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Finnegan M, McLoughlin J, Bainbridge E, McGuinness D, Hallahan B, McDonald C. Quality of life after involuntary psychiatric admission. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 83:101810. [PMID: 35696760 DOI: 10.1016/j.ijlp.2022.101810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Studies seeking predictors of outcomes after involuntary admission, including quality of life (QoL), are limited and results inconsistent. We aimed to describe QoL 3 months after involuntary psychiatric admission and to investigate associated factors. One hundred and fifty-three involuntarily admitted inpatients were assessed for a range of sociodemographic and clinical variables. Structured scales included the Brief Psychiatric Rating Scale (BPRS), the MacArthur Admission Experience Survey, the Heinrichs Quality of Life Scale and the World Health Organisation Quality of Life Brief Assessment (WHOQOL-BREF, n = 124). The mean total score on the Heinrichs QoL scale at 3 months was 69.3 (SD = 24.1). Predictors of higher 3 month QoL after involuntary admission in a multiple regression model (adjusted R2 = 0.37, F = 7.1 (14, 138), p ≤0.001) were less severe negative symptoms on the BPRS at baseline (B = -4.56, p < 0.001), improvement in negative symptom scores between baseline and follow up (B = 4.58, p < 0.001) and higher current social class (B = -14.31, p = 0.001). Events during involuntary admission, such as being subject to coercive experiences, were not significantly associated with QoL after admission. The results suggest that a core determinant of service users' QoL after involuntary admission is negative symptom severity and change over time.
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Affiliation(s)
- M Finnegan
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J McLoughlin
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - E Bainbridge
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - D McGuinness
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - B Hallahan
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C McDonald
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
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2
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Hehir MK, Conaway M, Clark EM, Aronzon DB, Kolb N, Kolb A, Ruzhansky K, Sadjadi R, De Sousa EA, Burns TM. The Adverse Event Unit (AEU): A novel metric to measure the burden of treatment adverse events. PLoS One 2022; 17:e0262109. [PMID: 35176061 PMCID: PMC8853570 DOI: 10.1371/journal.pone.0262109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/18/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To design a physician and patient derived tool, the Adverse Event Unit (AEU), akin to currency (e.g. U.S. Dollar), to improve AE burden measurement independent of any particular disease or medication class. Patients/Methods A Research Electronic Data Capture (REDCap) online survey was administered to United States physicians with board certification or board eligibility in general neurology, subspecialty neurology, primary care internal medicine or family medicine, subspecialty internal medicine, general pediatrics, and subspecialty pediatrics. Physicians assigned value to 73 AE categories chosen from the Common Terminology Criteria of Adverse Events (CTCAE) relevant to neurologic disorder treatments. An online forced choice survey was administered to non-physician, potential patients, through Amazon Mechanical Turk (MTurK) to weight the severity of the same AE categories. Physician and non-physician data was combined to assign value to the AEU. Surveys completed between 1/2017 and 3/2019. Results 363 physicians rated the 73 AE categories derived from CTCAE. 660 non-physicians completed forced choice experiments comparing AEs. The AEU provides 0–10, weighted values for the AE categories studied that differ from the ordinal 1–4 CTCAE scale. For example, CTCAE severe diabetes (category 4) is assigned an AEU score of 9. Although non-physician input changed physician assigned AEU values, there was general agreement among physicians and non-physicians about severity of AEs. Conclusion The AEU has promise to be a useful, practical tool to add precision to AE burden measurement in the clinic and in comparative efficacy research with neurology patients. AEU utility will be assessed in planned comparative efficacy clinical trials.
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Affiliation(s)
- Michael K. Hehir
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, Vermont, United States of America
- * E-mail:
| | - Mark Conaway
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Eric M. Clark
- University of Vermont Complex Systems Center, Burlington, Vermont, United States of America
| | - Denise B. Aronzon
- Timberlane Pediatrics, South Burlington, Vermont, United States of America
| | - Noah Kolb
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, Vermont, United States of America
| | - Amanda Kolb
- Department of Family Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, United States of America
| | - Katherine Ruzhansky
- Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Reza Sadjadi
- Harvard Medical School Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Eduardo A. De Sousa
- Mercy Clinic Neurology, Neuroscience Institute of Oklahoma City, Oklahoma City, Oklahoma, United States of America
| | - Ted M. Burns
- University of Virginia, Charlottesville, Virginia, United States of America
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Weston-Green K. Antipsychotic Drug Development: From Historical Evidence to Fresh Perspectives. Front Psychiatry 2022; 13:903156. [PMID: 35782443 PMCID: PMC9243257 DOI: 10.3389/fpsyt.2022.903156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Schizophrenia is a complex disorder of varied etiology, manifesting symptoms that can differ between patients and change throughout an individual's lifespan. Antipsychotic drugs have evolved through first (e.g., haloperidol), second (olanzapine and clozapine) and a possible third (aripiprazole) generation of drugs in an attempt to improve efficacy and tolerability, with minimal side-effects. Despite robust scientific efforts over the past 70 years, there remains a need to develop drugs with greater efficacy, particularly in relation to the negative and cognitive symptoms of schizophrenia, addressing treatment resistance, with a lower side-effects profile compared to existing antipsychotic drugs. Identifying and investigating novel therapeutic targets remains an important component of future antipsychotic drug discovery; however, mounting evidence demonstrates neurobiological, neuroanatomical and functional heterogeneity in cohorts of individuals with schizophrenia. This presents an opportunity to refresh the approach to drug trials to a more targeted strategy. By increasing understanding of the basic science and pharmacological mechanisms underlying the potential antipsychotic efficacy of novel therapeutics prior to clinical trials, new drugs may be appropriately directed to a target population of schizophrenia subjects based on the drug mechanisms and correlating biological sub-groupings of patient characteristics. Improving the lives of sub-populations of people with schizophrenia that share common biological characteristics and are likely to be responsive to a particular compound may be more achievable than aiming to treat the complexities of schizophrenia as a homogenous disorder. This approach to clinical trials in antipsychotic research is discussed in the present review.
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Affiliation(s)
- Katrina Weston-Green
- Neurohorizons Laboratory, Molecular Horizons and School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,Australian Centre for Cannabinoid Clinical and Research Excellence, New Lambton Heights, NSW, Australia
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4
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Ishigooka J, Nakagome K, Ohmori T, Iwata N, Inada K, Iga JI, Kishi T, Fujita K, Kikuchi Y, Shichijo T, Tabuse H, Koretsune S, Terada H, Terada H, Kishimoto T, Tsutsumi Y, Kanda Y, Ohi K, Sekiyama K. Discontinuation and remission rates and social functioning in patients with schizophrenia receiving second-generation antipsychotics: 52-week evaluation of JUMPs, a randomized, open-label study. Psychiatry Clin Neurosci 2022; 76:22-31. [PMID: 34626144 PMCID: PMC9299006 DOI: 10.1111/pcn.13304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
AIM Globally, evidence from short-term studies is insufficient for the guidelines to uniformly recommend a particular antipsychotic(s) for the maintenance treatment of schizophrenia. Therefore, long-term comprehensive evaluation of antipsychotics is required from a social rehabilitation perspective, especially for drugs that have not yet been studied. The Japan Useful Medication Program for Schizophrenia (JUMPs) is a large-scale, long-term naturalistic study to present pivotal 52-week data on the continuity of second-generation antipsychotics (SGA: aripiprazole, blonanserin, and paliperidone). METHODS JUMPs was an open-label, three-arm, randomized, parallel-group, 52-week study. Enrolled patients had schizophrenia, were ≥20 years old, and required antipsychotic treatment or switched from previous therapy. The primary endpoint was treatment discontinuation rate over 52 weeks. Secondary outcomes included remission rate, social functioning, and quality-of-life scores [Personal and Social Performance Scale (PSP) and EuroQol-5 dimensions], and safety. RESULTS In total, 251 patients received aripiprazole (n = 82), blonanserin (n = 85), or paliperidone (n = 84). The discontinuation rate (P = 0.9771) and remission rates (P > 0.05) over 52 weeks did not differ significantly between the three treatment groups. The discontinuation rates were 68.3%, 68.2%, and 65.5% in the aripiprazole, blonanserin, and paliperidone groups, respectively. Significant improvements (all P < 0.05) from baseline in PSP scores were observed at start of monotherapy, week 26, and week 52 in the overall cohort and blonanserin group and at week 26 in the aripiprazole group. The adverse event profile favored blonanserin. CONCLUSION All three SGAs evaluated in this study showed similar treatment discontinuation rates in patients with chronic schizophrenia in Japan.
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Affiliation(s)
- Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan
| | - Kazuyuki Nakagome
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake-shi, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan
| | - Jun-Ichi Iga
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake-shi, Japan
| | - Kiyoshi Fujita
- Okehazama Hospital Fujita Kokoro Care Center, Toyoake-shi, Japan
| | - Yuka Kikuchi
- Department of Psychiatry, Akita University Hospital, Akita, Japan
| | | | - Hideaki Tabuse
- Department of Psychiatry, Holy Cross Hospital, Toki-shi, Japan
| | | | | | | | | | | | - Yoshiki Kanda
- Musashikoganei Minamiguchi Shinryou Clinic, Koganei-shi, Japan
| | - Kazutaka Ohi
- Department of Neuropsychiatry, Kokubu Hospital, Osaka, Japan
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5
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Möller HJ. Antipsychotic agents. Gradually improving treatment from the traditional oral neuroleptics to the first atypical depot. Eur Psychiatry 2020; 20:379-85. [PMID: 15994065 DOI: 10.1016/j.eurpsy.2005.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Accepted: 03/21/2005] [Indexed: 10/25/2022] Open
Abstract
AbstractRelapse is one of the key factors in the long-term outcome of schizophrenia. The consequences of relapse are diverse and often unpredictable, and the time to recovery and degree of recovery worsen with each successive relapse. There is now overwhelming evidence that advances in antipsychotic drug treatment have led to significant reductions in the rate of relapse. This review charts the developments that have taken place in antipsychotic therapy from the introduction of depot formulations, through atypical agents, to the development of the first long-acting atypical antipsychotic. Depot formulations of conventional antipsychotics were developed in the 1960s and led to fewer relapses and episodes of hospitalization, compared with oral equivalents. Meta-analysis has confirmed that patients receiving depot antipsychotics experience significantly greater global improvement than those receiving the respective oral agents. Conventional antipsychotics are, however, associated with a range of potentially serious adverse events. The atypical antipsychotics were introduced in the 1990s and have significant advantages over conventional agents with regard to positive and negative symptoms. There is also evidence that atypical agents can reduce the risk of relapse. Importantly, atypical antipsychotics have an improved safety profile compared with older agents, particularly with regard to extrapyramidal symptoms. One disadvantage of atypical agents has been that they are only available in an oral form. The recent development of a long-acting injectable formulation of risperidone means that a new treatment option is available to physicians.
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Affiliation(s)
- H-J Möller
- Department of Psychiatry, Ludwig-Maximilians-University, Nussbaum Strasse 7, 80336 Munich, Germany.
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6
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Subjective response to antipsychotics in bipolar disorders: A review of a
neglected area. Eur Psychiatry 2020; 62:45-49. [DOI: 10.1016/j.eurpsy.2019.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/07/2019] [Accepted: 09/07/2019] [Indexed: 12/27/2022] Open
Abstract
Abstract
Background:
The term “subjective response to antipsychotic” (SRA) refers to
changes in the subjective state experienced due to antipsychotic (AP)
exposition that is independent of the therapeutic or physical side
effects of these drugs. This dimension of analysis has been extensively
explored in schizophrenic disorders, finding that negative SRA is an
early and independent predictor of compliance as well as a successful
pathway to construct current theoretical frameworks of these disorders.
There is an increasing use of AP in bipolar disorders’ treatment (BD)
but no reviews on the topic have been published to date in this
population. The aim of this work is to review published data of SRA in
BD patients and to discuss their clinical and theoretical
implications.
Methods:
An extensive search in online databases was performed. Reports were
reviewed and included if they described SRA in BD or included
instruments aimed to assess it. Reports of cognitive, sexual, motor
autonomic side effects were excluded. Findings were summarized in a
narrative fashion.
Results:
Nine reports fulfilled the inclusion criteria and were included in
the revision, reporting data from 1282 BD patients. Among these, three
were prospective studies and three explored relations between SRA and
treatment compliance.
Conclusions:
There is an asymmetry between the increase in the use of
antipsychotics in BD and the lack of data regarding the SRA.
Phenomenologically, SRA in BD is similar to that found in schizophrenic
subjects. Some of these symptoms may be misdiagnosed as depressive
symptoms. The existing data show that SRA has a strong correlation with
treatment compliance as well as a promising way to develop theoretical
paradigms for these disorders.
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7
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Ramerman L, Hoekstra PJ, de Kuijper G. Health-related quality of life in people with intellectual disability who use long-term antipsychotic drugs for challenging behaviour. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 75:49-58. [PMID: 29482036 DOI: 10.1016/j.ridd.2018.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/05/2018] [Accepted: 02/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Many people with intellectual disabilities use long-term antipsychotics for challenging behaviour and experience side-effects from these drugs, which may affect Health-related Quality of Life (HQoL). AIMS This study aimed to investigate HQoL in people with intellectual disabilities who use long-term antipsychotics and to investigate its associations with challenging behaviour and physical symptoms often associated with antipsychotics. MATERIALS AND METHODS We used baseline data of two studies of long-term used antipsychotics. The RAND-36 and the emotional and physical wellbeing subscales of the Personal Outcome Scale (POS) were used to assess HQoL. Associations with challenging behaviour, measured with the Aberrant Behavior Checklist (ABC) and physical symptoms (extrapyramidal, autonomic, metabolic) with HQoL outcomes were analysed by univariate and multivariate linear regression. RESULTS The mental subscales of the RAND-36 and emotional wellbeing of the POS were associated with the irritability and lethargy ABC-subscales. Physical wellbeing was negatively associated with parkinsonism urinary problems, dysphagia and temperature dysregulation possibly due to antipsychotics use. CONCLUSION Both mental and physical wellbeing are related to challenging behaviour and physical symptoms associated with antipsychotics. Therefore HQoL could be a helpful measure when balancing benefits and disadvantages of antipsychotics prescribed for challenging behaviour.
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Affiliation(s)
- Lotte Ramerman
- Centre for Intellectual Disability and Mental Health/GGZ Drenthe, Assen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, The Netherlands.
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, The Netherlands
| | - Gerda de Kuijper
- Centre for Intellectual Disability and Mental Health/GGZ Drenthe, Assen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, The Netherlands
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8
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Greene C, Kealy J, Humphries MM, Gong Y, Hou J, Hudson N, Cassidy LM, Martiniano R, Shashi V, Hooper SR, Grant GA, Kenna PF, Norris K, Callaghan CK, Islam MDN, O’Mara SM, Najda Z, Campbell SG, Pachter JS, Thomas J, Williams NM, Humphries P, Murphy KC, Campbell M. Dose-dependent expression of claudin-5 is a modifying factor in schizophrenia. Mol Psychiatry 2018; 23:2156-2166. [PMID: 28993710 PMCID: PMC6298981 DOI: 10.1038/mp.2017.156] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 11/12/2022]
Abstract
Schizophrenia is a neurodevelopmental disorder that affects up to 1% of the general population. Various genes show associations with schizophrenia and a very weak nominal association with the tight junction protein, claudin-5, has previously been identified. Claudin-5 is expressed in endothelial cells forming part of the blood-brain barrier (BBB). Furthermore, schizophrenia occurs in 30% of individuals with 22q11 deletion syndrome (22q11DS), a population who are haploinsufficient for the claudin-5 gene. Here, we show that a variant in the claudin-5 gene is weakly associated with schizophrenia in 22q11DS, leading to 75% less claudin-5 being expressed in endothelial cells. We also show that targeted adeno-associated virus-mediated suppression of claudin-5 in the mouse brain results in localized BBB disruption and behavioural changes. Using an inducible 'knockdown' mouse model, we further link claudin-5 suppression with psychosis through a distinct behavioural phenotype showing impairments in learning and memory, anxiety-like behaviour and sensorimotor gating. In addition, these animals develop seizures and die after 3-4 weeks of claudin-5 suppression, reinforcing the crucial role of claudin-5 in normal neurological function. Finally, we show that anti-psychotic medications dose-dependently increase claudin-5 expression in vitro and in vivo while aberrant, discontinuous expression of claudin-5 in the brains of schizophrenic patients post mortem was observed compared to age-matched controls. Together, these data suggest that BBB disruption may be a modifying factor in the development of schizophrenia and that drugs directly targeting the BBB may offer new therapeutic opportunities for treating this disorder.
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Affiliation(s)
- C Greene
- 0000 0004 1936 9705grid.8217.cDepartment of Genetics, Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin, Ireland
| | - J Kealy
- 0000 0004 1936 9705grid.8217.cDepartment of Genetics, Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin, Ireland
| | - M M Humphries
- 0000 0004 1936 9705grid.8217.cDepartment of Genetics, Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin, Ireland
| | - Y Gong
- 0000 0001 2355 7002grid.4367.6Division of Renal Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO USA
| | - J Hou
- 0000 0001 2355 7002grid.4367.6Division of Renal Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO USA
| | - N Hudson
- 0000 0004 1936 9705grid.8217.cDepartment of Genetics, Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin, Ireland
| | - L M Cassidy
- 0000 0004 1936 9705grid.8217.cDepartment of Genetics, Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin, Ireland
| | - R Martiniano
- 0000 0004 1936 9705grid.8217.cDepartment of Genetics, Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin, Ireland
| | - V Shashi
- 0000000100241216grid.189509.cDepartment of Pediatrics, Duke University Medical Center, Durham, NC USA
| | - S R Hooper
- 0000000122483208grid.10698.36Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - G A Grant
- 0000000419368956grid.168010.eDepartment of Neurosurgery, Stanford University School of Medicine, Stanford, CA USA
| | - P F Kenna
- 0000 0004 1936 9705grid.8217.cDepartment of Genetics, Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin, Ireland
| | - K Norris
- 0000 0001 0303 540Xgrid.5884.1Biosciences Department, Faculty of Health and Wellbeing, Biosciences and Chemistry, Sheffield Hallam University, Sheffield, UK
| | - C K Callaghan
- 0000 0004 1936 9705grid.8217.cTrinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland ,0000 0004 1936 9705grid.8217.cSchool of Psychology, Trinity College Dublin, Dublin, Ireland
| | - M dN Islam
- 0000 0004 1936 9705grid.8217.cTrinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland ,0000 0004 1936 9705grid.8217.cSchool of Psychology, Trinity College Dublin, Dublin, Ireland
| | - S M O’Mara
- 0000 0004 1936 9705grid.8217.cTrinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland ,0000 0004 1936 9705grid.8217.cSchool of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Z Najda
- 0000 0004 1936 9705grid.8217.cDepartment of Genetics, Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin, Ireland
| | - S G Campbell
- 0000 0001 0303 540Xgrid.5884.1Biosciences Department, Faculty of Health and Wellbeing, Biosciences and Chemistry, Sheffield Hallam University, Sheffield, UK
| | - J S Pachter
- 0000000419370394grid.208078.5Department of Cell Biology, University of Connecticut Health Center, Farmington, CT USA
| | - J Thomas
- 0000 0001 0807 5670grid.5600.3Department of Psychological Medicine and Neurology, MRC Centre in Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK
| | - N M Williams
- 0000 0001 0807 5670grid.5600.3Department of Psychological Medicine and Neurology, MRC Centre in Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK
| | - P Humphries
- 0000 0004 1936 9705grid.8217.cDepartment of Genetics, Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin, Ireland
| | - K C Murphy
- 0000 0004 0488 7120grid.4912.eDepartment of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Campbell
- Department of Genetics, Smurfit Institute of Genetics, Lincoln Place Gate, Trinity College Dublin, Dublin, Ireland.
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9
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Ragguett RM, Hahn M, Messina G, Chieffi S, Monda M, De Luca V. Association between antipsychotic treatment and leptin levels across multiple psychiatric populations: An updated meta-analysis. Hum Psychopharmacol 2017; 32. [PMID: 28980344 DOI: 10.1002/hup.2631] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/21/2017] [Accepted: 07/31/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Antipsychotics (APs) are associated with metabolic syndrome, with increases in leptin proposed as an underlying mechanism of AP-induced weight gain. Currently available meta-analyses on this topic have limited their populations of interest to those diagnosed with schizophrenia. The purpose of this meta-analysis is to explore the relationship between leptin levels and AP use across multiple psychiatric diagnoses, and also in healthy controls. METHOD Systematic electronic searches were conducted using PubMed and OVID: Medline. Longitudinal studies were included if showing leptin levels before and after AP use. We included participants with any psychiatric disorders and mentally healthy participants, if exposed to AP use. The differences in leptin levels were evaluated using Hedges' g with a random effects model. RESULTS Forty-two studies were found (36 schizophrenia, 2 bipolar disorder, 1 anorexia nervosa, and 3 healthy controls), encompassing 66 study arms and 1,156 participants. The meta-analysis showed that regardless of diagnoses, leptin levels increase with AP use (Hedges' g = 0.811, p ≤ .001). CONCLUSION Leptin increases induced by APs are present across all diagnoses. More comprehensive research is needed to understand the relationship between AP use and leptin levels across multiple diagnoses.
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Affiliation(s)
| | - Margaret Hahn
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Sergio Chieffi
- Department of Experimental Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcellino Monda
- Department of Experimental Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo De Luca
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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10
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West S, Rowbotham D, Xiong G, Kenedi C. Clozapine induced gastrointestinal hypomotility: A potentially life threatening adverse event. A review of the literature. Gen Hosp Psychiatry 2017. [PMID: 28622812 DOI: 10.1016/j.genhosppsych.2017.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The haematological and cardiac complications of clozapine have been well documented. Recent evidence from pharmacovigilance databases suggests that gastrointestinal (GI) complications are the leading cause of clozapine related deaths. This review aims to describe clinical features along with preventative and treatment options. METHOD A review of MEDLINE via PubMed searching for all articles published up to February of 2016. Inclusion criteria were articles that provided clinical or epidemiological information relating to the diagnosis, outcome, management or pathophysiology of clozapine related gastrointestinal disorders in humans. RESULTS Three large case series were identified with 104 cases, 20 of these reported clinical details. A further 52 cases reports were included. Median age was 40, with 79% being male, mean daily clozapine dose was 453 mg. Mortality was 38% with survivors being younger (39 vs. 42), on lower daily doses (400 mg vs. 532 mg), more likely to be female (32% vs. 6%). Four patients were re-challenged with clozapine following CIGH, two suffered a recurrence. CONCLUSION Risk factors for CIGH appear to be older age, male gender, patients in the first four months of treatment, co-prescription of constipating agents, higher daily dose of clozapine, and previous CIGH. Risk factors for death were older age and male gender. Patients receiving clozapine should be counselled about the dangers of constipation and to report new GI symptoms. Once severe CIGH has occurred clozapine should be halted and reviewed with bowel symptoms managed promptly. Re-challenging with clozapine may present substantial risks due to the severity of CIGH and a paucity of evidence. From the available evidence a treatment strategy has been proposed. Further prospective data regarding CIGH are needed to allow a better assessment of the scale of the problem with the development and testing of treatment strategies.
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Affiliation(s)
- Stephen West
- Department of Liaison Psychiatry, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand.
| | - David Rowbotham
- Department of Gastroenterology and Hepatology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Glen Xiong
- Department of Psychiatry and Behavioural Sciences, University of California at Davis, Sacramento, CA, United States
| | - Chris Kenedi
- Department of Liaison Psychiatry, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand; Division of Internal Medicine and Division of Psychiatry, Duke University Medical Center, Durham, NC, United States
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11
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Khan AA, Ashraf A, Baker D, Al-Omary MS, Savage L, Ekmejian A, Singh RSH, Brienesse S, Majeed T, Gordon T, Drinkwater V, Collins NJ. Clozapine and incidence of myocarditis and sudden death - Long term Australian experience. Int J Cardiol 2017; 238:136-139. [PMID: 28343762 DOI: 10.1016/j.ijcard.2017.03.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/05/2017] [Accepted: 03/04/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Clozapine is the cornerstone of therapy for refractory schizophrenia; however, the potential for cardiotoxicity is an important limitation in its use. In the current analysis we sought to evaluate the long term cardiac outcomes of clozapine therapy. METHODS All-cause mortality, incidence of sudden death and time to myocarditis were assessed in a cohort of patients maintained on clozapine between January 2009 and December 2015. All patients had regular electrocardiograms, complete blood count, clozapine levels and echocardiography as part of a formal protocol. RESULTS A total of 503 patients with treatment-resistant schizophrenia were maintained on clozapine during the study period of which 93 patients (18%) discontinued therapy with 29 (6%) deaths. The incidence of sudden death and myocarditis were 2% (n=10) and 3% (n=14) respectively. Amongst patients with sudden death, 7 out of 10 (70%) were documented to have used illicit drugs prior to death, with a tendency to weight gain also noted. The mean time to myocarditis post clozapine commencement was 15±7days. The reduction in left ventricular ejection fraction in those with myocarditis was 11±2%. CONCLUSION Myocarditis and sudden cardiac death are uncommon but clinically important complications in a cohort of patients followed while maintained on clozapine undergoing regular cardiac assessment. Further studies are required to document the role of preventive measures for left ventricular dysfunction and sudden cardiac death in this population.
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Affiliation(s)
| | | | | | - Mohammed S Al-Omary
- John Hunter Hospital, Newcastle, Australia; University of Newcastle, Australia
| | | | | | | | | | | | | | | | - Nicholas J Collins
- John Hunter Hospital, Newcastle, Australia; University of Newcastle, Australia.
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12
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François C, Guiraud-Diawara A, Lançon C, Llorca PM, Hartry A, Hammer-Helmich L, Zighed DA, Tanasescu A, Toumi M. A tolerability burden index in schizophrenia: incorporating patient perspective in clinical trial adverse event reporting. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2017; 5:1372026. [PMID: 29081922 PMCID: PMC5645905 DOI: 10.1080/20016689.2017.1372026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/21/2017] [Indexed: 05/02/2023]
Abstract
Background: Adverse event (AE) reporting in clinical trials does not fully capture the patient-level perspective and comparing tolerability across treatments or among studies is difficult. Objective: This study was designed to develop a treatment tolerability index algorithm that combines AE reporting with physician- and patient-level AE information into a global burden score to allow comparison of the overall tolerability of antipsychotic medications used in treating schizophrenia. Study design: Data from a 4-arm, placebo-controlled clinical trial were used in the proposed tolerability index algorithm. For each patient, AEs were adjusted by frequency, severity, duration, and patient-experienced importance, and average tolerability-related burden scores were calculated. Setting: Algorithm development analyses. Patients: This study analyzed data from a previously completed clinical trial that evaluated a potential antipsychotic medication; no patients were involved in the current study. Intervention: No interventions were administered in this study; the analyses described used data derived from a previously completed clinical trial in which patients received bifeprunox, risperidone, or placebo. Main outcome measure: Burden scores and tolerability index scores were compared for patients who did or did not discontinue treatment because of AEs. Results: The number of AEs varied widely among patients. Burden scores were significantly worse for patients who discontinued treatment because of AEs. Mean tolerability index scores, adjusted based on AE frequency, severity-adjusted duration, and patient-experienced impact, were poorer for active medications than placebo, and increased with dose. Conclusion: The treatment tolerability index will allow comparison of AE burden and tolerability between treatments using existing clinical trial information. This suggests that scoring is possible, is clinically relevant, and allows standardized comparison of antipsychotic tolerability.
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Affiliation(s)
- Clément François
- Health Economics Outcome Research, Lundbeck, Deerfield, IL, USA
- CONTACT Clément François Lundbeck LLC, 6 Parkway North, Deerfield, IL, USA
| | | | - Christophe Lançon
- Laboratoire de Santé Publique Évaluation des Systèmes de Soins et Santé Perçue, Université de la Méditerranée – EA 3279 – Faculté de Médecine, Marseille 5, France
| | - Pierre Michel Llorca
- Centre Hospitalier Universitaire Clermont-Ferrand, EA 7280 Université Clermont-Auvergne, Clermont Ferrand, France
| | - Ann Hartry
- Health Economics Outcome Research, Lundbeck, Deerfield, IL, USA
| | | | | | | | - Mondher Toumi
- Department of Public Health, Aix Marseille University, Marseille 5, France
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13
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Alptekin K, Akdede BB, Akvardar Y, Celikgün S, Dilşen NS, Durak G, Türk A, Fidaner H. Quality of Life Assessment in Turkish Patients with Schizophrenia and Their Relatives. Psychol Rep 2016; 95:197-206. [PMID: 15460376 DOI: 10.2466/pr0.95.1.197-206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Quality of life of first-degree relatives living in the same household with patients having schizophrenia has not been sufficiently explored. 30 patients with schizophrenia (16 women, 14 men), diagnosed using DSM–IV criteria, 31 of their relatives (15 women, 16 men), and 34 control subjects (21 women, 13 men) were included in the study. The mean age of the patients, their relatives, and the control subjects were 39.8 ± 10.9, 58.1 ± 12.5 and 37.3 ± 17.0, respectively. The World Health Organization Quality of Life–Brief Form was administered to all subjects. Quality of life was worse for the patient group than for their relatives and control subjects, but relatives of the patients and control subjects were not significantly different on Quality of life. Quality of life was negatively correlated with the severity of psychopathology and extrapyramidal side effects induced by antipsychotic drugs in the patients.
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Affiliation(s)
- Köksal Alptekin
- Department of Psychiatry, Adnan Menderes University Medical School, Aydin, Turkey.
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14
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Pietrini F, Spadafora M, Tatini L, Talamba GA, Andrisano C, Boncompagni G, Manetti M, Ricca V, Ballerini A. LAI versus oral: A case-control study on subjective experience of antipsychotic maintenance treatment. Eur Psychiatry 2016; 37:35-42. [PMID: 27442981 DOI: 10.1016/j.eurpsy.2016.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/05/2016] [Accepted: 05/13/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To present real-world evidence on the differences between long-acting injectable (LAI) and oral antipsychotic maintenance treatment (AMT) in terms of subjective well-being, attitudes towards drug and quality of life in a sample of remitted schizophrenic subjects. METHODS Twenty outpatients with remitted schizophrenia treated with either olanzapine or paliperidone and switching from the oral to the LAI formulation of their maintenance treatment were recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral AMT and matching main sociodemographic, clinical and treatment variables made up the control group (oral-AMT group). All participants were assessed in terms of objective (PANSS, YMRS, MADRS) and subjective (SWN-K, DAI-10, SF-36) treatment outcomes at baseline (T0) and after 6 months (T1). RESULTS Between T0 and T1, general psychopathology of the PANSS, DAI-10, and all but one of the SWN-K dimensions (except for social integration), showed significantly higher percentages of improvement in the LAI-AMT group compared to the oral-AMT group. A generalized expansion of health-related quality of life, with better functioning in almost all areas of daily living, was reported by the LAI-AMT group after the 6-month period. In contrast, the oral-AMT group reported a significant worsening of health-related quality of life in the areas of emotional role and social functioning in the same period. CONCLUSIONS Our study indicates possible advantages of LAI over oral antipsychotic formulation in terms of subjective experience of maintenance treatment in remitted schizophrenic patients. Size and duration of this study need to be expanded in order to produce more solid and generalizable results.
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Affiliation(s)
- F Pietrini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy.
| | - M Spadafora
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - L Tatini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - G A Talamba
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - C Andrisano
- Department of biomedical and neuromotor sciences, university of Bologna, Bologna, Italy
| | - G Boncompagni
- Department of mental health and substance abuse, local health trust of Bologna, Bologna, Italy
| | - M Manetti
- Therapeutic psychiatric community, Campo del Vescovo Union, La Spezia, Italy
| | - V Ricca
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - A Ballerini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
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15
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Szmulewicz A, Samamé C, Caravotta P, Martino DJ, Igoa A, Hidalgo-Mazzei D, Colom F, Strejilevich SA. Behavioral and emotional adverse events of drugs frequently used in the treatment of bipolar disorders: clinical and theoretical implications. Int J Bipolar Disord 2016; 4:6. [PMID: 26879750 PMCID: PMC4754238 DOI: 10.1186/s40345-016-0047-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/04/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Behavioral and emotional adverse events induced by drugs commonly prescribed to patients with bipolar disorders are of paramount importance to clinical practice and research. However, no reviews on the topic have been published so far. METHODS An extensive search was performed. Reports were reviewed if they described behavioral side effects related to pharmacological treatments for bipolar disorders in healthy subjects or patients with different neuropsychiatric disorders. For this review, lithium, antipsychotics, anticonvulsants and selective serotonin reuptake inhibitors were included. RESULTS Apathy or emotional blunting, diminished sexual desire, and inability to cry were reported to be associated with exposure to selective serotonin reuptake inhibitors. Neuroleptic-induced deficit syndrome/emotional detachment and obsessive-compulsive symptomatology and decision-making modifications. A lithium-related amotivational syndrome was also reported in the literature. Furthermore, hypersexuality and obsessive-compulsive symptoms have been noted in subjects treated with lamotrigine. LIMITATIONS Primary studies on drug-related adverse events are scant so far and most of the data currently available derive from case reports. Moreover, most of the evidence reviewed is based on studies performed on healthy subjects and patients with neuropsychiatric conditions other than bipolar disorders. DISCUSSION There is a remarkable dearth of data on behavioral adverse events of pharmacological treatment for bipolar disorders. However, the pieces of evidence available at present, though scant and scattered, suggest that different behavioral adverse events may be related to pharmacological treatment for these disorders. The implications of these findings for research and management of patients with mood disorders are discussed.
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Affiliation(s)
- Alejandro Szmulewicz
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina. .,Hospital de Emergencias Psiquiátricas Torcuato de Alvear (HEPTA), Buenos Aires, Argentina.
| | - Cecilia Samamé
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina. .,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
| | - Pablo Caravotta
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina. .,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
| | - Diego J Martino
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina. .,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
| | - Ana Igoa
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina.
| | | | - Francesc Colom
- Bipolar Disorders Program, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina. .,, Congreso 2477 Dto. D (1428), Buenos Aires, Argentina.
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Left Ventricular Thrombus as a Complication of Clozapine-Induced Cardiomyopathy: A Case Report and Brief Literature Review. Case Rep Cardiol 2015; 2015:835952. [PMID: 26664756 PMCID: PMC4667025 DOI: 10.1155/2015/835952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/07/2015] [Indexed: 11/17/2022] Open
Abstract
A 48-year-old male with history of schizoaffective disorder on clozapine presented with chest pain, dyspnea, and new left bundle branch block. He underwent coronary angiography, which revealed no atherosclerosis. The patient's workup was unrevealing for a cause for the cardiomyopathy and thus it was thought that clozapine was the offending agent. The patient was taken off clozapine and started on guideline directed heart failure therapy. During the course of hospitalization, he was also discovered to have a left ventricular (LV) thrombus for which he received anticoagulation. To our knowledge, this is the first case report of clozapine-induced cardiomyopathy complicated by a LV thrombus.
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17
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Antipsychotic medication-induced dysphoria: its meaning, association with typical vs. atypical medications and impact on adherence. Psychiatr Q 2015; 86:199-205. [PMID: 25164199 DOI: 10.1007/s11126-014-9319-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Antipsychotic medication-induced dysphoria is a relatively under-recognized and understudied effect of antipsychotic medication. Although the term is encountered in clinical practice and in the literature, there is no consensus regarding its exact meaning. This article is a narrative review of the literature on antipsychotic medication and dysphoria based on a pubmed database search. We found that antipsychotic medication-induced dysphoria is a term used to describe a negative and unpleasant affective state which seems to be more often associated with high potency first-generation antipsychotics and could potentially lead to medication non-adherence. Though it is plausible to expect antipsychotic medication-induced dysphoria to be related to extrapyramidal symptoms, most especially akathisia, the nature of the association remains unspecified. Furthermore, there is some evidence that dopamine blockade maybe involved in the pathogenesis of antipsychotic medication-induced dysphoria. However, the limited methods of the currently available studies make it impossible to conclusively address the question of which class of antipsychotic (first- or second-generation) has a higher prevalence and severity of the syndrome.
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Pietrini F, Spadafora M, Talamba GA, Godini L, Lelli L, Arcabasso S, Manetti M, Ballerini A. The effects of switching from oral to LAI antipsychotic treatment on subjective experience of schizophrenic and schizoaffective patients: Preliminary results. Int J Psychiatry Clin Pract 2015; 19:106-13. [PMID: 25410156 DOI: 10.3109/13651501.2014.988268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To present real-world preliminary evidence on the specific effects of switching from oral to long-acting injectable (LAI) antipsychotic treatment on patient's subjective experience and quality of life (QoL) in a sample of clinically stable psychotic subjects. METHODS Twenty-six clinically stable adult schizophrenic and schizoaffective outpatients were recruited. All patients were under a stabilized therapy with a single oral second-generation antipsychotic and were switched to the equivalent maintenance regimen with the long-acting formulation of the same antipsychotic. Two subgroups of patients were created on the basis of the presence/absence of a complete clinical remission at enrollment. Anthropometric (body mass index), psychometric (Montgomery-Asberg Depression Rating Scale, Young Mania Rating Scale, and Positive And Negative Syndrome Scale), and patient's reported outcome (Subjective Well-Being Under Neuroleptics scale short form, Drug Attitude Inventory short version, and Short Form-36 health survey) data were collected at enrollment (T0) and after 6 months from the treatment switch (T1). RESULTS Significant improvements in psychometric indexes, and patients' subjective experience of treatment and attitudes toward drug (reflecting in an enrichment of patients' health-related QoL) were found both in initial remitters and non-remitters. CONCLUSIONS Our preliminary results suggest that the switch from oral to LAI antipsychotic treatment may help to address the subjective core of an optimal and satisfying recovery of psychotic patients. Size and duration of this study need to be expanded in order to produce more solid and generalizable results.
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Affiliation(s)
- Francesco Pietrini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Section of Neuroscience, University of Florence , Florence , Italy
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Association of symptom severity, insight and increased pharmacologic side effects in acutely hospitalized patients with schizophrenia. Compr Psychiatry 2014; 55:1914-9. [PMID: 25217308 DOI: 10.1016/j.comppsych.2014.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/19/2014] [Accepted: 07/23/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Many studies have shown that more severe symptoms and poorer insight are associated with poor treatment compliance in schizophrenia while severe symptoms may result in higher medication dosages. Since pharmacologic side effects may accompany greater medication compliance and higher medication dosage, the relationship between symptoms, insight and side effects deserves study. METHODS In this study, 174 inpatients diagnosed with schizophrenia were assessed during the week before hospital discharge from a large psychiatric hospital in Guangzhou, China. Symptoms were measured by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). Insight was assessed by the Insight and Treatment Attitudes Questionnaire (ITAQ). Pharmacologic side effects were assessed by the Treatment Emergent Symptoms Scale (TESS). Bivariate and multivariate regression models were used to examine the relationship of symptoms, insight and the interaction between the two, to the severity of side effects. RESULTS As expected, the PANSS total score was significantly associated with poorer ITAQ scores and with more severe side effects, and on multivariate analysis both higher PANSS and lower ITAQ scores were associated with more severe side effects. Stepwise multiple linear regression analysis showed that the model with the PANSS total score alone explained 3.4% of the variance in side-effect scores, while adding the ITAQ increased the explained variance to 11.8%. Analysis of the interaction of symptoms and insight showed that patients with both more severe symptoms and high insight had the most severe side effects (B=.006, p=.008, R(2)=15.4%). CONCLUSION More severe symptoms and greater insight among schizophrenic inpatients were both significantly if modestly associated with more severe pharmacologic side effects, the former presumably because of the need for higher doses of medication and the latter because of greater medication compliance. In addition, patients with both more severe symptoms and greater insight were even more prone to pharmacologic side effects than others presumably reflecting higher doses and higher compliance. Clinicians treating highly symptomatic but insightful patients, i.e. those most likely to need and to adhere to prescribed medications, may need to be especially vigilant about side effects.
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Kim HY, Lee HW, Jung SH, Kang MH, Bae JN, Lee JS, Kim CE. Prescription patterns for patients with schizophrenia in Korea: a focus on antipsychotic polypharmacy. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2014; 12:128-36. [PMID: 25191503 PMCID: PMC4153859 DOI: 10.9758/cpn.2014.12.2.128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/19/2014] [Accepted: 03/10/2014] [Indexed: 12/24/2022]
Abstract
Objective This study investigated the prescription patterns for Korean patients with schizophrenia with a particular focus on antipsychotic polypharmacy. All data were gathered from patients presenting at 41 tertiary university hospitals and 8 secondary hospitals. Methods Data from three multicenter studies conducted in Korea were retrospectively reviewed and integrated to identify patients with schizophrenia who had their antipsychotic medication switched to paliperidone extended-release between 2008 and 2009. The rates for antipsychotic polypharmacy, combined use of different antipsychotic classes with a special focus on atypical antipsychotics, and psychotropic polypharmacy using benzodiazepines, mood stabilizers, and other relevant drugs were identified. Results Of the 851 Korean patients analyzed in this study, 20.4% (n=173) had been prescribed antipsychotic polypharmacy. Of the 678 patients receiving antipsychotic monotherapy, 6.9% (n=47) were prescribed a typical antipsychotic and 93.1% (n=631) were prescribed an atypical antipsychotic. Of the 173 patients receiving a combination of antipsychotic drugs, only 6.4% (n=11) had been prescribed polypharmacy with typical antipsychotics, while 46.82% (n=81) were prescribed atypical+atypical antipsychotics or typical+atypical antipsychotics. The highest co-prescription rates for other psychotropic drugs in conjunction with antipsychotics included benzodiazepines (30.3%), anticholinergic drugs (28.8%), antidepressants (13.3%), β-blockers (10.1%), and mood stabilizers (8.7%). Conclusion The present findings demonstrate that the rate of antipsychotic polypharmacy is relatively low in Korea and that Korean clinicians prefer to prescribe atypical, rather than typical, antipsychotic drugs. This suggests that there is a distinct prescription pattern in Korea that is focused on antipsychotic polypharmacy.
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Affiliation(s)
- Hee-Yun Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Hee-Won Lee
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Seung-Ho Jung
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Min-Hee Kang
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Jae-Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Jeong-Seop Lee
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Chul-Eung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
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Alawami M, Wasywich C, Cicovic A, Kenedi C. A systematic review of clozapine induced cardiomyopathy. Int J Cardiol 2014; 176:315-20. [PMID: 25131906 DOI: 10.1016/j.ijcard.2014.07.103] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 06/15/2014] [Accepted: 07/26/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clozapine is a unique anti-psychotic medication that is most effective in the treatment of refractory schizophrenia and reducing suicidality. Cardiomyopathy is among the side effects of this medication that limits its use. There are a number of case reports, case series and expert opinion papers discussing clozapine induced cardiomyopathy, but there is no evidence-based review of the subject to guide clinicians. METHODS We undertook a systematic review of the literature on cardiomyopathy associated with clozapine. The primary systemic search was in MEDLINE but EMBASE, PsycINFO, and Cochrane were searched and manufacturers of clozapine were contacted for cases. Articles were then individually reviewed to find additional reports. RESULTS We identified 17 articles detailing 26 individual cases and 11 additional articles without individual case data. The mean age at time of diagnosis was 33.5 years. The mean dose of clozapine on presentation was 360 mg. Symptoms developed at an average of 14.4 months after initiating clozapine. The clinical presentation was generally consistent with heart failure: including shortness of breath (60%) and palpitations (36%). Echocardiography at presentation showed dilated cardiomyopathy in 39% of cases and was not specified in other cases. CONCLUSION There should be a low threshold in performing echocardiography in suspected cases of clozapine induced cardiomyopathy. Clozapine should be withheld in the setting of cardiomyopathy without other explanation. There is limited data on the safety of drug re-challenge in clozapine induced cardiomyopathy. Re-challenge may be considered in carefully selected cases but close monitoring and frequent echocardiography are required.
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Affiliation(s)
- Mohammed Alawami
- Department of Cardiology, Auckland District Health Board, Auckland, New Zealand.
| | - Cara Wasywich
- Department of Cardiology, Auckland District Health Board, Auckland, New Zealand
| | - Aleksandar Cicovic
- Department of Cardiology, Auckland District Health Board, Auckland, New Zealand
| | - Christopher Kenedi
- Department of Liaison Psychiatry, Auckland District Health Board, Auckland, New Zealand
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Millier A, Schmidt U, Angermeyer MC, Chauhan D, Murthy V, Toumi M, Cadi-Soussi N. Humanistic burden in schizophrenia: a literature review. J Psychiatr Res 2014; 54:85-93. [PMID: 24795289 DOI: 10.1016/j.jpsychires.2014.03.021] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 03/22/2014] [Accepted: 03/24/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES OF THE STUDY AND BACKGROUND Schizophrenia is a complex disease that affects 1% of the population. This disease has a considerable impact not only on patients' health and well-being but also on their surrounding environment. The costs of the disease's management remain large for individuals and society. While literature on the economic impact of schizophrenia is abundant, few studies have focused on its humanistic burden. This does not only concern patients, but also caregivers, relatives, neighbours and others in a patient's daily life. This burden appears through several dimensions, including treatment side effects and the impact on caregivers and features of the patient's environment. The aim of this review is to consider, compile and describe the humanistic burden of schizophrenia as documented in the literature. MATERIALS AND METHODS We conducted a literature review assessing the worldwide disease burden of schizophrenia, taking into account all humanistic burden topics. The search considered several databases, including Embase, Medline, Cochrane Library, The German Institute of Medical Documentation and Information (DIMDI) and the ISPOR conference websites. RESULTS The search identified 200 literature reviews, covering several dimensions of humanistic burden and documenting many issues. Main findings included the high death rates that may be explained by long-lasting negative health habits, disease- and treatment-related metabolic disorders, and consequent increased frequencies of cardiovascular diseases. Co-existing depression was found to have adverse consequence on the course of schizophrenia progression, morbidity and mortality. Cognitive impairment also adds to the burden of schizophrenia. Social impairment is worsened by underestimated stigmatisation and lack of corresponding awareness within the professional and social spheres. Finally, caregiver burden was found to be considerable. DISCUSSION Humanistic burden among patients with schizophrenia is substantial potentially impacted by co-morbid depressive symptoms, caregiver burden and cognitive impairment. Effects of treatment on humanistic burden in addition to economic burden need to be explored in future trials.
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Affiliation(s)
| | - U Schmidt
- Creativ-Ceutical, Luxembourg, Luxembourg.
| | - M C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Austria; Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy.
| | - D Chauhan
- Takeda Pharmaceuticals, London, England, United Kingdom.
| | - V Murthy
- Takeda Pharmaceuticals, London, England, United Kingdom.
| | - M Toumi
- University Claude Bernard Lyon I, UFR d'Odontologie 11, rue Guillaume Paradin, 69372 Lyon CEDEX 08, France.
| | - N Cadi-Soussi
- Takeda Pharmaceuticals, Takeda Pharmaceuticals International GmbH, Thurgauerstrasse 130, CH-8152 Glattpark-Opfikon, Zurich, Switzerland.
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Pazvantoğlu O, Simşek OF, Aydemir O, Sarisoy G, Böke O, Uçok A. Factor structure of the Subjective Well-being under Neuroleptic treatment Scale-short form in schizophrenic outpatients: five factors or only one? Nord J Psychiatry 2014; 68:259-65. [PMID: 23834339 DOI: 10.3109/08039488.2013.807875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED BACKROUND AND AIM: The Subjective Well-Being under Neuroleptics Scale, short form (SWNS), is a self-report measure that evaluates the states of well-being of schizophrenia patients using antipsychotic drugs independently from psychopathology of disease. This study examined the factor structure of the Turkish version of the scale using high-level statistical analyses. METHODS The SWNS was translated into Turkish and applied to 103 schizophrenic patients. A type of multi-trait-multi-method (MTMM) confirmatory factor analysis was conducted to determine the factor structure of the Turkish version of the scale. RESULTS The results of factor analysis of the SWNS were incompatible with the factor structure of the original scale. A set of MTMM analyses showed distinct method effects for both positive and negative item wording in the scale. In light of these findings, the factor structure of the SWNS was determined as having a one-dimensional structure, with bias due to item wording. CONCLUSIONS The results of the present investigation indicated that the sub-factors of the SWNS failed to emerge from the data. This study is the first to show that there is an urgent need for further examination of the factor structure of the SWNS with regard to method effects. This issue has important implications for the use of sub-factors by both researchers and practitioners.
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Affiliation(s)
- Ozan Pazvantoğlu
- Ozan Pazvantoğlu, M.D., Department of Psychiatry, Ondokuz Mayis University, Faculty of Medicine , Samsun , Turkey
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Awad G, Hassan M, Loebel A, Hsu J, Pikalov A, Rajagopalan K. Health-related quality of life among patients treated with lurasidone: results from a switch trial in patients with schizophrenia. BMC Psychiatry 2014; 14:53. [PMID: 24559217 PMCID: PMC3936838 DOI: 10.1186/1471-244x-14-53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 02/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with schizophrenia frequently switch between antipsychotics, underscoring the need to achieve and maintain important treatment outcomes such as health-related quality of life (HRQoL) following the switch. This analysis evaluated HRQoL changes among patients with schizophrenia switched from their current antipsychotic to lurasidone. METHODS Stable but symptomatic outpatients with schizophrenia were switched from their current antipsychotic to lurasidone in a six-week, open-label trial. HRQoL was assessed using two validated patient-reported measures, the Personal Evaluation of Transitions in Treatment (PETiT) scale and the Short-Form 12 (SF-12). Total and domain scores (psychosocial function and adherence-related attitude) were assessed using the PETiT scale; patients' mental and physical component summary scores (MCS and PCS) were assessed using the SF-12. Changes in HRQoL from baseline to study endpoint were compared using ANCOVA, with baseline score, treatment, and pooled site as covariates. Changes were assessed among all patients and those switched from specific antipsychotics to lurasidone. RESULTS The analysis included 235 patients with data on the PETiT and SF-12 who had received ≥ 1 dose of lurasidone. Statistically significant improvements were observed from baseline to study endpoint on the PETiT total (mean change [SD]: 3.2 [8.5]) and psychosocial functioning (2.5 [6.9]) and adherence-related attitude (0.7 [2.6]) domain scores (all p ≤ 0.002). When examined by preswitch antipsychotic, significant improvements in PETiT total scores were observed in patients switched from quetiapine, risperidone, aripiprazole, and ziprasidone (all p < 0.03) but not olanzapine (p = 0.893). Improvements on the SF-12 MCS score were observed for all patients (mean change [SD]: 3.7 [11.5], p < 0.001) and for those switched from quetiapine or aripiprazole (both p < 0.03). The SF-12 PCS scores remained comparable to those at baseline in all patient groups. CONCLUSIONS These findings indicate that patients switching from other antipsychotics to lurasidone experienced statistically significant improvement of HRQoL, based on PETiT scores, within six weeks of treatment. Patient health status remained stable with respect to the SF-12 physical component and showed improvement on the mental component. Changes in HRQoL varied based on the antipsychotic used before switching to lurasidone. TRIAL REGISTRATION NCT01143077.
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Affiliation(s)
- George Awad
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry and Mental Health, Humber River Regional Hospital, Toronto, ON, Canada
| | | | | | - Jay Hsu
- Sunovion Pharmaceuticals, Inc, Fort Lee, NJ, USA
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Ritsner M, Kurs R. Impact of antipsychotic agents and their side effects on the quality of life in schizophrenia. Expert Rev Pharmacoecon Outcomes Res 2014; 2:347-56. [DOI: 10.1586/14737167.2.4.347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Haring L, Mõttus R, Jaanson P, Pilli R, Mägi K, Maron E. Subjective Well-Being Under Neuroleptics Scale short form (SWN-K): reliability and validity in an Estonian speaking sample. Ann Gen Psychiatry 2013; 12:28. [PMID: 24025191 PMCID: PMC3847444 DOI: 10.1186/1744-859x-12-28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 09/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Subjective Well-Being Under Neuroleptic Treatment Scale short form (SWN-K) is a self-rating scale developed to measure mentally ill patients' well-being under the antipsychotic drug treatment. This paper reports on adaptation and psychometric properties of the instrument in an Estonian psychiatric sample. METHODS In a naturalistic study design, 124 inpatients or outpatients suffering from the first psychotic episode or chronic psychotic illness completed the translated SWN-K instrument. Item content analysis, internal consistency analysis, exploratory principal components analysis, and confirmatory factor analysis were used to construct the Estonian version of the SWN-K (SWN-K-E). Additionally, socio-demographic and clinical data, observer-rated psychopathology, medication side effects, daily antipsychotic drug dosages, and general functioning were assessed at two time points, at baseline and after a 29-week period; the associations of the SWN-K-E scores with these variables were explored. RESULTS After having selected 20 items for the Estonian adaptation, the internal consistency of the total SWN-K-E was 0.93 and the subscale consistencies ranged from 0.70 to 0.80. Good test-retest reliabilities were observed for the adapted scale scores, with the correlation of the total score over about 6 months being r = 0.70. Confirmatory factor analysis replicated the presence of a higher-order factor (general well-being) and five first-order factors (mental functioning, physical functioning, social integration, emotional regulation, and self-control); the model fitted the data well. The results indicated a moderate-high correlations r = 0.54 between the SWN-K-E total score and the evaluation how satisfied patients were with their lives in generally. No significant correlations were found between the overall subjective well-being score and age, severity of the psychopathology, drug adverse effects, or prescribed drug dosage. CONCLUSION Taken together, the results demonstrated that the Estonian version of the SWN-K is a reliable and valid instrument with psychometric properties similar to the original English version. The potential uses of the scale in both research and clinical settings are considered.
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Affiliation(s)
- Liina Haring
- Psychiatry Clinic of Tartu University Hospital, University of Tartu, Tartu, Estonia.
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Hayhurst KP, Drake RJ, Massie JA, Dunn G, Barnes TRE, Jones PB, Lewis SW. Improved quality of life over one year is associated with improved adherence in patients with schizophrenia. Eur Psychiatry 2013; 29:191-6. [PMID: 23769325 DOI: 10.1016/j.eurpsy.2013.03.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/20/2012] [Accepted: 03/17/2013] [Indexed: 11/24/2022] Open
Abstract
AIM Quality of life (QoL) is increasingly considered an important outcome in health research. We wished to explore the determinants of change in QoL in patients with schizophrenia over the course of a one-year RCT. METHODS Predictors of change in observer-rated QoL (Quality of Life Scale: QLS) were assessed in 363 patients with schizophrenia during the CUtLASS clinical trial. RESULTS Change in QLS score over the course of a year correlated with change in psychotic and depressive symptoms and treatment adherence. Linear regression showed that improvement in QoL was predicted by reduction in negative and depressive symptoms and improvement in adherence rating. These three change scores together explained 38% of the variance in QLS change. Exploration of the direction of any possible causal effect, using TETRAD, indicated that improved adherence leads to improved QoL, and that change in depression also leads to QoL change. The relationship between QoL and negative symptoms suggests that greater social activity (reflected as better QoL scores) improves negative symptoms. Such a direct relationship between treatment adherence and QoL has not been reported before. CONCLUSION Improving adherence to medication would appear to be a key approach to improving measured quality of life in people with schizophrenia.
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Affiliation(s)
- K P Hayhurst
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, United Kingdom.
| | - R J Drake
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, United Kingdom
| | - J A Massie
- Mental Health Unit, Laureate House, Manchester Mental Health & Social Care Trust, Wythenshawe Hospital, Southmoor Road, Manchester, United Kingdom
| | - G Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, United Kingdom
| | - T R E Barnes
- Centre for Mental Health, Imperial College London, Charing Cross Campus, London, United Kingdom
| | - P B Jones
- Department of Psychiatry & CPFT, University of Cambridge, Cambridge, United Kingdom
| | - S W Lewis
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, United Kingdom
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Mena A, De la Casa LG. Prepulse inhibition modulation by contextual conditioning of dopaminergic activity. Behav Brain Res 2013; 252:188-94. [PMID: 23756135 DOI: 10.1016/j.bbr.2013.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 06/01/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
When a neutral stimulus is repeatedly paired with a drug, an association is established between them that can induce two different responses: either an opponent response that counteracts the effect of the drug, or a response that is similar to that induced by the drug. In this paper, we focus on the analysis of the associations that can be established between the contextual cues and the administration of dopamine agonists or antagonists. Our hypothesis suggests that repeated administration of drugs that modulate dopaminergic activity in the presence of a specific context leads to the establishment of an association that subsequently results in a conditioned response to the context that is similar to that induced by the drug. To test this hypothesis, we conducted two experiments that revealed that contextual cues acquired the property to modulate pre-pulse inhibition by prior pairings of such context with the dopamine antagonist haloperidol (Experiment 1), and with the dopamine agonist d-amphetamine (Experiment 2). The implications of these results are discussed both at a theoretical level, and attending to the possibilities that could involve the use of context cues for the therapeutic administration of dopaminergic drugs.
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Affiliation(s)
- Auxiliadora Mena
- Department of Experimental Psychology, University of Seville, 41018 Seville, Spain
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Intramuscular Aripiprazole in the Acute Management of Psychomotor Agitation. Pharmacotherapy 2013; 33:603-14. [DOI: 10.1002/phar.1260] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wright JM, Dobosiewicz MRS, Clarke PBS. The role of dopaminergic transmission through D1-like and D2-like receptors in amphetamine-induced rat ultrasonic vocalizations. Psychopharmacology (Berl) 2013; 225:853-68. [PMID: 23052567 DOI: 10.1007/s00213-012-2871-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 09/02/2012] [Indexed: 12/23/2022]
Abstract
RATIONALE Systemic amphetamine (AMPH) administration increases the rate of 50-kHz ultrasonic vocalizations (USVs) in adult rats and preferentially enhances the 'trill' subtype; these effects of AMPH critically depend on noradrenergic transmission, but the possible contributions of dopamine are unclear. OBJECTIVE To assess the role of dopamine in 50-kHz USVs emitted drug-free and following systemic AMPH administration. METHODS Adult male Long-Evans rats pre-selected for high AMPH-induced calling rates were tested with AMPH (1 mg/kg, intraperitoneal (IP)) and saline following pretreatment with the following dopamine receptor antagonists: SCH 23390 (0.005-0.02 mg/kg, subcutaneous (SC)), SCH 39166 (0.03-0.3 mg/kg, SC), haloperidol (0.1, 0.2 mg/kg, IP), sulpiride (20-80 mg/kg, SC), raclopride (0.1-0.5 mg/kg, SC), clozapine (4 mg/kg, SC), risperidone (0.5 mg/kg, SC), and pimozide (1 mg/kg, IP). The dopamine and noradrenaline reuptake inhibitors (GBR 12909 and nisoxetine, respectively) were also tested, alone and in combination. RESULTS SCH 23390, SCH 39166, haloperidol, and raclopride dose-dependently inhibited vocalizations under AMPH and suppressed the proportion of trill calls. Sulpiride, however, had no discernable effect on call rate or profile, even at a high dose that reduced locomotor activity. Single doses of clozapine, risperidone, and pimozide all markedly decreased calling under saline and AMPH. Finally, GBR 12909 and nisoxetine failed to promote 50-kHz USVs detectably or alter the subtype profile, when tested alone or in combination. CONCLUSIONS The rate of 50-kHz USVs and the call subtype profile following systemic AMPH administration depends on dopaminergic neurotransmission through D1-like and D2-like receptors. However, inhibiting dopamine and/or noradrenaline reuptake appears insufficient to induce calling.
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Affiliation(s)
- Jennifer M Wright
- Department of Pharmacology and Therapeutics, McGill University, McIntyre Medical Building Rm. 1320 3655 Promenade Sir William Osler, Montreal, QC, H3G 1Y6, Canada
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Hasan A, Falkai P, Wobrock T, Lieberman J, Glenthoj B, Gattaz WF, Thibaut F, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. World J Biol Psychiatry 2013; 14:2-44. [PMID: 23216388 DOI: 10.3109/15622975.2012.739708] [Citation(s) in RCA: 272] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract These updated guidelines are based on a first edition of the World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia published in 2006. For this 2012 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidence-based update. These guidelines provide evidence-based practice recommendations that are clinically and scientifically meaningful. They are intended to be used by all physicians diagnosing and treating people suffering from schizophrenia. Based on the first version of these guidelines, a systematic review of the MEDLINE/PUBMED database and the Cochrane Library, in addition to data extraction from national treatment guidelines, has been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into six levels of evidence (A-F) and five levels of recommendation (1-5) ( Bandelow et al. 2008a ,b, World J Biol Psychiatry 9:242, see Table 1 ). This second part of the updated guidelines covers long-term treatment as well as the management of relevant side effects. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication and other pharmacological treatment options) of adults suffering from schizophrenia.
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Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
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Bressington D, Mui J, Gray R. Factors associated with antipsychotic medication adherence in community-based patients with schizophrenia in Hong Kong: a cross sectional study. Int J Ment Health Nurs 2013; 22:35-46. [PMID: 22738372 DOI: 10.1111/j.1447-0349.2012.00830.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The purpose of the present study was to examine the factors affecting adherence to antipsychotic medication in patients with schizophrenia registered with a community psychiatric nursing service in Hong Kong. The study was a cross-sectional observational survey; symptoms, drug attitudes, insight, side-effects, and sociodemographic characteristics were measured and explored in terms of their relationship with medication adherence. A total of 584 patients who were visited by community psychiatric nurses (CPN) participated, and 30% of these patients were non-adherent with their antipsychotic medication. Positive treatment attitudes, awareness of the need for treatment, being prescribed clozapine, receiving state benefits, lower levels of symptoms, and fewer side-effects were associated with adherence. The findings from this study suggest that the clinical efforts of CPN to improve adherence should aim to help patients amplify the personal relevance of treatment and modify patients' attitudes towards medication.
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Affiliation(s)
- Dan Bressington
- Department of Health, Well-Being and the Family, Canterbury Christ Church University, Kent, UK.
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Mojtabai R, Corey-Lisle PK, Ip EHS, Kopeykina I, Haeri S, Cohen LJ, Shumaker S. The Patient Assessment Questionnaire: initial validation of a measure of treatment effectiveness for patients with schizophrenia and schizoaffective disorder. Psychiatry Res 2012; 200:857-66. [PMID: 22840524 DOI: 10.1016/j.psychres.2012.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 06/06/2012] [Accepted: 06/10/2012] [Indexed: 11/29/2022]
Abstract
Investigation of patients' subjective perspective regarding the effectiveness - as opposed to efficacy - of antipsychotic medication has been hampered by a relative shortage of self-report measures of global clinical outcome. This paper presents data supporting the feasibility, inter-item consistency, and construct validity of the Patient Assessment Questionnaire (PAQ)-a self-report measure of psychiatric symptoms, medication side effects and general wellbeing, ultimately intended to assess effectiveness of interventions for schizophrenia-spectrum patients. The original 53-item instrument was developed by a multidisciplinary team which utilized brainstorming sessions for item generation and content analysis, patient focus groups, and expert panel reviews. This instrument and additional validation measures were administered, via Audio Computer-Assisted Self-Interviewing (ACASI), to 300 stable, medicated outpatients diagnosed with schizophrenia or schizoaffective disorder. Item elimination was based on psychometric properties and Item-Response Theory information functions and characteristic curves. Exploratory factor analysis of the resulting 40-item scale yielded a five factor solution. The five subscales (General Distress, Side Effects, Psychotic Symptoms, Cognitive Symptoms, Sleep) showed robust convergent (β's=0.34-0.75, average β=0.49) and discriminant validity. The PAQ demonstrates feasibility, reliability, and construct validity as a self-report measure of multiple domains pertinent to effectiveness. Future research needs to establish the PAQ's sensitivity to change.
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Affiliation(s)
- Ramin Mojtabai
- Johns Hopkins University, School of Public Health, Mental Health Department, Baltimore, MD, USA
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Fujimaki K, Morinobu S, Yamashita H, Takahashi T, Yamawaki S. Predictors of quality of life in inpatients with schizophrenia. Psychiatry Res 2012; 197:199-205. [PMID: 22370148 DOI: 10.1016/j.psychres.2011.10.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 10/31/2011] [Indexed: 10/28/2022]
Abstract
Shortening hospital stays has become a key focus in psychiatric care in recent years. However, patients with schizophrenia account for about 60% of inpatients in psychiatry departments in Japan. This study was designed to investigate the relationship between quality of life (QOL) and key indicators for long-term hospital stays among schizophrenia inpatients. A further aim was to elucidate the clinical determinants of QOL among long-stay inpatients. The study sample consisted of 217 inpatients with schizophrenia. Age, duration of illness, duration of hospitalization, years of education, body mass index, neurocognitive function, drug-induced extrapyramidal symptoms, involuntary movements, psychiatric symptoms, and dose equivalents of antipsychotics and anticholinergic agents were used as index factors. Pearson linear correlation and regression analyses were performed to examine the associations between QOL and the above-mentioned factors. Negative symptoms, psychological discomfort, and resistance as rated on the Brief Psychiatric Rating Scale (BPRS) were correlated with all subscale scores of the Japanese version of the Schizophrenia Quality of Life Scale (JSQLS). Stepwise regression showed that negative symptoms, psychological discomfort, and resistance predicted the dysfunction of psycho-social activity score and the dysfunction of motivation and energy score on the JSQLS. This study shows that active treatment for negative symptoms, psychological discomfort, and resistance should be recommended to improve QOL among inpatients with schizophrenia.
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Affiliation(s)
- Koichiro Fujimaki
- Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Japan.
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Koranek AM, Smith TL, Mican LM, Rascati KL. Impact of the CATIE trial on antipsychotic prescribing patterns at a state psychiatric facility. Schizophr Res 2012; 137:137-40. [PMID: 22364675 DOI: 10.1016/j.schres.2012.01.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/27/2012] [Accepted: 01/30/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) indicate that, with the exception of olanzapine, no substantial overall differences were identified between second generation antipsychotics (SGAs) and the first generation antipsychotic (FGA) perphenazine. METHODS This study evaluated the effect of CATIE on antipsychotic prescribing. A retrospective review of 1807 adults with schizophrenia was conducted and relative quarterly percentages of FGA versus SGA prescriptions were calculated. RESULTS Time series analysis did not identify significant differences in rates of FGA prescriptions. CONCLUSIONS Critiques of the methods used in CATIE may have mitigated its potential impact on antipsychotic prescribing despite cost-effectiveness of perphenazine treatment.
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Affiliation(s)
- Angela M Koranek
- The University of Texas at Austin, College of Pharmacy, 1 University Station-A1900, Austin, TX 78712, USA.
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Fallon P, Dursun S, Deakin B. Drug-induced supersensitivity psychosis revisited: characteristics of relapse in treatment-compliant patients. Ther Adv Psychopharmacol 2012; 2:13-22. [PMID: 23983951 PMCID: PMC3736929 DOI: 10.1177/2045125311431105] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND An association between abnormal involuntary movements and psychotic relapse was previously reported in a group of patients compliant with antipsychotic medication (Fallon and Dursun 2011). This was interpreted as the presence of an antipsychotic medication-induced supersensitivity psychosis. METHOD From the results of that study and the Chouinard diagnostic criteria for supersensitivity psychosis an abbreviated diagnostic checklist was developed to identify the phenomenon. In the present study the checklist was used on a larger sample of medication-compliant individuals experiencing a psychotic relapse. RESULTS The checklist demonstrated its utility by identifying a cause of relapse in 70% (29/41) of patients. Furthermore, it identified the presence of supersensitivity psychosis in 39% (16/41) of patients. This study also replicated a number of findings from the previous paper supporting the idea that supersensitivity psychosis is one cause of relapse in psychosis. DISCUSSION These results suggested that clinicians should exercise caution in prescribing and may have to augment treatment with other agents or switch to low dopamine-affinity antipsychotics.
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Bouloudnine S, Azorin JM, Petitjean F, Parry-Pousse P, Sciorato F, Blin O, Fakra E. Analyse de discours de patients schizophrènes et perception des effets indésirables de différents antipsychotiques atypiques. Étude TALK. Encephale 2011; 37 Suppl 2:S143-50. [DOI: 10.1016/s0013-7006(11)70042-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karadayi G, Emiroğlu B, Uçok A. Relationship of symptomatic remission with quality of life and functionality in patients with schizophrenia. Compr Psychiatry 2011; 52:701-7. [PMID: 21296345 DOI: 10.1016/j.comppsych.2010.11.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 11/16/2010] [Accepted: 11/29/2010] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between remission and quality of life (QoL) of patients with schizophrenia. METHOD Quality of life was investigated with the Quality-of-Life Scale, the Personal and Social Performance Scale (PSP), and the Evaluation of Functional Remission Scale in 102 outpatients with schizophrenia. Positive and Negative Syndrome Scale and Calgary Depression Scale for Schizophrenia (CDSS) were used to assess symptom severity. Remission was defined based on the Andreasen et al criteria (2005). RESULTS The remission group had higher levels of QoL and functionality as measured by the Quality-of-Life Scale (P = .001), PSP (P = .001), and Evaluation of Functional Remission Scale (P = .001). The remission group also had higher employment rates, lower smoking rates, and less depressive symptoms. We found that negative (P = .001) and positive symptoms of the Positive and Negative Syndrome Scale (P = .05) and CDSS score (P = .005) independently contributed to PSP score in a linear regression analysis. Years of education and positive symptoms were related to CDSS score. All of the 3 scales that we used to assess QoL and functionality were highly correlated with each other. In addition, the opinions of patients or relatives/partners about functionality of the patient was highly correlated with all of the scales. CONCLUSION We found significant differences between patients with schizophrenia with and without remission for QoL and functionality. Relative/partner's evaluation of functional status provides a reliable measure of QoL as well.
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Affiliation(s)
- Gülşah Karadayi
- Department of Psychiatry, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Kim JH, Ann JH, Kim MJ. Relationship between improvements of subjective well-being and depressive symptoms during acute treatment of schizophrenia with atypical antipsychotics. J Clin Pharm Ther 2011; 36:172-8. [PMID: 21366646 DOI: 10.1111/j.1365-2710.2010.01175.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE It has been suggested that atypical antipsychotics may exert beneficial effects on subjective well-being as well as depressive symptoms in schizophrenia. However, the relationship between the two remains to be clarified. The authors examined the relationship between subjective well-being and depressive symptoms across the course of acute treatment with atypical antipsychotics in patients with schizophrenia. METHODS Thirty-five inpatients with schizophrenia were examined for subjective well-being, psychopathology, and extrapyramidal side effects before and 8 weeks after the initiation of new treatment with atypical antipsychotics. RESULTS AND DISCUSSION Significant improvement was observed in subjective well-being, psychotic symptoms, and depressive symptoms. No change was observed in the severity of extrapyramidal side effect. The subjective well-being score had significant negative correlations with depressive symptom score both at baseline and at week 8. The mean change in subjective well-being score was significantly correlated with that in depressive symptom score. The severity of depressive symptoms at baseline was significantly correlated with the subsequent change in subjective well-being score and the change in depressive symptom score was the only predictor of change in subjective well-being score. WHAT IS NEW AND CONCLUSION Depressive symptoms were significantly associated with subjective well-being in patients with schizophrenia and may moderate the acute effects of atypical antipsychotic treatment on subjective well-being. Further investigations are necessary to fully define the place of depressive symptoms in the conceptualization of subjective well-being in schizophrenia and the optimal use of atypical antipsychotics.
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Affiliation(s)
- J-H Kim
- Department of Psychiatry, Gil Medical Center, Gachon University of Medicine and Science, Incheon, South Korea.
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Chiang YL, Klainin-Yobas P, Ignacio J, Chng CML. The impact of antipsychotic side effects on attitudes towards medication in people with schizophrenia and related disorders. J Clin Nurs 2011; 20:2172-82. [PMID: 21539628 DOI: 10.1111/j.1365-2702.2010.03659.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This research aimed to: (i) investigate the prevalence and perceived severity of antipsychotic side effects in people with schizophrenia and related disorders living in communities in Singapore; (ii) examine the relationship between antipsychotic variables (type, dose, route, prescription duration) and side effects; and (iii) examine the relationship between side effects and attitudes towards medication. BACKGROUND Antipsychotics are the mainstay treatment in schizophrenia and other psychotic disorders. However, antipsychotics are associated with a wide range of side effects, which potentially have adverse effects on patients' functioning. A lack of studies comparing the frequency of side effects and their associated levels of distress across multiple antipsychotics and different medication variables has been noted. Additionally, it is essential to assess patients' attitudes towards antipsychotics in relation to their experience of side effects. DESIGN A cross-sectional, non-experimental research design was used. METHOD A convenience sample of 96 adults with schizophrenia and related disorders on antipsychotic treatment and attending the hospital's outpatient clinic was recruited. Variables collected included antipsychotic type, dose, route, prescription duration and side effects, attitudes towards medication and demographic and clinical variables. They were analysed with descriptive statistics and correlational analyses. RESULTS Many participants experienced psychic (80·2%), extrapyramidal (69·8%) and miscellaneous side effects (61·5%). Side effects positively correlated with dose (p = 0·016) and negatively correlated with prescription duration (p = 0·014). Negative attitudes towards medication were positively correlated with side effects in general (p = 0·023), along with hormonal (p = 0·013) and psychic side effects (p = 0·008). CONCLUSION Findings revealed that majority of the participants experienced and were distressed over psychic, extrapyramidal and weight gain, which may be related to high doses and treatment duration. Additionally, patients experiencing psychic and hormonal side effects are at risk of developing negative attitudes towards medication. RELEVANCE TO CLINICAL PRACTICE Findings guide the development of appropriate nursing interventions that aim to alleviate side effects, reduce negative attitudes towards medication and prevent compliance problems.
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Affiliation(s)
- Yan Ling Chiang
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.
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Subjective effects of antipsychotic drugs and their relevance for compliance and remission. ACTA ACUST UNITED AC 2011; 17:174-6. [DOI: 10.1017/s1121189x00001238] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractOnly recently, success criteria became more ambitious and include a more thorough consideration of negative symptoms and cognitive dysfunction. The most important change within the last decade is the long overdue consideration of the patient's perspective. His/her subjective well-being, often unchanged or even worsened by typical antipsychotics, was neglected for a long time. One reason was the prejudice that schizophrenic patients are not able to self-rate their quality of life. Another reason was the belief that such data are not necessary because the psychiatrists' perspective, “objective” psychopathology, includes these domains. Among other scales, a self-report instrument has been constructed to evaluate “subjective well-being under neuroleptics” (SWN). This scale was used in numerous open and controlled trials, indicating: a) patients, if no longer acutely psychotic or suffering from severe cognitive deficits, are able to reliably assess their subjective well-being, b) high SWN is correlated with high compliance, c) atypical antipsychotics increase SWN, and d) individual improvements of SWN and of PANSS are not strongly related. Moreover, several studies found that early improvement of subjective well-being is a major predictor for the chance of remission. All these data indicate that a better consideration of the patient's perspective is possible and necessary.
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Differential 3-year effects of first- versus second-generation antipsychotics on subjective well-being in schizophrenia using marginal structural models. J Clin Psychopharmacol 2011; 31:226-30. [PMID: 21346606 DOI: 10.1097/jcp.0b013e3182114d21] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined the differential effects of first- (FGAs) versus second-generation antipsychotics (SGAs) on subjective well-being in patients with schizophrenia. METHOD Data were collected in an observational 3-year follow-up study of 2224 patients with schizophrenia. Subjective well-being was assessed with the Subjective Well-being under Neuroleptic Treatment Scale (SWN-K). Differential effects of FGAs versus SGAs were analyzed using marginal structural models in those patients taking antipsychotic monotherapy. RESULTS The marginal structural model, which analyzed the differential effect on the SWN-K total score, revealed that patients on SGAs had significantly higher SWN-K total scores, starting at 6 months (3.02 points; P = 0.0061, d = 0.20) and remaining significant thereafter (end point: 5.35 points; P = 0.0074, d = 0.36). CONCLUSIONS Results of this large observational study are consistent with a small but clinically relevant superiority of SGAs over FGAs in subjective well-being extending previous positive findings of differential effects on quality of life.
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Vothknecht S, Schoevers RA, de Haan L. Subjective well-being in schizophrenia as measured with the Subjective Well-Being under Neuroleptic Treatment scale: a review. Aust N Z J Psychiatry 2011; 45:182-92. [PMID: 21438745 DOI: 10.3109/00048674.2010.545984] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The Subjective Well-being under Neuroleptic Treatment scale (SWN) is the most widely used self-rating scale in recent research of subjective well-being in schizophrenia. We reviewed all available publications on relevant research of subjective well-being using the SWN, in order to evaluate measurement of subjective well-being with a single instrument. METHOD A MEDLINE and Embase search was performed for studies published between January 1994 and August 2010, analysing controlled and open clinical trials using the SWN. RESULTS A total of 52 publications were identified covering 44 studies. Strong evidence exists for improvement of subjective well-being during treatment. Atypical antipsychotics are associated with a higher level of well-being. However, dosage is more important than the kind of medication. Striatal dopamine D(2) receptor occupancy is correlated with subjective well-being. Early positive response of subjective well-being is predictive of a better outcome. Research on determinants of subjective well-being is rapidly expanding, focusing mostly on the effects of medication. CONCLUSIONS Subjective well-being of schizophrenia patients is a valuable outcome measure. It can be improved by optimizing antipsychotic treatment. More research on psychological and genetic predictors of subjective well-being is needed.
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Affiliation(s)
- Sylke Vothknecht
- Department of Training and Research, Arkin Mental Health Amsterdam, The Netherlands.
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Altamura AC, Porcellana M, Marinaccio PM, Ciabatti M, Nocito EP, Magri L, Bressi C. Is it possible to assess subjective well-being among bipolar inpatients? An 18-week follow-up study. Gen Hosp Psychiatry 2011; 33:185-90. [PMID: 21596212 DOI: 10.1016/j.genhosppsych.2011.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 12/31/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The study evaluates the association between subjective well-being and psychopathology in bipolar inpatients at the time of hospitalization and during a follow-up period. METHOD One hundred twenty consecutive inpatients with a diagnosis of bipolar affective disorder were studied on admission (T0), at discharge (T1) and every 6 weeks for 18 weeks after hospitalization. The Young's Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HAM-D) were used to determine affective symptoms, while subjective well-being was assessed by subjective well-being under neuroleptic (SWN). Associations between SWN and HAM-D or YMRS scores and between their changes were analyzed across the different time points by using Pearson correlation coefficients. Linear regression models were constructed using SWN as the dependent variable and demographic and clinical characteristics as possible predictors. RESULTS At baseline, depression explained 24% and mania explained an additional 16% of baseline SWN variance. Changes in SWN and HAM-D total score displayed an inverse correlation during hospitalization and follow-up. End point severity of depression was associated with the end point SWN total score explaining additional 26% of SWN total score variance, whereas severity of mania was inversely associated with SWN total score. CONCLUSION Data of this study provide further support for the need to consider the subjective well-being as a personal variable associated to psychopathological state in bipolar patients. However, results seem to be in line with authors who suggest to use other subjective quality of life scales in acute mania.
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Affiliation(s)
- A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, via F. Sforza, 35-20122 Milan, Italy
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Jung SH, Kim WH, Choi HJ, Kang MH, Lee JS, Bae JN, Kim CE. Factors affecting treatment discontinuation and treatment outcome in patients with schizophrenia in Korea: 10-year follow-up study. Psychiatry Investig 2011; 8:22-9. [PMID: 21519533 PMCID: PMC3079182 DOI: 10.4306/pi.2011.8.1.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 09/09/2010] [Accepted: 10/27/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE There have been few long-term studies that have assessed factors influencing treatment discontinuation and long-term outcome of schizophrenia in Korea. The present study aimed to evaluate factors affecting treatment discontinuation and treatment outcome, after 10 years, in patients with schizophrenia. METHODS Among hospitalized patients between 1997 and 1999, 191 patients were given continuous follow-up service. We examined the clinical characteristics and outcome of patients who remained in treatment. Regression analyses were used to find any clinical factors affecting treatment discontinuation. RESULTS One hundred thirty-three patients (71.12%) discontinued the treatment. The treatment retention group contained more female patients, paranoid-type patients, patients who had shown self-harming behavior, patients receiving clozapine, and patients with good medication compliance. The recovery rate was 25%. However, 42.3% did not have gainful employment. Further, most patients couldn't live independently. CONCLUSION The results show the importance of gender, patient behavior, medication, and medication compliance in predicting treatment discontinuation in patients with schizophrenia.
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Affiliation(s)
- Seung-Ho Jung
- Department of Psychiatry, In-ha University College of Medicine, Incheon, Korea
| | - Won-Hyung Kim
- Department of Psychiatry, In-ha University College of Medicine, Incheon, Korea
| | - Hye-Jin Choi
- Department of Psychiatry, In-ha University College of Medicine, Incheon, Korea
| | - Min-Hee Kang
- Department of Psychiatry, In-ha University College of Medicine, Incheon, Korea
| | - Jeong-Seop Lee
- Department of Psychiatry, In-ha University College of Medicine, Incheon, Korea
| | - Jae-Nam Bae
- Department of Psychiatry, In-ha University College of Medicine, Incheon, Korea
| | - Chul-Eung Kim
- Department of Psychiatry, In-ha University College of Medicine, Incheon, Korea
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Antipsychotic drugs prevent the motor hyperactivity induced by psychotomimetic MK-801 in zebrafish (Danio rerio). Behav Brain Res 2010; 214:417-22. [DOI: 10.1016/j.bbr.2010.06.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 06/08/2010] [Accepted: 06/13/2010] [Indexed: 11/17/2022]
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DiBonaventura MD, Panish J, Kenworthy D, Wagner JS, Dirani R. The association of well-being, productivity and resource use among community-dwelling patients with schizophrenia using atypical antipsychotics. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2010. [DOI: 10.1111/j.1759-8893.2010.00033.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Long-acting injections of antipsychotic medication (or depots) were developed specifically to promote treatment adherence and are a valuable option for maintenance medication in psychotic illnesses. Approximately 40-60% of patients with schizophrenia are partially or totally non-adherent to their antipsychotic regimen, but only 30% or less are prescribed a long-acting injection. The use of such injections has declined in recent years after the introduction of second-generation (atypical) oral antipsychotic drugs. Research shows that possible reasons for this decline include concerns that may be based on suboptimal knowledge, as well as an erroneous assumption that one's own patient group is more adherent than those of one's colleagues. Research on attitudes has also revealed that psychiatrists feel that long-acting injections have an ;image' problem. This editorial addresses the gaps in knowledge and behaviour associated with possible underutilisation of these formulations, highlighting the role of stigma and the need for more research.
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Adrianzén C, Arango-Dávila C, Araujo DM, Ruíz I, Walton RJ, Dossenbach M, Karagianis J. Relative association of treatment-emergent adverse events with quality of life of patients with schizophrenia: post hoc analysis from a 3-year observational study. Hum Psychopharmacol 2010; 25:439-47. [PMID: 20737517 DOI: 10.1002/hup.1143] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore the relative association of adverse events with health-related quality of life (HRQL) in patients (N = 16 091) with schizophrenia, treated with antipsychotic medication. METHODS In this post hoc analysis of data from two 3-year observational studies, a mixed effects model with repeated measures was used to evaluate the association between HRQL (EuroQoL visual analogue scale (EQ-VAS)) and pre-specified covariates including: severity of illness, extrapyramidal symptoms, tardive dyskinesia, sexual dysfunction, and clinically significant weight gain (> 7% increase from baseline after > or = 3 months of treatment). RESULTS Mean EQ-VAS increased from 47.8 +/- 21.7 at baseline to 72.4 +/- 18.4 after 36 months. The rank order of the negative association of adverse events with HRQL was: sexual dysfunction (effect estimate -4.04; 95% CI -4.30 to -3.79), extrapyramidal symptoms (effect estimate -2.09; 95% CI -2.43 to -1.75), and tardive dyskinesia (effect estimate -0.89; 95% CI -1.46 to -0.32). CONCLUSIONS Differences were observed in the direction and magnitude of the association between each adverse event and HRQL. Recognition of the relative association of adverse events with HRQL may contribute to improved adherence of patients with schizophrenia to antipsychotic therapy.
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