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Chellappa SA, Pathak AK, Sinha P, Jainarayanan ASHWINK, Jain S, Brahmachari SK. Meta-analysis of genomic variants and gene expression data in schizophrenia suggests the potential need for adjunctive therapeutic interventions for neuropsychiatric disorders. J Genet 2019. [DOI: 10.1007/s12041-019-1101-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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52
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Abstract
Background:
Qualitative and quantitative analysis of atypical antipsychotic drugs used for
the treatment of schizophrenia, depression, anxiety, and bipolar disorder obtaining satisfactory results
can be ensured by voltammetric techniques. The aim of this review is to present the application of voltammetric
techniques developed for the determination of the atypical antipsychotic drugs, which are
amisulpride, aripiprazole, clozapine, olanzapine, quetiapine fumarate, risperidone, sertindole, and ziprasidone,
in pharmaceutical dosage forms and biological samples.
Methods:
Studies in the literature published between 2004 and 2017 based on the voltammetric determination
of atypical antipsychotic drugs were gathered using scientific databases. The results obtained
from these studies were combined and interpreted.
Results:
oltammetric techniques applied for the sensitive determination of trace amounts of the selected
atypical antipsychotic drugs in their pharmaceutical dosage forms and biological fluids were
compared. The best analysis conditions were obtained after the optimization of some parameters such as
buffer type, pH, and scan rate. For diffusion controlled electrode processes, it was observed that differential
pulse and square wave voltammetry methods were generally used for the sensitive quantitative
determination of the drugs, whereas stripping methods were used for the adsorption controlled electrode
processes. Detection limits were between 1.53×10-3 µM for clozapine and 0.97 µM for risperidone.
Conclusion:
The electrodes used in the studies showed high selectivity, sensitivity, and good accuracy
with precision. The developed methods were also applied to pharmaceutical preparations of the drugs
and biological fluids with satisfactory results, without any interference from inactive excipients.
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Affiliation(s)
- Dilek Kul
- Faculty of Pharmacy, Department of Analytical Chemistry, Karadeniz Technical University, 61080, Ortahisar, Trabzon, Turkey
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53
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López-Muñoz F, Povedano-Montero FJ, Chee KY, Shen WW, Fernández-Martín P, García-Pacios J, Rubio G, Álamo C. A Bibliometric Analysis of Scientific Production on Second-Generation Anti-Psychotic Drugs in Malaysia. Malays J Med Sci 2019; 25:40-55. [PMID: 30899186 PMCID: PMC6422559 DOI: 10.21315/mjms2018.25.3.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/24/2018] [Indexed: 11/23/2022] Open
Abstract
Objective We carried out a bibliometric study on the scientific papers related to second-generation antipsychotic drugs (SGAs) in Malaysia. Methods With the SCOPUS database, we selected those documents made in Malaysia whose title included descriptors related to SGAs. We applied bibliometric indicators of production and dispersion, as Price’s law and Bradford’s law, respectively. We also calculated the participation index of the different countries. The bibliometric data were also been correlated with some social and health data from Malaysia (total per capita expenditure on health and gross domestic expenditure on R&D). Results We found 105 original documents published between 2004 and 2016. Our results fulfilled Price’s law, with scientific production on SGAs showing exponential growth (r = 0.401, vs. r = 0.260 after linear adjustment). The drugs most studied are olanzapine (9 documents), clozapine (7), and risperidone (7). Division into Bradford zones yields a nucleus occupied by the Medical Journal of Malaysia, Singapore Medical Journal, Australian and New Zealand Journal of Psychiatry, and Pharmacogenomics. Totally, 63 different journals were used, but only one in the top four journals had an impact factor being greater than 3. Conclusion The publications on SGAs in Malaysia have undergone exponential growth, without evidence a saturation point.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences, University Camilo José Cela, Madrid, Spain.,Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain.,Portucalense Institute of Neuropsychology and Cognitive and Behavioural Neurosciences (INPP), Portucalense University, Porto, Portugal.,Thematic Network for Cooperative Health Research (RETICS), Addictive Disorders Network, Health Institute Carlos III, MICINN and FEDER, Madrid, Spain
| | - Francisco J Povedano-Montero
- Faculty of Health Sciences, University Camilo José Cela, Madrid, Spain.,Faculty of Biomedical Sciences and Health, European University of Madrid, Spain
| | - Kok-Yoon Chee
- Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Winston W Shen
- Departments of Psychiatry, Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Javier García-Pacios
- Faculty of Health Sciences, University Camilo José Cela, Madrid, Spain.,Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Technical University of Madrid and Complutense University of Madrid, Spain
| | - Gabriel Rubio
- Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain.,Thematic Network for Cooperative Health Research (RETICS), Addictive Disorders Network, Health Institute Carlos III, MICINN and FEDER, Madrid, Spain.,Department of Psychiatry, "Doce de Octubre" University Hospital, Complutense University, Madrid, Spain
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
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Brandão-Teles C, de Almeida V, Cassoli JS, Martins-de-Souza D. Biochemical Pathways Triggered by Antipsychotics in Human [corrected] Oligodendrocytes: Potential of Discovering New Treatment Targets. Front Pharmacol 2019; 10:186. [PMID: 30890939 PMCID: PMC6411851 DOI: 10.3389/fphar.2019.00186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/14/2019] [Indexed: 01/22/2023] Open
Abstract
Schizophrenia is a psychiatric disorder that affects more than 21 million people worldwide. It is an incurable disorder and the primary means of managing symptoms is through administration of pharmacological treatments, which consist heavily of antipsychotics. First-generation antipsychotics have the properties of D2 receptor antagonists. Second-generation antipsychotics are antagonists of both D2 and 5HT2 receptors. Recently, there has been increasing interest in the effects of antipsychotics beyond their neuronal targets and oligodendrocytes are one of the main candidates. Thus, our aim was to evaluate the molecular effects of typical and atypical drugs across the proteome of the human oligodendrocyte cell line, MO3.13. For this, we performed a mass spectrometry-based, bottom-up shotgun proteomic analysis to identify differences triggered by typical (chlorpromazine and haloperidol) and atypical (quetiapine and risperidone) antipsychotics. Proteins which showed changes in their expression levels were analyzed in silico using Ingenuity® Pathway Analysis, which implicated dysregulation of canonical pathways for each treatment. Our results shed light on the biochemical pathways involved in the mechanisms of action of these drugs, which may guide the identification of novel biomarkers and the development of new and improved treatments.
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Affiliation(s)
- Caroline Brandão-Teles
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Valéria de Almeida
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Juliana S Cassoli
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, Brazil.,Faculdade de Palmas, Palmas, Brazil
| | - Daniel Martins-de-Souza
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, Brazil.,UNICAMP's Neurobiology Center, Campinas, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria, Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
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55
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Lima WG, Ramos-Alves MC, Soares AC. Dos distúrbios psiquiátricos à antibioticoterapia: reposicionamento da clorpromazina como agente antibacteriano. ACTA ACUST UNITED AC 2019. [DOI: 10.15446/rcciquifa.v48n1.80062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
O alarmante aumento na taxa de resistência aos antibióticos põe em check à eficácia da terapia antibacteriana futura. Em contrapartida, as indústrias farmacêuticas negligenciam os investimentos em pesquisa e desenvolvimento de novos fármacos antimicrobianos em virtude de questões financeiras, legais e farmacológicas. Assim sendo, o reposicionamento de agentes disponíveis clinicamente torna-se uma promissora ferramenta para tentar driblar o desinteresse das indústrias. O fármaco antipsicótico clorpromazina (CPZ) destaca-se por possuir uma ampla faixa de atividade antibacteriana, a qual cobre desde patógenos Gram-positivos e Gram-negativos, até as micobactérias. A atividade antibacteriana é independente do perfil de susceptibilidade do microrganismo, sendo ela mantida mesmo em cepas altamente resistentes aos antibióticos. Alguns estudos mostram que mesmo nas concentrações clinicamente disponíveis no plasma (entre 0,1-0,5 μg/mL), a CPZ é capaz de matar Staphylococcus aureus e Mycobacterium tuberculosis dentro dos macrófagos. Em adição, estudos clínicos têm revelado os benefícios do uso da CPZ na terapia de suporte para pacientes com infecções em curso. Em conclusão, a CPZ pode eventualmente ser direcionada ao arsenal terapêutico antimicrobiano, especialmente no manejo das infecções causadas por microrganismos intracelulares com fenótipo multirresistente.
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56
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López-Muñoz F, Tracy DK, Povedano-Montero FJ, Breedvelt J, García-Pacios J, Fernández-Martín MP, Rubio G, Álamo C. Trends in the scientific literature on atypical antipsychotic drugs in the United Kingdom: a bibliometric study. Ther Adv Psychopharmacol 2019; 9:2045125318820207. [PMID: 30800284 PMCID: PMC6378637 DOI: 10.1177/2045125318820207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE A bibliometric study was undertaken of peer-reviewed publications on atypical antipsychotic drugs (AADs) from the United Kingdom and the findings are presented herein. METHODS We selected the documents from the Scopus database. We applied several production and dispersion bibliometric indicators, including Price's law on the growth of the scientific literature, and Bradford's law. We also calculated a so-called 'participation index' across different countries. The bibliometric data were thereafter correlated with social and health data from the UK, including total per capita expenditure on health and gross domestic expenditure. RESULTS A total of 4156 original manuscripts were published within the timeframe 1967-2015. Our results are in accord with Price's law, with scientific output demonstrating exponential growth (r = 0.9227, as against an r = 0.8766 after adjustment). The drugs most widely evaluated were clozapine (465 documents), olanzapine (263) and risperidone (248). Stratification into Bradford zones produced a nucleus represented by the Journal of Psychopharmacology (168 articles) and British Journal of Psychiatry (159 articles). A total of 1250 different journals were evaluated. CONCLUSIONS Publications on AADs in the UK have shown exponential growth across the studied period, which is in line with the progressively burgeoning novel AAD releases. No evidence of a saturation point was observed.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences, Camilo José Cela University, C/ Alarcón 49, 28692 Villanueva de la Cañada, Madrid, Spain Neuropsychophar-macology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain Portucalense Institute of Neuropsychology and Cognitive and Behavioural Neurosciences (INPP), Portucalense University, Porto, Portugal
| | - Derek K Tracy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - F Javier Povedano-Montero
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain Faculty of Biomedical Sciences and Health, European University of Madrid, Spain
| | | | - Javier García-Pacios
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Technical University of Madrid and Complutense University of Madrid, Spain
| | | | - Gabriel Rubio
- Neuropsychophar-macology Unit, Hospital 12 de Octubre Research Institute (i+12), Madrid, Spain
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
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Shinfuku N. A History of Mental Health Care in Japan:International Perspectives. TAIWANESE JOURNAL OF PSYCHIATRY 2019. [DOI: 10.4103/tpsy.tpsy_43_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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58
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Robinson E. Psychopharmacology: From serendipitous discoveries to rationale design, but what next? Brain Neurosci Adv 2018; 2:2398212818812629. [PMID: 32166162 PMCID: PMC7058199 DOI: 10.1177/2398212818812629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Indexed: 12/15/2022] Open
Abstract
Psychopharmacology really developed as a discipline from the mid-20th century with the discovery of a number of new classes of psychoactive drugs which could modify behaviour. These drugs were discovered as a consequence of clinical observations of patients, often being treated for other conditions. These serendipitous discoveries were the start of an era of drug development which has led to the antidepressants, antipsychotics, anxiolytics and mood stabilisers used today. Subsequent research focused on understanding why these drugs were effective, and used this information to develop a second generation of drugs that were more selective for their therapeutic targets, and therefore had reduced side effects and improved safety and tolerability. After a period of decline in new discoveries and withdrawal of the majority of the major pharmaceutical companies from active development programmes in psychiatry, new avenues are emerging fuelling renewed interest in this area.
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Affiliation(s)
- Emma Robinson
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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59
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Pringsheim T, Barnes TRE. Antipsychotic Drug-Induced Movement Disorders: A Forgotten Problem? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:717-718. [PMID: 29950107 PMCID: PMC6299188 DOI: 10.1177/0706743718786702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Alberta
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The Role of Precision Medicine in Child Psychiatry: What Can We Expect and When? J Am Acad Child Adolesc Psychiatry 2018; 57:813-817. [PMID: 30392618 PMCID: PMC7875186 DOI: 10.1016/j.jaac.2018.07.874] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/11/2018] [Accepted: 08/15/2018] [Indexed: 12/28/2022]
Abstract
In the United States, nearly 1 in 5 adults and 1 in 4 children suffer with a mental illness, and for most, these illnesses confer significant social, occupational, or academic impairment.1,2 Whereas considerable progress has been made toward diminishing the impact of mental illness, in the last few decades, advances toward new, more effective, and more refined psychiatric treatments have slowed. First-line medications for depression, schizophrenia, bipolar disorder, and attention-deficit/hyperactivity disorder (ADHD) were all introduced decades ago,3-6 and little progress has been made in augmenting their effectiveness.7,8.
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61
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Lee ES, Vidal C, Findling RL. A Focused Review on the Treatment of Pediatric Patients with Atypical Antipsychotics. J Child Adolesc Psychopharmacol 2018; 28:582-605. [PMID: 30312108 DOI: 10.1089/cap.2018.0037] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The use of atypical antipsychotic medications in pediatric patients has become more prevalent in recent years. The purpose of this review is to provide a clinically relevant update of recent selected key publications regarding the use of atypical antipsychotics in this population. METHODS Studies reviewed included randomized, double-blind, placebo-controlled medication trials conducted within the past 5 years. A PubMed search was conducted for each of the 11 second-generation antipsychotic medications currently approved by the Food and Drug Administration for use in the United States: clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, paliperidone, asenapine, iloperidone, lurasidone, and cariprazine. Trials published in English with subjects 18 years of age and younger were included in this review. Additional studies, chosen for their significance to clinical practice, were also included at the discretion of the authors. RESULTS This review demonstrates that more empiric data are available regarding both the acute efficacy and, to a lesser extent, the longer-term efficacy and tolerability for several of the considered antipsychotic medications. The clinical conditions for which these medications have been studied include schizophrenia, bipolar disorder, Tourette's disorder, and autism spectrum disorder. They have also been used as an adjunctive treatment for disruptive behavior disorders with aggression, which have not responded to treatment with stimulants. CONCLUSION Evidence regarding the efficacy and tolerability of antipsychotic medications for mental health disorders in children and adolescents has expanded exponentially in recent years. However, more information is needed so that evidence-based comparisons between medications can be made. In the future, data enabling the selection of medications based upon individual patient characteristics could potentially lead to greater efficacy and efficiency in treating what are frequently debilitating medical conditions. Maladaptive aggression in children, often treated with antipsychotics, is one such area in which there is a dearth of actual information available to the clinician. It is to be hoped that additional, longer-term studies of these medications will further inform evidence-based practice in clinical settings.
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Affiliation(s)
- Esther S Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital School of Medicine , Baltimore, Maryland
| | - Carol Vidal
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital School of Medicine , Baltimore, Maryland
| | - Robert L Findling
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital School of Medicine , Baltimore, Maryland
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Olagunju AT, Clark SR, Baune BT. Clozapine and Psychosocial Function in Schizophrenia: A Systematic Review and Meta-Analysis. CNS Drugs 2018; 32:1011-1023. [PMID: 30155842 DOI: 10.1007/s40263-018-0565-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Clozapine has unique efficacy for symptoms in treatment-resistant schizophrenia; however, symptomatic remission is not necessary nor sufficient for functional improvement. No study has pooled the effect of clozapine on psychosocial function across clinical trials. OBJECTIVE We conducted a systematic review and meta-analysis to compare the effects of clozapine with other antipsychotics on psychosocial function, and described the predictors of functional outcome. METHODS We searched MEDLINE/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of controlled trials and clinical trial registries till April 2018, with no language limits. Eligible studies were randomised controlled trials of clozapine vs. typical or atypical antipsychotics among adults with treatment-resistant schizophrenia. We included studies with flexible or fixed doses of antipsychotics within the therapeutic range to reflect naturalistic care. Effect sizes of studies were pooled using generic inverse variance and random-effects models and presented as standard mean differences. Study quality was assessed in accordance with the Cochrane Collaboration guideline, and subgroup analyses were carried out to identify potential moderators and methodological biases. RESULTS Nine studies with 1279 participants (69.7% male) were included. Clozapine showed beneficial effects on psychosocial function, but both short-term trials [n = 3; comparing 99 people taking clozapine with 97 controls (standardised mean difference = 0.04; 95% confidence interval - 0.24, 0.32; p = 0.77; I2 = 0%)] and long-term trials [n = 5; comparing 415 people taking clozapine with 427 controls (standardised mean difference = 0.05; 95% confidence interval - 0.16, 0.27; p = 0.64; I2 = 50%)] showed no superiority of clozapine to other antipsychotics in this regard. Only one study explored the predictors of psychosocial function. Baseline severity of illness, illicit drug use, extrapyramidal side effects, sex and cognition explained the variability in functional outcome. A range of scales measured psychosocial function, and the quality of reporting varied across trials. CONCLUSIONS Clozapine does not appear superior to other antipsychotics for improvement of psychosocial function. Standardisation of psychosocial function measurement is needed to improve the quality of evidence. Further exploration of the predictors of good psychosocial outcomes with clozapine treatment may improve personalisation of care.
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Affiliation(s)
- Andrew T Olagunju
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Level 6, 57 North Terrace, Adelaide, SA, 5000, Australia.,Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Scott R Clark
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Level 6, 57 North Terrace, Adelaide, SA, 5000, Australia
| | - Bernhard T Baune
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Level 6, 57 North Terrace, Adelaide, SA, 5000, Australia. .,Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Melbourne, VIC, Australia.
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63
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Lee H, Song DH, Kwon JW, Han E, Chang MJ, Kang HY. Assessing the risk of type 2 diabetes mellitus among children and adolescents with psychiatric disorders treated with atypical antipsychotics: a population-based nested case-control study. Eur Child Adolesc Psychiatry 2018; 27:1321-1334. [PMID: 29460164 DOI: 10.1007/s00787-018-1123-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 02/09/2018] [Indexed: 11/26/2022]
Abstract
To examine the associations between atypical antipsychotic (AAP) exposure and the development of type 2 diabetes mellitus (T2DM) in Korean pediatric patients with psychiatric disorders, we conducted a nested case-control study using the claims data of the National Health Insurance system of Korea between 2010 and 2014. A cohort of patients with psychiatric disorders was identified, and enrollment was taken as the date of the first psychiatric diagnosis. Cases involved patients with a diagnosis of T2DM or prescriptions for glucose lowering drugs after enrollment, and the identification of T2DM was defined as the index date. We performed a conditional logistic regression analysis for matched case-control data to assess associations between AAP exposure and T2DM, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) are presented. From 1,092,019 patients aged 2-19 years, we identified 20,263 cases with T2DM and 80,043 controls, matched by sex, age, enrollment date, and primary psychiatric diagnosis. After adjusting for comorbidities, psychotropic medication history, and the healthcare institution characteristics, the aOR of having T2DM was significantly higher in multi-AAP users compared with non-users (aOR 1.89; 95% CI 1.63-2.20). Particularly high ORs for T2DM were observed in clozapine users compared with non-users (aOR 3.47; 95% CI 1.88-6.41). We observed a linear relationship between the increase in risperidone dose and the increase in the risk of developing T2DM. Our findings suggest a significantly increased risk of developing T2DM in child or adolescent patients with psychiatric disorders exposed to AAPs compared with those not exposed to AAPs.
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Affiliation(s)
- Hankil Lee
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 85 Songdogwahak-ro, Incheon, 21983, Republic of Korea
| | - Dong-Ho Song
- Department of Psychiatry and Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jin-Won Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 85 Songdogwahak-ro, Incheon, 21983, Republic of Korea
| | - Min-Jung Chang
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 85 Songdogwahak-ro, Incheon, 21983, Republic of Korea
| | - Hye-Young Kang
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, 85 Songdogwahak-ro, Incheon, 21983, Republic of Korea.
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Jordan S, Logan PA, Panes G, Vaismoradi M, Hughes D. Adverse Drug Reactions, Power, Harm Reduction, Regulation and the ADRe Profiles. PHARMACY 2018; 6:E102. [PMID: 30231573 PMCID: PMC6165166 DOI: 10.3390/pharmacy6030102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 12/15/2022] Open
Abstract
The power and influence of healthcare systems comes largely from the ability to prescribe efficacious medicine. However, medicine can sometimes cause harm rather than bring benefits. Systematically checking patients for the adverse effects of medicines, as listed in manufacturers' literature, would protect patients from iatrogenic harm, but this is rarely undertaken. We argue for the benefits of this approach using the example of the prescription of antipsychotics to older adults. Prescribing antipsychotics to control challenging behaviours associated with dementia is a controversial matter, and regulatory intervention is under discussion. Improved regulatory systems could protect against iatrogenic harm, such as over-sedation, falls, tremor, or drug-induced Parkinsonism. However, measuring the impact and outcomes of regulatory interventions has proved difficult, not least because there are rarely systematic records of all adverse effects of medicines. We indicate how regulatory initiatives to reduce antipsychotic prescribing can be supported by systematic monitoring and documentation of patients' signs and symptoms of putative adverse drug reactions. Monitoring documentation then provides the rationale and support for professionals' responses to identified problems. Longitudinal monitoring records would improve understanding of the impact and outcomes of adverse drug reactions (ADRs) on health and wellbeing, and the many costs of ADRs.
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Affiliation(s)
- Sue Jordan
- College of Human and Health Sciences, Swansea University, Swansea SA2 8PP, UK.
| | - Patricia A Logan
- Faculty of Science, Charles Sturt University, Bathurst Campus, NSW 2795, Australia.
| | - Gerwyn Panes
- College of Human and Health Sciences, Swansea University, Swansea SA2 8PP, UK.
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway.
| | - David Hughes
- College of Human and Health Sciences, Swansea University, Swansea SA2 8PP, UK.
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Berkhout SG. Paradigm shift? Purity, progress and the origins of first-episode psychosis. MEDICAL HUMANITIES 2018; 44:172-180. [PMID: 29431144 DOI: 10.1136/medhum-2017-011383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 06/08/2023]
Abstract
First-episode psychosis has garnered significant attention and resources within mental health services in North America, Europe and Australia/New Zealand since the 1990s. Despite this widespread embrace, little scholarship exists that examines underlying concepts, ideologies and imagery embedded within the early intervention paradigm. In this paper, I offer a sociohistorical analysis of the emergence of first-episode psychosis and early intervention as entities in psychiatry, drawing on contemporary philosophical thought to explore various concepts embedded in them. Although scattered references to 'prodrome' and 'incipient cases' exist in the historic psychiatric literature, the notion of first-episode psychosis as a distinct chronological stage emerged in the late 1980s. This occurred in response to a desire for a homogeneous, medication-naive population within schizophrenia research. Thematically, concerns regarding 'purity' as well as notions of 'progress' can be read off of the body of work surrounding the creation of the term and its development into a clinical organising concept. Furthermore, examining the sociohistorical context of the term demonstrates its entanglement with the course of atypical antipsychotic drug development, the expansion of clinical rating scales and wider neoliberal biopolitics within healthcare. Within psychiatry, the early intervention model has been termed a 'paradigm shift,' with the promise that earlier interventions will translate into shorter durations of untreated illness, improved utilisation of services and better prognoses for recovery. While these are laudable goals, they are tied to assumptions about biomedical progress and idealisations of clinical populations that feminist and disability critiques problematise.
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Proschak E, Stark H, Merk D. Polypharmacology by Design: A Medicinal Chemist's Perspective on Multitargeting Compounds. J Med Chem 2018; 62:420-444. [PMID: 30035545 DOI: 10.1021/acs.jmedchem.8b00760] [Citation(s) in RCA: 276] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Multitargeting compounds comprising activity on more than a single biological target have gained remarkable relevance in drug discovery owing to the complexity of multifactorial diseases such as cancer, inflammation, or the metabolic syndrome. Polypharmacological drug profiles can produce additive or synergistic effects while reducing side effects and significantly contribute to the high therapeutic success of indispensable drugs such as aspirin. While their identification has long been the result of serendipity, medicinal chemistry now tends to design polypharmacology. Modern in vitro pharmacological methods and chemical probes allow a systematic search for rational target combinations and recent innovations in computational technologies, crystallography, or fragment-based design equip multitarget compound development with valuable tools. In this Perspective, we analyze the relevance of multiple ligands in drug discovery and the versatile toolbox to design polypharmacology. We conclude that despite some characteristic challenges remaining unresolved, designed polypharmacology holds enormous potential to secure future therapeutic innovation.
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Affiliation(s)
- Ewgenij Proschak
- Institute of Pharmaceutical Chemistry , Goethe University Frankfurt , Max-von-Laue-Strasse 9 , D-60438 Frankfurt , Germany
| | - Holger Stark
- Institute of Pharmaceutical and Medicinal Chemistry , Heinrich Heine University Düsseldorf , Universitaetsstrasse 1 , D-40225 , Duesseldorf , Germany
| | - Daniel Merk
- Institute of Pharmaceutical Chemistry , Goethe University Frankfurt , Max-von-Laue-Strasse 9 , D-60438 Frankfurt , Germany.,Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences , Swiss Federal Institute of Technology (ETH) Zürich , Vladimir-Prelog-Weg 4 , CH-8093 Zürich , Switzerland
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López-Muñoz F, Shen WW, D'Ocon P, Romero A, Álamo C. A History of the Pharmacological Treatment of Bipolar Disorder. Int J Mol Sci 2018; 19:E2143. [PMID: 30041458 PMCID: PMC6073684 DOI: 10.3390/ijms19072143] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 01/16/2023] Open
Abstract
In this paper, the authors review the history of the pharmacological treatment of bipolar disorder, from the first nonspecific sedative agents introduced in the 19th and early 20th century, such as solanaceae alkaloids, bromides and barbiturates, to John Cade's experiments with lithium and the beginning of the so-called "Psychopharmacological Revolution" in the 1950s. We also describe the clinical studies and development processes, enabling the therapeutic introduction of pharmacological agents currently available for the treatment of bipolar disorder in its different phases and manifestations. Those drugs include lithium salts, valproic acid, carbamazepine, new antiepileptic drugs, basically lamotrigine and atypical antipsychotic agents (olanzapine, risperidone, quetiapine, ziprasidone, aripiprazole, asenapine, cariprazine and lurasidone). Finally, the socio-sanitary implications derived from the clinical introduction of these drugs are also discussed.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences, University Camilo José Cela, C/Castillo de Alarcón 49, 28692 Villanueva de la Cañada, Madrid, Spain.
- Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute (i+12), Avda. Córdoba, s/n, 28041 Madrid, Spain.
- Portucalense Institute of Neuropsychology and Cognitive and Behavioural Neurosciences (INPP), Portucalense University, R. Dr. António Bernardino de Almeida 541, 4200-072 Porto, Portugal.
- Thematic Network for Cooperative Health Research (RETICS), Addictive Disorders Network, Health Institute Carlos III, MICINN and FEDER, 28029 Madrid, Spain.
| | - Winston W Shen
- Departments of Psychiatry, Wan Fang Medical Center and School of Medicine, Taipei Medical University, 111 Hsin Long Road Section 3, Taipei 116, Taiwan.
| | - Pilar D'Ocon
- Department of Pharmacology, Faculty of Pharmacy, University of Valencia, Avda. Vicente Andrés, s/n, 46100 Burjassot, Valencia, Spain.
| | - Alejandro Romero
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Complutense University, Avda. Puerta de Hierro, s/n, 28040 Madrid, Spain.
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Crta. de Madrid-Barcelona, Km. 33,600, 28871 Alcalá de Henares, Madrid, Spain.
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Do Antipsychotics "Thin" the Brain?: It Is a Rather Gray Matter. J Clin Psychopharmacol 2018; 38:167-169. [PMID: 29620691 DOI: 10.1097/jcp.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Azmanova M, Pitto-Barry A, Barry NPE. Schizophrenia: synthetic strategies and recent advances in drug design. MEDCHEMCOMM 2018; 9:759-782. [PMID: 30108966 PMCID: PMC6072500 DOI: 10.1039/c7md00448f] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/09/2018] [Indexed: 12/19/2022]
Abstract
Schizophrenia is a complex and unpredictable mental disorder which affects several domains of cognition and behaviour. It is a heterogeneous illness characterised by positive, negative, and cognitive symptoms, often accompanied by signs of depression. In this tutorial review, we discuss recent progress in understanding the target sites and mechanisms of action of second-generation antipsychotic drugs. Progress in identifying and defining target sites has been accelerated recently by advances in neuroscience, and newly developed agents that regulate signalling by the main excitatory neurotransmitters in the brain are surveyed. Examples of novel molecules for the treatment of schizophrenia in preclinical and clinical development and their industrial sponsors are highlighted.
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Affiliation(s)
- Maria Azmanova
- School of Chemistry and Biosciences , University of Bradford , Bradford BD7 1DP , UK . ;
| | - Anaïs Pitto-Barry
- School of Chemistry and Biosciences , University of Bradford , Bradford BD7 1DP , UK . ;
| | - Nicolas P E Barry
- School of Chemistry and Biosciences , University of Bradford , Bradford BD7 1DP , UK . ;
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Olivieri-Mui BL, Devlin JW, Ochoa A, Schenck D, Briesacher B. Perceptions vs. evidence: therapeutic substitutes for antipsychotics in patients with dementia in long-term care. Aging Ment Health 2018; 22:544-549. [PMID: 28080146 PMCID: PMC5547007 DOI: 10.1080/13607863.2016.1277974] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare differences between clinician perceptions of therapeutic substitutes for antipsychotics prescribed to patients with dementia in long term care (LTC) and published evidence. METHODS A mixed-methods approach that included a drug information search, online survey of 55 LTC clinicians and a comprehensive literature review was used. For 41 pharmacologic antipsychotic substitute candidates identified, LTC clinicians rated the likelihood they would substitute each for patients with dementia and identified non-pharmacologic antipsychotic substitutes. The quality of evidence supporting the most likely antipsychotic substitutes was assessed using a modified GRADE approach. RESULTS Among 36 (65%) of LTC clinicians responding, the pharmacologic candidates deemed likely or somewhat likely to be substituted for an antipsychotic were: valproic acid, serotonin modulator antidepressants, short-acting benzodiazepines, serotonin reuptake inhibitor antidepressants, alpha-adrenoceptor antagonist, buspirone, acetaminophen, serotonin-norepinephrine reuptake inhibitor antidepressants, memantine, and a cholinesterase inhibitor. High quality evidence supporting these substitutions existed for only memantine and cholinesterase inhibitors, while high quality evidence cautioning against this substitution existed for valproic acid. Activities and music therapy were the most commonly cited non-pharmacologic substitutes but the supporting evidence for each is sparse. CONCLUSION Perceptions of LTC clinicians regarding substitutes for antipsychotics in LTC patients with dementia vary widely and are often discordant with published evidence.
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Affiliation(s)
- Brianne L. Olivieri-Mui
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - John W. Devlin
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Aileen Ochoa
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Danielle Schenck
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Becky Briesacher
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
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Scott KA, Njardarson JT. Analysis of US FDA-Approved Drugs Containing Sulfur Atoms. Top Curr Chem (Cham) 2018; 376:5. [DOI: 10.1007/s41061-018-0184-5] [Citation(s) in RCA: 339] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/05/2018] [Indexed: 12/18/2022]
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Pringsheim T, Barnes TRE. Antipsychotic Drug-Induced Movement Disorders: A Forgotten Problem? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018:706743718772526. [PMID: 29685067 DOI: 10.1177/0706743718772526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tamara Pringsheim
- 1 Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Thomas R E Barnes
- 2 Department of Psychiatry, Imperial College London, Kensington, London, UK
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Jiang J, Huang Z, Chen X, Luo R, Cai H, Wang H, Zhang H, Sun T, Zhang Y. Trifluoperazine Activates FOXO1-Related Signals to Inhibit Tumor Growth in Hepatocellular Carcinoma. DNA Cell Biol 2017; 36:813-821. [PMID: 28876084 DOI: 10.1089/dna.2017.3790] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Schizophrenic patients tend to have reduced incidence of some cancers due to the treatment of antipsychotic drugs with antitumor effects, such as chlorpromazine and trifluoperazine (TFP). Forkhead Box O1 (FOXO1) as tumor suppressor in many malignancies is often inactivated by nuclear export, which could be inhibited by TFP. However, the antitumor efficiency of TFP and related role of FOXO1 in hepatocellular carcinoma (HCC) are unclear. Thus, two HCC cell lines SMMC-7721 and Bel-7402 were treated with different concentrations of TFP and the IC50 was determined. We found that TFP could inhibit the vitality of two cell lines and induce cell cycle arrest at G0/G1. Meanwhile, the apoptosis was also increased and the ability of migration or invasion was found to be impaired by TFP. Interestingly, TFP reversed the cytoplasmic localization of FOXO1 to nuclear and increased its expression in nuclear, and increased the ratio of Bax/Bcl-2. However, knockdown of FOXO1 significantly abrogated the TFP-induced
apoptosis by decreasing the Bcl-2 expression [corrected]. Furthermore, we found that TFP in vivo could effectively restrict the angiogenesis and tumor growth with reduced expression of VEGF, Bcl-2, and PCNA, and increased the nuclear localization of FOXO1, which indicated its antitumor role in HCC.
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Affiliation(s)
- Jingwen Jiang
- 1 Department of Medical Oncology, Hainan Province Hospital of Traditional Chinese Medicine , Haikou, China
| | - Zhongxi Huang
- 2 Guangdong Provincial Key Laboratory of Cancer Immunotherapy, Cancer Research Institute, School of Basic Medical Sciences, Southern Medical Sciences, Southern Medical University , Guangzhou, China
| | - Xuewu Chen
- 1 Department of Medical Oncology, Hainan Province Hospital of Traditional Chinese Medicine , Haikou, China
| | - Rongcheng Luo
- 3 TCM-Integrated Cancer Center, Southern Medical University , Guangzhou, China
| | - Hongbin Cai
- 4 Department of Medical Oncology, TCM-Integrated Cancer Center of Southern Medical University , Guangzhou, China
| | - Hairu Wang
- 5 Department of Surgical Oncology, Haikou People's Hospital , Haikou, China
| | - Hui Zhang
- 1 Department of Medical Oncology, Hainan Province Hospital of Traditional Chinese Medicine , Haikou, China
| | - Tao Sun
- 6 College of Traditional Chinese Medicine, Hainan Medical University , Haikou, Hainan, China
| | - Yunfang Zhang
- 1 Department of Medical Oncology, Hainan Province Hospital of Traditional Chinese Medicine , Haikou, China
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Affiliation(s)
- Sujoy Ray
- St. John's Medical College and Hospital; Department of Psychiatry; Sarjapur Road Bangalore Karnataka India 560008
| | - Amita Ray
- DM Wayanad Institute of Medical Sciences; Department of Obstetrics and Gynaecology; Naseera Nagar ,Meppadi (PO) Wayanad Wayanad Kerala India 673577
| | - Arun Gopi
- DM Wayanad Institute of Medical Sciences; Department of Community Medicine; Wayanad Kerala India
| | - Robert Hunter
- Greater Glasgow Health Board; Research and Development; Gartnavel Royal Hospital 1055 Great Western Road Glasgow Scotland UK G12 0XH
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Abstract
Schizophrenia is a devastating illness that affects up to 1% of the population; it is characterized by a combination of positive symptoms, negative symptoms, and cognitive impairment. Currently, treatment consists of one class of medications known as antipsychotics, which include typical (first-generation) and atypical (second-generation) agents. Unfortunately, antipsychotic medications have limited efficacy, with up to a third of patients lacking a full response. Clozapine, the first atypical antipsychotic developed, is the only medication shown to be superior to all other antipsychotics. However, owing to several life-threatening side effects and required enrollment in a registry with routine blood monitoring, clozapine is greatly underutilized in the US. Developing a medication as efficacious as clozapine with limited side effects would likely become the first-line therapy for schizophrenia and related disorders. In this review, we discuss the history of clozapine, landmark studies, and its clinical advantages and disadvantages. We further discuss the hypotheses for clozapine's superior efficacy based on neuroreceptor binding, and the limitations of a receptor-based approach to antipsychotic development. We highlight some of the advances from pharmacogenetic studies on clozapine and then focus on studies of clozapine using unbiased approaches such as pharmacogenomics and gene expression profiling. Finally, we examine how these approaches could provide insights into clozapine's mechanism of action and side-effect profile, and lead to novel and improved therapeutics.
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Affiliation(s)
- Frederick C Nucifora
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | - Brian J Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Akira Sawa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Potential drug targets and treatment of schizophrenia. Inflammopharmacology 2017; 25:277-292. [DOI: 10.1007/s10787-017-0340-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/17/2017] [Indexed: 12/25/2022]
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Abstract
INTRODUCTION Limited efficacy on negative and cognitive symptoms and adverse effects of current antipsychotics raise the need of developing new antipsychotics. Brexpiprazole, a new antipsychotic drug approved by the U.S. Food and Drug Administration in July 2015 for the treatment of schizophrenia, is a novel serotonin-dopamine receptor modulator with partial agonist activity at serotonin 1A (5-HT1A) and D2/3 receptors. Areas covered: We reviewed brexpiprazole related in vitro and in vivo studies, including phase II and phase III clinical trials in this article. Brexpiprazole showed significant improvement of psychotic symptoms for patients with schizophrenia in clinical trials. Most of the clinical trials demonstrated the antipsychotic effect of brexpiprazole using Positive and Negative Syndrome Scale (PANSS) in acute schizophrenia patients, and found that higher doses (2-4 mg daily) of brexpiprazole had better outcomes. In short-term trials, brexpiprazole did not show benefit for cognitive function in 6 weeks. Insomnia, akathisia, headache, and agitation were the most frequently recorded adverse events. Expert commentary: Brexpiprazole showed better efficacy than placebo in acute phase of schizophrenia. Long-term studies are needed to investigate the efficacy of brexpiprazole for cognitive function as well as the strength and weakness of brexpiprazole among current antipsychotic drugs.
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Affiliation(s)
- Wen-Yu Hsu
- a Graduate Institute of Clinical Medical Science , China Medical University , Taichung , Taiwan.,b Department of Psychiatry , Changhua Christian Hospital , Changhua , Taiwan.,c School of Medicine , Chung Shan Medical University , Taichung , Taiwan
| | - Hsien-Yuan Lane
- a Graduate Institute of Clinical Medical Science , China Medical University , Taichung , Taiwan.,d Department of Psychiatry , China Medical University and Hospital , Taichung , Taiwan.,e Graduate Institute of Biomedical Sciences , China Medical University , Taichung , Taiwan
| | - Chieh-Hsin Lin
- a Graduate Institute of Clinical Medical Science , China Medical University , Taichung , Taiwan.,e Graduate Institute of Biomedical Sciences , China Medical University , Taichung , Taiwan.,f Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital , Chang Gung University College of Medicine , Kaohsiung , Taiwan.,g Center for General Education , Cheng Shiu University , Kaohsiung , Taiwan
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Ricq EL, Hooker JM, Haggarty SJ. Toward development of epigenetic drugs for central nervous system disorders: Modulating neuroplasticity via H3K4 methylation. Psychiatry Clin Neurosci 2016; 70:536-550. [PMID: 27485392 PMCID: PMC5764164 DOI: 10.1111/pcn.12426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2016] [Indexed: 12/19/2022]
Abstract
The mammalian brain dynamically activates or silences gene programs in response to environmental input and developmental cues. This neuroplasticity is controlled by signaling pathways that modify the activity, localization, and/or expression of transcriptional-regulatory enzymes in combination with alterations in chromatin structure in the nucleus. Consistent with this key neurobiological role, disruptions in the fine-tuning of epigenetic and transcriptional regulation have emerged as a recurrent theme in studies of the genetics of neurodevelopmental and neuropsychiatric disorders. Furthermore, environmental factors have been implicated in the increased risk of heterogeneous, multifactorial, neuropsychiatric disorders via epigenetic mechanisms. Aberrant epigenetic regulation of gene expression thus provides an attractive unifying model for understanding the complex risk architecture of mental illness. Here, we review emerging genetic evidence implicating dysregulation of histone lysine methylation in neuropsychiatric disease and outline advancements in small-molecule probes targeting this chromatin modification. The emerging field of neuroepigenetic research is poised to provide insight into the biochemical basis of genetic risk for diverse neuropsychiatric disorders and to develop the highly selective chemical tools and imaging agents necessary to dissect dynamic transcriptional-regulatory mechanisms in the nervous system. On the basis of these findings, continued advances may lead to the validation of novel, disease-modifying therapeutic targets for a range of disorders with aberrant chromatin-mediated neuroplasticity.
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Affiliation(s)
- Emily L. Ricq
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
- Chemical Neurobiology Laboratory, Center for Human Genetic Research, Departments of Neurology & Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Jacob M. Hooker
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - Stephen J. Haggarty
- Chemical Neurobiology Laboratory, Center for Human Genetic Research, Departments of Neurology & Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, United States
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Brixner DI, Said Q, Corey-Lisle PK, Tuomari AV, L'italien GJ, Stockdale W, Oderda GM. Naturalistic Impact of Second-Generation Antipsychotics on Weight Gain. Ann Pharmacother 2016; 40:626-32. [PMID: 16569802 DOI: 10.1345/aph.1g564] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: While second-generation antipsychotics (SGAs) have had benefits over earlier antipsychotic treatments, their use has been associated with reports of weight gain. Body mass index (BMI) has been studied in clinical trials with limited comparison between drugs. Objective: To investigate the impact of each SGA on the risk of weight increase in an adult population. Methods: Using a national electronic medical records database, a naturalistic impact of SGAs on BMI was evaluated. Patients (aged ≥ 18 y) receiving a prescription for an antipsychotic drug between January 1995 and March 2004 were identified. An adverse event was defined as at least a 7% increase in BMI from baseline within one year of antipsychotic prescription and a post-increase BMI of at least 25 kg/m2. Results: A total of 9394 patients were identified, with 1514 cases of increased BMI after initial prescription. Risperidone (OR 1.39; 95% CI 1.16 to 1.66), quetiapine (OR 1.36; 95% CI 1.13 to 1.64), and olanzapine (OR 1.76; 95% CI 1.50 to 2.07)were significantly more likely to cause BMI increase compared with first-generation antipsychotics (FGAs). Aripiprazole (OR 0.72; 95% CI 0.36 to 1.46), ziprasidone (OR 0.68; 95% CI 0.39 to 1.18), and clozapine (OR 1.01; 95% CI 0.56 to 1.81) were less likely to induce weight gain compared with FGAs. Conclusions: This study provides a foundation for understanding how SGAs impact weight gain in a naturalistic, as opposed to a clinical trial, setting and provides evidence that there are differential risks of weight gain between SGAs. Because of negative long-term health effects of weight gain, physicians need to take all factors into consideration when recommending pharmaceutical therapy for patients with severe mental illness.
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Affiliation(s)
- Diana I Brixner
- Executive Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City, UT 84108, USA.
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Datka W, Jaeschke RR, Styczeñ K, Koperny M, Waligora M, Hubert J, Storman D. Lurasidone versus typical antipsychotics for schizophrenia. Hippokratia 2016. [DOI: 10.1002/14651858.cd012429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Wojciech Datka
- Chair of Psychiatry, Jagiellonian University Medical College; Department of Affective Disorders; Cracow Unit of Mental Health, Kopernika Street, Krakow Poland 31-501
| | - Rafal R Jaeschke
- Chair of Psychiatry, Jagiellonian University Medical College; Department of Affective Disorders; Cracow Unit of Mental Health, Kopernika Street, Krakow Poland 31-501
| | - Krzysztof Styczeñ
- Chair of Psychiatry, Jagiellonian University Medical College; Department of Affective Disorders; Cracow Unit of Mental Health, Kopernika Street, Krakow Poland 31-501
| | - Magdalena Koperny
- Province Sanitary Epidemiological Station; Public Health and Health Promotion Department; Pradnicka 76 Krakow Poland 31-202
| | - Marcin Waligora
- Jagiellonian University Medical College; Department of Philosophy and Bioethics; Michaelowskiego 12 Street 31 - 126 Krakow Krakow Poland
| | - Joanna Hubert
- Jagiellonian University Medical College; Faculty of Medicine; Krakow Poland
| | - Dawid Storman
- Jagiellonian University Medical College; Faculty of Medicine; Krakow Poland
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Abstract
Although there has been more than 50 years of development, there remains a great need for better antipsychotic medications. This article looks at the recent advances in treatment of schizophrenia. New hypotheses have been suggested that may replace or complement the dopamine hypotheses. The article explores the different novel drugs that impact some of the key neurotransmitter systems currently. Phosphodiesterase 10A inhibitors and α-7 neuronal nicotinic acetylcholine receptor modulators constitute the majority. The marketing of these medications eventually may result in change about how schizophrenia is treated.
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Binding of phenothiazines into allosteric hydrophobic pocket of human thioredoxin 1. EUROPEAN BIOPHYSICS JOURNAL: EBJ 2016; 45:279-86. [PMID: 26820562 DOI: 10.1007/s00249-016-1113-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/25/2015] [Accepted: 01/10/2016] [Indexed: 10/22/2022]
Abstract
Thioredoxins are multifunctional oxidoreductase proteins implicated in the antioxidant cellular apparatus and oxidative stress. They are involved in several pathologies and are promising anticancer targets. Identification of noncatalytic binding sites is of great interest for designing new allosteric inhibitors of thioredoxin. In a recent work, we predicted normal mode motions of human thioredoxin 1 and identified two major putative hydrophobic binding sites. In this work we investigated noncovalent interactions of human thioredoxin 1 with three phenotiazinic drugs acting as prooxidant compounds by using molecular docking and circular dichroism spectrometry to probe ligand binding into the previously predicted allosteric hydrophobic pockets. Our in silico and CD spectrometry experiments suggested one preferred allosteric binding site involving helix 3 and adopting the best druggable conformation identified by NMA. The CD spectra showed binding of thioridazine into thioredoxin 1 and suggested partial helix unfolding, which most probably concerns helix 3. Taken together, these data support the strategy to design thioredoxin inhibitors targeting a druggable allosteric binding site.
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Cassoli JS, Guest PC, Santana AG, Martins-de-Souza D. Employing proteomics to unravel the molecular effects of antipsychotics and their role in schizophrenia. Proteomics Clin Appl 2016; 10:442-55. [PMID: 26679983 DOI: 10.1002/prca.201500109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/15/2015] [Accepted: 12/09/2015] [Indexed: 12/20/2022]
Abstract
Schizophrenia is an incurable neuropsychiatric disorder managed mostly by treatment of the patients with antipsychotics. However, the efficacy of these drugs has remained only low to moderate despite intensive research efforts since the early 1950s when chlorpromazine, the first antipsychotic, was synthesized. In addition, antipsychotic treatment can produce often undesired severe side effects in the patients and addressing these remains a large unmet clinical need. One of the reasons for the low effectiveness of these drugs is the limited knowledge about the molecular mechanisms of schizophrenia, which impairs the development of new and more effective treatments. Recently, proteomic studies of clinical and preclinical samples have identified changes in the levels of specific proteins in response to antipsychotic treatment, which have converged on molecular pathways such as cell communication and signaling, inflammation and cellular growth, and maintenance. The findings of these studies are summarized and discussed in this review and we suggest that this provides validation of proteomics as a useful tool for mining drug mechanisms of action and potentially for pinpointing novel molecular targets that may enable development of more effective medications.
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Affiliation(s)
- Juliana S Cassoli
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Paul C Guest
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Aline G Santana
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Daniel Martins-de-Souza
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.,UNICAMP Neurobiology Center, Campinas, São Paulo, Brazil
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84
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Konstantinidou H, Evans C. Pharmacotherapy and psychotherapy: the challenges of integrating two paradigms. PSYCHOANALYTIC PSYCHOTHERAPY 2015. [DOI: 10.1080/02668734.2015.1051096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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85
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Euesden J, Breen G, Farmer A, McGuffin P, Lewis CM. The relationship between schizophrenia and rheumatoid arthritis revisited: genetic and epidemiological analyses. Am J Med Genet B Neuropsychiatr Genet 2015; 168B:81-8. [PMID: 25656077 PMCID: PMC4833173 DOI: 10.1002/ajmg.b.32282] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/09/2014] [Accepted: 11/13/2014] [Indexed: 11/13/2022]
Abstract
Epidemiological studies are inconsistent on the relationship between schizophrenia (SCZ) and rheumatoid arthritis (RA). Several studies have shown that SCZ has a protective effect on RA, with RA occurring less frequently in SCZ cases than would be expected by chance, whilst other studies have failed to replicate this. We sought to test the hypothesis that this effect is due to a protective effect of SCZ risk alleles on RA onset. We first reviewed the literature on the comorbidity of RA and SCZ and performed a meta-analysis. We then used polygenic risk scoring in an RA case control study in order to investigate the contribution of SCZ risk alleles to RA risk. Meta-analysis across studies over the past half-century showed that prevalence of RA in SCZ cases was significantly reduced (OR=0.48, 95% CI: 0.34-0.67, p<0.0001). The relationship between SCZ genetic risk and RA status was weak. Polygenic risk of SCZ explained a small (0.1%) and non-significant (p=0.085) proportion of variance in RA case control status. This relationship was nominally positive, with RA cases carrying more SCZ risk alleles than controls. The current findings do not support the assertion that the relationship between RA and SCZ is explained by genetic factors, which appear to have little or no effect. The protective effect of SCZ on RA may be due to environmental factors, such as an anti-inflammatory effect of anti-psychotic medication or merely due to confounding limitations in study designs.
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Affiliation(s)
- Jack Euesden
- MRC SGDP Centre Institute of PsychiatryKing's College LondonLondonUK
| | - Gerome Breen
- MRC SGDP Centre Institute of PsychiatryKing's College LondonLondonUK
| | - Anne Farmer
- MRC SGDP Centre Institute of PsychiatryKing's College LondonLondonUK
| | - Peter McGuffin
- MRC SGDP Centre Institute of PsychiatryKing's College LondonLondonUK
| | - Cathryn M Lewis
- MRC SGDP Centre Institute of PsychiatryKing's College LondonLondonUK,Department of Medical and Molecular GeneticsKing's College LondonLondonUK
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86
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Crocq MA. Histoire des traitements antipsychotiques à action prolongée dans la schizophrénie. Encephale 2015; 41:84-92. [DOI: 10.1016/j.encep.2014.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/01/2014] [Indexed: 11/17/2022]
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87
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Hein LC, Scharer KM. A modern history of psychiatric-mental health nursing. Arch Psychiatr Nurs 2015; 29:49-55. [PMID: 25634875 DOI: 10.1016/j.apnu.2014.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 10/10/2014] [Accepted: 10/25/2014] [Indexed: 11/29/2022]
Abstract
This paper discusses the progression of developments in psychiatric-mental health nursing from the 1960s to the present. The 1960s were a time of shortage of psychiatric APRNs, with legislation expanding the availability of mental health services. We find ourselves in a similar time with 7 million new health insurance enrollees, because of the Affordable Care Act (ACA). The expansion of health insurance coverage comes at a time when some colleges of nursing are closing master's programs in psychiatric-mental health, in lieu of the DNP mandate from the American Association of Colleges of Nursing. Is history repeating itself?
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88
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Whitney Z, Procyshyn RM, Fredrikson DH, Barr AM. Treatment of clozapine-associated weight gain: a systematic review. Eur J Clin Pharmacol 2015; 71:389-401. [PMID: 25627831 DOI: 10.1007/s00228-015-1807-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 01/12/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE Clozapine is an antipsychotic drug with superior efficacy in treatment-resistant schizophrenia. Clozapine is associated with a low likelihood of extrapyramidal symptoms and other neurological side-effects but a high propensity to induce weight gain and general metabolic dysregulation. Various pharmacological and behavioral treatment approaches for reducing clozapine-associated weight gain exist in the literature; however, there are currently no clear clinical guidelines as to which method is preferred. The aim of the current review is to systematically summarize studies that have studied both pharmacological and non-pharmacological interventions to attenuate or reverse clozapine-associated weight gain. METHODS A systematic review of EMBASE and MEDLINE databases of all articles published prior to January 2014 was conducted. Seventeen studies were identified as meeting inclusion criteria and included in the review. RESULTS Aripiprazole, fluvoxamine, metformin, and topiramate appear to be beneficial; however, available data are limited to between one and three randomized controlled trials per intervention. Orlistat shows beneficial effects, but in males only. Behavioral and nutritional interventions also show modest effects on decreasing clozapine-associated weight gain, although only a small number of such studies exist. CONCLUSIONS While a number of pharmacological interventions can produce modest weight loss, each may be associated with negative side effects, which should be considered before beginning treatment. Given the pressing need to improve cardiometabolic health in most clozapine-treated patients, substantially more research is needed to develop sound clinical practice guidelines for the treatment of clozapine-associated weight gain.
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Affiliation(s)
- Z Whitney
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
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89
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Iuga C, Campero A, Vivier-Bunge A. Antioxidant vs. prooxidant action of phenothiazine in a biological environment in the presence of hydroxyl and hydroperoxyl radicals: a quantum chemistry study. RSC Adv 2015. [DOI: 10.1039/c4ra14918a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In aqueous solution, phenothiazine regenerates and acts as an excellent antioxidant while in lipid media, it behaves as a prooxidant.
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Affiliation(s)
- C. Iuga
- Departamento de Sistemas Biológicos
- Universidad Autónoma Metropolitana-Xochimilco
- 04960 México
- México
| | - A. Campero
- Departamento de Química
- Universidad Autónoma Metropolitana-Iztapalapa
- 09340 México
- México
| | - A. Vivier-Bunge
- Departamento de Química
- Universidad Autónoma Metropolitana-Iztapalapa
- 09340 México
- México
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90
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Veenstra-VanderWeele J, Warren Z. Intervention in the context of development: pathways toward new treatments. Neuropsychopharmacology 2015; 40:225-37. [PMID: 25182180 PMCID: PMC4262912 DOI: 10.1038/npp.2014.232] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/31/2014] [Accepted: 09/01/2014] [Indexed: 02/07/2023]
Abstract
Neuropsychiatric disorders vary substantially in age of onset but are best understood within the context of neurodevelopment. Here, we review opportunities for intervention at critical points in developmental trajectories. We begin by discussing potential opportunities to prevent neuropsychiatric disorders. Once symptoms begin to emerge, a number of interventions have been studied either before a diagnosis can be made or shortly after diagnosis. Although some of these interventions are helpful, few are based upon an understanding of pathophysiology, and most ameliorate rather than resolve symptoms. As such, in the next portion of the review, we turn our discussion to genetic syndromes that are rare phenocopies of common diagnoses such as autism spectrum disorder or schizophrenia. Cellular or animal models of these syndromes point to specific regulatory or signaling pathways. As examples, findings from the mouse models of Fragile X and Rett syndromes point to potential treatments now being tested in randomized clinical trials. Paralleling oncology, we can hope that our treatments will move from nonspecific, like chemotherapies thrown at a wide range of tumor types, to specific, like the protein kinase inhibitors that target molecularly defined tumors. Some of these targeted treatments later show benefit for a broader, yet specific, array of cancers. We can hope that medications developed within rare neurodevelopmental syndromes will similarly help subgroups of patients with disruptions in overlapping signaling pathways. The insights gleaned from treatment development in rare phenocopy syndromes may also teach us how to test treatments based upon emerging common genetic or environmental risk factors.
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Affiliation(s)
| | - Zachary Warren
- Departments of Psychiatry and Pediatrics, and Kennedy Center for Research on Human Development, Vanderbilt University, Nashville, TN, USA
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91
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Litzenburger M, Kern F, Khatri Y, Bernhardt R. Conversions of tricyclic antidepressants and antipsychotics with selected P450s from Sorangium cellulosum So ce56. Drug Metab Dispos 2014; 43:392-9. [PMID: 25550480 DOI: 10.1124/dmd.114.061937] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Human cytochromes P450 (P450s) play a major role in the biotransformation of drugs. The generated metabolites are important for pharmaceutical, medical, and biotechnological applications and can be used for derivatization or toxicological studies. The availability of human drug metabolites is restricted and alternative ways of production are requested. For this, microbial P450s turned out to be a useful tool for the conversion of drugs and related derivatives. Here, we used 10 P450s from the myxobacterium Sorangium cellulosum So ce56, which have been cloned, expressed, and purified. The P450s were investigated concerning the conversion of the antidepressant drugs amitriptyline, clomipramine, imipramine, and promethazine; the antipsychotic drugs carbamazepine, chlorpromazine, and thioridazine, as well as their precursors, iminodibenzyl and phenothiazine. Amitriptyline, chlorpromazine, clomipramine, imipramine, and thioridazine are efficiently converted during the in vitro reaction and were chosen to upscale the production by an Escherichia coli-based whole-cell bioconversion system. Two different approaches, a whole-cell system using M9CA medium and a system using resting cells in buffer, were used for the production of sufficient amounts of metabolites for NMR analysis. Amitriptyline, clomipramine, and imipramine are converted to the corresponding 10-hydroxylated products, whereas the conversion of chlorpromazine and thioridazine leads to a sulfoxidation in position 5. It is shown for the first time that myxobacterial P450s are efficient to produce known human drug metabolites in a milligram scale, revealing their ability to synthesize pharmaceutically important compounds.
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Affiliation(s)
- Martin Litzenburger
- Institut für Biochemie, Universität des Saarlandes, Saarbruecken, Germany (M.L., F.K., Y.K., R.B.)
| | - Fredy Kern
- Institut für Biochemie, Universität des Saarlandes, Saarbruecken, Germany (M.L., F.K., Y.K., R.B.)
| | - Yogan Khatri
- Institut für Biochemie, Universität des Saarlandes, Saarbruecken, Germany (M.L., F.K., Y.K., R.B.)
| | - Rita Bernhardt
- Institut für Biochemie, Universität des Saarlandes, Saarbruecken, Germany (M.L., F.K., Y.K., R.B.)
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92
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Veselinović T, Paulzen M, Gründer G. Cariprazine, a new, orally active dopamine D2/3 receptor partial agonist for the treatment of schizophrenia, bipolar mania and depression. Expert Rev Neurother 2014; 13:1141-59. [PMID: 24175719 DOI: 10.1586/14737175.2013.853448] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cariprazine is a novel drug with partial agonist activity at dopamine D2/3 receptors and six- to eightfold higher affinity for human dopamine D3 over D2 receptors. Results from several placebo-controlled Phase II/III trials in patients with a The Diagnostic and Statistical Manual of Mental Disorders IV diagnosis of schizophrenia or bipolar I disorder suggest that cariprazine is superior to placebo with respect to antipsychotic and antimanic activity. Reports concerning safety and tolerability of cariprazine are mainly favorable, although the rates of treatment-associated adverse events, which most commonly included akathisia and extrapyramidal symptom, are rather high. However, only minor alterations of clinical laboratory values, prolactin concentrations and ECG parameters are reported in cariprazine-treated patients. A new drug application to the U.S. F DA for cariprazine for the treatment of both schizophrenia and manic or mixed episodes associated with bipolar I disorder was submitted in November 2012. A more precise assessment of the clinical properties of this new drug will require additional studies, aimed to compare and contrast cariprazine with other antipsychotic agents.
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Affiliation(s)
- Tanja Veselinović
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany and
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93
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Li HJ, Zhang YJ, Zhou L, Han F, Wang MY, Xue MQ, Qi Z. Chlorpromazine confers neuroprotection against brain ischemia by activating BKCa channel. Eur J Pharmacol 2014; 735:38-43. [PMID: 24755143 DOI: 10.1016/j.ejphar.2014.04.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 01/13/2023]
Abstract
Chlorpromazine (CPZ) is a well-known antipsychotic drug, still widely being used to treat symptoms of schizophrenia, psychotic depression and organic psychoses. We have previously reported that CPZ activates the BKCa (KCa1.1) channel at whole cell level. In the present study, we demonstrated that CPZ increased the single channel open probability of the BKCa channels without changing its single channel amplitude. As BKCa channel is one of the molecular targets of brain ischemia, we explored a possible new use of this old drug on ischemic brain injury. In middle cerebral artery occlusion (MCAO) focal cerebral ischemia, a single intraperitoneal injection of CPZ at several dosages (5mg/kg, 10mg/kg and 20mg/kg) could exert a significant neuroprotective effect on the brain damage in a dose- and time-dependent manner. Furthermore, blockade of BKCa channels abolished the neuroprotective effect of CPZ on MCAO, suggesting that the effect of CPZ is mediated by activation of the BKCa channel. These results demonstrate that CPZ could reduce focal cerebral ischemic damage through activating BKCa channels and merits exploration as a potential therapeutic agent for treating ischemic stroke.
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Affiliation(s)
- Hua-Juan Li
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen 361102, China
| | - Yu-Jiao Zhang
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen 361102, China
| | - Li Zhou
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen 361102, China
| | - Feng Han
- College of Pharmaceutical Sciences, Zhejiang University, 388 Yuhangtang Road, Hangzhou 310058, China
| | - Ming-Yan Wang
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen 361102, China
| | - Mao-Qiang Xue
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen 361102, China.
| | - Zhi Qi
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen 361102, China.
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Zong D, Zielinska-Chomej K, Juntti T, Mörk B, Lewensohn R, Hååg P, Viktorsson K. Harnessing the lysosome-dependent antitumor activity of phenothiazines in human small cell lung cancer. Cell Death Dis 2014; 5:e1111. [PMID: 24625970 PMCID: PMC3973193 DOI: 10.1038/cddis.2014.56] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/23/2013] [Accepted: 01/14/2014] [Indexed: 12/02/2022]
Abstract
Phenothiazines are a family of heterocyclic compounds whose clinical utility includes treatment of psychiatric disorders as well as chemotherapy-induced emesis. Various studies have demonstrated that these compounds possess cytotoxic activities in tumor cell lines of different origin. However, there is considerable confusion regarding the molecular basis of phenothiazine-induced cell death. Lung cancer (LC) remains one of the most prevalent and deadly malignancies worldwide despite considerable efforts in the development of treatment strategies, especially new targeted therapies. In this work, we evaluated the potential utility of phenothiazines in human LC. We show that phenothiazines as single treatment decreased cell viability and induced cell death preferentially in small cell lung carcinoma (SCLC) over non small cell lung carcinoma (NSCLC) cell lines. Sensitivity to phenothiazines was not correlated with induction of apoptosis but due to phenothiazine-induced lysosomal dysfunction. Interestingly, the higher susceptibility of SCLC cells to phenothiazine-induced cell death correlated with an intrinsically lower buffer capacity in response to disruption of lysosomal homeostasis. Importantly, this effect in SCLC occurred despite mutation in p53 and was not influenced by intrinsic sensitivity/resistance toward conventional chemotherapeutic agents. Our data thus uncovered a novel context-dependent activity of phenothiazines in SCLC and suggest that phenothiazines could be considered as a treatment regimen of this disease, however, extended cell line analyses as well as in vivo studies are needed to make such conclusion.
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Affiliation(s)
- D Zong
- Department of Oncology-Pathology, Karolinska Biomics Center, Karolinska Institutet, Stockholm, Sweden
| | - K Zielinska-Chomej
- Department of Oncology-Pathology, Karolinska Biomics Center, Karolinska Institutet, Stockholm, Sweden
| | - T Juntti
- Department of Oncology-Pathology, Karolinska Biomics Center, Karolinska Institutet, Stockholm, Sweden
| | - B Mörk
- Department of Oncology-Pathology, Karolinska Biomics Center, Karolinska Institutet, Stockholm, Sweden
| | - R Lewensohn
- Department of Oncology-Pathology, Karolinska Biomics Center, Karolinska Institutet, Stockholm, Sweden
| | - P Hååg
- Department of Oncology-Pathology, Karolinska Biomics Center, Karolinska Institutet, Stockholm, Sweden
| | - K Viktorsson
- Department of Oncology-Pathology, Karolinska Biomics Center, Karolinska Institutet, Stockholm, Sweden
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95
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Kroken RA, Løberg EM, Drønen T, Grüner R, Hugdahl K, Kompus K, Skrede S, Johnsen E. A critical review of pro-cognitive drug targets in psychosis: convergence on myelination and inflammation. Front Psychiatry 2014; 5:11. [PMID: 24550848 PMCID: PMC3912739 DOI: 10.3389/fpsyt.2014.00011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/20/2014] [Indexed: 12/19/2022] Open
Abstract
Antipsychotic drugs have thus far focused on dopaminergic antagonism at the D2 receptors, as counteracting the hyperdopaminergia in nigrostriatal and mesolimbic projections has been considered mandatory for the antipsychotic action of the drugs. Current drugs effectively target the positive symptoms of psychosis such as hallucinations and delusions in the majority of patients, whereas effect sizes are smaller for negative symptoms and cognitive dysfunctions. With the understanding that neurocognitive dysfunction associated with schizophrenia have a greater impact on functional outcome than the positive symptoms, the focus in pharmacotherapy for schizophrenia has shifted to the potential effect of future drugs on cognitive enhancement. A major obstacle is, however, that the biological underpinnings of cognitive dysfunction remain largely unknown. With the availability of increasingly sophisticated techniques in molecular biology and brain imaging, this situation is about to change with major advances being made in identifying the neuronal substrates underlying schizophrenia, and putative pro-cognitive drug targets may be revealed. In relation to cognitive effects, this review focuses on evidence from basic neuroscience and clinical studies, taking two separate perspectives. One perspective is the identification of previously under-recognized treatment targets for existing antipsychotic drugs, including myelination and mediators of inflammation. A second perspective is the development of new drugs or novel treatment targets for well-known drugs, which act on recently discovered treatment targets for cognitive enhancement, and which may complement the existing drugs. This might pave the way for personalized treatment regimens for patients with schizophrenia aimed at improved functional outcome. The review also aims at identifying major current constraints for pro-cognitive drug development for patients with schizophrenia.
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Affiliation(s)
- Rune A. Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Tore Drønen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Renate Grüner
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - Kenneth Hugdahl
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- NORMENT Center of Excellence, University of Bergen, Bergen, Norway
| | - Kristiina Kompus
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Silje Skrede
- NORMENT Center of Excellence, University of Bergen, Bergen, Norway
- Dr. Einar Martens’ Research Group for Biological Psychiatry, Centre for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, K.G. Jebsen Centre for Psychosis Research, University of Bergen, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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López-Muñoz F, Sim K, Shen WW, Huelves L, Moreno R, Molina JDD, Rubio G, Noriega C, Pérez-Nieto MÁ, Alamo C. A bibliometric study of scientific research conducted on second-generation antipsychotic drugs in Singapore. Singapore Med J 2014; 55:24-33. [PMID: 24452974 PMCID: PMC4291907 DOI: 10.11622/smedj.2014006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A bibliometric study was carried out to ascertain the volume and impact of scientific literature published on second-generation antipsychotic drugs (SGAs) in Singapore from 1997 to 2011. METHODS A search of the EMBASE and MEDLINE databases was performed to identify articles originating from Singapore that included the descriptors 'atypic* antipsychotic*', 'second-generation antipsychotic*', 'clozapine', 'risperidone', 'olanzapine', 'ziprasidone', 'quetiapine', 'sertindole', 'aripiprazole', 'paliperidone', 'amisulpride', 'zotepine', 'asenapine', 'iloperidone', 'lurasidone', 'perospirone' and 'blonanserin' in the article titles. Certain bibliometric indicators of production and dispersion (e.g. Price's Law on the increase of scientific literature, and Bradford's Law) were applied, and the participation index of various countries was calculated. The bibliometric data was also correlated with some social and health data from Singapore, such as the total per capita expenditure on health and gross domestic expenditure on research and development. RESULTS From 1997 to 2011, a total of 51 articles on SGAs in Singapore were published. Our results suggested non-fulfilment of Price's Law (r = 0.0648 after exponential adjustment vs. r = 0.2140 after linear adjustment). The most widely studied drugs were clozapine (21 articles), risperidone (16 articles) and olanzapine (8 articles). Division into Bradford zones yielded a nucleus occupied by the Journal of Clinical Psychopharmacology (6 articles) and the Singapore Medical Journal(4 articles). The analysed material was published in a total of 30 journals, with the majority from six journals. Four of these six journals have an impact factor greater than 2. CONCLUSION Publications on SGAs in Singapore are still too few to confirm an exponential growth of scientific literature.
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Affiliation(s)
- Francisco López-Muñoz
- Faculty of Health Sciences, Camilo José Cela University, C/ Castillo de Alarcón, 49, Urb Villafranca del Castillo, Villanueva de la Cañada, 28692 Madrid, Spain.
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97
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Linxweiler M, Schorr S, Schäuble N, Jung M, Linxweiler J, Langer F, Schäfers HJ, Cavalié A, Zimmermann R, Greiner M. Targeting cell migration and the endoplasmic reticulum stress response with calmodulin antagonists: a clinically tested small molecule phenocopy of SEC62 gene silencing in human tumor cells. BMC Cancer 2013; 13:574. [PMID: 24304694 PMCID: PMC3878975 DOI: 10.1186/1471-2407-13-574] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 11/27/2013] [Indexed: 11/16/2022] Open
Abstract
Background Tumor cells benefit from their ability to avoid apoptosis and invade other tissues. The endoplasmic reticulum (ER) membrane protein Sec62 is a key player in these processes. Sec62 is essential for cell migration and protects tumor cells against thapsigargin-induced ER stress, which are both linked to cytosolic Ca2+. SEC62 silencing leads to elevated cytosolic Ca2+ and increased ER Ca2+ leakage after thapsigargin treatment. Sec62 protein levels are significantly increased in different tumors, including prostate, lung and thyroid cancer. Methods In lung cancer, the influence of Sec62 protein levels on patient survival was analyzed using the Kaplan-Meier method and log-rank test. To elucidate the underlying pathophysiological functions of Sec62, Ca2+ imaging techniques, real-time cell analysis and cell migration assays were performed. The effects of treatment with the calmodulin antagonists, trifluoperazine (TFP) and ophiobolin A, on cellular Ca2+ homeostasis, cell growth and cell migration were compared with the effects of siRNA-mediated Sec62 depletion or the expression of a mutated SEC62 variant in vitro. Using Biacore analysis we examined the Ca2+-sensitive interaction of Sec62 with the Sec61 complex. Results Sec62 overproduction significantly correlated with reduced patient survival. Therefore, Sec62 is not only a predictive marker for this type of tumor, but also an interesting therapeutic target. The present study suggests a regulatory function for Sec62 in the major Ca2+ leakage channel in the ER, Sec61, by a direct and Ca2+-sensitive interaction. A Ca2+-binding motif in Sec62 is essential for its molecular function. Treatment of cells with calmodulin antagonists mimicked Sec62 depletion by inhibiting cell migration and rendering the cells sensitive to thapsigargin treatment. Conclusions Targeting tumors that overproduce Sec62 with calmodulin antagonists in combination with targeted thapsigargin analogues may offer novel personalized therapeutic options.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Markus Greiner
- Department of Medical Biochemistry and Molecular Biology, Saarland University, Homburg, Saarland, Germany.
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98
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Keller DM, Myhre KE, Dowben JS, Keltner NL. Biological perspectives: akathisia: ants in your pants. Perspect Psychiatr Care 2013; 49:149-51. [PMID: 23819664 DOI: 10.1111/ppc.12032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- David M Keller
- Behavioral Medicine, Brooke Army Medical Center, San Antonio, Texas, USA
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99
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Antipsychotics can modulate the cytokine profile in schizophrenia: attenuation of the type-2 inflammatory response. Schizophr Res 2013; 147:103-109. [PMID: 23602340 DOI: 10.1016/j.schres.2013.03.027] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 03/13/2013] [Accepted: 03/21/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We recently reported that the type-2 cytokine response is increased in schizophrenia. The aim of this study was to analyse the effects of antipsychotic drugs on the serum levels of type-1 (TNF-α, IFN-γ), type-2 (IL-4, IL-10), type-17 (IL-17) and regulatory cytokines (TGF-β, IL-27 and IL-6). METHODS Cytokine measurements in the patients were performed on day 0 and day 30 of the treatment using standard ELISA assays. Three groups of subjects were studied: patients that were unmedicated with First Episode Psychosis (FEP; n=88), patients that were treated with antipsychotics with Schizophrenia in relapse (SC in relapse; n=45) and healthy controls (n=36). RESULTS TGF-β levels were increased in both patient groups and were further enhanced after treatment in the FEP group (p=0.014) but not in the SC relapse group. Antipsychotic treatment was correlated with lower levels of IL-4, IL-6 and IL-27 (p<0.005) in the FEP group. Finally, the serum levels of IL-17 were not significantly altered between the two measurements but were significantly lower in the FEP group (p<0.001) when compared with healthy controls. After therapy, patients with SC who were in relapse had decreased serum levels of IL-4 (p=0.006) and IL-6 (p=0.007). We also observed a weak negative correlation between the IFN-γ/TGF-β ratio and the total PANSS score and between the IL-17/TGF-β ratio and the negative and general psychopathology subscales. CONCLUSION The increased type-2 cytokine serum levels in schizophrenia appear to be downregulated by antipsychotic treatment.
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100
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Johnsen E, Hugdahl K, Fusar-Poli P, Kroken RA, Kompus K. Neuropsychopharmacology of auditory hallucinations: insights from pharmacological functional MRI and perspectives for future research. Expert Rev Neurother 2013; 13:23-36. [PMID: 23253389 DOI: 10.1586/ern.12.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Experiencing auditory verbal hallucinations is a prominent symptom in schizophrenia that also occurs in subjects at enhanced risk for psychosis and in the general population. Drug treatment of auditory hallucinations is challenging, because the current understanding is limited with respect to the neural mechanisms involved, as well as how CNS drugs, such as antipsychotics, influence the subjective experience and neurophysiology of hallucinations. In this article, the authors review studies of the effect of antipsychotic medication on brain activation as measured with functional MRI in patients with auditory verbal hallucinations. First, the authors examine the neural correlates of ongoing auditory hallucinations. Then, the authors critically discuss studies addressing the antipsychotic effect on the neural correlates of complex cognitive tasks. Current evidence suggests that blood oxygen level-dependant effects of antipsychotic drugs reflect specific, regional effects but studies on the neuropharmacology of auditory hallucinations are scarce. Future directions for pharmacological neuroimaging of auditory hallucinations are discussed.
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Affiliation(s)
- Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
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