Sir: We report a case in which steroid-induced psychosis was eliminated with combined therapy with valproic acid and risperidone in a patient with systemic lupus erythematosus SLE ; . Case report. Ms. A, a 46-year-old woman, had had a diagnosis of SLE for 20 years. She had been treated with prednisolone from a minimum of 7.5 mg to a maximum of 30 mg daily. Her SLE symptoms had been controlled with prednisolone, 12.5 mg daily, for 5 years. For the last 15 years, she had taken triazolam, 7.5 mg daily, or flunitrazepam, 2 mg daily, for insomnia. She had not experienced episodes of depression, mania, or psychosis. In December 2002, approximately 2 months before her admission to our hospital, her prednisolone dosage was increased to 40 mg daily owing to exacerbation of erythema. After 1 month at this dosage, she had a hypomanic episode DSM-IV criteria ; , with symptoms including being more talkative than!

Mothers taking risperidone should not breast feed their babies. Three quarters of the patients had changes in eating behaviours during episodes Table 2 ; . The majority typically ate larger amounts of food megaphagia ; . Increased food intake ranged from a mild increase to `three times his usual diet' Shukla et al., 1982 ; or `68 meals a day' Hart, 1985 ; with a 730 lb 3.213.6 kg ; weight gain. A patient was hospitalized for breathlessness caused by a distended abdomen, due to recent enormous meals Prabhakaran et al., 1970 ; . Increased drinking of water and juice was also occasionally present, but was never observed alone. A minority of patients 5% ; had an aversion to food or ate less during one or several episodes, but would overeat during other episodes Kellett, 1977; Manni et al., 1993; Portilla et al., 2002; Poppe et al., 2003 ; . Several authors noted that the symptoms were distinct from bulimia, since patients never alternated with periods of self-induced vomiting and voluntary fasting. Food cravings and megaphagia were the most critical elements. Some patients stole food in shops or off the plates of other patients in the hospital George, 1970; Prabhakaran et al., 1970; Rosenow et al., 2000 ; , searched for food in dustbins Prabhakaran et al., 1970 ; and, because risperidone 2mg.

Results Experiments with rat brain homogenates indicated that olanzapine, risperidone and quetiapine all had very low affinity at NMDA, AMPA and KA receptors. At concentrations of 10100 M, olanzapine, risperidone and quetiapine inhibited binding of all three radioligands by only 0%6% all Ki 10 M ; The observed distribution of ionotropic Glu receptors accorded closely with our previous findings in rat brain Tarazi et al., 1996, 1998 ; that NMDA and AMPA receptors are highly expressed in hippocampal areas CA1 CA3 ; , followed by cerebral cortex, CPu and NAc Tables 1, 2 ; . In contrast, KA receptors were expressed selectively in the hippocampal CA3 region, MPC, and NAc Table 3 ; . Two-way ANOVA measuring overall changes across drug treatments and brain regions for NMDA assay was highly significant p 0.001 ; . Four weeks of continuous infusion of olanzapine, risperidone and quetiapine reduced labeling of NMDA receptors in the medial by 30%, 33% and 27%, respectively; F [2; 20 df] 8.7, p 0.001 ; and lateral portions of caudateputamen by 31%, 35% and 24%, F [2; 20 df] 11.3, p 0.001 ; . In addition, olanzapine and risperidone, but not quetiapine, significantly decreased NMDA receptor binding in the CA1 by 21% and 19%, F [2; 20 df] 5.3, p 0.01 ; and CA3 by 23% and 22%, F 5.3, p 0.01 ; regions of hippocampus Table 1 ; . There were no significant changes in NMDA receptor levels in cerebral cortical MPC, DFC and EC regions Table 1 ; . Two-way ANOVA for AMPA receptor assay was also significant p 0.05 ; . Continuous administration of olanzapine, risperidone and quetiapine increased binding of AMPA receptors in medial CPu [by 19%, 30% and 26%, respectively, F [2; 20 df] 4.4, p 0.02] and lateral [by 24%, 31% and 29%, F 4.9, p 0.001] regions, with no significant changes in cortical or limbic brain regions Table 2 ; . Long-term infusion of all test agents failed to alter tissue concentrations of KA receptors in any brain region Table 3. Toriseltm temsirolimus ; wyeth pharmaceuticals inc.

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