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CASE REPORT
Can typical and atypical antipsychotics show differential effectiveness in treating paranoia and hallucinations in schizophrenia?
  1. Emanuele F Osimo1,2,3,4,
  2. Marie Juliette Goujon1,
  3. Jesus Perez2,3 and
  4. Graham K Murray2,3
  1. 1 Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2 Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
  3. 3 Department of Psychiatry, University of Cambridge, Cambridge, UK
  4. 4 MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London, UK
  1. Correspondence to Dr Emanuele F Osimo, efo22{at}cam.ac.uk

Abstract

A dopamine excess is thought to be involved in positive psychotic symptoms in schizophrenia. All current antipsychotics show a degree of dopamine receptor antagonism. Little is known about the differential effectiveness of different antipsychotics in treating specific sets of symptoms. We report the case of a 35-year-old man with schizophrenia who presented with prominent hallucinatory symptoms (Positive and Negative Syndrome Scale [PANSS] P1=5, P3=5, P6=5) resistant to high doses of a dopamine, serotonin receptor antagonist, olanzapine. Switching from olanzapine to zuclopenthixol, a dopamine D2 receptor antagonist, led to a complete shift of his symptomatology: his hallucinations abated, however, he presented as very highly paranoid (PANSS P1=6, P3=2, P6=7). On a combination of both antipsychotics, his symptoms subsided (PANSS P1=3, P3=2, P6=2). We discuss the potential for differential effectiveness of different antipsychotic medications in treating hallucinations and paranoia. We argue that future studies could address this question by stratifying patients based on symptoms.

  • therapeutic indications
  • psychiatry
  • schizophrenia
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Footnotes

  • Contributors EFO: had the idea and drafted the manuscript. MJG: helped with pt assessment and drafting. JP and GKM: reviewed the manuscript and gave guidance and advice.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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