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Discussion To date, the metamorphosis into a frog or a bee has not been described in the medical literature. Both patients suffered from schizophrenia, and the lycanthropy was accompanied by other psychotic symptoms. Psychodynamically, lycanthropy could be an attempt to delegate affects to the animal. Lycanthropy in our cultural context seems bizarre and strange, appears suddenly, and does not seem to be understood rationally. In his discussion of countertransference phenomena induced by lycanthropy, Knoll points out that its strange and often threatening aspect may lead therapists to neglect it (3). This might explain why the phenomenon is rarely described in psychiatric literature. Focusing on the patient’s subconscious choice of animal species may hint at the patient’s subconscious conflicts and might be helpful in psychotherapy of the mental disease. References 1. Keck PE, Pope HG, Hudson JI, McElroy SL, Kulick AR. Lycanthropy: alive and well in the twentieth century. Psychol Med 1988;18:113–20 T Gödecke-Koch, MD, |
Re: Weight Change With Antipsychotic Use
Dear Editor: Weight increase with the use of antipsychotics, especially novel antipsychotics, has been of significant concern to patients suffering from psychotic disorders. There are several psychosocial issues associated with weight gain (for example, issues of self-esteem, discrimination, and medical morbidity). Studies and clinical practice involving antipsychotic use consistently indicate weight gain as a potentially serious side effect. It has been stated that weight gain and loss may not be dosage-related. In my clinical observation on 2 different occasions, however, dosage appeared to be related to weight loss after initial weight gain. I present here the cases of 2 patients who lost weight, following initial gain. Case Report 1 A 25-year-old man suffering from schizophrenia was prescribed olanzapine 20 mg daily (monotherapy). His weight was recorded at 100 kg. He was clinically stable. The dosage was reduced to 17.5 mg daily, and then to 15 mg daily, with no rebound increase in psychosis. His recorded weight showed a reduction of 7 kg, accompanied by more self-confidence in the patient. |
There was no other change in his medication regimen, diet, medical condition, lab values, or daily routine. Case Report 2 A 37-year-old lady suffering from schizoaffective disorder with manic and psychotic symptoms had a trial of several mood stabilizers, typical antipsychotics, long-acting antipsychotics, and clozapine, with multiple subsyndromal to full-blown symptoms and frequent hospitalisations. She was treated with 75 mg of topiramate and was started on olan- zapine with dose titration and final increase to 20 mg daily. She experienced a weight gain of 11 kg in 3 months. This combination of mood stabilizers and olanzapine led to significant improvement in her mental state. Initially, it was a daily struggle keeping her on olanzapine, because she was extremely weight-conscious. With improvement in her clinical condition, olanzapine dosage was decreased to 17.5 mg daily, and then to 15 mg daily, with weight reduction of 3 kg. She was much more accepting of olanzapine and was discharged. Based on these observations, it is not possible to determine the mechanism of action leading to weight loss. Olanzapine dosage reduction—wherever possible at the earliest opportunity—may, however, be a useful strategy to reduce weight following initial gain. VK Dewan, MD, FRCPC |