alexa Add-on Atomoxetine Mitigated Different Symptom Domains in a Case of Early- Onset Schizophrenia | OMICS International
ISSN: 2378-5756
Journal of Psychiatry
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Add-on Atomoxetine Mitigated Different Symptom Domains in a Case of Early- Onset Schizophrenia

Ahmed Naguy1* and Haya Al-Mutairi2


1Child & Adolescent Psychiatrist, Kuwait Centre for Mental Health (KCMH), Kuwait

2Consultant Psychiatrist, Adan Hospital and Director General of KCMH, Kuwait

*Corresponding Author:
Ahmed Naguy
Child & Adolescent Psychiatry Unit
Kuwait Centre for Mental Health
State of Kuwait
Tel: 96565541937
E-mail: [email protected]

Received Date: March 12, 2015; Accepted Date: March 30, 2015; Published Date: April 07, 2015

Citation: Naguy A, Al-Mutairi H (2015) Add-on Atomoxetine Mitigated Different Symptom Domains in a Case of Early-Onset Schizophrenia. J Psychiatry 18:279. doi: 10.4172/Psychiatry.1000279

Copyright: ©2015 Naguy A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Visit for more related articles at Journal of Psychiatry


Early-onset Schizophrenia; Atomoxetine; Negative domain; Cognitive domain; Metabolic syndrome

To The Editor

Early-onset schizophrenia (EOS), with an onset before age of 13, is notorious to be of poor prognosis, male preponderance, insidious onset, heavy genetic load, negative and cognitive domains presentation, subtle neurologic signs, gross impairment and generally poor antipsychotic response [1]. Despite initial enthusiasm about the potential of Atypical Antipsychotics (AAPs) to help with negative and cognitive domains, in stark contradistinction to conventional neuroleptics, clinical experience with these agents called this conjecture into question [2]. Significant cognitive impairment is commonplace affecting up to 75% of patients and is a prime driver of the significant disabilities in social, occupational and economic functioning [3]. Negative symptoms affect individuals’ ability to cope with everyday activities and have a negative impact on their quality of life and continues to remain a major clinical hurdle [4]. Atomoxetine (ATX), is a non-stimulant, FDA-approved for Attention-Deficit/Hyperactivity Disorder (ADHD) and selectively inhibits norepinephrine reuptake (NRI) [5]. Here, we are reporting a pharmacologically-challenging case of EOS where add-on ATX was very impressive, helped with negative and cognitive domains, and curbed binge-eating-like episodes that occurred more as part of disorganized symptom cluster (DSC) rather than bona fide comorbid eating disorder and strikingly counteracted weight gain induced by AAPs. This was achieved with high tolerability and no significant drugdrug interactions.

A 15-year-old Kuwaiti male youngster was brought in to hospital by his parents for disorganized behaviours coupled with scholastic failure. This dated circa 2 years back with incipient onset of social withdrawal, neglected grooming and hygiene, fitful sleep, vague and digressive speech, and scholastic underachievement. School reported recent hostile and quarrelsome behaviours, dishevelled appearance and academic failure. At home, he began to demonstrate pervasive suspiciousness, giggling, binge-eating-like episodes with no rationale, and at times muttering under breath. It ran a progressively deteriorating course and reached a nadir when the patient, in jactitation, gripped a knife to ‘protect’ himself from those ‘stealing’ his thoughts as he reported. The patient has a schizophrenic paternal uncle. He has unremarkable developmental trajectories, apart from notable ‘clumsiness’ as parents reported. Hospitalization for safety concerns was suggested, but declined by parents. Full work-up for a ‘first-episode psychosis’ was contemplated including baseline laboratory investigations, TFT, B12, Prolactin, Toxicology screen , ECG, EEG, and MRI brain, all with negative yield. The patient has failed adequate sequential trials on Aripiprazole, Olanzapine, and Quetiapine monotherapy, despite ensured compliance. Enormous weight gain was recorded. Clozapine was proposed but again declined by parents in spite of psychoeducation. We decided to embark on Risperidone trial at 4 mg/d. Clonazepam 1 mg/d was added to help with agitation and insomnia. Lamotrigine augmentation, 6 weeks later on, was then pursued at 100 mg/d for associated parathymia. Tangible improvement was noticed chiefly in the positive domain. Contrariwise, binge-eating, which was more bothersome to parents, together with negative and cognitive domains were very much impairing both socially and academically. Atomoxetine, after another 6 weeks, was suggested and parents’ consent obtained. At 40 mg/d, over 4 weeks now, binge-eating dramatically diminished. Simultaneously noted was better interpersonal socialization. Negative symptomatology improvement clinically was objectified on Scale for Assessment of Negative Symptoms (SANS) in comparison to baseline records. Digital Symbol Substitution Test (DSST) was employed to assess cognitive domains and the results were very impressive, again when contrasted with pre-treatment scores. Response was well-sustained at 4, 8, and 12 weeks with great tolerability and no pharmacokinetic drug interactions of significance. Strikingly, the patient experienced significant weight loss with ATX, which was so advantageous given previous AAPs-induced weight gain. He is now being engaged in social skills training facility

We assume that boosting nor-adrenergic (NE) drive in the prefrontal cortex (PFC) by atomoxetine accounts for its procongnitive effects akin to its mechanism in ADHD. Having said so, a pilot study of adjunctive ATX to AAP for cognitive deficits was negative, however [6]. NRI by atomoxetine with subsequent disinhibition of dopaminergic projections to the dorsolateral PFC hence corrects the hypofrontality that is thought to underlie the negative symptoms. Moreover, decreased NE in chronic schizophrenics is well-documented in the literature and psychotropics acting primarily to increase NE (e.g. milnacipran, mirtazapine) were reported to mitigate negative symptoms [7,8]. We postulate that ATX ameliorated negative symptoms in this case through a similar mechanism and also, possibly, by reducing extra-pyramidal burden, a finding reported in idiopathic Parkinson disease [9]. Bingeeating markedly diminished, ascribed to anorexogenic effects of ATX and goes in tandem with numerous reports of utility of ATX in bingeeating disorder [10]. Given the propensity of AAPs to expectedly invoke weight gain and subsequently metabolic syndrome, ATX, possibly by virtue of its anorexogenic effect, might counteract this, as is the case with reboxeine in anecdotal reports [11,12].

We opine that cognitive enhancers, like atomoxetine, remain a viable option to tackle residual negative and cognitive domains in schizophrenia that adversely impact functioning, and possibly a novel strategy to counteract metabolic syndrome that plagued treatment with AAPs, now increasingly and oftentimes indiscriminately used in paediatric population, a definitely top priority in youngsters with EOS.


Authors declare no conflicts of interest.


Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Recommended Conferences

Article Usage

  • Total views: 11894
  • [From(publication date):
    May-2015 - May 26, 2018]
  • Breakdown by view type
  • HTML page views : 8131
  • PDF downloads : 3763

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2018-19
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri & Aquaculture Journals

Dr. Krish

[email protected]

1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals


[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001Extn: 9042

© 2008- 2018 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
Leave Your Message 24x7