title: Effective treatment with clozapine and valproate for refractory schizophrenia-like psychosis after cerebellar hemorrhage.
abstract: BACKGROUND
  The cerebellum has traditionally been regarded as an organ of motor coordination. However, the importance of the cerebellum in psychiatric disorders, behavior, and cognition is increasingly being recognized. There is no consensus concerning treatment of schizophrenia-like psychosis after cerebellar pathology. Reports describe the use of several antipsychotics, either alone or in combination with antidepressants or lithium. Clozapine is used for the treatment of refractory schizophrenia, but there are no reports of its use in the above-mentioned situation.
  
  
  METHODS
  We report the case of a 20-year-old woman who developed a schizophrenia-like psychosis after rupture of arteriovenous malformation at 13 years of age. The psychotic symptoms proved to be resistant to treatment, and several psychopharmacological schemas were tried. The clinical picture only showed consistent improvement with the combined use of clozapine and valproate.
  
  
  CONCLUSIONS
  The relationship between chronic psychosis and cerebellar pathology remains poorly understood. Cases like the present one suggest that clozapine and valproate may be used safely and effectively in refractory schizophrenia-like psychosis associated with cerebellar pathology.
authors.affiliation: CEDOC, Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal. jaime.almeida@fcm.unl.pt
authors.forename: Jaime
authors.initials: J
authors.lastname: Almeida
authors.forename: Eva Mendes
authors.initials: EM
authors.lastname: Serrão
authors.forename: Andre Traça
authors.initials: AT
authors.lastname: Almeida
authors.forename: Joana Gois
authors.initials: JG
authors.lastname: Afonso
mesh_terms: D002531:Cerebellum / Q000187:drug effects / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003024:Clozapine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D014635:Valproic Acid / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D014635:Valproic Acid; D003024:Clozapine