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Introduction: Clozapine and chlorpromazine are widely used for treating schizophrenia. However, irregular medical follow-ups are common in patients with schizophrenia, potentially leading to long-term super-dose medication. Managing such cases poses significant challenges for clinical psychiatrists. Case presentation: This report describes a 24-year-old Han Chinese male diagnosed with schizophrenia who had been taking long-term super-doses of clozapine (18–107 tablets/day, 25 mg/tablet) and chlorpromazine (7–40 tablets/day, 50 mg/tablet) for five months due to irregular medical follow-ups. Upon hospitalization, the doses of antipsychotic drugs were gradually tapered, and the medication regimen was adjusted based on the patient's previous treatment history. Comprehensive health education about schizophrenia was also provided. The patient was followed for four years, during which his psychiatric symptoms remained under partial control. Conclusion: Clinicians must consider individual differences in the efficacy and adverse effects of antipsychotics and weigh the benefits and risks of combination therapy. Future efforts should focus on strengthening health education for patients with schizophrenia and their families to improve treatment compliance and outcomes. [ABSTRACT FROM AUTHOR]

AbstractFerulic acid (FA) is a natural phenolic compound that has been documented for its antioxidant properties and potential in managing hypertension. However, its use is limited due to poor solubility and permeability (BCS Class IV classification). To overcome this, nanostructured lipid carriers (NLCs) of FA were developed using the emulsification probe sonication technique, with formulation optimized through Box-Behnken design. The optimized FA-NLCs (F12) demonstrated a particle size of 103.4 nm, zeta potential of −43.6 mV, polydispersity index of 0.531, and entrapment efficiency of 88.9%. Key Findings of the research manifested, that during in-vitro release studies, FA-NLCs showed sustained release action (40.34% over 24 h) compared to plain FA (103.13% in 4 h). Pharmacokinetics of FA-NLC suggested that increased Cmax by 2.6-fold, AUC by 1.9-fold, and half-life significantly (p < .001), also Pharmacodynamics revealed that FA-NLCs reduced blood pressure more effectively (39.9 mmHg vs. 30.8 mmHg for plain FA; p < .001). Furthermore, FA-NLC was showing successful intestinal uptake through lymphatic absorption via clathrin-mediated endocytosis, bypassing first-pass metabolism, hence showed enhancement in bioavailability, Thus the study concluded that FA-NLCs significantly improve therapeutic efficacy and sustained blood pressure reduction compared to plain FA. [ABSTRACT FROM AUTHOR]

Background: Foreign language syndrome is a rare neuropsychiatric phenomenon typically following general anesthesia. To date, foreign language syndrome has not been associated with neuroleptic malignant syndrome (NMS) in the literature. This case aims to broaden the clinical understanding of NMS by presenting an atypical manifestation of foreign language syndrome and emphasizing the need for prompt recognition of such presentations for accurate diagnosis and management. Case presentation: A 34-year-old Caucasian male with a history of schizoaffective disorder and recurrent psychiatric hospitalizations was admitted for a depressive episode. His condition worsened hours after the administration of intramuscular chlorpromazine, leading to NMS characterized by agitation, muscle rigidity, hyperthermia, autonomic instability, abnormal laboratory findings, and altered mental status, including foreign language syndrome. Management included the discontinuation of the prior psychopharmacotherapy, intravenous hydration, and medications (biperiden, lorazepam). The patient showed significant improvement, with resolution of NMS symptoms and normalized sleep patterns by the time of discharge. Conclusion: Foreign language syndrome is an exceptionally rare occurrence, with only nine documented cases to date, all involving male patients. This case presents a novel instance of foreign language syndrome in the context of NMS in a male patient, providing insight into the potential sex-specific mechanisms underlying this rare phenomenon. This case adds valuable evidence to the understanding of the clinical spectrum of NMS and highlights the importance of recognizing atypical presentations in managing patients with neuropsychiatric conditions. [ABSTRACT FROM AUTHOR]

In this work, a magnetic porous material (Fe3O4@MoS2) was facilely prepared and applied for magnetic solid-phase extraction clean-up before the determination of chlorpromazine in urine samples via high-performance liquid chromatography with ultraviolet detection. Various key factors affecting the extraction and desorption recoveries, including the amount of adsorbent, extraction time, pH, sample volume, adsorption capacity, and desorption conditions, were systematically investigated. Under optimized conditions, the calibration curve was linear over a wide concentration range of 10.00–5000 ng/mL, with a correlation coefficient of 0.9997. The limit of detection was determined to be 3.2 μg/L. Besides, recoveries for spiked urine samples at three concentration levels ranged from 97.2 to 105.8%, and the enhancement factor was 48. These results demonstrate that the proposed method is efficient and economical for the determination of chlorpromazine at trace levels in urine samples. [ABSTRACT FROM AUTHOR]

Breast cancer remains a global health challenge, prompting interest in the anticancer properties of other drugs, including chlorpromazine (CPZ). This study presents a novel approach in breast cancer treatment using laser irradiated CPZ. CPZ dissolved in distilled water, was exposed to 266 nm laser irradiation for varying durations, characterized by UV-Vis and FTIR spectroscopy, followed by drug-likeness and ADME-Tox predictions. In vitro assays evaluated the cytotoxicity and cellular effects on MCF-7 breast cancer cells, and compared with MCF-12 A healthy cell line. Laser irradiation altered CPZ molecular structure resulting in photoproducts with favourable drug-like properties and ADME-Tox profiles. In vitro evaluations demonstrate dose and irradiation time-dependent cytotoxicity against breast cancer cells, and reduced toxicity on healthy cell line. Significant alterations in F-actin organization, and excessive ROS generation were also proved, suggesting the potential of laser-modified CPZ for breast cancer therapy. This study introduces a novel approach to breast cancer treatment through laser irradiated CPZ, highlighting promising advancements in therapy and emphasizing the role of laser-generated compounds. [ABSTRACT FROM AUTHOR]

Aims: Women may experience unique mental disorders due to hormone shifts. Rates of schizophrenia and bipolar disorder are similar between genders, but onset and symptoms may differ. Women tend to use more psychotropic drugs due to limited therapeutic options. This study was aimed to estimate the prevalence of psychotropic polypharmacy among females of childbearing potential and factors impacting prescribing patterns. Methods: This was a quantitative retrospective chart review for patients admitted to inpatient units at the Mental Health Hospital in Qatar. SPSS® Statistics was used for data analysis. In addition to descriptive statistics applied, linear regression and binary logistic regression models were used to examine the clinical and sociodemographic factors associated with polypharmacy and full therapeutic response upon discharge, respectively. An alpha value of 0.05 was used. Results: Of the 347 patients, 52.7% of the patients received a prescription of at least two psychotropic drugs upon discharge. Around two‐thirds (63.1%) were prescribed at least one antipsychotic. Potential predictors of polypharmacy were age (p = 0.027), longer hospital stay (p = 0.003), family history (p < 0.001), absence of suicidal history (p = 0.005), and a diagnosis of a mood disorder (p = 0.009), or a diagnosis of a psychotic disorder (p = 0.015). A full response upon discharge was less likely to occur in patients with a longer stay (OR = 0.940; p = 0.029) and in those with a substance use disorder (OR = 0.166; p = 0.035). Conclusion: There is a notably high prevalence of total polypharmacy upon discharge. Some identified factors are modifiable. Evidence‐based prescription practices through hospital guidelines and education should be emphasized to avoid unreasonable polypharmacy. [ABSTRACT FROM AUTHOR]

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In this study, we have proposed an electrochemiluminescence (ECL) signal amplification system which is based on two-dimensional (2D) flower-like CdS@Co/Mo-MOF composites as a co-reaction accelerator of the g-C3N4/S2O82− system for ultrasensitive detection of chlorpromazine hydrochloride (CPH). Specifically, the 2D flower-like Co/Mo-MOF with mesoporous alleviated the aggregation of CdS NPs while simultaneously fostering reactant-active site contact and improving the reactant–product transport rate. This allowed the material to act as a novel co-reaction accelerator, speeding up the transformation of the S2O82− into SO4•− and enhancing the cathodic ECL emission of g-C3N4. Moreover, the signal probe which was synthesized by coupling the 2D CdS@Co/Mo-MOF and graphitic carbon nitride (g-C3N4) achieved the generation of SO4•− in situ and reduced energy loss. The results confirmed that the ECL signal was enhanced 6.2-fold and stabilized by CdS@Co/Mo-MOF. Based on the extremely strong quenching effect of chlorpromazine hydrochloride (CPH) on this system, a "signal-off" type sensor was constructed. The sensor demonstrated excellent sensitivity and linear response to CPH concentrations ranging from 1 pmol L−1 to 100 μmol L−1, with a low detection limit of 0.4 pmol L−1 (S/N = 3). [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the efficacy of propofol and chlorpromazine in managing acute migraine attacks and to contribute to optimizing the treatment of patients with migraine in the ED.Methods: This prospective, randomized observational study included 180 migraine patients aged 18–65 presenting to the ED. Patients were randomized into two groups: one received propofol (10 mg every 10 minutes, up to 50 mg), and the other received chlorpromazine (12.5 mg every 20 minutes, up to 37.5 mg). Pain was monitored every 10 minutes using a visual analog scale (VAS).Results: At admission, the mean VAS score was 8.24 ± 1.72 in the propofol group and 8.83 ± 1.43 in the chlorpromazine group. In the propofol group, the VAS score decreased by 5.19 ± 2.79, 2.66 ± 2.91, and 1.25 ± 2.14 units at the 10th, 20th, and 30th minutes, respectively. In the chlorpromazine group, the VAS score decreased by 4.82 ± 2.99, 2.50 ± 2.93, and 1.03 ± 2.20 units at the 10th, 20th, and 30th minutes, respectively. By the 60th minute, the total VAS reduction was 25.00 ± 12.25 in the propofol group and 23.10 ± 11.40 in the chlorpromazine group. Although pain reduction initially occurred more rapidly in the chlorpromazine group, there was no statistically significant difference between the groups at the 60-minute mark. Conclusion: Propofol was as effective as chlorpromazine for treating migraines in the ED, with a comparable onset of action and a better side-effect profile.

Antipsychotic drugs, including chlorpromazine, are frequently used to treat mental illnesses. However, prolonged exposure to even small amounts of the substance can accumulate and cause a potential human health risk. Thus, the selective and sensitive detection of these drugs is crucial. Molecularly imprinted polymers (MIPs) are receptors that are designed to have a highly specific molecular recognition ability, which is the primary and crucial function of receptors. The synthesis of chlorpromazine-imprinted polymers involves the polymerization of functional monomers and cross-linkers in the presence of chlorpromazine as a template, followed by the removal of the template to create cavities with complementary binding sites. Various strategies, including bulk polymerization, free radical polymerization surface imprinting, and nanoimprinting, have been employed to fabricate chlorpromazine-molecular imprinted polymers with high affinity and selectivity. Characterization techniques such as UV-vis spectroscopy, Fourier-transform infrared spectroscopy, and scanning electron microscopy are commonly employed to confirm the successful imprinting of chlorpromazine. The high selectivity of MIP toward templates enables them to be used in various applications like solid-phase extraction and chemical sensors, among others. The aim of this review is to present and highlight the various methods used to determine chlorpromazine based on molecular imprinting polymers in different samples.

Chlorpromazine (CPZ), an antipsychotic drug derived from phenothiazine, can cause a range of adverse effects in humans, notably visual problems and hematological disorders upon consumption of chlorpromazine‐contaminated water. In this regard, a novel electrochemical sensing platform based on a copper–aluminum‐layered double hydroxide (Cu–Al LDH)‐modified platinum electrode for the highly sensitive and selective detection of chlorpromazine in groundwater samples has been developed. The immobilized Cu–Al LDH showed an electrocatalytic effect on chlorpromazine reduction and oxidation. Among the employed electroanalytical techniques, only the square‐wave voltammetry‐assisted Pt/Cu–Al LDH electrode could detect chlorpromazine with a remarkable sensitivity of 0.065 µA µM−1 over a broad linear detection range of 0.01–760 µM, with low detection and quantification limits of 4.86 and 16.18 nM, respectively. Furthermore, the developed electrode can rapidly detect chlorpromazine within less than 10 s. In addition, the diffusion profiles of steady‐state concentrations of oxidized and reduced chlorpromazine within the immobilized Cu–Al were studied using the Legendre wavelet method. Moreover, the developed Pt/Cu–Al LDH electrode demonstrated satisfactory rates in the quantification of chlorpromazine in groundwater samples, yielding satisfactory recovery rates (97.63–102.57%), confirming the practicability of the fabricated electrode in real‐time monitoring of chlorpromazine levels in groundwater without requiring any sample pretreatment. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Identifying biomarkers that predict treatment response in early psychosis (EP) is a priority for psychiatry research. Previous work suggests that resting-state connectivity biomarkers may have promise as predictive measures, although prior results vary considerably in direction and magnitude. Here, we evaluated the relationship between intrinsic functional connectivity of the attention, default mode, and salience resting-state networks and 12-month clinical improvement in EP. Study Design Fifty-eight individuals with EP (less than 2 years from illness onset, 35 males, average age 20 years) had baseline and follow-up clinical data and were included in the final sample. Of these, 30 EPs showed greater than 20% improvement in Brief Psychiatric Rating Scale (BPRS) total score at follow-up and were classified as "Improvers." Study Results The overall logistic regression predicting Improver status was significant (χ2 = 23.66, Nagelkerke's R 2 = 0.45, P  < .001, with 85% concordance). Significant individual predictors of Improver status included higher default mode within-network connectivity, higher attention-default mode between-network connectivity, and higher attention-salience between-network connectivity. Including baseline BPRS as a predictor increased model significance and concordance to 92%, and the model was not significantly influenced by the dose of antipsychotic medication (chlorpromazine equivalents). Linear regression models predicting percent change in BPRS were also significant. Conclusions Overall, these results suggest that resting-state functional magnetic resonance imaging connectivity may serve as a useful biomarker of clinical outcomes in recent-onset psychosis. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the ability of pentoxifylline when compared to lovastatin and chlorpromazine as nephroprotective substances in cases of renal ischemia and reperfusion syndrome (IRI). A total of 36 adult male animals were randomly allocated into four groups (untreated control group, pentoxifylline group, lovastatin group, and chlorpromazine group), each consisting of nine animals. All groups were submitted to experimental ischemia and reperfusion procedures. The animals were evaluated 24, 72 and 120 hours after IRI, including physical examinations, serum urea and creatinine measurements, as well as histopathological, morphometric, and stereological analyses of the renal tissue. Results indicated that 24 hours after IRI, only chlorpromazine was effective in controlling azotemia. At the 72-hour mark, both chlorpromazine and pentoxifylline exhibited efficacy. After 120 hours, all three substances demonstrated renal protective qualities. Pentoxifylline was the most effective in preserving the structural integrity of kidney tissue, followed by chlorpromazine. In conclusion, all three treatments (pentoxifylline, chlorpromazine, and lovastatin) were effective. Pentoxifylline proved to be promising in the response against acute tubular necrosis, although chlorpromazine presented earlier renoprotective effects in terms of maintaining renal function. [ABSTRACT FROM AUTHOR]

Chlorpromazine (CPZ) is a first-generation neuroleptic with well-established antitumor and antiviral properties. Currently, numerous studies are focused on developing new methods for CPZ delivery; however, the knowledge regarding its conjugates with metal nanoparticles remains limited. The aim of this study was to prepare CPZ conjugates with gold nanoparticles (AuNPs) and evaluate their biological activity on human lymphocytes (HUT-78 and COLO 720L), as well as human (COLO 679) and murine (B16-F0) melanoma cells, in comparison to the effects induced by unconjugated CPZ molecules and AuNPs with well-defined properties. During the treatment of cells with CPZ, AuNPs, and CPZ-AuNP conjugates, changes in mitochondrial activity, membrane integrity, and the secretion of lipid peroxidation mediators were studied using standard biological assays such as MTT, LDH, and MDA assays. It was found that positively charged CPZ-AuNP conjugates more effectively reduced cell viability compared to AuNPs alone. The dose-dependent membrane damage was correlated with oxidative stress resulting from exposure to CPZ-AuNP conjugates. The activity of the conjugates depended on their composition and the size of the AuNPs. It was concluded that conjugating CPZ to AuNPs reduced its biological activity, while the cellular response to the treatment varied depending on the specific cell type. [ABSTRACT FROM AUTHOR]

Purpose: to study sex differences in self-reported symptoms measured with the Scale of Patient-Reported Impact of Symptoms in Schizophrenia (PRISS), to investigated sex differences in the degree of agreements between self-reported symptoms and clinical symptoms assessed by professionals, and to identify which clinical and sociodemographic variables predicted a greater presence of self-reported symptoms split by sex. Methods: 161 patients (37 females; 124 males), aged between 18 and 65 years, with a diagnosis of schizophrenia assisted in non-acute mental health services at four mental health catchment areas in Andalucia and Catalonia were included. The PRISS scale was administered to asses self-reported symptoms. Results: males reported higher presence of excitement, grandiosity, motor retardation and poor attention) than women. There was less agreement in the presence of psychotic symptoms in men than in women when comparing self-reported symptoms and clinical symptoms assessed by professionals. Finally, in men the predictors variables for the greater presence of self-perceived symptoms were greater psychotic symptomatology and more disability, while in women were greater presence of alogia and higher doses of chlorpromazine. Conclusions: Assessing and being aware of the self-perceived symptoms of patients with schizophrenia should be considered in the clinic, especially in men, as there appears to be a lack of agreement on certain items. This would allow treatments to be more focused on patients' need by sex, and would make them feel part of the therapeutic process, improving their therapeutic adherence, evolution and quality of life. [ABSTRACT FROM AUTHOR]

This study investigates the synthesis, characterization, and antimicrobial properties of hydrogels synthesized through the UV-pulsed laser photopolymerization of a polymer–photoinitiator–chlorpromazine mixture. Chlorpromazine was used for its known enhanced antimicrobial properties when exposed to UV laser radiation. The hydrogel was formed from a mixture containing 0.05% Irgacure 2959, 10% gelatin methacryloyl, and various concentrations of chlorpromazine (1, 2, and 4 mg/mL). Laser-induced fluorescence spectroscopy was employed to monitor the photoinduced changes of chlorpromazine and Irgacure 2959 during hydrogel formation, providing insight into the photodegradation dynamics. FTIR spectroscopy confirmed the incorporation of irradiated chlorpromazine within the hydrogel matrix, while the release profiles of chlorpromazine showed sustained release only in hydrogels containing 1 mg/mL of CPZ. The hydrogel showed significant antimicrobial activity against MRSA bacteria when compared to that of penicillin. These findings highlight the potential of CPZ loaded during the photopolymerization process into hydrogels as effective antimicrobial agents with sustained release properties, making them suitable for combating resistant bacterial strains. [ABSTRACT FROM AUTHOR]

Introduction: Citrus juice has been shown to cause QT prolongation in electrocardiograms of healthy volunteers, and naringenin, a major flavonoid found in citrus juice, has been identified as the potent inhibitor of human ether-a-go-go-related gene (HERG) channels as the cause of QT prolongation. Inhibition of HERG channels and prolongation of QT interval by antipsychotic drugs such as haloperidol, chlorpromazine, and clozapine have also been shown. However, naringenin’s effect on HERG channel function in conjunction with antipsychotic medications has not been investigated. Methods: In the present study, we evaluated the effect of combining naringenin with antipsychotics on the function of HERG channels expressed in Xenopus oocytes. Results: When 30 µm naringenin was added to antipsychotic drugs (1 µm haloperidol, 10 µm chlorpromazine, or 10 µm clozapine), significantly greater HERG inhibition was demonstrated, compared to the inhibition caused by antipsychotic drugs alone. Co-application studies also showed that the magnitudes of inhibitions caused by naringenin + antipsychotics were similar to that predicted by the allotopic interaction model, suggesting that naringenin and antipsychotics bind to the HERG channel at different sites. Conclusion: The results suggest that there is an additive interaction between antipsychotics and naringenin. Due to the potential for repolarization heterogeneity and a decrease in repolarization reserve, this additive HERG inhibition may increase the risk of arrhythmias. [ABSTRACT FROM AUTHOR]

Soybean allergen entering the body is the initial step to trigger intestinal allergic response. However, it remains unclear how glycinin, the major soybean allergen, is transported through the intestinal mucosal barrier. The objective of this study was to elucidate the pathway and mechanism of glycinin hydrolysates transport through the intestinal epithelial barrier using IPEC‐J2 cell model. Purified glycinin was digested by in vitro static digestion model. The pathway and mechanism of glycinin hydrolysates transport through intestinal epithelial cells were investigated by cellular transcytosis assay, cellular uptake assay, immunoelectron microscopy and endocytosis inhibition assay. The glycinin hydrolysates were transported across IPEC‐J2 cell monolayers in a time/dose‐dependent manner following the Michaelis equation. Immunoelectron microscopy showed a number of glycinin hydrolysates appeared in the cytoplasm, but no glycinin hydrolysates were observed in the intercellular space of IPEC‐J2 cells. The inhibitors, colchicine, chlorpromazine and methyl‐β‐cyclodextrin, significantly inhibited the cellular uptake of glycinin hydrolysates. The glycinin hydrolysates crossed IPEC‐J2 cell monolayers through the transcellular pathway. Both clathrin‐ and caveolae‐dependent endocytosis were involved in the epithelial uptake of the hydrolysates. These findings provided potential targets for the prevention and treatment of soybean allergy. [ABSTRACT FROM AUTHOR]

Objective: The objective of current research is to design, develop, and optimize a cilnidipine (CLN) nanostructured lipid carrier (NLC)-based drug delivery system for the effective treatment of hypertension (HT). Significance: Oral administration of CLN-loaded NLC (CLN NLC) containing glyceryl monostearate (GMS) as a solid and isopropyl myristate (IPM) as a liquid lipid may show remarkable lymphatic uptake through payer patches. Methods: The emulsification probe sonication technique was used followed by optimization using 32 factorial designs. Results: The optimized batch showed a mean particle size of 115.4 ± 0.22 nm with encapsulation efficiency of 98.32 ± 0.23%, polydispersity index (PDI) of 0.342 ± 0.03, and zeta potential (ZP, ζ) was −60.5 ± 0.24 which indicate excellent physical stability. In vitro studies showed a controlled release of CLN NLCs. Pharmacokinetics studies determined the Cmax of NLCs (373.47 ± 15.1) indicates 2.3-fold enhancement compared with plain drug (160.64 ± 7.63). Pharmacodynamic studies indicated that CLN NLCs were maintaining systolic blood pressure in a controlled manner without any signs of side effects. Conclusion: CLN NLCs significantly improved lymphatic delivery and proved to be effective in the treatment and management of HT. It has been proved that CLN NLCs are found to be better than any traditional CLN dosage form due to enhancement in solubility, absorption, bioavailability, intestinal permeability, avoidance of first-pass metabolism, P-glycoprotein efflux and reduction in dose-related side effects, achievement of controlled and sustained release action. [ABSTRACT FROM AUTHOR]

Monitoring antipsychotic drugs in biological fluids, such as human serum and urine, is important for ensuring the safety and efficacy of psychiatric treatments. This process helps maintain therapeutic drug levels, minimize side effects, and optimize patient well‐being. Chlorpromazine (CZ) is a widely prescribed antipsychotic drug used for conditions like schizophrenia, bipolar disorder, and acute psychosis. Almost all existing sensing techniques for CZ are either insensitive spectrophotometric methods or involve long and complex chromatographic procedures, limiting their routine use. In this work, we introduce a facile, green, and sensitive fluorimetric strategy with high reproducibility for detecting CZ in its pure form, tablet formulation, and spiked human plasma and urine without the need for derivatization reactions. The proposed method relies on the inhibition of the intramolecular photoinduced electron transfer (PET) effect by using 2.0 M acetic acid. This approach enables the linear detection of CZ from 3.0 to 600 ng/mL with remarkably low quantitation and detection limits of 1.51 and 0.49 ng/mL, respectively. Moreover, the developed method's greenness was evaluated. [ABSTRACT FROM AUTHOR]

IntroductionClozapine and chlorpromazine are widely used for treating schizophrenia. However, irregular medical follow-ups are common in patients with schizophrenia, potentially leading to long-term super-dose medication. Managing such cases poses significant challenges for clinical psychiatrists.Case presentationThis report describes a 24-year-old Han Chinese male diagnosed with schizophrenia who had been taking long-term super-doses of clozapine (18–107 tablets/day, 25 mg/tablet) and chlorpromazine (7–40 tablets/day, 50 mg/tablet) for five months due to irregular medical follow-ups. Upon hospitalization, the doses of antipsychotic drugs were gradually tapered, and the medication regimen was adjusted based on the patient’s previous treatment history. Comprehensive health education about schizophrenia was also provided. The patient was followed for four years, during which his psychiatric symptoms remained under partial control.ConclusionClinicians must consider individual differences in the efficacy and adverse effects of antipsychotics and weigh the benefits and risks of combination therapy. Future efforts should focus on strengthening health education for patients with schizophrenia and their families to improve treatment compliance and outcomes.

Introduction There is no consensus on the optimal antipsychotic for acute agitation. Whereas haloperidol is frequently used and has proven efficacy, second generation antipsychotics show similar efficacy and improved safety and tolerability. This study aimed to determine the effectiveness of short-acting intramuscular (IM) haloperidol versus other IM antipsychotics for acute agitation in adults admitted to an inpatient psychiatry unit. Methods This was a retrospective medical record review of patients who received 1 or more doses of a short-acting IM antipsychotic, including chlorpromazine, haloperidol, olanzapine, or ziprasidone. The primary endpoint was the need for subsequent IM antipsychotic(s) or physical restraint within 2 hours of the initial IM antipsychotic. Secondary endpoints assessed outcomes at 24 hours and adverse events. Results One hundred six patients were included. Four patients in the haloperidol group and 0 patients in the other antipsychotic group received an additional IM antipsychotic or required physical restraints within 2 hours (5.3% versus 0%, p = .319). More patients in the other antipsychotic group required an additional dose of IM antipsychotic within 24 hours compared with the haloperidol group (p = .0096). More adverse events were seen in patients who received haloperidol. Discussion Haloperidol was used more frequently than other short-acting IM antipsychotics. Whereas the effectiveness at 2 hours was not significantly different between groups, patients who received haloperidol were more likely to experience adverse events and were more often subjected to polypharmacy with benzodiazepines and/or diphenhydramine. This study further supports the use of olanzapine and ziprasidone for acute agitation in patients hospitalized in inpatient psychiatry.

Abstract Background In the fight against GBM, drug repurposing emerges as a viable and time-saving approach to explore new treatment options. Chlorpromazine, an old antipsychotic medication, has recently arisen as a promising candidate for repositioning in GBM therapy in addition to temozolomide, the first-line standard of care. We previously demonstrated the antitumor efficacy of chlorpromazine and its synergistic effects with temozolomide in suppressing GBM cell malignant features in vitro. This prompted us to accomplish a Phase II clinical trial to evaluate the efficacy and safety of adding chlorpromazine to temozolomide in GBM patients with unmethylated MGMT gene promoter. In this in vitro study, we investigate the potential role of chlorpromazine in overcoming temozolomide resistance. Methods In our experimental set, we analyzed Connexin-43 expression at both the transcriptional and protein levels in control- and chlorpromazine-treated GBM cells. DNA damage and subsequent repair were assessed by immunofluorescence of γ-H2AX and Reverse-Phase Protein microArrays in chlorpromazine treated GBM cell lines. To elucidate the relationship between DNA repair systems and chemoresistance, we analyzed a signature of DNA repair genes in GBM cells after treatment with chlorpromazine, temozolomide and Connexin-43 downregulation. Results Chlorpromazine treatment significantly downregulated connexin-43 expression in GBM cells, consequently compromising connexin-dependent cellular resilience, and ultimately contributing to cell death. In line with this, we observed concordant post-translational modifications of molecular determinants involved in DNA damage and repair pathways. Our evaluation of DNA repair genes revealed that temozolomide elicited an increase, while chlorpromazine, as well as connexin-43 silencing, a decrease in DNA repair gene expression in GBM cells. Conclusions Chlorpromazine potentiates the cytotoxic effects of the alkylating agent temozolomide through a mechanism involving downregulation of Cx43 expression and disruption of the cell cycle arrest essential for DNA repair processes. This finding suggests that chlorpromazine may be a potential therapeutic strategy to overcome TMZ resistance in GBM cells by inhibiting their DNA repair mechanisms.

Chlorpromazine (CPZ) is one of the most effective antipsychotic drugs used for managing psychotic related disorders owing to its dopamine receptor blocking action. However, pharmacological investigations against CPZ’s cytotoxic effect have remained scarce. Hence, this study investigated the preventive and reversal effects of taurine and coenzyme-Q10 (COQ-10), which are compounds with proven natural antioxidant properties, against CPZ-induced hematological impairments in male rats. In the preventive study, rats received oral saline (10 ml/kg), taurine (150 mg/kg/day), COQ-10 (10 mg/kg/day) or in combination for 56 days, alongside CPZ (30 mg/kg, p.o.) between days 29–56. In the reversal protocol, rats had CPZ repeatedly for 56 days before taurine and COQ-10 treatments or their combination from days 29–56. Rats were also given taurine (150 mg/kg/day), and COQ-10 (10 mg/kg/day) alone for 56 days. Serums were extracted and assayed for hematological, with oxidative and inflammatory markers. CPZ induced decreased red/white blood cells, erythropoietin, platelet count, packed cell volume and hemoglobin, neutrophil, and lymphocyte, which were prevented and reversed by taurine and COQ-10, or their combination. Taurine and COQ-10 improved mean corpuscular volume, hemoglobin concentration, with increased erythropoietin levels relative to CPZ groups. CPZ-induced increased malondialdehyde, tumor necrosis factor-alpha and interleukin-6 levels with decreased interleukin-10, glutathione, and superoxide-dismutase were prevented and reversed by taurine and COQ-10 in comparison with CPZ groups. Taurine and COQ-10 alone notably improved the antioxidant/anti-inflammatory status relative to controls. Among other mechanisms, taurine and COQ-10 abated CPZ-induced hematological deficiencies, via decreased serum levels of oxidative stress, and pro-inflammatory cytokines release, with increased antioxidants and anti-inflammation function.

Abstract Introduction Hiccups are among the rare complications of COVID-19 infections. There are several published reports of persistent hiccups presenting during the acute COVID-19 period. However, there are very few published reports of persistent hiccups occurring in the post-acute COVID-19 period. Consequently, most clinicians may not be aware of this rare presentation. This case highlights an atypical presentation of persistent hiccups that manifested during the post-acute COVID -19 period that clinicians need to be aware of. The caseadds to the ever increasing body of knowledge about symptoms and signs associated with Severe Acute Respiratory Syndrome Corona Virus type 2 (SARS CoV-2) infection. Case presentation A 27 year old male black Zambian patient presented to the emergency department of our hospital with persistent hiccup, 35 days after the initial acute episode of COVID-19. This was associated with breathlessness. There were no other symptoms. He had no history of pulmonary, gastrointestinal, neurological disease or malignancy. He did not take any alcohol or smoke. He had never used any recreational drugs. He was employed as a monitoring and evaluation officer at one of the main COVID centres in the capital. On examination, the patient was anxious. Blood pressure was 141/82, pulse rate was 95 beats per minute, respiratory rate was 26 breaths per minute, temperature was 36.8C and oxygen saturation was 97% on room air. Systemic examination was normal. Chest X-ray and abdominal ultrasonography were normal. A rapid COVID-19 antigen test, and COVID-19 Polymerase Chain Reaction (PCR) test that were done the following day were negative. All other haematological and biochemical tests, including D-dimer and C-reactive protein (CRP), were also normal. A diagnosis of post-acute COVID-19 associated hiccups was made. The patient responded well to treatment with chlorpromazine 25 mg 8 hourly. The hiccups disappeared completely after the fourth dose of chlorpromazine. Conclusion This is one of the few published cases of COVID-19 associated persistent hiccups, occurring more than a month after the initial presentation. Most of the published cases report hiccups occurring in the acute COVID-19 period. Consequently, hiccups occurring in the post-acute COVID-19 period may not be attributable to COVID-19. This case has highlighted the need to consider post-acute COVID-19 in the differential diagnosis of persistent hiccup.

This study examined the possibility of using an alcoholic extract of S. costus root as a protective agent against chlorpromazine, which causes male infertility. The study divided white male rats into five groups, each containing six rats, for 30 days. The results revealed that the rats that received doses of chlorpromazine had significant changes in the hormones LH, FSH, and testosterone, in addition to a decrease in sperm motility, distortion of some sperm, and death of others. When injecting the rats with different doses of the alcoholic extract of the S. costus plant (at concentrations of 1.25 mg/kg, 2.4 mg/kg, and 4 mg/kg), in conjunction with doses of chlorpromazine at 2 mg/kg, there was no decrease in the aforementioned attributes. The histological test of the testicles showed significant changes in the histological structure of the testis in the group that received chlorpromazine. Both the amount of Leydig and Sertoli cells were reduced, as well as the average diameter of the seminiferous tubules, as a result of taking the drug. This led to a lower number of sperm-forming cells, the presence of gaps or spaces between the seminiferous tubules, and few or no mature sperm. Compared to the control group, the interstitial tissue was similarly dense, the spacing between the seminiferous tubules was reduced, and spermatogenic cells with mature spermatogonia appeared within the lumen of the tubules. There was a slight increase in the diameter of the seminiferous tubules and the number of Sertoli and Leydig cells compared to the control group. Seminiferous tubules and the average Leydig and Sertoli cell diameters increased significantly in the two groups at doses of 2.4 mg/kg and 4 mg/kg.

Objective: Cervical epidural steroid injections (ESIs) can provide effective pain management for patients suffering from chronic neck pain due to various pathological changes of the cervical spine. There are several rare adverse effects reported from interventional pain procedures, including persistent hiccups ("singultus"). Based on a limited number of cases, we propose a modified treatment algorithm for this adverse outcome (Fig. 3). Case report: Singultus has been documented as an adverse effect of interventional pain procedures, including epidural steroid, facet joint, and sacroiliac joint injections. We describe the case of a general contractor who presented to our clinic with chronic neck pain and central canal stenosis. The patient received an uncomplicated lumbar ESI in the past and was recommended for a cervical interlaminar ESI. After an uneventful C6-C7 interlaminar ESI with dexamethasone, 1% lidocaine, and normal saline the patient developed singultus. Baclofen was sent to his pharmacy, but this was unsuccessful at alleviating his hiccups. The patient was subsequently started on chlorpromazine and found relief from his symptomatology. Conclusion: Persistent hiccups after ESI or interventional pain procedures can be treated with conservative measures and non-pharmacologic methods, with escalation to therapy with baclofen, gabapentin, pregabalin, metoclopramide, chlorpromazine, other antipsychotic or antidopaminergic agents, and possible dual or triple therapy if further indicated. [ABSTRACT FROM AUTHOR]

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is gaining attention in pharmacovigilance, but its association with antipsychotics, other than clozapine, is still unclear. Methods: We conducted a case/non-case study with disproportionality analysis based on the World Health Organization (WHO) global spontaneous reporting database, VigiBase®. We analyzed individual case safety reports of DRESS syndrome related to antipsychotics compared to (1) all other medications in VigiBase®, (2) carbamazepine (a known positive control), and (3) within classes (typical/atypical) of antipsychotics. We calculated reporting odds ratio (ROR) and Bayesian information component (IC), with 95% confidence intervals (CIs). Disproportionate reporting was prioritized based on clinical importance, according to predefined criteria. Additionally, we compared characteristics of patients reporting with serious/non-serious reactions. Results: A total of 1534 reports describing DRESS syndrome for 19 antipsychotics were identified. The ROR for antipsychotics as a class as compared to all other medications was 1.0 (95% CI 0.9–1.1). We found disproportionate reporting for clozapine (ROR 2.3, 95% CI 2.1–2.5; IC 1.2, 95% CI 1.1–1.3), cyamemazine (ROR 2.3, 95% CI 1.5–3.5; IC 1.2, 95% CI 0.5–1.7), and chlorpromazine (ROR 1.5, 95% CI 1.1–2.1; IC 0.6, 95% CI 0.1–1.0). We found 35.7% of cases with co-reported anticonvulsants, and 25% with multiple concurrent antipsychotics in serious compared to 8.6% in non-serious cases (p = 0.03). Fatal cases were 164 (10.7%). Conclusions: Apart from the expected association with clozapine, chlorpromazine and cyamemazine (sharing an aromatic heteropolycyclic molecular structure) emerged with a higher-than-expected reporting of DRESS. Better knowledge of the antipsychotic-related DRESS syndrome should increase clinicians' awareness leading to safer prescribing of antipsychotics. [ABSTRACT FROM AUTHOR]

Near-infrared spectroscopy (NIRS) is a noninvasive functional neuroimaging modality that can detect changes in blood oxygenation levels by tracking cortical neural activity. We recorded the resting-state brain activity of 24 individuals with schizophrenia and 90 healthy controls for 8 min using a whole-head NIRS arrangement and then used partial correlation analysis to estimate the resting-state functional connectivity (RSFC) between 17 cortical regions. We found that the RSFC between the bilateral orbitofrontal cortices (OFCs) and between the right temporal and parietal lobes was significantly higher in patients with schizophrenia than in healthy controls. The RSFC between the bilateral OFCs was positively correlated with negative symptom severity, whereas the RSFC between the right temporal and parietal lobes was positively correlated with the chlorpromazine equivalent for antipsychotics prescribed to patients with schizophrenia. This finding was consistent with that for the RSFC calculated using the anterior 52-channel signals. Our results suggest that NIRS-based RSFC measurements have potential clinical applications. [ABSTRACT FROM AUTHOR]

Goats respond to pain and often require chemical restraints for veterinary procedures. Information regarding the cardiopulmonary, haematological and biochemical effects of chlorpromazine (CPZ) or chlorpromazine-pentazocine (CPZ-PTZ) in West African Dwarf (WAD) goats has not been fully established. The study aimed to evaluate the cardiopulmonary, haematological and biochemical responses of WAD goats following sedation with either CPZ alone or a combination of CPZ-PTZ. Six healthy adult WAD bucks were randomly selected for two separate experiments using CPZ or CPZ-PTZ in a prospective crossover trial. Anaesthetic indices were taken. Blood samples were collected before the experiment (0 minutes), 45 minutes, 90 minutes and 24 hours for haematology and serum biochemistry assay. Heart rate (HR), respiratory rate (RR) and rectal temperature (°C) were measured at intervals of 10 minutes for 90 minutes. In between clinical trials, the bucks were given a 14-day break. The duration of recumbency for CPZ (43.00 ± 12.95 minutes) was significantly lower compared to the CPZ-PTZ protocol (46.50 ± 27.32 minutes). Analgesia was recorded in only the CPZ-PTZ group for 41.67 ± 1.75 minutes. The HR was significantly higher (p<0.05) in the CPZ-PTZ group than in the CPZ group from 0 to 70 minutes. The CPZ-PTZ protocol was a better one as it did not exert a negative effect on the red blood cells or serum protein compared with CPZ alone in the goats. Haematological, biochemical and cardiopulmonary changes were also evident in the goats. Further research may determine the risk-benefit profile of this anaesthetic regimen. [ABSTRACT FROM AUTHOR]

Background Dysmyelination could be part of the pathophysiology of schizophrenia spectrum (SCZ) and bipolar disorders (BPD), yet few studies have examined myelination of the cerebral cortex. The ratio of T1- and T2-weighted magnetic resonance images (MRI) correlates with intracortical myelin. We investigated the T1w/T2w-ratio and its age trajectories in patients and healthy controls (CTR) and explored associations with antipsychotic medication use and psychotic symptoms. Methods Patients with SCZ (n = 64; mean age = 30.4 years, s.d. = 9.8), BPD (n = 91; mean age 31.0 years, s.d. = 10.2), and CTR (n = 155; mean age = 31.9 years, s.d. = 9.1) who participated in the TOP study (NORMENT, University of Oslo, Norway) were clinically assessed and scanned using a General Electric 3 T MRI system. T1w/T2w-ratio images were computed using an optimized pipeline with intensity normalization and field inhomogeneity correction. Vertex-wise regression models were used to compare groups and examine group × age interactions. In regions showing significant differences, we explored associations with antipsychotic medication use and psychotic symptoms. Results No main effect of diagnosis was found. However, age slopes of the T1w/T2w-ratio differed significantly between SCZ and CTR, predominantly in frontal and temporal lobe regions: Lower T1w/T2w-ratio values with higher age were found in CTR, but not in SCZ. Follow-up analyses revealed a more positive age slope in patients who were using antipsychotics and patients using higher chlorpromazine-equivalent doses. Conclusions While we found no evidence of reduced intracortical myelin in SCZ or BPD relative to CTR, different regional age trajectories in SCZ may suggest a promyelinating effect of antipsychotic medication. [ABSTRACT FROM AUTHOR]

Background: In the fight against GBM, drug repurposing emerges as a viable and time-saving approach to explore new treatment options. Chlorpromazine, an old antipsychotic medication, has recently arisen as a promising candidate for repositioning in GBM therapy in addition to temozolomide, the first-line standard of care. We previously demonstrated the antitumor efficacy of chlorpromazine and its synergistic effects with temozolomide in suppressing GBM cell malignant features in vitro. This prompted us to accomplish a Phase II clinical trial to evaluate the efficacy and safety of adding chlorpromazine to temozolomide in GBM patients with unmethylated MGMT gene promoter. In this in vitro study, we investigate the potential role of chlorpromazine in overcoming temozolomide resistance. Methods: In our experimental set, we analyzed Connexin-43 expression at both the transcriptional and protein levels in control- and chlorpromazine-treated GBM cells. DNA damage and subsequent repair were assessed by immunofluorescence of γ-H2AX and Reverse-Phase Protein microArrays in chlorpromazine treated GBM cell lines. To elucidate the relationship between DNA repair systems and chemoresistance, we analyzed a signature of DNA repair genes in GBM cells after treatment with chlorpromazine, temozolomide and Connexin-43 downregulation. Results: Chlorpromazine treatment significantly downregulated connexin-43 expression in GBM cells, consequently compromising connexin-dependent cellular resilience, and ultimately contributing to cell death. In line with this, we observed concordant post-translational modifications of molecular determinants involved in DNA damage and repair pathways. Our evaluation of DNA repair genes revealed that temozolomide elicited an increase, while chlorpromazine, as well as connexin-43 silencing, a decrease in DNA repair gene expression in GBM cells. Conclusions: Chlorpromazine potentiates the cytotoxic effects of the alkylating agent temozolomide through a mechanism involving downregulation of Cx43 expression and disruption of the cell cycle arrest essential for DNA repair processes. This finding suggests that chlorpromazine may be a potential therapeutic strategy to overcome TMZ resistance in GBM cells by inhibiting their DNA repair mechanisms. [ABSTRACT FROM AUTHOR]

A nanosodalite (SOD) was synthesized utilizing Cameroonian kaolin and then used to prepare a nanocomposite (SOD‐GF) with graphene foam (GF). The as‐synthesized materials were characterized using X‐ray diffractometry (XRD), Fourier transform‐infrared (FT‐IR) spectroscopy, N2 adsorption‐desorption and scanning electron microscopy coupled with emission dispersive X‐ray (SEM/EDX). The results show a pure sodalite with high degree of crystallinity with crystallite size and BET surface area of 38.3 nm and 22 m2/g, respectively. The composite's characterization revealed a well‐integrated material in which the structural integrity of each material is maintained, its surface area being 4‐fold that of pristine SOD. Stable SOD and SOD‐GF modified glassy carbon electrode (GCE) were prepared by drop coating without a binder and utilized to study the electrochemistry of chlorpromazine (CPZ) in acidic, neutral and basic pHs. It appeared that (i) CPZ's electrochemical oxidation was a two‐step one‐electron process at SOD/GCE and a one‐step two‐electron process at SOD‐GF/GCE and (ii) the electrochemical reaction mechanism was an EEC mechanism at SOD/GCE while at SOD‐GF/GCE the mechanism was EEC at pH<4 and EC for greater pH. SOD/GCE and SOD‐GF/GCE were used to sense CPZ within CPZ's concentration ranging from 0.5‐30 μM with low detection limits. [ABSTRACT FROM AUTHOR]

The article reviews examples where additional focus or training is needed to optimize pharmacological treatments of schizophrenia. These include the use of hierarchical approach to treatment planning, making the therapeutic relationship with patients a priority, and embracing expertise in pharmacological management.

The tractable preparation of Phase I drug metabolites is a critical step to understand the firstpass behaviour of novel chemical entities (NCEs) in drug discovery. In this study, we have developed a structure–electroactivity relationship (SeAR)-informed electrochemical reaction of the parent 2-chlorophenothiazine and the antipsychotic medication, chlorpromazine. With the ability to dial-in under current controlled conditions, the formation of S-oxide and novel S,S-dioxide metabolites has been achieved for the first time on a multi-milligram scale using a direct batch electrode platform. A potential rationale for the electrochemical formation of these metabolites in situ is proposed using molecular docking to a cytochrome P450 enzyme. [ABSTRACT FROM AUTHOR]