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McDonagh MS, Dana T, Selph S, Devine EB, Cantor A, Bougatsos C, Blazina I, Grusing S, Fu R, Haupt DW. Updating the Comparative Evidence on Second‐Generation Antipsychotic Use With Schizophrenia. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2020; 2:76-87. [PMID: 36101867 PMCID: PMC9175869 DOI: 10.1176/appi.prcp.20200004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/14/2020] [Accepted: 03/27/2020] [Indexed: 12/02/2022] Open
Abstract
Objective The objective of this study was to conduct a systematic review of literature comparing second‐generation antipsychotics (SGAs) with each other and with first‐generation antipsychotics (FGAs) in treating schizophrenia. Methods MEDLINE, the Cochrane Library, and PsycINFO databases were searched through January 2020. Following standard methods, recent high‐quality systematic reviews of each drug comparison and subsequently published primary studies were included to update the meta‐analyses with any new data. Two reviewers independently conducted study selection, abstraction, and quality assessment. Results Two systematic reviews and 29 newer trials (total of 162 trials of SGAs, N=53,861; 116 trials of SGAs versus FGAs, N=119,558) were included. Most trials were of fair quality, industry‐funded, and included older SGAs and a few recently approved SGAs (asenapine, lurasidone, iloperidone, cariprazine, brexpiprazole and long‐acting injection [LAI] formulations of aripiprazole and paliperidone). Older SGAs had similar effects on function, quality of life, mortality, and adverse event incidence, although clozapine improved symptoms more than most other drugs and olanzapine and risperidone were superior to some other drugs. Olanzapine, risperidone, ziprasidone, and aripiprazole performed similarly on outcomes of benefit compared with haloperidol. Risperidone LAI and olanzapine resulted in fewer withdrawals due to adverse events, but risk of diabetes increased with olanzapine. Haloperidol had greater incidence of adverse events than did olanzapine and risperidone, but similar effects on other outcomes. Conclusions Most comparative evidence favored older SGAs, with clozapine, olanzapine, and risperidone superior on more outcomes than other SGAs. Older SGAs had similar benefits as haloperidol but with fewer adverse events. Use of the second‐generation antipsychotics olanzapine, aripiprazole, risperidone, quetiapine, and ziprasidone resulted in similar function, quality of life, mortality, and overall incidence of adverse events. Core illness symptoms improved more with olanzapine and risperidone than asenapine, quetiapine, or ziprasidone, and more with paliperidone than lurasidone or iloperidone. Haloperidol showed similar benefits but more adverse events than did olanzapine or risperidone.
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Affiliation(s)
- Marian S. McDonagh
- Pacific Northwest Evidence‐Based Practice Center Portland Oregon
- Department of Medical Informatics and Clinical Epidemiology
| | - Tracy Dana
- Pacific Northwest Evidence‐Based Practice Center Portland Oregon
- Department of Medical Informatics and Clinical Epidemiology
| | - Shelley Selph
- Pacific Northwest Evidence‐Based Practice Center Portland Oregon
- Department of Medical Informatics and Clinical Epidemiology
| | - Emily B. Devine
- Oregon Health and Science University Portland
- Department of Pharmacy and Comparative Health Outcomes Police and Economics Institute University of Washington Seattle
| | - Amy Cantor
- Pacific Northwest Evidence‐Based Practice Center Portland Oregon
- Department of Medical Informatics and Clinical Epidemiology
- Department of Family Medicine
| | - Christina Bougatsos
- Pacific Northwest Evidence‐Based Practice Center Portland Oregon
- Department of Medical Informatics and Clinical Epidemiology
| | - Ian Blazina
- Pacific Northwest Evidence‐Based Practice Center Portland Oregon
- Department of Medical Informatics and Clinical Epidemiology
| | - Sara Grusing
- Pacific Northwest Evidence‐Based Practice Center Portland Oregon
- Department of Medical Informatics and Clinical Epidemiology
| | - Rongwei Fu
- Pacific Northwest Evidence‐Based Practice Center Portland Oregon
- School of Public Health
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Claassen JN, Park JS. Examining the dispensing patterns of antipsychotics in Australia from 2006 to 2018 - A pharmacoepidemiology study. Res Social Adm Pharm 2020; 17:1159-1165. [PMID: 32928657 DOI: 10.1016/j.sapharm.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/11/2020] [Accepted: 09/01/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Antipsychotic medications can be prescribed in Australia by medical and nurse practitioners under the Pharmaceutical Benefits Scheme (PBS). The current pharmacoepidemiology study aims to determine the dispensing rates of antipsychotic medicines in Australia, and to produce and examine a time-trend of the dispensing patterns of these medicines. METHODS Dispensing counts of antipsychotic medication from 2006 to 2018 were accessed from the PBS dataset. All of the antipsychotic medicines dispensed were included for time trend analysis. Cumulative dispensing counts and defined daily dose (DDD) per 1000 concessional population days (DPD) were analysed for the purpose of time trend analysis. RESULTS Sixteen antipsychotic medications were assessed and had a total cumulative dispensing count of 33, 732, 404. Olanzapine had the highest cumulative prescription count and Quetiapine experienced the highest average dispensing count and rate as determined by DPD. Twelve out of the sixteen medications were second-generation antipsychotics (SGAs). Overall, eleven out of the sixteen medications (aripiprazole, asenapine, brexpiprazole, clozapine, flupentixol, lurasidone, olanzapine, paliperidone, quetiapine, ziprasidone, zuclopenthixol) had an increase in both dispensing count and rate, as expressed per DPD. CONCLUSIONS The current study highlights the increasing prescription rates of SGAs and the stagnation of FGA prescription among Australian health practitioners. This is observed through particularly large increase in the dispensing rates of Olanzapine and Quetiapine. Further interdisciplinary investigation is required to ensure that these medications are being prescribed under the appropriate medical rationale, particularly to groups that are vulnerable to the adverse effects of the medications.
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Affiliation(s)
- Johann Niklas Claassen
- International Research Collaborative - Oral Health and Equity, School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia; School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
| | - Joon Soo Park
- International Research Collaborative - Oral Health and Equity, School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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53
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Alves MR, Bergamaschi CDC, Sorrilha FB, Fulone I, Barberato-Filho S, Mayer RCF, Melo DOD, Lopes L. Critical appraisal and comparison of recommendations of clinical practice guidelines for treatment of schizophrenia in children and adolescents: a methodological survey protocol. BMJ Open 2020; 10:e038646. [PMID: 32938601 PMCID: PMC7497528 DOI: 10.1136/bmjopen-2020-038646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The number of clinical practice guidelines (CPGs) have increased substantially mainly in the paediatric area of mental health. However, little is known about the quality or how recommendations for the treatment of disorders such as schizophrenia in children and adolescents have changed over time. The aim of this study will be to assess the quality of the development of CPGs for the treatment and management of schizophrenia in children and adolescents over time using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to compare the recommendations and interventions described in these documents. METHODS AND ANALYSIS CPGs will be identified using a prospective protocol through a systematic search of multiple databases (Medline, Embase, Health Systems Evidence, Epistemonikos, Lilacs, etc) and guideline websites from 2004 to December 2020. The quality of the guidelines will be assessed by three reviewers, independently using the AGREE II. CPGs will be considered of high-quality if they scored ≥60% in four or more domains of the AGREE II instrument. Non-parametric tests will be used to test for the change of quality over time. We will summarise the different evidence grading systems and compare the recommendations. ETHICS AND DISSEMINATION Ethical approval is not required since it is a literature-based study. Future results of the research can be submitted for publication in scientific journals of high impact, peer reviewed and also published in national and international conferences. The results derived from this study will contribute to the improvement of health institutions and policies, informing about existing recommendation guidelines and about deficiencies and qualities found in those. This study may also identify key areas for future research. This study may guide the search and choice for high quality CPGs by health policy makers and health professionals and subsidise future adaptations. PROTOCOL REGISTRATION NUMBER CRD42020164899.
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Affiliation(s)
- Maíra Ramos Alves
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Flávia Blaseck Sorrilha
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | - Izabela Fulone
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | - Silvio Barberato-Filho
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Daniela Oliveira de Melo
- Graduate Course of Pharmaceutical Sciences, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Luciane Lopes
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
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Oltra JAE. Improving Therapeutic Interventions of Schizophrenia with Advances in Stem Cell Technology. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:352-361. [PMID: 32702214 PMCID: PMC7383010 DOI: 10.9758/cpn.2020.18.3.352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 12/19/2022]
Abstract
Although historic documents posit schizophrenia to the beginnings of mankind, its diagnosis remains poorly defined, currently relying on unspecific clinical symptoms; and controversies still maintain its origin under intense debate. This review aimed at quantitatively assessing the preferential forefronts of clinical trials towards the treatment of schizophrenia from inception till present, according to clinicaltrials.gov database registry. Towards that end study status and study phase classifications were used as criteria for progress in the field. Study groups by sex and age together with countries and organisms involved in the studies were used as indicators of the populations studied and as evidence of main promoter institutions, in both, pharmacological and drug-free protocols. The findings clearly show a decline of active clinical research with small synthetic compounds and limited numbers of novel initiatives, mostly based on drug-free alternatives with expected reduced secondary effects. A paucity of sex- and age-oriented designs is detected, and it is proposed that future clinical trials should set their basis on data obtained from patient-derived induced pluripotent stem cells, brain organoid systems and human brain circuitry platforms. Only individual precision medical approaches may turn effective for the treatment of this complex and highly incapacitating disease.
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Affiliation(s)
- José Andrés Espejo Oltra
- School of Experimental Sciences, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain
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55
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Chang J, Kim JA, Kim K, Choi S, Kim SM, Nam YY, Park S, Goo AJ, Park SM. Association of antipsychotics adherence and cardiovascular disease among newly diagnosed schizophrenia patients: A national cohort among Koreans. Asian J Psychiatr 2020; 52:102161. [PMID: 32454424 DOI: 10.1016/j.ajp.2020.102161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/17/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The effect of antipsychotics adherence on the risk of cardiovascular disease (CVD) among schizophrenia patients has not been studied. While antipsychotic adherence is favorable for all-cause mortality, its association with CVD incidence is unclear due to the potential risk of CVD caused by antipsychotics. METHODS Using the Korean National Health Insurance Service Database, we constructed a case-cohort of 80,581 newly-diagnosed schizophrenia patients between 2004 and 2013 from a cohort of all Koreans 20-40 years old. Patients were divided into quartiles by adherence determined by their two-year medication possession ratio. Patients were followed from two years following the diagnosis of schizophrenia until Dec. 31st, 2017 for the primary outcome of incident CVD and secondary outcomes of stroke, myocardial infarction, and all-cause mortality. Cox proportional hazards analysis was performed adjusting for conventional risk factors. OUTCOMES Newly diagnosed schizophrenia patients were followed for a median of 7.0 years resulting in 1396 incident CVD cases over 5.73 × 105 person-years. When adjusted for potential confounders, the best adherence quartile group had significantly lower risk of CVD (HR, 95%CI; 0.78, 0.66-0.92; p-trend, 0.003), stroke (HR, 95%CI; 0.79, 0.66-0.94; p-trend, 0.015), and all-cause mortality (HR, 95%CI; 0.86, 0.78-0.95; p-trend, 0.003) compared to the worst adherent quartile group. Subgroup analysis by antipsychotics generation, concurrent medication, and comorbidities did not significantly alter results. INTERPRETATION Among newly diagnosed schizophrenia patients, better adherence to antipsychotics lowered the risk CVD incidence despite previously suggested antipsychotic-associated CVD risk. Thus, efforts to improve antipsychotics adherence may improve CVD outcomes in schizophrenia patients.
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Affiliation(s)
- Jooyoung Chang
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Jihoon Andrew Kim
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Yoon-Young Nam
- Department of Psychiatry, National Center for Mental Health, Seoul, South Korea
| | - Subin Park
- Department of Research Planning, National Center for Mental Health, Seoul, South Korea
| | - Ae Jin Goo
- Department of Family Medicine, National Center for Mental Health, Seoul, South Korea.
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea; Department of Family Medicine, Seoul National University Hospital, 127, Yongmasan-ro, Gwangjin-gu, Seoul, South Korea.
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56
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Suresh A, Narayan R, Nayak UY. Recent advances in the development of asenapine formulations. Expert Opin Drug Deliv 2020; 17:1377-1393. [PMID: 32633149 DOI: 10.1080/17425247.2020.1792439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Asenapine maleate (AM) is an atypical antipsychotic agent, that has been widely prescribed for the management of schizoaffective disorders. However, the bioavailability of AM is extremely poor due to the extensive first-pass metabolism. With the advancement in pharmaceutical technologies, significant strides have been made to create novel formulations to address the bioavailability problem of AM. AREAS COVERED This review article provides an insight into all the formulation approaches undertaken by researchers to increase the bioavailability of AM encompassing the works utilizing ultrasound mediated transdermal delivery, nose to brain delivery, intestinal lymphatic system targeting, in situ implants, etc. All the patents associated with AM formulation have also been discussed and summarized. EXPERT OPINION Numerous studies have been carried out on AM formulations over the recent years, many of these studies have shown significant improvement in bioavailability. We have also mentioned the unexplored domains which can be exploited for further enhancing the bioavailability of AM. Nonetheless, most of these studies are still limited to the research laboratory level and face multiple hurdles before making into the market. Attaining controllability and reproducibility for the production of novel formulations is needed to enable its transition from bench to bedside.
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Affiliation(s)
- Akhil Suresh
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education , Manipal, India
| | - Reema Narayan
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education , Manipal, India
| | - Usha Y Nayak
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education , Manipal, India
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Morrison AP, Pyle M, Gumley A, Schwannauer M, Turkington D, MacLennan G, Norrie J, Hudson J, Bowe S, French P, Hutton P, Byrne R, Syrett S, Dudley R, McLeod HJ, Griffiths H, Barnes TR, Davies L, Shields G, Buck D, Tully S, Kingdon D. Cognitive-behavioural therapy for clozapine-resistant schizophrenia: the FOCUS RCT. Health Technol Assess 2020; 23:1-144. [PMID: 30806619 DOI: 10.3310/hta23070] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of cognitive-behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome. DESIGN The Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial was a parallel-group, randomised, outcome-blinded evaluation trial. Randomisation was undertaken using permuted blocks of random size via a web-based platform. Data were analysed on an intention-to-treat (ITT) basis, using random-effects regression adjusted for site, age, sex and baseline symptoms. Cost-effectiveness analyses were carried out to determine whether or not CBT was associated with a greater number of quality-adjusted life-years (QALYs) and higher costs than treatment as usual (TAU). SETTING Secondary care mental health services in five cities in the UK. PARTICIPANTS People with CRS aged ≥ 16 years, with an International Classification of Diseases, Tenth Revision (ICD-10) schizophrenia spectrum diagnoses and who are experiencing psychotic symptoms. INTERVENTIONS Individual CBT included up to 30 hours of therapy delivered over 9 months. The comparator was TAU, which included care co-ordination from secondary care mental health services. MAIN OUTCOME MEASURES The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months and the primary secondary outcome was PANSS total score at the end of treatment (9 months post randomisation). The health benefit measure for the economic evaluation was the QALY, estimated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), health status measure. Service use was measured to estimate costs. RESULTS Participants were allocated to CBT (n = 242) or TAU (n = 245). There was no significant difference between groups on the prespecified primary outcome [PANSS total score at 21 months was 0.89 points lower in the CBT arm than in the TAU arm, 95% confidence interval (CI) -3.32 to 1.55 points; p = 0.475], although PANSS total score at the end of treatment (9 months) was significantly lower in the CBT arm (-2.40 points, 95% CI -4.79 to -0.02 points; p = 0.049). CBT was associated with a net cost of £5378 (95% CI -£13,010 to £23,766) and a net QALY gain of 0.052 (95% CI 0.003 to 0.103 QALYs) compared with TAU. The cost-effectiveness acceptability analysis indicated a low likelihood that CBT was cost-effective, in the primary and sensitivity analyses (probability < 50%). In the CBT arm, 107 participants reported at least one adverse event (AE), whereas 104 participants in the TAU arm reported at least one AE (odds ratio 1.09, 95% CI 0.81 to 1.46; p = 0.58). CONCLUSIONS Cognitive-behavioural therapy for CRS was not superior to TAU on the primary outcome of total PANSS symptoms at 21 months, but was superior on total PANSS symptoms at 9 months (end of treatment). CBT was not found to be cost-effective in comparison with TAU. There was no suggestion that the addition of CBT to TAU caused adverse effects. Future work could investigate whether or not specific therapeutic techniques of CBT have value for some CRS individuals, how to identify those who may benefit and how to ensure that effects on symptoms can be sustained. TRIAL REGISTRATION Current Controlled Trials ISRCTN99672552. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Douglas Turkington
- Academic Psychiatry, Northumberland, Tyne and Wear NHS Foundation Trust, Centre for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Clinical Trials Unit, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Suzy Syrett
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Hamish J McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Griffiths
- Department of Clinical Psychology, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | | | - Linda Davies
- Division of Population Health, University of Manchester, Manchester, UK
| | - Gemma Shields
- Division of Population Health, University of Manchester, Manchester, UK
| | - Deborah Buck
- Division of Population Health, University of Manchester, Manchester, UK
| | - Sarah Tully
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - David Kingdon
- Department of Psychiatry, University of Southampton, Academic Centre, Southampton, UK
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Mas S, Gassó P, Rodríguez N, Cabrera B, Mezquida G, Lobo A, González-Pinto A, Parellada M, Corripio I, Vieta E, Castro-Fornieles J, Bobes J, Usall J, Saiz-Ruiz J, Contreras F, Parellada E, Bernardo M, Bioque M, Diaz‐Caneja CM, González‐Peñas J, Solis AA, Rebella M, González‐Ortega I, Besga A, SanJuan J, Nacher J, Morro L, Montserrat C, Jimenez E, Costa SGD, Baeza I, de la Serna E, Rivas S, Diaz C, Saiz PA, Garcia‐Álvarez L, Fraile MG, Rabadán AZ, Torio I, Rodríguez‐Jimenez R, Butjosa A, Pardo M, Sarró S, Pomarol‐Clotet E, Cuadrado AI, Cuesta MJ. Personalized medicine begins with the phenotype: identifying antipsychotic response phenotypes in a first-episode psychosis cohort. Acta Psychiatr Scand 2020; 141:541-552. [PMID: 31746462 DOI: 10.1111/acps.13131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/16/2019] [Accepted: 11/17/2019] [Indexed: 12/29/2022]
Abstract
AIMS Here, we present a clustering strategy to identify phenotypes of antipsychotic (AP) response by using longitudinal data from patients presenting first-episode psychosis (FEP). METHOD One hundred and ninety FEP with complete data were selected from the PEPs project. The efficacy was assessed using total PANSS, and adverse effects using total UKU, during one-year follow-up. We used the Klm3D method to cluster longitudinal data. RESULTS We identified four clusters: cluster A, drug not toxic and beneficial; cluster B, drug beneficial but toxic; cluster C, drug neither toxic nor beneficial; and cluster D, drug toxic and not beneficial. These groups significantly differ in baseline demographics, clinical, and neuropsychological characteristics (PAS, total PANSS, DUP, insight, pIQ, age of onset, cocaine use and family history of mental illness). CONCLUSIONS The results presented here allow the identification of phenotypes of AP response that differ in well-known simple and classic clinical variables opening the door to clinical prediction and application of personalized medicine.
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Affiliation(s)
- S Mas
- Pharmacology Unit, Department of Clinical Foundations, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - P Gassó
- Pharmacology Unit, Department of Clinical Foundations, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - N Rodríguez
- Fundació Clinic per la Recerca Biomédica (FCRB), Barcelona, Spain
| | - B Cabrera
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain
| | - G Mezquida
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.,Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Fundació Clínic per la Recerca Biomèdica (FCRB), Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - A Lobo
- Department of Medicine and Psychiatry, University of Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - A González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, Hospital Universitario de Alava, Vitoria, Spain.,BIOARABA Health Research Institute, Vitoria, Spain.,University of the Basque Country, Vitoria, Spain
| | - M Parellada
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain
| | - I Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Servicio de Psiquiatría, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Instituto de Investigación Biomédica Sant Pau (IIB-SANT PAU), Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.,Hospital Clínic de Barcelona, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - J Castro-Fornieles
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Child and Adolescent Psychiatry and Psychology Department, 2017SGR881, Institute Clinic of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
| | - J Bobes
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Área de Psiquiatría, Hospital Universitario Central de Asturias (HUCA), Universidad de Oviedo, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - J Usall
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - J Saiz-Ruiz
- Hospital Ramon y Cajal, Universidad de Alcala, IRYCIS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - F Contreras
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.,Psychiatric Service, Bellvitge University Hospital, Hospitalet del Llobregat, Spain.,University of Barcelona, Barcelona, Spain
| | - E Parellada
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Spain
| | - M Bernardo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Spain
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59
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de Leon J, Ruan CJ, Schoretsanitis G, De las Cuevas C. A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, and Clinical Pharmacopsychology. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:200-214. [PMID: 32289791 PMCID: PMC7206357 DOI: 10.1159/000507638] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
Using Richardson and Davidson's model and the sciences of pharmacokinetics and clinical pharmacopsychology, this article reviewed the: (1) poor life expectancy associated with treatment-resistant schizophrenia (TRS), which may be improved in patients who adhere to clozapine; (2) findings that clozapine is the best treatment for TRS (according to efficacy, effectiveness and well-being); and (3) potential for clozapine to cause vulnerabilities, including potentially lethal adverse drug reactions such as agranulocytosis, pneumonia, and myocarditis. Rational use requires: (1) modification of the clozapine package insert worldwide to include lower doses for Asians and to avoid the lethality associated with pneumonia, (2) the use of clozapine levels for personalizing dosing, and (3) the use of slow and personalized titration. This may make clozapine as safe as possible and contribute to increased life expectancy and well-being. In the absence of data on COVID-19 in clozapine patients, clozapine possibly impairs immunological mechanisms and may increase pneumonia risk in infected patients. Psychiatrists should call their clozapine patients and families and explain to them that if the patient develops fever or flu-like symptoms, the psychiatrist should be called and should consider halving the clozapine dose. If the patient is hospitalized with pneumonia, the treating physician needs to assess for symptoms of clozapine intoxication since halving the dose may not be enough for all patients; consider decreasing it to one-third or even stopping it. Once the signs of inflammation and fever have disappeared, the clozapine dose can be slowly increased to the prior dosage level.
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Affiliation(s)
- Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, Kentucky, USA, .,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain, .,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain,
| | - Can-Jun Ruan
- The National Clinical Research Centre for Mental Disorders, Beijing Key Laboratory of Mental Disorders, and Laboratory of Clinical Psychopharmacology, Beijing Anding Hospital, Capital Medical University, Beijing, China,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Georgios Schoretsanitis
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
| | - Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, University of La Laguna, San Cristóbal de La Laguna, Spain
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60
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Guinart D, Moreno E, Galindo L, Cuenca-Royo A, Barrera-Conde M, Pérez EJ, Fernández-Avilés C, Correll CU, Canela EI, Casadó V, Cordomi A, Pardo L, de la Torre R, Pérez V, Robledo P. Altered Signaling in CB1R-5-HT2AR Heteromers in Olfactory Neuroepithelium Cells of Schizophrenia Patients is Modulated by Cannabis Use. Schizophr Bull 2020; 46:1547-1557. [PMID: 32249318 PMCID: PMC7846100 DOI: 10.1093/schbul/sbaa038] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Schizophrenia (SCZ) has been associated with serotonergic and endocannabinoid systems dysregulation, but difficulty in obtaining in vivo neurological tissue has limited its exploration. We investigated CB1R-5-HT2AR heteromer expression and functionality via intracellular pERK and cAMP quantification in olfactory neuroepithelium (ON) cells of SCZ patients non-cannabis users (SCZ/nc), and evaluated whether cannabis modulated these parameters in patients using cannabis (SCZ/c). Results were compared vs healthy controls non-cannabis users (HC/nc) and healthy controls cannabis users (HC/c). Further, antipsychotic effects on heteromer signaling were tested in vitro in HC/nc and HC/c. Results indicated that heteromer expression was enhanced in both SCZ groups vs HC/nc. Additionally, pooling all 4 groups together, heteromer expression correlated with worse attentional performance and more neurological soft signs (NSS), indicating that these changes may be useful markers for neurocognitive impairment. Remarkably, the previously reported signaling properties of CB1R-5-HT2AR heteromers in ON cells were absent, specifically in SCZ/nc treated with clozapine. These findings were mimicked in cells from HC/nc exposed to clozapine, suggesting a major role of this antipsychotic in altering the quaternary structure of the CB1R-5-HT2AR heteromer in SCZ/nc patients. In contrast, cells from SCZ/c showed enhanced heteromer functionality similar to HC/c. Our data highlight a molecular marker of the interaction between antipsychotic medication and cannabis use in SCZ with relevance for future studies evaluating its association with specific neuropsychiatric alterations.
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Affiliation(s)
- Daniel Guinart
- Neuropsychiatry and Addictions Institute (INAD) of Parc de Salut Mar, Barcelona, Spain,Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain,Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, New York, NY
| | - Estefanía Moreno
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona, University of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Liliana Galindo
- Neuropsychiatry and Addictions Institute (INAD) of Parc de Salut Mar, Barcelona, Spain,Department of Psychiatry, University of Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Aida Cuenca-Royo
- Integrative Pharmacology and Systems Neuroscience, IMIM-Hospital del Mar Research Institute, Barcelona, Spain
| | - Marta Barrera-Conde
- Integrative Pharmacology and Systems Neuroscience, IMIM-Hospital del Mar Research Institute, Barcelona, Spain,Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Ezequiel J Pérez
- Neuropsychiatry and Addictions Institute (INAD) of Parc de Salut Mar, Barcelona, Spain
| | | | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, New York, NY,Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Enric I Canela
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona, University of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Vicent Casadó
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona, University of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Madrid, Spain
| | - Arnau Cordomi
- Laboratori de Medicina Computacional, Unitat de Bioestadística, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Leonardo Pardo
- Laboratori de Medicina Computacional, Unitat de Bioestadística, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rafael de la Torre
- Integrative Pharmacology and Systems Neuroscience, IMIM-Hospital del Mar Research Institute, Barcelona, Spain,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Pérez
- Neuropsychiatry and Addictions Institute (INAD) of Parc de Salut Mar, Barcelona, Spain,Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental G21, Instituto de Salud Carlos III, Madrid, Spain
| | - Patricia Robledo
- Integrative Pharmacology and Systems Neuroscience, IMIM-Hospital del Mar Research Institute, Barcelona, Spain,Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain,To whom correspondence should be addressed; IMIM-Hospital del Mar Research Institute, PRBB, Calle Dr. Aiguader 88, Barcelona 08003, Spain; telephone: +34 93 316 0455; e-mail:
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61
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Rotella F, Cassioli E, Calderani E, Lazzeretti L, Ragghianti B, Ricca V, Mannucci E. Long-term metabolic and cardiovascular effects of antipsychotic drugs. A meta-analysis of randomized controlled trials. Eur Neuropsychopharmacol 2020; 32:56-65. [PMID: 31917068 DOI: 10.1016/j.euroneuro.2019.12.118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 12/11/2022]
Abstract
Most of the randomized controlled trials (RCTs) on antipsychotics (APs) have efficacy as their primary endpoint, leading to a lack of evidence on long-term metabolic effects of APs. The aim of the present meta-analysis is to compare different APs for the long-term modification of risk of major adverse cardiovascular events (MACE) and related mortality, in patients with schizophrenia and bipolar disorder. All RCTs found on Medline/Embase of at least 52 weeks up to 19 December 2017, enrolling patients with bipolar disorder or schizophrenia and comparing an AP with another AP or placebo were included. The primary outcome of this analysis was the association of APs with the incidence of cardiovascular death, myocardial infarction (MI), and stroke. 3013 studies were screened, 92 met the selection criteria. MI, stroke and cardiovascular death were reported in 11, 6 and 24 studies, respectively. No significant difference was observed with respect to MI and Stroke; a significantly higher cardiovascular mortality was observed for sertindole when compared to risperidone (Mantel-Haenszel Odds Ratio: 2.56, 95% CI: 1.33 - 5). Long-term cardiovascular effects of APs deserve to be studied more extensively. The request by regulatory authorities of cardiovascular safety data from specifically designed trials would be useful.
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Affiliation(s)
| | - Emanuele Cassioli
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Enrico Calderani
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lisa Lazzeretti
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Valdo Ricca
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
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62
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Miglietta E, Lasalvia A, Bonetto C, Comacchio C, Cristofalo D, Tosato S, De Santi K, Petterlini S, Zanatta G, Cremonese C, Ramon L, Ruggeri M. Pathways to care, DUP, and types of interventions over 5 years following psychosis onset: findings from a naturalistic study conducted in routine generalist mental health services. Soc Psychiatry Psychiatr Epidemiol 2020; 55:175-186. [PMID: 31511926 DOI: 10.1007/s00127-019-01775-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/04/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE To describe pathways to care, duration of untreated psychosis (DUP), and types of interventions provided to first-episode psychosis (FEP) patients by routine Italian mental health services over 5 years since the first service contact. METHODS Naturalistic study conducted in Veneto, within the context of the Psychosis Incident Cohort Outcome Study (PICOS). A comprehensive set of measures was used, including schedules designed to collect information on referrals to psychiatric services and on psychological and pharmacological treatments at 1, 2, and 5 years since first service contact. RESULTS Overall, 397 patients were assessed. Most engaged with services with the help of family members (47.4%) and through emergency routes (60.3%). Those referred by clinicians were more likely to access care in a non-emergency way. Mean DUP was 5.62 months (SD 11.8) and longer DUP was associated with poorer functioning at 2 and 5 years. Interventions provided over 5 years were mainly constituted by antipsychotic medications (95.4% at 1 year; 85.8% at 2 years; 80.6% at 5 years), whereas a lower percentage (69.1% at 1 year; 61.5% at 2 years; 44.9% at 5 years) also received some forms of psychological interventions, mainly consisting of unspecific support sessions. Other structured interventions, such as CBT or family interventions, were seldom provided at each time-point. CONCLUSIONS Mental health services in Veneto seem effective in engaging FEP patients within a short time since illness onset. However, type of care provided does not meet quality standards recommended by treatment guidelines, especially regarding psychological interventions.
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Affiliation(s)
- Elisabetta Miglietta
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy. .,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy.
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Carla Comacchio
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Sarah Tosato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
| | - Katia De Santi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
| | - Sara Petterlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Gioia Zanatta
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Carla Cremonese
- Psychiatric Clinic, Department of Neuroscience, University of Padua, Padua, Italy
| | - Luana Ramon
- Department of Mental Health, NHS, Local Health Authority Portogruaro (VE), Portogruaro, Italy
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.,Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "GB Rossi", Verona, Italy
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63
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Sun L, von Moltke L, Rowland Yeo K. Physiologically-Based Pharmacokinetic Modeling for Predicting Drug Interactions of a Combination of Olanzapine and Samidorphan. CPT Pharmacometrics Syst Pharmacol 2020; 9:106-114. [PMID: 31919994 PMCID: PMC7020312 DOI: 10.1002/psp4.12488] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/12/2019] [Indexed: 01/16/2023] Open
Abstract
A combination of the antipsychotic olanzapine and the opioid receptor antagonist samidorphan (OLZ/SAM) is intended to provide the antipsychotic efficacy of olanzapine while mitigating olanzapine-associated weight gain. As cytochrome P450 (CYP) 1A2 and CYP3A4 are the major enzymes involved in metabolism of olanzapine and samidorphan, respectively, physiologically-based pharmacokinetic (PBPK) modeling was applied to predict any drug-drug interaction (DDI) potential between olanzapine and samidorphan or between OLZ/SAM and CYP3A4/CYP1A2 inhibitors/inducers. A PBPK model for OLZ/SAM was developed and validated by comparing model-simulated data with observed clinical study data. Based on model-based simulations, no DDI between olanzapine and samidorphan is expected when administered as OLZ/SAM. CYP3A4 inhibition is predicted to have a weak effect on samidorphan exposure and negligible effect on olanzapine exposure. CYP3A4 induction is predicted to reduce both samidorphan and olanzapine exposure. CYP1A2 inhibition or induction is predicted to increase or decrease, respectively, olanzapine exposure only.
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Affiliation(s)
- Lei Sun
- Alkermes, Inc.WalthamMassachusettsUSA
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64
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Hynes C, McWilliams S, Clarke M, Fitzgerald I, Feeney L, Taylor M, Boland F, Keating D. Check the effects: systematic assessment of antipsychotic side-effects in an inpatient cohort. Ther Adv Psychopharmacol 2020; 10:2045125320957119. [PMID: 33029344 PMCID: PMC7522839 DOI: 10.1177/2045125320957119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/10/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Antipsychotics are associated with a range of side-effects that can influence patients' subjective well-being negatively resulting in poor adherence. In order to limit the negative consequences of side-effects, they should be regularly systematically assessed. The aim of this study was to systematically assess antipsychotic side-effects in an inpatient cohort using validated rating scales. METHODS Eligible individuals prescribed an antipsychotic for at least 2 weeks were invited to have their side-effects assessed systematically. RESULTS A total of 208 individuals were assessed systematically for antipsychotic side-effects; 71.5% (n = 138) stated that they had not reported side-effects to their clinician prior to the assessment. The most commonly reported side-effects were daytime drowsiness (75%), dry mouth (58.2%) and weight gain (50.0%), while the most distressing side-effects reported were erectile dysfunction (35.0%), sexual dysfunction (26.3%) and amenorrhoea (26.3%). There was no evidence of an association between side-effect severity/number of side-effects reported/distress caused by those taking high dose/combination antipsychotics versus standard dose monotherapy. CONCLUSION Side-effects must be regularly and systematically assessed using a validated rating scale. As distress caused by side-effects plays a major role in non-adherence, assessment should examine distress and data on distressing side-effects should be available to those choosing an antipsychotic. Given the lack of correlation between high dose/combination antipsychotics and side-effects, treatment should be tailored to the individual based on response/tolerance and dose reduction/avoidance of polypharmacy should not be recommended to minimise side-effects.
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Affiliation(s)
- Caroline Hynes
- Saint John of God Hospitaller Services, Stillorgan, Dublin, DL1 1RW, Ireland
| | | | - Mark Clarke
- Detect, Dublin East Treatment and Early Care Team, Blackrock, Ireland
| | | | - Larkin Feeney
- Cluain Mhuire Community Mental Health Services, Blackrock, Ireland
| | - Mark Taylor
- The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Fiona Boland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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65
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One-Year Outcome and Adherence to Pharmacological Guidelines in First-Episode Schizophrenia: Results From a Consecutive Cohort Study. J Clin Psychopharmacol 2020; 40:534-540. [PMID: 33136922 PMCID: PMC7643791 DOI: 10.1097/jcp.0000000000001303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Remission in schizophrenia is difficult to achieve. Antipsychotic drugs are critical in the treatment of schizophrenia. International guidelines for the pharmacological treatment of schizophrenia recommend a 3-step algorithm with clozapine being the third-line antipsychotic agent. This study investigated the 1-year outcome and the application of the guidelines for the pharmacological treatment of nonremitted first-episode schizophrenia (FES) patients during the first year of follow-up. METHODS A sample of 78 FES patients from the Norwegian TIPS (Early Treatment and Intervention in Psychosis) 2 study was assessed at the end of the first year of follow-up. The symptom remission criteria were those defined by the Remission in Schizophrenia Working Group. The adherence to the pharmacological guidelines was assessed by reading the medical files and by a digital search of the words "clozapine," "klozapin," and "Leponex" in the hospital electronic data system. RESULTS The majority (n = 53, 67.9%) of the patients included were nonremitted at the 1-year follow-up. The majority of the nonremitted patients received either none (7.5%), one (56.6%), or 2 types (15.1%) of antipsychotic drugs during the first year of follow-up. Only 2 (3.8%) received treatment with clozapine, and 3 (5.7%) in total were offered it. CONCLUSIONS For our FES sample, there was a low 1-year remission rate and a poor adherence to the pharmacological guidelines. Higher adherence to treatment guidelines with a more intensified antipsychotic treatment, which in some cases will include clozapine, will enhance the quality of treatment and may enhance the rates of remission for schizophrenia.
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66
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Coentre R, Mendes T, Rebelo A, Fonseca A, Levy P. PROFIP: A Portuguese early intervention programme for first-episode psychosis in Lisbon. Early Interv Psychiatry 2019; 13:1525-1529. [PMID: 31264775 DOI: 10.1111/eip.12852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/25/2019] [Accepted: 06/09/2019] [Indexed: 12/15/2022]
Abstract
AIM There is currently no national plan for early intervention in first-episode psychosis in Portugal. Consequently, there is some heterogeneity in the evaluation and treatment of first-episode psychosis across the country. The aim of this article is to provide a complete description of the early intervention programme Programa de Intervenção nas Fases Iniciais da Psicose (PROFIP) in Lisbon, a pioneering team in Portugal for treating first-episode psychosis (FEP) patients. We also describe the baseline socio-demographic and clinical data obtained from new patients over a 1-year period. PROFIP programme accepts all cases of FEP, taking a transdiagnostic approach. METHODS Description of PROFIP programme and baseline socio-demographic and clinical data obtained from new patients over a 1-year period. RESULTS The team was constituted to provide early detection, treatment and support to people aged 16 to 35 years with affective and non-affective FEP. Over a 1-year period, 39 patients were included in the PROFIP programme. The majority of patients were young male patients with a diagnosis of non-affective psychosis, and with 56% of patients reporting cannabis use. Patients received pharmacological and psychosocial interventions based on evidence and individual needs. CONCLUSIONS Our team allowed young people with early psychosis to receive effective care. We do need improvements, namely in referrals and the education of health professionals. More teams in our country should be constituted, allowing larger numbers of patients with early psychosis to be treated by specialized teams.
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Affiliation(s)
- Ricardo Coentre
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Tiago Mendes
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ana Rebelo
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Alexandra Fonseca
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Pedro Levy
- Department of Psychiatry, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
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Chronic low-grade peripheral inflammation is associated with ultra resistant schizophrenia. Results from the FACE-SZ cohort. Eur Arch Psychiatry Clin Neurosci 2019; 269:985-992. [PMID: 29808267 DOI: 10.1007/s00406-018-0908-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
A high rate of patients with schizophrenia (SZ) does not sufficiently respond to antipsychotic medication, which is associated with relapses and poor outcomes. Chronic peripheral inflammation has been repeatedly associated with schizophrenia risk and particularly to poor responders to treatment as usual with cognitive impairment in SZ subjects. The objective of present study was to confirm if ultra resistance to treatment in schizophrenia (UTRS) was associated to chronic peripheral inflammation in a non-selected sample of community-dwelling outpatients with schizophrenia. Participants were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia and received a thorough clinical assessment, including recording of current treatment. Current psychotic symptomatology was evaluated by the Positive and Negative Syndrome scale for Schizophrenia (PANSS). UTRS was defined by current clozapine treatment + PANSS total score ≥ 70. Functioning was evaluated by the Global Assessment of Functioning scale. High sensitivity CRP (hs-CRP) was measured for each participant as a proxy to define peripheral low-grade inflammation. 609 stabilized community-dwelling SZ subjects (mean age = 32.5 years, 73.6% male gender) have been included. 60 (9.9%) patients were classified in the UTRS group. In multivariate analyses, UTRS has been associated independently with chronic peripheral inflammation (OR = 2.6 [1.2-5.7], p = 0.01), illness duration (0R = 1.1 [1.0-1.2], p = 0.02) and impaired functioning (OR = 0.9 [0.9-0.9], p = 0.0002) after adjustment for age, sex, current daily tobacco smoking, metabolic syndrome and antidepressant consumption. Peripheral low-grade inflammation is associated with UTRS. Future studies should explore if anti-inflammatory strategies are effective in UTRS with chronic low-grade peripheral inflammation.
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68
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Takaesu Y, Watanabe K, Numata S, Iwata M, Kudo N, Oishi S, Takizawa T, Nemoto K, Yasuda Y, Tagata H, Tsuboi T, Tsujino N, Hashimoto N, Matsui Y, Hori H, Yamamori H, Sugiyama N, Suwa T, Kishimoto T, Hishimoto A, Usami M, Furihata R, Iwamoto K, Fujishiro H, Nakamura T, Mizuno K, Inagaki T, Katsumoto E, Tomita H, Ohi K, Muraoka H, Atake K, Iida H, Nagasawa T, Fujita J, Yamamura S, Onitsuka T, Murata A, Takayanagi Y, Noda H, Matsumura Y, Takezawa K, Iga J, Ichihashi K, Ogasawara K, Yamada H, Inada K, Hashimoto R. Improvement of psychiatrists' clinical knowledge of the treatment guidelines for schizophrenia and major depressive disorders using the 'Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)' project: A nationwide dissemination, education, and evaluation study. Psychiatry Clin Neurosci 2019; 73:642-648. [PMID: 31437336 PMCID: PMC6852015 DOI: 10.1111/pcn.12911] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/18/2019] [Accepted: 06/27/2019] [Indexed: 02/03/2023]
Abstract
AIM Although treatment guidelines for pharmacological therapy for schizophrenia and major depressive disorder have been issued by the Japanese Societies of Neuropsychopharmacology and Mood Disorders, these guidelines have not been well applied by psychiatrists throughout the nation. To address this issue, we developed the 'Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)' integrated education programs for psychiatrists to disseminate the clinical guidelines. Additionally, we conducted a systematic efficacy evaluation of the programs. METHODS Four hundred thirteen out of 461 psychiatrists attended two 1-day educational programs based on the treatment guidelines for schizophrenia and major depressive disorder from October 2016 to March 2018. We measured the participants' clinical knowledge of the treatment guidelines using self-completed questionnaires administered before and after the program to assess the effectiveness of the programs for improving knowledge. We also examined the relation between the participants' demographics and their clinical knowledge scores. RESULTS The clinical knowledge scores for both guidelines were significantly improved after the program. There was no correlation between clinical knowledge and participant demographics for the program on schizophrenia; however, a weak positive correlation was found between clinical knowledge and the years of professional experience for the program on major depressive disorder. CONCLUSION Our results provide evidence that educational programs on the clinical practices recommended in guidelines for schizophrenia and major depressive disorder might effectively improve participants' clinical knowledge of the guidelines. These data are encouraging to facilitate the standardization of clinical practices for psychiatric disorders.
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Affiliation(s)
- Yoshikazu Takaesu
- Department of Neuropsychiatry, School of MedicineKyorin UniversityTokyoJapan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, School of MedicineKyorin UniversityTokyoJapan
| | - Shusuke Numata
- Department of Psychiatry, Institute of Biomedical ScienceTokushima University Graduate SchoolTokushimaJapan
| | - Masaaki Iwata
- Division of Neuropsychiatry, Department of Brain and Neurosciences, Faculty of MedicineTottori UniversityTottoriJapan
| | - Noriko Kudo
- Department of Pathology of Mental Diseases, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Satoru Oishi
- Department of PsychiatryKitasato University School of MedicineKanagawaJapan
| | - Takeya Takizawa
- Department of PsychiatryKitasato University School of MedicineKanagawaJapan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Faculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
- Life Grow Brilliant Mental ClinicMedical Corporation FosterOsakaJapan
| | - Hiromi Tagata
- Department of NeuropsychiatryToho University School of MedicineTokyoJapan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, School of MedicineKyorin UniversityTokyoJapan
| | - Naohisa Tsujino
- Department of PsychiatrySaiseikai Yokohamashi Tobu HospitalKanagawaJapan
| | - Naoki Hashimoto
- Department of PsychiatryHokkaido University Graduate School of MedicineHokkaidoJapan
| | - Yuki Matsui
- Department of Pathology of Mental Diseases, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
- Department of PsychiatryJindai HospitalAichiJapan
| | - Hikaru Hori
- Department of Psychiatry, School of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Hidenaga Yamamori
- Department of Pathology of Mental Diseases, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
- Japan Community Health Care Organization Osaka HospitalOsakaJapan
| | - Nobuhiro Sugiyama
- Department of Applied Occupational TherapyShinshu University School of Health SciencesNaganoJapan
- Department of PsychiatryShinshu University School of MedicineNaganoJapan
| | - Taro Suwa
- Department of Psychiatry, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Taishiro Kishimoto
- Keio University School of MedicineDepartment of NeuropsychiatryTokyoJapan
| | - Akitoyo Hishimoto
- Department of PsychiatryKobe University Graduate School of MedicineHyogoJapan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai HospitalNational Center for Global Health and MedicineChibaJapan
| | - Ryuji Furihata
- Department of PsychiatryNihon University School of MedicineTokyoJapan
| | - Kunihiro Iwamoto
- Department of PsychiatryNagoya University Graduate School of MedicineAichiJapan
| | - Hiroshige Fujishiro
- Department of PsychiatryNagoya University Graduate School of MedicineAichiJapan
- Department of PsychiatryKawasaki Memorial HospitalKanagawaJapan
| | - Toshinori Nakamura
- Department of PsychiatryShinshu University School of MedicineNaganoJapan
| | | | - Takahiko Inagaki
- Biwako HospitalShigaJapan
- Department of PsychiatryShiga University of Medical ScienceShigaJapan
| | | | - Hiroaki Tomita
- Department of Psychiatry, Graduate School of MedicineTohoku UniversityMiyagiJapan
| | - Kazutaka Ohi
- Department of NeuropsychiatryKanazawa Medical UniversityIshikawaJapan
| | - Hiroyuki Muraoka
- Department of PsychiatryTokyo Women's Medical UniversityTokyoJapan
| | - Kiyokazu Atake
- Department of Psychiatry, School of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of MedicineFukuoka UniversityFukuokaJapan
| | - Tatsuya Nagasawa
- Department of NeuropsychiatryKanazawa Medical UniversityIshikawaJapan
| | - Junichi Fujita
- Department of Child PsychiatryYokohama City University HospitalKanagawaJapan
| | | | - Toshiaki Onitsuka
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | | | - Yoichiro Takayanagi
- Department of NeuropsychiatryUniversity of Toyama Graduate School of Medicine and Pharmaceutical SciencesToyamaJapan
| | - Hokuto Noda
- Yamanashi Prefectural Kita HospitalYamanashiJapan
| | - Yukiko Matsumura
- Department of Neuropsychiatry, Faculty of Medical SciencesUniversity of FukuiFukuiJapan
| | - Kenji Takezawa
- Medical Corporation Matsuzaki HospitalToyohashi Mental Care CenterAichiJapan
| | - Jun‐ichi Iga
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineEhimeJapan
| | - Kayo Ichihashi
- Department of NeuropsychiatryUniversity of Tokyo HospitalTokyoJapan
| | - Kazuyoshi Ogasawara
- Department of PsychiatryNagoya University Graduate School of MedicineAichiJapan
- Medical Research and Clinical Ethics Promotion OfficeNagoya University HospitalAichiJapan
| | - Hisashi Yamada
- Department of Pathology of Mental Diseases, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
- Department of NeuropsychiatryHyogo College of MedicineHyogoJapan
| | - Ken Inada
- Department of PsychiatryTokyo Women's Medical UniversityTokyoJapan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
- Department of PsychiatryOsaka University Graduate School of MedicineOsakaJapan
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Huh L, Lee BJ. Comparison of long-term efficacy and safety of blonanserin treatment in individuals with first-episode and relapsed schizophrenia: a 3-year retrospective study. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1625184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Lyang Huh
- Department of Psychiatry, Military Manpower Administration, Daegu, Republic of Korea
| | - Bong Ju Lee
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Takeuchi H, Siu C, Remington G, Fervaha G, Zipursky RB, Foussias G, Agid O. Does relapse contribute to treatment resistance? Antipsychotic response in first- vs. second-episode schizophrenia. Neuropsychopharmacology 2019; 44:1036-1042. [PMID: 30514883 PMCID: PMC6462044 DOI: 10.1038/s41386-018-0278-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/13/2018] [Indexed: 01/20/2023]
Abstract
Although some studies have suggested that relapse may be associated with antipsychotic treatment resistance in schizophrenia, the number and quality of studies is limited. The current analysis included patients with a diagnosis of first-episode schizophrenia or schizoaffective disorder who met the following criteria: (1) referral to the First-Episode Psychosis Program between 2003 and 2013; (2) treatment with an oral second-generation antipsychotic according to a standardized treatment algorithm; (3) positive symptom remission; (4) subsequent relapse (i.e., second episode) in association with non-adherence; and (5) reintroduction of antipsychotic treatment with the same agent used to achieve response in the first episode. The following outcomes were used as an index of antipsychotic treatment response: changes in the brief psychiatric rating scale (BPRS) total and positive symptom scores and number of patients who achieved positive symptom remission and 20 and 50% response. A total of 130 patients were included in the analyses. Although all patients took the same antipsychotic in both episodes, there were significant episode-by-time interactions for all outcomes of antipsychotic treatment response over 1 year in favor of the first episode compared to the second episode (50% response rate: 48.7 vs. 10.4% at week 7; 88.2 vs. 27.8% at week 27, respectively). Although antipsychotic doses in the second episode were significantly higher than those in the first episode, results remained unchanged after adjusting for antipsychotic dose. The present findings suggest that antipsychotic treatment response is reduced or delayed in the face of relapse following effective treatment of the first episode of schizophrenia.
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Affiliation(s)
- Hiroyoshi Takeuchi
- 0000 0004 1936 9959grid.26091.3cDepartment of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan ,0000 0000 8793 5925grid.155956.bSchizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON Canada
| | | | - Gary Remington
- 0000 0000 8793 5925grid.155956.bSchizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Institute of Medical Science, University of Toronto, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bCampbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Gagan Fervaha
- 0000 0000 8793 5925grid.155956.bSchizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0004 1936 8331grid.410356.5School of Medicine, Queen’s University, Kingston, ON Canada
| | - Robert B. Zipursky
- 0000 0000 8793 5925grid.155956.bSchizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - George Foussias
- 0000 0000 8793 5925grid.155956.bSchizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Institute of Medical Science, University of Toronto, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bCampbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Ofer Agid
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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71
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Abstract
PURPOSE OF REVIEW To provide an update of recent studies relevant for maintenance treatment with antipsychotic medication after a first psychotic episode (FEP). RECENT FINDINGS Despite controversy derived from a follow-up analysis from an earlier study showing that attempted early discontinuation after remission was associated with improved long-term functioning, most other studies support better long-term outcome with continuous maintenance treatment after the first episode. However, the main question is not whether, but for how long maintenance treatment after FEP should be offered. Consistent evidence shows that withdrawal from antipsychotics increases the risk for a relapse or re-hospitalization. On the other hand, maintenance treatment is associated with the risk to develop burdensome antipsychotic-induced side-effects and one should keep in mind that around 20% of FEP will not have a second episode. In this regard, the decision for maintenance treatment for periods above some months must be the result of a comprehensive risk-benefit evaluation during a shared decision-making process. SUMMARY There is no replicated evidence that prognosis can be improved by discontinuing antipsychotic medication after a FEP. There is a clear need for additional studies to develop single-subject outcome predictors and to identify long-term efficacy of maintenance treatment beyond relapse (e.g. recovery).
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Abstract
Brexpiprazole (Rxulti®, Rexulti®) is an oral atypical antipsychotic agent approved for the treatment of schizophrenia in the EU (in adult patients) and the USA, as well as in some other countries, including Japan. Like aripiprazole, it is a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and an antagonist at serotonin 5-HT2A receptors. However, brexpiprazole displays less intrinsic activity at D2 receptors and, coupled with actions at 5HT1A, 5HT2A and noradrenaline α1B receptors that are at least as potent as its action at D2 receptors, is predicted to demonstrate a lower propensity for activating adverse events and extrapyramidal symptoms than aripiprazole. Brexpiprazole 2-4 mg/day produced statistically significant and clinically meaningful improvements in overall symptomatology and psychosocial functioning compared with placebo in adults with acute exacerbation of schizophrenia. As maintenance treatment, brexpiprazole 1-4 mg/day significantly delayed the time to relapse compared with placebo in patients who were already stabilized on the drug and was associated with stabilization or continued improvement in patients' symptoms and functioning. Brexpiprazole was generally well tolerated, exhibiting an adverse event profile characterized by a relatively low incidence of activating and sedating adverse effects, small changes in QT interval and metabolic parameters that were not clinically significant, and moderate weight gain. Clinical evidence to date suggests it usefully extends the range of therapeutic options for schizophrenia.
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Affiliation(s)
- James E Frampton
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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73
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Pérez-Ruixo C, Remmerie B, Peréz-Ruixo JJ, Vermeulen A. A Receiver Operating Characteristic Framework for Non-adherence Detection Using Drug Concentration Thresholds-Application to Simulated Risperidone Data in Schizophrenic Patients. AAPS JOURNAL 2019; 21:40. [PMID: 30874997 DOI: 10.1208/s12248-019-0299-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/12/2019] [Indexed: 01/10/2023]
Abstract
Non-adherence to antipsychotic medication is a primary factor in disease relapse in schizophrenic patients. We sought to evaluate if plasma concentrations of the antipsychotic risperidone can be used as a predictor of treatment adherence and to identify the optimal plasma concentration threshold to reliably distinguish between adherent and non-adherent patients. A population pharmacokinetic model was used to simulate plasma risperidone steady-state trough concentrations in 1000 virtual patients, where 60% of the patients were 100% adherent to their medication, while 40% of the patients were non-adherent to their medication. The probability of adherence was assessed by receiver operating characteristic (ROC) analysis on Ctrough. The area under the ROC curve (AUCROC) was used to identify the optimal Ctrough threshold. Single vs multiple Ctrough at steady state was also evaluated. After a single risperidone Ctrough measurement, the AUCROC (95% CI) was estimated to be 0.71 (0.69-0.72) and the optimal Ctrough threshold accounting for the lowest number of adherent and non-adherent misclassifications was estimated to be 11.9 ng/mL. After multiple Ctrough measurements, the AUCROC (95% CI) increased up to 0.85 (0.84-0.87) for three Ctrough measurements. The optimal probability threshold to reliably discriminate between adherent and non-adherent patients was estimated to be 0.51. Using this model which is reflective of typical adherence to antipsychotic medication, we found that three consecutive steady-state Ctrough measurements are needed for an accurate and precise diagnostic test to discriminate between patients who are adherent or non-adherent to treatment.
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Affiliation(s)
- Carlos Pérez-Ruixo
- Janssen Research & Development, Clinical Pharmacology & Pharmacometrics, Beerse, Belgium.
| | - Bart Remmerie
- Janssen Research & Development, Clinical Pharmacology & Pharmacometrics, Beerse, Belgium
| | - Juan José Peréz-Ruixo
- Janssen Research & Development, Clinical Pharmacology & Pharmacometrics, Beerse, Belgium
| | - An Vermeulen
- Janssen Research & Development, Quantitative Sciences Consulting, Beerse, Belgium
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74
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Fond G, Tinland A, Boucekine M, Girard V, Loubière S, Auquier P, Boyer L. Prescription of potentially inappropriate psychotropic drugs in homeless people with schizophrenia and bipolar disorders. Results from the French Housing First (FHF) program. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:84-89. [PMID: 30153497 DOI: 10.1016/j.pnpbp.2018.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Guidelines have been edited for the treatment of schizophrenia (SZ) and bipolar disorders (BD). Background regimen is currently recommended for both illnesses (antipsychotic drug for SZ and mood stabilizer for BD). The recommendations are less clear for major depression in these disorders. Long-term anxiolytic and hypnotic prescriptions may have potential side effects and should be withdrawn as soon as possible. OBJECTIVE The aim of this study was to investigate the prevalence and associated factors of Potentially Inappropriate Psychotropic drugs (PIP) in a large multicenter sample of Homeless Schizophrenia (SZ) and Bipolar Disorder (BD) (HSB) patients. METHODS This multicenter study was conducted in 4 French cities: Lille, Marseille, Paris and Toulouse. PIP was defined by at least one item among: (i) absence of background regimen (antipsychotic for SZ or mood stabilizer for BD), (ii) absence of antidepressant for major depressive disorder and (iii) daily long-term anxiolytic or (iv) hypnotic prescription. RESULTS Overall, 703 HSB patients, mean aged 38 years and 82.9% men were included, 487 SZ (69.3%) and 216 BD (30.7%). 619 (88.4%) of the patients reported at least one PIP. 386 (54.9%) patients had an inappropriate background regimen prescription (209(43.4%) of SZ had no antipsychotic prescription and 177(81.9%) of BD no mood stabilizer), 336 (48%) had an inappropriate antidepressant prescription (with no significant difference between SZ and BD), 326 (46.4%) had an inappropriate prescription of anxiolytics and 107 (15.2%) had an inappropriate prescription of hypnotics. 388(55%) of the subjects were diagnosed with major depression but only 52(13%) of them were administered antidepressants. In multivariate analysis, PIP was associated with bipolar disorder diagnosis (aOR = 4.67 [1.84-11.89], p = 0.001), current major depressive disorder (aOR = 27.72 [9.53-80.69], p < 0.0001), lower rate of willingness to ask for help (aOR = 0.98[0.96-0.99], p = 0.001). Potentially inappropriate background regimen prescription was associated with bipolar disorder diagnosis (aOR = 6.35 [3.89-10.36], p < 0.0001), lower willingness to ask for help (aOR = 0.99[0.98-0.99], p = 0.01) and lack of lifetime history of psychiatric care (aOR = 0.30[0.12-0.78], p = 0.01). Inappropriate antidepressant prescription was associated with antisocial personality disorder (aOR = 1.58 [1.01-2.48], p = 0.04) and current substance use disorder (aOR = 2.18[1.48-3.20], p < 0.0001). CONCLUSION The present findings suggest that almost 9 on 10 HSB subjects may receive a PIP including inappropriate prescriptions or absence of appropriate prescription. Bipolar disorder and/or major depression should be targeted in priority and treated with mood stabilizers and/or antidepressants in this population, while anxiolytics and hypnotics should be withdrawn as much as possible. Major depression should be particularly explored in subjects with comorbid antisocial personality disorder and substance use disorder. The psychiatric care has been associated with better appropriate psychotropic prescriptions and should be reinforced in this population.
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Affiliation(s)
- G Fond
- Aix Marseille Univ, School of Medicine, La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France.
| | - A Tinland
- Aix Marseille Univ, School of Medicine, La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - M Boucekine
- Aix Marseille Univ, School of Medicine, La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Assistance Publique Hôpitaux de Marseille, Service Epidémiologie et Economie de la Santé, Marseille, France
| | - V Girard
- Aix Marseille Univ, School of Medicine, La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - S Loubière
- Aix Marseille Univ, School of Medicine, La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Assistance Publique Hôpitaux de Marseille, Service Epidémiologie et Economie de la Santé, Marseille, France
| | - P Auquier
- Aix Marseille Univ, School of Medicine, La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France
| | - L Boyer
- Aix Marseille Univ, School of Medicine, La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France
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75
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Martins MJRV, Pinto AM, Castilho P, Macedo AF, Pereira AT, Bajouco M, Leite R, Matos O, Morais S, Madeira N, Nogueira V, Roque C, Santos P, Santos T, Santos T, Santos V, Troia AF, Barreto-Carvalho C. Assessing beliefs and attitudes towards antipsychotic medication from a recovery-based perspective: Psychometric properties of a new scale. Psychiatry Res 2019; 273:325-330. [PMID: 30677722 DOI: 10.1016/j.psychres.2019.01.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/10/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
Antipsychotic medication non-adherence is a complex and multifaceted problem that may hinder recovery in psychosis-spectrum disorders. Therefore, it warrants an early and comprehensive assessment. Current self-report measures focus entirely on behavioral and attitudinal barriers to adherence, failing to provide insight about key psychosocial drivers such as shame and stigma that may also account for non-adherence. This study's main goals were to develop a brief scale for measuring antipsychotic (non)-adherence and associated intra and interpersonal barriers (Antipsychotic Medication Beliefs and Attitudes Scale - AMBAS), and explore its psychometric properties. One hundred and seventy participants with a psychosis-spectrum disorder were recruited and filled in a battery of self-report measures. Exploratory factor analysis supported a two-factor solution, with one factor tapping the influence of different barriers to medication adherence and other factor encompassing perceived positive effects of medication. The scale presented good reliability and convergent validity as evidenced by significant moderate associations with the Medication Adherence Rating Scale. Although in need for further study, AMBAS seems a valid and reliable measure to assess antipsychotic (non)-adherence and underlying behavioral and psychosocial drivers. With replication, AMBAS might be a useful measure that could be used in different clinical and research settings.
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Affiliation(s)
- Maria João R V Martins
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal; Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal.
| | - Ana Margarida Pinto
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal; Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal
| | - Paula Castilho
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - António F Macedo
- Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal; Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Ana Telma Pereira
- Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal
| | - Miguel Bajouco
- Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal; Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Rita Leite
- Baixo Vouga Hospital Centre, Aveiro, Portugal
| | | | - Sofia Morais
- Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal; Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Nuno Madeira
- Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal; Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Vasco Nogueira
- Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal; Figueira da Foz District Hospital, Figueira da Foz, Portugal
| | - Carolina Roque
- Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal; Coimbra Hospital and University Centre, Coimbra, Portugal
| | | | | | | | - Vítor Santos
- Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal; Coimbra Hospital and University Centre, Coimbra, Portugal
| | | | - Célia Barreto-Carvalho
- Department of Psychology, Faculty of Human and Social Sciences, University of Azores, Portugal
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76
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Vähäniemi A, Välimäki M, Pekurinen V, Anttila M, Lantta T. Quality and utilization of the Finnish clinical practice guideline in schizophrenia: evaluation using AGREE II and the vignette approach. Neuropsychiatr Dis Treat 2019; 15:1239-1248. [PMID: 31190830 PMCID: PMC6512783 DOI: 10.2147/ndt.s192752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This study aims to evaluate the quality of the Finnish clinical practice guideline related to schizophrenia care and how it can be utilized in psychiatric services. PARTICIPANTS AND METHODS The data were collected from one psychiatric ward and seven psychiatric outpatient units situated in two cities in Southern Finland. A total of 49 professionals working in these sites participated in this study. A descriptive study design was adopted. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument with six domains including 23 items was used to assess the quality of the guideline, whereas a vignette was implemented to describe how staff would use the guideline in hypothetical cases in daily practice. The analysis of AGREE II was based on rating each of the 23 items on a seven-point scale and calculating a quality score for the six domains. To describe the utilization of the guideline, eight key recommendations of the guideline were deductively rated out of the respondents' answers. RESULTS The results showed that the "scope and purpose" of the guideline were well described, but "applicability" was insufficient. The overall quality of the guideline was high (73%). Almost one fifth of the respondents were in agreement with key recommendations. CONCLUSION The overall quality of Guideline for Schizophrenia was good, but its "applicability" and utilization should be improved.
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Affiliation(s)
- Anu Vähäniemi
- Department of Nursing Science, University of Turku, Turku, Finland, .,Mental Health and Substance Abuse Services, City of Tampere, Tampere, Finland,
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland, .,Turku University Hospital, Turku, Finland.,School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Virve Pekurinen
- Department of Nursing Science, University of Turku, Turku, Finland,
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland,
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland,
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Na Takuathung M, Hanprasertpong N, Teekachunhatean S, Koonrungsesomboon N. Impact of CYP1A2 genetic polymorphisms on pharmacokinetics of antipsychotic drugs: a systematic review and meta-analysis. Acta Psychiatr Scand 2019; 139:15-25. [PMID: 30112761 DOI: 10.1111/acps.12947] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the impact of CYP1A2 genetic polymorphisms on the pharmacokinetics of CYP1A2-metabolized antipsychotic drugs in humans by means of systematic review and meta-analysis. METHOD A systematic search was conducted in PubMed and Scopus databases as of June 26, 2018. Studies reporting the pharmacokinetic parameters of CYP1A2-metabolized antipsychotic drugs in individuals who were genotyped for CYP1A2 genetic polymorphisms were retrieved. Pharmacokinetic parameters of individuals who have mutant alleles of a CYP1A2 genetic polymorphism were compared with the wild-type individuals. Pooled-effect estimates, presented as standardized mean difference, were calculated by means of the fixed-effect or random-effects model, as appropriate. RESULTS Ten studies involving 872 clozapine users, seven studies involving 712 olanzapine users, and two studies involving 141 haloperidol users were included. All but one study reported no associations between any CYP1A2 genetic polymorphisms and the pharmacokinetics of CYP1A2-metabolized antipsychotic drugs. The pooled-effect estimates through meta-analyses of seven studies demonstrated no significant associations between the -163C>A or -2467delT polymorphism and clozapine or olanzapine concentrations in the blood. CONCLUSIONS This study suggests that CYP1A2 genetic polymorphisms have no significant impact on the pharmacokinetics of CYP1A2-metabolized antipsychotic drugs. CYP1A2 genotyping may have no clinical implications for personalized dosing of CYP1A2-metabolized antipsychotic drugs.
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Affiliation(s)
- M Na Takuathung
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - N Hanprasertpong
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - S Teekachunhatean
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Center of Thai Traditional and Complementary Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - N Koonrungsesomboon
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Citrome L, McEvoy JP, Todtenkopf MS, McDonnell D, Weiden PJ. A commentary on the efficacy of olanzapine for the treatment of schizophrenia: the past, present, and future. Neuropsychiatr Dis Treat 2019; 15:2559-2569. [PMID: 31564881 PMCID: PMC6733343 DOI: 10.2147/ndt.s209284] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/20/2019] [Indexed: 01/29/2023] Open
Abstract
Olanzapine is a second-generation atypical antipsychotic with proven efficacy for the treatment of schizophrenia. Approved in 1996, olanzapine is one of the most studied antipsychotics, resulting in a considerable amount of clinical data across diverse patient populations. Despite the fact that olanzapine is associated with a known risk of metabolic side effects, including weight gain, many clinicians continue to prescribe olanzapine for the treatment of schizophrenia with the expectation of additional therapeutic antipsychotic efficacy relative to other first-line atypical antipsychotics. The goal of this narrative is to revisit the role of oral olanzapine in the management of patients with schizophrenia, including those with recently diagnosed schizophrenia ("first-episode"), those with an established schizophrenia diagnosis who experience acute exacerbations, those receiving long-term antipsychotic treatment as a maintenance intervention, and those with suboptimal response to antipsychotic treatment, including treatment resistance. Collectively, data from published literature support the favorable efficacy of olanzapine compared with other first- and second-generation antipsychotics, including lower rates of treatment discontinuation and clinically meaningful improvements in the symptoms of schizophrenia. The development of antipsychotic medications with the favorable efficacy of olanzapine, but with reduced weight gain, could address a major unmet need in the treatment of schizophrenia.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| | - Joseph P McEvoy
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Should we be targeting sleep architecture to more effectively treat schizophrenia? JAAPA 2018; 31:52-54. [DOI: 10.1097/01.jaa.0000544303.53824.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cognitive Behavioural Therapy for Psychosis: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2018; 18:1-141. [PMID: 30443277 PMCID: PMC6235075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) for psychosis is a distinct type of psychotherapy that has been recommended together with antipsychotic drugs and comprehensive usual care in the management of schizophrenia, a complex mental health disorder associated with a high economic and societal burden. The objectives of this report were to assess the effectiveness, harms, cost-effectiveness, and lived experience of CBT for psychosis in improving outcomes for adults with a primary diagnosis of schizophrenia. METHODS We performed literature searches on March 28 and April 5, 2017, and undertook a qualitative synthesis of systematic reviews of the clinical and economic literature comparing CBT for psychosis with any comparator interventions (e.g., usual care, waitlist control, or pharmacotherapy) in adults with a diagnosis of schizophrenia as defined by any criteria (including related disorders such as schizoaffective disorder).We developed an individual-level state-transition probabilistic model for a hypothetical cohort of adults aged 18 years and older starting with first-episode psychosis. We compared three strategies: usual care, CBT for psychosis by physicians, and CBT for psychosis by regulated nonphysician therapists. The CBT was provided in person together with usual care including pharmacotherapy: 16 structured sessions (individual or group) for first-episode psychosis and 24 individual sessions for relapse or treatment-resistant disease. We calculated incremental cost-effectiveness ratios (ICERs) over 5 years using the Ontario Ministry of Health and Long-Term Care perspective and a discount rate of 1.5%. We also estimated the 5-year budget impact of publicly funding CBT for psychosis in Ontario.In addition, we interviewed 13 people with lived experience of schizophrenia and psychosis about their values and preferences surrounding CBT and other treatments. RESULTS CBT for psychosis compared with usual care significantly improved overall psychotic symptoms (standard mean difference [SMD] -0.33, 95% confidence interval [CI] -0.45 to -0.21), positive symptoms (e.g., hallucinations) (SMD -0.34, 95% CI -0.58 to -0.10), auditory symptoms (SMD 0.39, 95% Cl not reported, P < .005), delusions (SMD 0.33, 95% CI not reported, P < .05) and negative symptoms (e.g., blunt affect) (SMD -0.32, 95% CI -0.59 to -0.04) at end of treatment. No significant differences were observed for social function, distress associated with psychosis, relapse, or quality of life.Compared with any control, CBT for psychosis significantly improved overall psychotic symptoms, positive symptoms, auditory hallucinations, delusions, and negative symptoms. Compared with other forms of therapy, CBT for psychosis showed inconsistent results at end of treatment for overall psychotic symptoms, positive symptoms, auditory hallucinations, and delusions. In people with first-episode psychosis, CBT for psychosis was not significantly more effective for the prevention of relapse when compared with other forms of therapy or usual care (odds ratio [OR] 1.11, 95% CI 0.63-1.95 and OR 1.15, 95% CI 0.65-2.04, respectively).Low-intensity CBT for psychosis (fewer than 16 face-to-face sessions) compared with any type of treatment significantly improved overall psychotic symptoms and social function at follow-up (SMD -0.40, 95% CI -0.74 to -0.06 and SMD -0.57, 95% CI -0.81 to -0.33, respectively).In the cost-utility analysis, CBT for psychosis provided by nonphysician therapists compared with usual care was associated with increases in both quality-adjusted life-years (mean 0.1159 QALYs, 95% credible interval [CrI] 0.09-0.14) and costs (mean $2,494, 95% Crl $1,472-$3,544), yielding an ICER of $21,520 per QALY gained. CBT for psychosis provided by physicians was dominated because it was equally effective but more expensive (mean $2,976, 95% CrI $2,822-$3,129; ICER of CBT for psychosis vs. usual care: $47,196/QALY gained).Assuming a 20% increase in access per year (from 0% at baseline to 100% in year 5), we estimated the total 5-year net budget impact of publicly funding CBT for psychosis would be about $15.2 million for nonphysician providers and about $35.4 million if provided by psychiatrists. It is estimated that by the year 2021, approximately 110 nonphysician therapists or 150 physicians would be needed to provide CBT for psychosis to more than 12,000 adults with schizophrenia (including about 8,500 incident cases) in Ontario.People with schizophrenia and their family members reported positive experiences with CBT for psychosis. They felt it provided effective tools to help manage their schizophrenia but stressed that it was only effective in conjunction with medication to control psychotic episodes and overcome a patient's denial of illness. Geographic and financial barriers have restricted access to this psychotherapy. CONCLUSIONS Compared with usual care or any control, CBT for psychosis significantly improved psychotic symptoms, based on evidence of moderate to adequate quality; no significant improvements were observed for social function, relapse, or quality of life outcomes. People affected by schizophrenia reported that CBT for psychosis was valuable in conjunction with antipsychotic medication but that access to this type of psychotherapy is limited. Adding CBT for psychosis to usual care in the management of adult schizophrenia probably represents good value for money in Ontario. Depending on the type of provider, therapy format, and rate of access, the net budget impact to Ontario's publicly funded health system would likely be between $15 million to $35 million over the next 5 years.
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Bosch P, Lim S, Staudte H, Yeo S, Lee SH, Barisch P, Perriard B, Van den Noort M. Pharmacological Treatment for Long-Term Patients with Schizophrenia and Its Effects on Sleep in Daily Clinical Practice: A Pilot Study. MEDICINES 2018; 5:medicines5020044. [PMID: 29757197 PMCID: PMC6023313 DOI: 10.3390/medicines5020044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/26/2018] [Accepted: 05/10/2018] [Indexed: 01/06/2023]
Abstract
Background: Pharmacological treatment is still the key intervention in the disease management of long-term patients with schizophrenia; however, how it affects sleep and whether gender differences exist remains unclear. Methods: Forty-six long-term outpatients with schizophrenia entered the study. The numbers of antipsychotics, sleep medications, antidepressants, and anxiolytics were analyzed. Moreover, all patients were tested using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Correlation analyses were conducted between the medication used and the scores on the two subjective sleep inventories. Results: A large variability, ranging from 0 to 8, in the total number of psychiatric drugs per person was found between the patients. Despite ongoing pharmacological treatment, the patients scored high on the PSQI, but not on the ESS; this indicates that they report problems with sleep, but not with daytime sleepiness. A significant positive correlation between the use of antipsychotics and the ESS score, but not the PSQI score, was found; moreover, no gender differences were found. Conclusions: A large variability exists in the pharmacological treatment of long-term patients with schizophrenia. To date, patients’ sleep problems have been insufficiently treated, and gender differences have not been adequately accounted for in the pharmacological treatment of schizophrenia. More and larger international clinical studies are warranted to verify the findings of the present preliminary pilot study before any firm conclusions can be drawn and before any changes to the drug treatment of male and female patients with schizophrenia can be recommended.
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Affiliation(s)
- Peggy Bosch
- Psychiatric Research Group, LVR-Klinik Bedburg-Hau, 47511 Bedburg-Hau, Germany.
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 Nijmegen, The Netherlands.
| | - Sabina Lim
- Research Group of Pain and Neuroscience, College of Korean Medicine, Kyung Hee University, Seoul 130-701, Korea.
| | - Heike Staudte
- Psychiatric Research Group, LVR-Klinik Bedburg-Hau, 47511 Bedburg-Hau, Germany.
| | - Sujung Yeo
- College of Korean Medicine, Sang Ji University, Wonju 26339, Korea.
| | - Sook-Hyun Lee
- Research Group of Pain and Neuroscience, College of Korean Medicine, Kyung Hee University, Seoul 130-701, Korea.
| | - Pia Barisch
- Institute of Experimental Psychology, Heinrich Heine University, 40225 Düsseldorf, Germany.
| | - Benoît Perriard
- Department of Medicine, Neurology, University of Fribourg, 1700 Fribourg, Switzerland.
| | - Maurits Van den Noort
- Research Group of Pain and Neuroscience, College of Korean Medicine, Kyung Hee University, Seoul 130-701, Korea.
- Brussels Institute for Applied Linguistics, Vrije Universiteit Brussel, 1050 Brussels, Belgium.
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Abstract
PURPOSE OF REVIEW Schizophrenia has a heterogeneous range of end states, from severe cases requiring repeated hospitalization to cases in which a single illness episode is followed by complete remission. The purpose of the present review is to examine recent literature on recovery in schizophrenia, focusing on the predictive factors and on the possibility to achieve it. RECENT FINDINGS Roughly half of schizophrenia patients recovered or significantly improved over the long term, suggesting that functional remission is possible. Several factors predict the course of schizophrenia, including demographic, clinical, and treatment characteristics, as well as socioeconomic variables. Antipsychotics are a fundamental element of schizophrenia treatment, although the available antipsychotics have significant limitations. In this context, psychosocial interventions are supported by substantial evidence of efficacy in many outcome measures and rehabilitation interventions should be considered as an evidence-based practice and need to become a part of the standard treatment of schizophrenia. SUMMARY As recovery is a multidimensional concept, some authors suggested that at least two areas should be taken into account: clinical remission and social functioning. Functional outcome should be a priority target for therapeutic interventions in schizophrenia and in this perspective measuring treatment response, remission and functional recovery is essential. Only an integrated and multifaceted approach involving pharmacotherapy, psychosocial interventions, and attention to environmental circumstances can improve outcome in schizophrenia.
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Abstract
PURPOSE/BACKGROUND For approximately one third of individuals treated for psychosis or schizophrenia, antipsychotic medications will have little or no therapeutic benefit. Clozapine remains the sole medication approved for treatment-resistant schizophrenia, and studies have demonstrated its superior efficacy in reducing psychotic symptoms. METHODS/PROCEDURES Data were collected from the medical records of people who originally presented with a first-episode psychosis between 1995 and 1999 (N = 171). Data were obtained from first presentation up to December 31, 2013 or until the patient was discharged or transferred. Information on service use and physical health was gathered using a data collection template designed specifically for this audit. FINDINGS/RESULTS Twenty-eight (16.3%) of the cohort were prescribed clozapine. Data were available for 24 individuals. Of this clozapine subsample, the mean age at baseline was 23.11 (SD = 4.58); 82.14% (n = 23) were male; and 82.14% (n = 23) had a baseline diagnosis of schizophrenia. The mean time to first trial of clozapine was 6.7 years. The mean number of antipsychotics prescribed before clozapine trial was 4.85. After the initiation of clozapine, the mean number of hospital admissions reduced from 6.04 per year to 0.88 per year. IMPLICATIONS/CONCLUSIONS Nearly 1 in 5 of the original cohort was considered to have a suboptimal response to trials of antipsychotic medication. The use of clozapine for treatment-resistant schizophrenia is underutilized, and better understanding of the barriers to prescribing clozapine is necessary given the implications for patient's quality of life and hospital admission rates. Physical health data further emphasizes the importance of physical health monitoring in this vulnerable population.
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