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Introduction: Malingering is a differential diagnosis in the field of medical disorders, especially in the field of forensic medicine. In medicine, malingering is when a person imitates a medical or psychiatric disorder with external motivations to gain financial gain or avoid social or occupational duties. In some cases, diagnosing a medical or psychological condition from malingering can be challenging and difficult. In this case report, a patient with a history of multiple hospitalization, neurodevelopmental disorders, and intellectual disability requested to receive injectable Biperiden due to aggression, irritable mood, and neck deviation, and in order to receive it, he deliberately showed neck dystonia. This report aimed to discuss on a neuropsychiatric symptom, after which the patient requested a drug injection to resolve it, in order to differentiate possible diagnoses such as drug complication, factitious disorder, and functional neurological symptom disorder. On the other hand, during the recent searches of similar texts, conflicting results and suggestions have been presented.

Background and Objective: Schizophrenia is a disorder characterized by a chronic recurrent course. Despite the availability of an ever-expanding range of typical and atypical antipsychotics, a substantial proportion of patients with schizophrenia show a partial or total lack of response to antipsychotic monotherapy. This study was done to evaluate the clinical effects of Ginkgo biloba as an adjunct to the Risperidone and Biperiden in the treatment of chronic schizophrenic patients. Materials and Methods: This randomized clinical trial study was carried out on 60 chronic schizophrenic patients in Sina hospital Shahrekord, Iran during 2009-10. Schizophrenia was diagnosed by DSM-IV-TR criteria. Subjects were randomly divided into intervention and control groups. Two groups were matched according to the age, sex, education, duration of illness. Patients in interventional group received Risperidone up to 6mg/day, Biperiden 4mg/day and Ginkgo biloba 240 mg/day for 12 weeks. The control group received Risperidone up to 6mg/day and Biperiden 4mg/day for 12 weeks. The scales for assessment of positive symptoms (SAPS) and assessment of negative symptoms (SANS) were recorded in prior, 6th and 12th weeks. Data analyzed by using SPSS-15 and student t-test. Results: The mean score of positive symptoms were 55.7±2.1 and 74.4±2.3 in interventional and control groups, respectively (P

Background and purpose: Oculogyric crisis which is a dystonic reaction commonly caused by typical antipsychotics treatment of acute dystonias, rarely occurs with atypical antipsychotics like clozapine. The aim of this report was to describe a rare case of clozapine-induced oculogyric crisis successfully treated with biperiden.Case: The patient was a 42-year-old woman with a 19-year history of schizophrenia treated with high-potency typical antipsychotics, risperidone and lithium augmentation with appropriate doses and duration. Because of poor response to prior medications, she was prescribed clozapine started with 25 mg/d and gradually titrated up to 150 mg/d. She has experienced two episodes of oculogyric crisis treated successfully with biperiden.Discussion: Although low affinity of clozapine for blocking D2 dopaminergic receptors and its anticholinergic activity may explain the significantly lower incidence of dystonic reactions, they may happen in some patients and could be suppressed with biperiden.Conclusion: Clinicians should consider dystonic reaction as a possible clozapine adverse effect and on the basis of this report, clozapine-induced oculogyric crisis may be treated successfully with biperiden.

Background and purpose: Despite the availability of typical and atypical antipsychotic drugs, a large number of patients with schizophrenia do not show a good response to monotherapy with these drugs. This study was done to evaluate the effect of purslane on psychological symptoms of schizophrenic patients. Materials and methods: This randomized clinical trial was carried out in 60 chronic schizophrenic patients treated with risperidone in Sina hospital Joneghan, Iran during 2011-2012. The patients were randomly divided into intervention and control groups. The control group received risperidone 6mg/day and Biperiden 4mg/day for eight weeks. The Patients in the interventional group received 1gr extract of purslane daily with the same regimen for eight weeks. The scales for assessment of positive symptoms (SAPS), assessment of negative symptoms (SANS) and CRP level were recorded prior to and 8th week after the study. The data was then analyzed using SPSS V. 16. Results: At the end of study, the mean score of positive symptoms were 47.93 ± 18.56 and 57.1 ± 14.83 in intervention and control groups, respectively (P<0.05), and the mean score of negative symptoms were 40.83 ± 11.03 and 46.13 ± 9.34, respectively (P<0.05). The CRP levels of patients in intervention and control groups were 0.53 ± 0.55 and 1.72 ± 0.73, respectively (P<0.05). Conclusion: According to findings using purslane as an adjunct to respridone can improve psychological condition of chronic schizophrenic patients and decrease their CRP levels. [ABSTRACT FROM AUTHOR]