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Fluvoxamine may prevent onset of psychosis a case report of a patient at ultra-high risk of psychotic disorder.doc

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Fluvoxamine may prevent onset of psychosis a case report of a patient at ultra-high risk of psychotic disorder

Tadokoroetal.AnnalsofGeneralPsychiatry2011,10:26 /content/10/1/26 CASE REPORT OpenAccess Fluvoxaminemaypreventonsetofpsychosis: acasereportofapatientatultra-highriskof psychoticdisorder ShigenoriTadokoro1,2*,NobuhisaKanahara1,ShuichiKikuchi2,KenjiHashimoto3andMasaomiIyo1,3 Abstract Background:Thereisemergingevidencethatantidepressantsmaybeeffectiveinpreventingpatientswithnon- specificandpsychotic-likeprodromalsymptoms,definedaspatientsatultra-highrisk(UHR)ofpsychoticdisorder, fromtransitioningtopsychosis.However,themechanismofsuchaneffectisstillunknown. Methods:Wereportthecaseofa19-year-oldJapanesemandeterminedtobeatUHRofpsychoticdisorderin whomfluvoxamine(oneoftheantidepressantswithsigma-1receptoragonism)showedpreventiveeffectson psychotic-likeprodromalsymptoms. Results:Ourpatient’sdepressivesymptomswerereducedandmaintainedbelowremissionasaresultof treatmentwith100mg/dayoffluvoxamine.Inaddition,itislikelythatanadditionaldoseoffluvoxamine(50mg/ day)improvedhispsychotic-likeprodromalsymptomsdirectly,independentofitsantidepressiveeffects. Conclusion:Fluvoxamine,asigma-1receptoragonist,maybeeffectiveinpreventingpatientsatUHRofpsychotic disorderfromonsetofpsychosisviaitsneuroprotective/neurotropicactions,independentofitsantidepressive effects. Background Casepresentation Inthepastdecadetherehasbeenincreasinginterestin Thepatientwasa19-year-oldJapaneseunmarriedoffice thepotential benefit ofearlypharmacological interven- worker with no personal orfamilial history of psychia- tioninpsychoticdisorders.Patientswithpsychoticdis- tric problems. On presentation he complained of dete- orders shownon-specific and psychotic-like prodromal rioration of his work performance. He had suffered symptomsprecedingtheonsetoffrankpsychosis.Inter- from anhedonia, insomnia, loss of appetite, concentra- estingly,thereisemergingevidencethatantidepressants tion deficit, anda sense of guilt for over 1 month, and maybeeffectiveinpreventingpatientswhoareatultra- was