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Psychocutaneous Disorders
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Kristen Russomanno, Vesna M. Petronic-Rosic
Antidepressants, including SSRIs, anxiolytics, and low-dose antipsychotics (e.g., aripiprazole, pimozide, risperidone, olanzapine) can be useful in the management of underlying depression, anxiety, and/or obsessive-compulsive behaviors respectively. Dosing of 0.5–1 mg/day of pimozide, risperidone 0.5–2 mg/day, or aripiprazole 2–5 mg/day may be beneficial; however, it is often difficult to approach the subject of these treatments given that patients often lack awareness and/or acceptance of an underlying psychologic etiology.
Tic Disorders and Tourette Syndrome
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
Valerie Brandt, Samuele Cortese
The most recent expert guidelines highlight that tics should be treated when they cause ‘subjective discomfort (e.g. pain or injury)’, ‘sustained social problems for the patient (e.g. social isolation or bullying)’, ‘social and emotional problems for the patient (e.g. reactive depressive symptoms)’ or ‘functional interference (e.g. impairment of academic achievements)’, and the pharmacological treatment should be considered if non-pharmacological treatments are ineffective or unavailable (Roessner et al., 2011). As for the choice of the agent, the guidelines highlight the paucity of comparative evidence. When taking into account expert opinion and experience, the guidelines recommend risperidone as a first-choice agent, but they also highlight that aripiprazole has a more favourable profile in terms of risk of weight gain. As for the other drugs, the guidelines recommend pimozide over haloperidol, due to its more favourable tolerability profile, and clonidine, especially when there is co-morbid ADHD. Finally, the guidelines suggest risperidone as first line when there is a co-morbid OCD.
Gilles de la Tourette’s syndrome
Published in David Enoch, Basant K. Puri, Hadrian Ball, Uncommon Psychiatric Syndromes, 2020
David Enoch, Basant K. Puri, Hadrian Ball
Antidepressant drugs of the SSRI category have been increasingly used following favourable reports in the late 1980s (Wetering et al., 1988). Cipriano et al. (1999) reported the successful treatment of a possible organically induced Tourette syndrome with a combination of clomipramine, fluvoxamine and pimozide. Antidepressants should certainly be considered if depressive symptoms are present. Successful treatments with other drug groups have also been reported, including calcium antagonists (Berg, 1985; Vieregge, 1987), lithium carbonate (Messiha, 1979), naloxone and tetrabenazine (Sandyk, 1985). In the United States, the α2-adrenergic agonists clonidine and guanfacine tend to be used as first-line drug treatments (Robertson et al., 2017). Other drugs treatments which may be helpful for Tourette syndrome and which may have a more tolerable side-effect profile than antipsychotic medication include baclofen, topiramate, botulinum toxin A, tetrabenazine and deutetrabenazine (Quezada and Coffman, 2018). These authors also have developed a treatment algorithm for Tourette syndrome; after behavioural intervention as the proposed first-line therapy, it includes three levels of pharmacotherapy, and it also mentions drugs which are currently under investigation.
The inhibitory effects of pimozide, an antipsychotic drug, on voltage-gated K+ channels in rabbit coronary arterial smooth muscle cells
Published in Drug and Chemical Toxicology, 2023
Mi Seon Seo, Jin Ryeol An, Ryeon Heo, Minji Kang, Seojin Park, Seo-Yeong Mun, Hongzoo Park, Eun-Taek Han, Jin-Hee Han, Wanjoo Chun, Geehyun Song, Won Sun Park
Pimozide is a typical antipsychotic drug used primarily to treat chronic psychosis, schizophrenia, Tourette’s syndrome, and resistant tics. The major molecular targets of pimozide are dopamine type 2 receptors, and its blockade of this receptor is thought to be important for normalizing the dopaminergic activity imbalance associated with Tourette’s syndrome (Pringsheim and Marras 2009). Although pimozide has beneficial characteristics, such as relatively less dyskinesia (Roessner et al. 2011), it can cause serious cardiac adverse effects, such as arrhythmias (Committee on Safety of Medicines—Medicines Control Agency 1995). It has a potent inhibitory effect on cardiac human ether-a-go-go-related gene (hERG) channels with high affinity and prolongs the QT interval (Kang et al. 2000, Kongsamut et al. 2002). Furthermore, it inhibits the human brain ERG3 K+ channel (Kang et al. 2001) and neuronal K+ channels, such as voltage-gated K+ (Kv) channels (Zhang et al. 2003) and cAMP-sensitive cyclic nucleotide-gated-like K+ channels (Gomora and Enyeart 1999). However, to date, the effects of pimozide on vascular K+ channels, specifically voltage-gated K+ (Kv) channels, have not been reported. Thus, we investigated the effects of pimozide on vascular Kv channels using freshly isolated coronary arterial smooth muscle cells.
Delusional infestation: a case for preserving pimozide as an option
Published in Journal of Dermatological Treatment, 2022
One very important advantage of pimozide in the United States is that this is the only medication with a powerful antipsychotic effect without a Food and Drug Administration (FDA) indication for a psychiatric disorder. In the United States, pimozide is only indicated for Tourette syndrome (7). It is well-known that patients with DI oppose vehemently the slightest implication that their problem is mental. It is incredibly challenging to get patients with DI to take an antipsychotic agent that is clearly labeled as an antipsychotic, as patients can easily discover this fact. On discovery, any rapport between physician and patient significantly erodes or even vanishes completely. The authors’ experience have been that, frequently, the only medication the patients are willing to accept may be pimozide. Another advantage of pimozide is that this medication does not have any known risk of metabolic syndrome, which is present in nearly all second-generation antipsychotics (1).
Treatment of tardive dyskinesia: a review and update for dermatologists managing delusions of parasitosis
Published in Journal of Dermatological Treatment, 2022
Christian Cheng, Nicholas Brownstone, John Koo
Despite the fact that a patient who presents with delusions of parasitosis may lead to a difficult and stressful patient encounter, medications exist which are very effective and can even lead to a cure (36). Pimozide, a first-generation antipsychotic agent, is unique in that it is often accepted as a therapy by this patient population given it has no official US FDA psychiatric indication (37). Patients presenting with delusions of parasitosis are strongly averse to any inkling of mental health or psychiatry as part of their treatment regimen (38). Pimozide typically is used to treat DOP at a low dose of 3 mg or less daily, starting with 0.5 or 1 mg and slowly titrating upward (typically by increments of 0.5 mg and not faster than every 2–4 weeks) until a clinically effective dose is reached. Pimozide rarely is used long-term; after the resolution of symptoms, the dose usually is continued at the clinically effective dose for a few months and then is slowly tapered off (39). This same dosing regimen can be used for risperidone, which is another option when treating delusions of parasitosis. Finally, aripiprazole and olanzapine are two other medications that are often effective if the first two options cannot be used.