When Iris Sommer retires, she wants to leave behind a new treatment for psychiatric illness that really makes a difference. “I realise this is easier said than done,” she tells The Lancet Psychiatry. “In neurology, we understand underlying mechanisms so much better than before. But in psychiatry, we are still trying to understand even the basic mechanisms behind many conditions.” Directed pharmacological therapy of ambiguous genitalia due to an androgen receptor gene mutationWe report a 46, XY infant with an M807T mutation in his androgen receptor that abrogated cellular responses to testosterone, but not to dihydrotestosterone (DHT), resulting in ambiguous genitalia. Treatment with a topical DHT gel restored male genital development allowing the infant to be reared in accordance with his chromosomal sex. Full-Text PDF Amisulpride and olanzapine followed by open-label treatment with clozapine in first-episode schizophrenia and schizophreniform disorder (OPTiMiSE): a three-phase switching studyFor most patients in the early stages of schizophrenia, symptomatic remission can be achieved using a simple treatment algorithm comprising the sequential administration of amisulpride and clozapine. Since switching to olanzapine did not improve outcome, clozapine should be used after patients fail a single antipsychotic trial—not until two antipsychotics have been tried, as is the current recommendation. Full-Text PDF Prosopometamorphopsia and facial hallucinationsIn July, 2011, a 52-year-old woman presented to our psychiatric outpatient clinic in The Hague with a life-long history of seeing people's faces change into dragon-like faces and hallucinating similar faces many times a day. She could perceive and recognise actual faces, but after several minutes they turned black, grew long, pointy ears and a protruding snout, and displayed a reptiloid skin and huge eyes in bright yellow, green, blue, or red. She saw similar dragon-like faces drifting towards her many times a day from the walls, electrical sockets, or the computer screen, in both the presence and absence of face-like patterns, and at night she saw many dragon-like faces in the dark. Full-Text PDF