle.net/2440/65865Indications:1 patient with treatment-refractory schizophrenia. Coexisting disease: Becker muscular dystrophy.Patients:One 20-year-old male patient.TypeofStudy:A case report describing the response to Leponex of a patient with refractory schizophrenia and comorbid Becker muscular dystrophy (BMD). Letters to the editor.DosageDuration:Titrated to a dose of 550 mg daily. Duration not stated.AuthorsConclusions:Although each case needs to be addressed on an individual basis, our report indicates that muscular dystrophy should not be an absolute contraindication to clozapine treatment. Careful medical and neurological investigations and monitoring should be conducted in such cases. Our report supports a link between BMD and schizophrenia, potentially mediated through dystrophin. The very positive outcome of our case may indicate that patients with comorbid BMD and schizophrenia may be particularly responsive to clozapine treatment.Results:After 6 months of Leponex therapy, there was a steady improvement in the patients mental state and a reduction in his aggressive outbursts. Leponex was titrated to a dose of 550 mg daily, on which therapeutic blood levels of Leponex were achieved. Within 12 months, all hallucinations and passivity experiences had stopped and there were no further episodes of aggression. Cognitive assessments showed that he was in the borderline range of intellectual functioning, with a deficit pattern consistent with a diagnosis of schizophrenia. Functional assessment showed the need for active rehabilitation to address deficits in social skills and adaptive functioning. Negative symptoms, including a blunted affect, poverty of speech and avolition, remained despite treatment. CK levels peaked at 14 000 U/l during the 2nd month of treatment and then steadily reduced. They remained increased and fluctuated between 1000 and 2000 U/l over the last 6 months of therapy. He did not develop any cardiac complications. He had increased triglyceride levels during Leponex treatment. He received dietary advice and omega-3 fatty acid supplements, which resulted in a normalization of his triglyceride levels. The potential cardiac risks was discussed with the patient and his family and there was a consensus that Leponex treatment should continue during rehabilitation.AdverseEffects:1 patient had increased triglyceride levels and increased CK level.FreeText:His psychotic symptoms had begun in early 2003 and that there had been a steady deterioration in his mental state since then. In 2005, while in prison, he had auditory hallucinations, passivity experiences, thought disorder and aggression which were not resolved with risperidone. Routine blood investigations revealed a markedly increased creatine kinase (CK) level. He was diagnosed with BMD based on muscle biopsy results and genetic testing. Over an 8-month period, despite a trial of 2 further antipsychotics medications, there had been little improvement in the patients mental state. In early 2006, Leponex was commenced. Test: therapeutic Leponex blood levels. Concomitant treatment: active rehabilitation to address deficits in social skills and adaptive functioning.en© 2008 The Authors Journal compilation © 2008 Blackwell MunksgaardTreatment of a patient suffering from schizophrenia and Becker muscular dystrophy with clozapineJournal article002011140910.1111/j.1601-5215.2008.00295.x0002560944000132-s2.0-4424911831428328Baune, B. [0000-0001-6548-426X]