{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T09:50:40Z","timestamp":1782467440824,"version":"3.54.5"},"reference-count":18,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PCN Reports"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mood stabilizer augmentation is frequently used in treatment\u2010resistant schizophrenia despite limited guideline recommendations. Evidence for its efficacy and safety in the residual phase, however, remains insufficient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 49\u2010year\u2010old Japanese woman with treatment\u2010resistant residual schizophrenia exhibited persistent agitation and aggression despite antipsychotic therapy. Valproate augmentation (800\u2009mg\/day) improved irritability and psychomotor agitation but was complicated by hypoglycemia, suggestive of relative carnitine deficiency, and subsequent pancytopenia. Both adverse events resolved after discontinuation. Behavioral symptoms markedly worsened following withdrawal. Clozapine and electroconvulsive therapy were declined. Lithium augmentation (600\u2009mg\/day; serum level 0.8 mEq\/L) was initiated, resulting in improvement of dangerous behaviors and agitation. The Brief Psychiatric Rating Scale total score improved from 80 to 64, particularly in the hostility and excitement items. No readmission to the psychiatric ward occurred during a 3\u2010month follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the clinical dilemma of mood stabilizer augmentation in residual\u2010phase schizophrenia. While valproate demonstrated behavioral efficacy, serious adverse events necessitated its discontinuation. Lithium may represent a potential alternative for managing aggression and agitation, but further research is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pcn5.70334","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T09:22:39Z","timestamp":1776417759000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical dilemma of mood stabilizer augmentation in treatment\u2010resistant schizophrenia with residual phase: A case report of valproate\u2010associated hypoglycemia and cytopenia, and subsequent lithium response"],"prefix":"10.1002","volume":"5","author":[{"given":"Yoshiki","family":"Kasagi","sequence":"first","affiliation":[{"name":"Department of Psychiatry University of Occupational and Environmental Health Kitakyushu Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2791-8113","authenticated-orcid":false,"given":"Naomichi","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Occupational and Environmental Health Kitakyushu Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7637-5576","authenticated-orcid":false,"given":"Reiji","family":"Yoshimura","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Occupational and Environmental Health Kitakyushu Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13498"},{"issue":"11","key":"e_1_2_11_3_1","article-title":"Valproate for schizophrenia","volume":"11","author":"Wang Y","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2020.177901"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2013.05.028"},{"issue":"10","key":"e_1_2_11_6_1","article-title":"Lithium for schizophrenia","volume":"2015","author":"Leucht S","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"e_1_2_11_7_1","article-title":"Carbamazepine for schizophrenia","volume":"2014","author":"Leucht S","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2012.11.006"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-200006000-00011"},{"issue":"2","key":"e_1_2_11_10_1","article-title":"Valproate\u2010induced bicytopenia: a case study","volume":"14","author":"Jaitpal V","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.20273"},{"issue":"4","key":"e_1_2_11_12_1","first-page":"182","article-title":"Neutropenia and leukopenia after cross taper from quetiapine to divalproex for the treatment of borderline personality disorder","volume":"39","author":"Richmond C","year":"2022","journal-title":"Fed Pract"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2017.08.041"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000013626"},{"issue":"3","key":"e_1_2_11_15_1","first-page":"68","article-title":"A rare case report of hypoketotic hypoglycemia induced seizures due to secondary carnitine deficiency in a 44\u2010year\u2010old female","volume":"14","author":"Bangolo A","year":"2024","journal-title":"J Community Hosp Intern Med Perspect"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc3742"},{"key":"e_1_2_11_17_1","unstructured":"World Health Organization Uppsala Monitoring Centre.The use of the WHO UMC system for standardised case causality assessment.Uppsala Monitoring Centre;2013. Available fromhttps:\/\/www.who.int\/publications\/m\/item\/WHO-causality-assessment"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/mp.2015.4"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1124\/pr.111.005512"}],"container-title":["Psychiatry and Clinical Neurosciences Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pcn5.70334","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pcn5.70334","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pcn5.70334","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T09:44:45Z","timestamp":1782467085000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pcn5.70334"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,17]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/pcn5.70334"],"URL":"https:\/\/doi.org\/10.1002\/pcn5.70334","archive":["Portico"],"relation":{},"ISSN":["2769-2558","2769-2558"],"issn-type":[{"value":"2769-2558","type":"print"},{"value":"2769-2558","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,17]]},"assertion":[{"value":"2026-02-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70334"}}