Endoxifen Response in Schizoaffective Disorder: A Case Series
Abstract
Schizoaffective disorder has symptoms of both bipolar disorder and schizophrenia. Protein kinase C (PKC) activation is identified as to play a key role in both illnesses. Endoxifen, a potent inhibitor of the PKC signaling pathway, is effective in controlling acute bipolar mania at a dosage strength of 8 mg. Considering the PKC inhibitory activity of Endoxifen, we are presenting two patients with schizoaffective disorder who were administered with Endoxifen 8 mg to explore its role in providing better responses in patients.
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Introduction
Schizoaffective disorder is a chronic illness with a prevalence of around 0.3%(1). Schizoaffective patients have features of either manic or depressive type, or in some cases, both. As per the DSM 5 diagnostic criteria, to be diagnosed with schizoaffective disorder at least two psychotic symptoms must be present as well as mood symptoms for a specific duration.
The symptoms of psychosis, which are identical to the primary criteria for schizophrenia, include (2):
Hallucinations
Delusions
Disorganized thinking or behavior
Disorganized speech
Negative symptoms
The mood symptoms that must be present include:
Mania: decreased need for sleep, high energy
Racing thoughts
Rapid speech
Bizarre or risk-taking behavior
Depression: feelings of sadness and worthlessness
Conclusion
Currently, no clinical trial has been done with Endoxifen on schizoaffective patients, and we prescribed Endoxifen to patients who were diagnosed with schizoaffective disorder and not getting better results with other medications. In our 2 patient cases with schizoaffective disorder, Endoxifen 8mg tablets reduced the severity of symptoms. YMRS score in patient 1 improved from 40 to 10 while in patient 2, it improved from 37 to 19.BPRS score too showed improvement from 54 to 19 in patient 1 and 45 to 26 in patient 2. Due to good tolerability profile and better efficacy, Endoxifen was continued beyond 6 months and both the patients have maintained well on treatment without any adverse events being reported.
Though large randomized trials with Endoxifen are lacking, it can be a worthy option to explore in schizophrenia as well. Further studies are required to generate evidence about efficacy and safety of Endoxifen for providing an alternative treatment for schizophrenic and schizoaffective disorder patients.