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Background: Proprietary or brand names of prescription drugs are generally with letters that are unusual in common English. There is little academic research exploring if this perception is true, despite the fact that manufacturers pay millions of dollars to research and develop drug names that conform to regulatory standards while remaining marketable. Objectives: To assess the extent to which letters used in prescription drug names may deviate from common English and to test if prescription drug names show measurable trends in letter frequency over time. Methods: The names of all prescription drugs approved in the United States between 1985 and 2020 were downloaded. Duplicates were removed and products without a proprietary name were excluded. Letter frequency analyses were then conducted on all letters in these names as an aggregate and year-over-year. Letter frequencies were compared to a validated academic reference, a corpus derived from all Google Books data, and the scoring system from the board game Scrabble. Results: Regardless of the comparator, prescription drug names use letters that are not common in typical English. Letters A (11.96% of all observed letters), V (3.08%), X (2.31%), and Z (1.91%) are all overrepresented in prescription drug names, while E (10.23%), H (0.90%), T (6.30%), and S (4.21%) are underrepresented. The letters C and N are becoming less common over time (frequency decrease of 0.10 percentage points and 0.12 percentage points per year, respectively), while V, Y, and Z are becoming more common (frequency increases of 0.61 to 0.86 percentage points per year). Conclusions: Proprietary prescription names use letters that are unlike words used in everyday American English, and there are measureable trends in letter selection. It remains to be seen how drug manufacturers will cope with an increasingly-narrow naming space as more products continue to be approved over time.

Schizophrenia occurs in 1% of the population and is severely impairing to those afflicted. Thereby, it is of the utmost importance to recognize and treat the disorder as early as possible. For the last several decades research has attempted to elucidate a variety of predictive factors in order to aid in the identification of patients at high risk of developing a schizophrenia spectrum disorder. These factors have included premorbid or prodromal movement symptoms. The literature has identified motor aberrations beginning early in life, in some cases even in infancy, ranging from neonatal hypotonicity to facial and upper body dyskinesia. These motor symptoms have not only been demonstrated to aid in predicting conversion to schizophrenia but carry prognostic importance for other outcomes as well. We present the case of a 34-year-old male who developed abnormal motor symptoms several years prior to the onset of psychosis. Our case builds upon the current body of literature by demonstrating the importance of spontaneous dyskinesia in the evaluation of populations at high risk for the development of a schizophrenia spectrum illnesses.

Capgras syndrome is characterized by the delusional belief that a familiar person has been replaced by a visually similar imposter or replica. Rarely, the delusional focus may be objects rather than people. Numerous etiologies have been described for Capgras to include seizures. Similarly, visual hallucinations, both simple and complex, can occur secondary to seizure activity. We present, to our knowledge, the first reported case of visual hallucinations and Capgras delusions for objects that developed secondary to new onset occipital lobe epilepsy. We then discuss the possible underlying neurologic mechanisms responsible for the symptomatology.

Neuroleptic Malignant Syndrome (NMS) is a rare condition clinically characterized by muscle rigidity, hyperthermia, autonomic instability, and acute mental status change. NMS is most often associated with use of high-potency first-generation antipsychotic medications; though, other neuroleptics have been implicated as well. NMS can be fatal with estimated mortality rates as high as 20%. Patients experiencing certain severe complications, including renal failure, have been associated with mortality as high as 50%, stressing the need for early recognition and treatment. Here we present the case of a 54-year-old male that initially presented with symptoms suspicious for sepsis, but who eventually developed a clinical picture consistent with NMS. We describe the diagnostic and treatment process leading to symptom remission. We then discuss our decision to reintroduce an atypical antipsychotic agent, quetiapine. This case illustrates the importance of early recognition of the signs and symptoms of NMS and the need to initiate treatment promptly in order to prevent complications, including death. This case also highlights the decision to resume antipsychotic pharmacotherapy after adequate resolution of NMS, demonstrating that it can be done so safely if started at low doses coupled with intensive monitoring of the patient.