Ursodeoxycholic acid augmentation in treatment-refractory schizophrenia: a case report
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CASE REPORT
Open Access
Ursodeoxycholic acid augmentation in treatment-refractory schizophrenia: a case report Mohsen Khosravi
Abstract Background: Treatment-resistance is recognized as a significant dilemma in schizophrenia, which has been reported to involve approximately one-third of patients with schizophrenia. Case presentation: This case report described a 12-week treatment course for a 39-year-old Persian man with treatment-refractory schizophrenia, who showed a significant improvement in terms of positive, negative, and cognitive symptoms after taking ursodeoxycholic acid 300 mg capsules twice a day. Also, ursodeoxycholic acid was well tolerated, and he did not exhibit any side effects during treatment, based on interview and physical examination. Conclusion: Ursodeoxycholic acid augmentation seems to be an effective treatment strategy for patients with treatment-refractory schizophrenia. However, further investigations in this field need to be carried out through randomized controlled trials. Keywords: Schizophrenia, Therapeutics, Ursodeoxycholic acid, Report
Background Treatment-resistance is a significant dilemma in schizophrenia, which has involved many patients, their families, and health care professionals. Treatment-refractory schizophrenia (TRS) is defined as a treatment failure despite the use of two adequate treatment trials with antipsychotics of two different classes (including a 4-to6-week trial of 400 to 600 mg/day chlorpromazine or its equivalent). TRS affects approximately one-third of patients with schizophrenia [1]. Over the past decade, many clinical practice guidelines have recommended clozapine for patients with TRS; however, only 40% of the patients have met the response criteria [2]. Furthermore, there has been no convincing evidence for the augmentation of clozapine yet; Even “novel” therapies, including N-methyl-D-aspartate receptor (NMDAR) Correspondence: [email protected] Department of Psychiatry and Clinical Psychology, Zahedan University of Medical Sciences, Zahedan 9813913777, Iran
enhancers (such as glycine, D-serine, D-cycloserine, and N-methylglycine), yielded contradictory results in clinical trials [3]. Bile acids are known as an associated category of molecules extracted from cholesterol and have been used as therapeutic agents in medicine for a long time [4]. Recent studies have shown that ursodeoxycholic acid (UDCA) and its main conjugate, that is, glycoursodeoxycholic acid (GUDCA), are bile acids with neuroprotective and homeostatic properties due to their capacity to inhibit glutamate release [5]. Based on these findings, a possible hypothesis is presented, stating that UDCA may be effective in reducing the psychotic and cognitive symptoms among patients with schizophrenia. In line with the above hypothesis, our report presented a 12week treatment course for a patient with TRS who made significant improvement in positive, negative, and cognitive symptoms following initiation of UDCA.
© The Author(s). 2020 Open Access This article is licensed under a Crea
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