1
|
Rodrigues P, Guimarães L, Carvalho AP, Oliva-Teles L. Carbamazepine, venlafaxine, tramadol, and their main metabolites: Toxicological effects on zebrafish embryos and larvae. JOURNAL OF HAZARDOUS MATERIALS 2023; 448:130909. [PMID: 36860067 DOI: 10.1016/j.jhazmat.2023.130909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/18/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
Pharmaceutical compounds and their metabolites are found in natural and wastewater. However, investigation of their toxic effects on aquatic animals has been neglected, especially for metabolites. This work investigated the effects of the main metabolites of carbamazepine, venlafaxine and tramadol. Zebrafish embryos were exposed (0.1-100 µg/L) for 168hpf exposures to each metabolite (carbamazepine-10,11-epoxide, 10,11-dihydrocarbamazepine, O-desmethylvenlafaxine, N-desmethylvenlafaxine, O-desmethyltramadol, N-desmethyltramadol) or the parental compound. A concentration-response relationship was found for the effects of some embryonic malformations. Carbamazepine-10,11-epoxide, O-desmethylvenlafaxine and tramadol elicited the highest malformation rates. All compounds significantly decreased larvae responses on a sensorimotor assay compared to controls. Altered expression was found for most of the 32 tested genes. In particular, abcc1, abcc2, abcg2a, nrf2, pparg and raraa were found to be affected by all three drug groups. For each group, the modelled expression patterns showed differences in expression between parental compounds and metabolites. Potential biomarkers of exposure were identified for the venlafaxine and carbamazepine groups. These results are worrying, indicating that such contamination in aquatic systems may put natural populations at significant risk. Furthermore, metabolites represent a real risk that needs more scrutinising by the scientific community.
Collapse
Affiliation(s)
- P Rodrigues
- Interdisciplinary Centre of Marine and Environmental Research - CIIMAR, University of Porto, Terminal de Cruzeiros do Porto de Leixões Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal; Faculty of Sciences - Biology Department, Rua do Campo Alegre s/n, University of Porto, 4169-007 Porto, Portugal; Institute of Biomedical Sciences Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - L Guimarães
- Interdisciplinary Centre of Marine and Environmental Research - CIIMAR, University of Porto, Terminal de Cruzeiros do Porto de Leixões Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal; Faculty of Sciences - Biology Department, Rua do Campo Alegre s/n, University of Porto, 4169-007 Porto, Portugal.
| | - A P Carvalho
- Interdisciplinary Centre of Marine and Environmental Research - CIIMAR, University of Porto, Terminal de Cruzeiros do Porto de Leixões Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal; Faculty of Sciences - Biology Department, Rua do Campo Alegre s/n, University of Porto, 4169-007 Porto, Portugal
| | - L Oliva-Teles
- Interdisciplinary Centre of Marine and Environmental Research - CIIMAR, University of Porto, Terminal de Cruzeiros do Porto de Leixões Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal; Faculty of Sciences - Biology Department, Rua do Campo Alegre s/n, University of Porto, 4169-007 Porto, Portugal
| |
Collapse
|
2
|
Puranen A, Koponen M, Lähteenvuo M, Tanskanen A, Tiihonen J, Taipale H. Real-world effectiveness of mood stabilizer use in schizophrenia. Acta Psychiatr Scand 2023; 147:257-266. [PMID: 36065482 DOI: 10.1111/acps.13498] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/16/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mood stabilizers (MS) are often used as adjunctive medication in patients with schizophrenia. The aim of this study was to investigate the real-world effectiveness of MS use in persons with schizophrenia. METHODS The study cohort included all persons treated in inpatient care due to schizophrenia during 1972-2014 in Finland (N = 61,889). Drug purchase data were obtained from the national Prescription register and modeled with the PRE2DUP method. The follow-up period covered the years 1996-2017. Mood stabilizers included carbamazepine, valproic acid, lamotrigine, and lithium. The main outcome was psychosis hospitalization. We utilized within-individual design to compare the risk of outcome between time-periods of MS use and non-use within the same person. Stratified Cox regression analyses were conducted with adjusted hazard ratios (aHR) and 95% confidence intervals (CIs). RESULTS Mean age at cohort entry was 46.2 years (SD 16.0) and 50.3% were male. During the follow-up (maximum of 22 years, median 14.8 years, interquartile range 7.5-22.0), 28.1% (N = 17,370) of the study cohort used MS, valproic acid being the most often used one (60.4%, N = 10,483). Risk of psychosis hospitalization was lower during MS use than non-use (aHR 0.88, 95% CI 0.86-0.90). Use of lithium (0.84, 0.81-0.87), valproic acid (0.87, 0.85-0.90), and lamotrigine (0.90, 0.85-0.95) were associated with lower risk of psychosis hospitalization compared with their non-use, whereas carbamazepine use was not. CONCLUSIONS Mood stabilizers were relatively often used as adjunctive treatments in schizophrenia and their use was associated with a 12% decreased risk of psychosis rehospitalization, a marker of relapse in schizophrenia.
Collapse
Affiliation(s)
- Arto Puranen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Heidi Taipale
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| |
Collapse
|
3
|
Poorna T A, Jr L, Ek J, John B, S N, S S. Extracranial schwannoma of the maxillary nerve misdiagnosed as trigeminal neuralgia in an elderly patient with schizophrenia - A diagnostic dilemma. SPECIAL CARE IN DENTISTRY 2023; 43:276-280. [PMID: 35916362 DOI: 10.1111/scd.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
The present paper discusses the diagnostic challenges we faced in a 60-year-old woman with a history of schizophrenia, presenting with left unilateral facial pain for the past three months. Based on the elaborate clinical examination and diagnostic nerve blocks, the patient was diagnosed with trigeminal neuralgia (TN) and non-surgical therapy commenced. Further investigations with magnetic resonance imaging (MRI) and ultrasound-guided fine needle aspiration cytology (FNAC) revealed the presence of an extracranial schwannoma involving a branch of the maxillary nerve. The patient was symptomatically relieved after surgical excision of the benign tumor under general anesthesia. Hence, we emphasize the need for special care and attention in psychiatric patients presenting with orofacial pain.
Collapse
Affiliation(s)
| | - Lokesh Jr
- Government Dental College, Kottayam, Kerala, India
| | - Joshna Ek
- Government Dental College, Kottayam, Kerala, India
| | - Bobby John
- Government Dental College, Kottayam, Kerala, India
| | - Neethu S
- Department of General Pathology, Government Medical College, Kottayam, Kerala, India
| | - Shankar S
- Department of General Pathology, Government Medical College, Kottayam, Kerala, India
| |
Collapse
|
4
|
Structural, Optical and Photocatalytic Properties of Mn Doped ZnO Nanoparticles Used as Photocatalysts for Azo-Dye Degradation under Visible Light. Catalysts 2022. [DOI: 10.3390/catal12111382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Doping ZnO with appropriate foreign metal and/or non-metal ions is one of the most promising ways to improve both the extension of ZnO photosensitization to the visible region and the separation of charge carriers. Herein, Mn-doped ZnO nanoparticles were synthesized using a precipitation method. The effect of the Mn amount on the physico-chemical properties of these nanomaterials was investigated using X-ray diffraction, Fourier-transform infrared spectroscopy, UV–visible diffuse reflectance spectroscopy, photoluminescence spectroscopy and scanning electron microscopy coupled with energy dispersive X-ray spectroscopy. The photocatalytic properties of the synthesized nanomaterials were assessed through methyl orange (MO) under visible light. The obtained results showed that the structural and optical properties of the synthesized Mn-ZnO nanomaterials depended greatly on the Mn amount. It was found that the substitution of Zn2+ by Mn2+/Mn3+ within the lattice of ZnO occurred. The photocatalytic experiments revealed that the sample containing 10 wt% exhibited the best MO conversion. For this sample, the discoloration reached 96%, while the chemical oxygen demand reached 1% after 820 min of visible illumination. The enhanced photocatalytic activity was attributed to the efficient separation of charge carriers. The active species quenching experiments showed that the holes are the main active species in MO degradation under visible light in the presence of 10%Mn-ZnO.
Collapse
|
5
|
Characterization in Inhibitory Effectiveness of Carbamazepine in Voltage-Gated Na + and Erg-Mediated K + Currents in a Mouse Neural Crest-Derived (Neuro-2a) Cell Line. Int J Mol Sci 2022; 23:ijms23147892. [PMID: 35887240 PMCID: PMC9321339 DOI: 10.3390/ijms23147892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 12/18/2022] Open
Abstract
Carbamazepine (CBZ, Tegretol®) is an anticonvulsant used in the treatment of epilepsy and neuropathic pain; however, several unwanted effects of this drug have been noticed. Therefore, the regulatory actions of CBZ on ionic currents in electrically excitable cells need to be reappraised, although its efficacy in suppressing voltage-gated Na+ current (INa) has been disclosed. This study was undertaken to explore the modifications produced by CBZ on ionic currents (e.g., INa and erg-mediated K+ current [IK(erg)]) measured from Neuro-2a (N2a) cells. In these cells, we found that this drug differentially suppressed the peak (transient, INa(T)) and sustained (late, INa(L)) components of INa in a concentration-dependent manner with effective IC50 of 56 and 18 μM, respectively. The overall current–voltage relationship of INa(T) with or without the addition of CBZ remained unchanged; however, the strength (i.e., ∆area) in the window component of INa (INa(W)) evoked by the short ascending ramp pulse (Vramp) was overly lessened in the CBZ presence. Tefluthrin (Tef), a synthetic pyrethroid, known to stimulate INa, augmented the strength of the voltage-dependent hysteresis (Hys(V)) of persistent INa (INa(P)) in response to the isosceles-triangular Vramp; moreover, further application of CBZ attenuated Tef-mediated accentuation of INa(P)’s Hys(V). With a two-step voltage protocol, the recovery of INa(T) inactivation seen in Neuro-2a cells became progressively slowed by adding CBZ; however, the cumulative inhibition of INa(T) evoked by pulse train stimulation was enhanced during exposure to this drug. Neuro-2a-cell exposure to CBZ (100 μM), the magnitude of erg-mediated K+ current measured throughout the entire voltage-clamp steps applied was mildly inhibited. The docking results regarding the interaction of CBZ and voltage-gate Na+ (NaV) channel predicted the ability of CBZ to bind to some amino-acid residues in NaV due to the existence of a hydrogen bond or hydrophobic contact. It is conceivable from the current investigations that the INa (INa(T), INa(L), INa(W), and INa(P)) residing in Neuro-2a cells are susceptible to being suppressed by CBZ, and that its block on INa(L) is larger than that on INa(T). Collectively, the magnitude and gating of NaV channels produced by the CBZ presence might have an impact on its anticonvulsant and analgesic effects occurring in vivo.
Collapse
|
6
|
El Mragui A, Logvina Y, Pinto da Silva L, Zegaoui O, Esteves da Silva JC. Synthesis of Fe- and Co-Doped TiO 2 with Improved Photocatalytic Activity Under Visible Irradiation Toward Carbamazepine Degradation. MATERIALS 2019; 12:ma12233874. [PMID: 31771256 PMCID: PMC6926595 DOI: 10.3390/ma12233874] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022]
Abstract
Pure TiO2 and Fe- and Co-doped TiO2 nanoparticles (NPs) as photocatalysts were synthesized using wet chemical methods (sol-gel + precipitation). Their crystalline structure and optical properties were analyzed using X-ray diffraction (XRD), Raman spectroscopy and Fourier-transform infrared (FTIR) spectroscopy, ultraviolet-visible light (UV-Vis) diffuse reflectance spectroscopy (DRS), and photoluminescence (PL) spectroscopy. The photocatalytic activity of the synthesized nanoparticles was evaluated through degradation of carbamazepine (CBZ) under UV-A and visible-light irradiations. The XRD and Raman analyses revealed that all synthesized nanomaterials showed only the anatase phase. The DRS results showed that the absorption edge was blue-shifted for Fe-doped TiO2 NPs. The decrease in charge recombination was evidenced from the PL investigation for both Co-doped and Fe-doped TiO2 nanomaterials. An enhancement in photocatalytic degradation of carbamazepine in aqueous suspension under both UV-A light and visible-light irradiations was observed for Fe-doped Titania NPs by comparison with pure TiO2. These results suggest that the doping cations could suppress the electron/hole recombination. Therefore, the photocatalytic activity of TiO2-based nanomaterials was enhanced.
Collapse
Affiliation(s)
- Abderrahim El Mragui
- Chemistry Research Unit (CIQUP), Faculty of Sciences of University of Porto, Rua do Campo Alegre 697, 4169-007 Porto, Portugal; (A.E.M.); (Y.L.); (L.P.d.S.)
- Research team “Materials and Applied Catalysis: MCA”, “CBAE” Laboratory, Faculty of Sciences, Moulay Ismail University, BP.11201 Zitoune, Meknès, Morocco;
| | - Yuliya Logvina
- Chemistry Research Unit (CIQUP), Faculty of Sciences of University of Porto, Rua do Campo Alegre 697, 4169-007 Porto, Portugal; (A.E.M.); (Y.L.); (L.P.d.S.)
| | - Luís Pinto da Silva
- Chemistry Research Unit (CIQUP), Faculty of Sciences of University of Porto, Rua do Campo Alegre 697, 4169-007 Porto, Portugal; (A.E.M.); (Y.L.); (L.P.d.S.)
- LACOMEPHI, GreenUPorto, Department of Geosciences, Environment and Territorial Planning, Faculty of Sciences, University of Porto, Rua do Campo Alegre 697, 4169-007 Porto, Portugal
| | - Omar Zegaoui
- Research team “Materials and Applied Catalysis: MCA”, “CBAE” Laboratory, Faculty of Sciences, Moulay Ismail University, BP.11201 Zitoune, Meknès, Morocco;
| | - Joaquim C.G. Esteves da Silva
- Chemistry Research Unit (CIQUP), Faculty of Sciences of University of Porto, Rua do Campo Alegre 697, 4169-007 Porto, Portugal; (A.E.M.); (Y.L.); (L.P.d.S.)
- LACOMEPHI, GreenUPorto, Department of Geosciences, Environment and Territorial Planning, Faculty of Sciences, University of Porto, Rua do Campo Alegre 697, 4169-007 Porto, Portugal
- Correspondence: ; Tel.: +351-220-402-569
| |
Collapse
|
7
|
Pennou A, Lecomte T, Potvin S, Khazaal Y. Mobile Intervention for Individuals With Psychosis, Dual Disorders, and Their Common Comorbidities: A Literature Review. Front Psychiatry 2019; 10:302. [PMID: 31130884 PMCID: PMC6510170 DOI: 10.3389/fpsyt.2019.00302] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/17/2019] [Indexed: 12/24/2022] Open
Abstract
Over 50% of people diagnosed with a severe mental illness, such as schizophrenia or bipolar disorder, will meet criteria for a substance use disorder in their lifetime. This dual disorder often starts during youth and leads to significant societal costs, including lower employability rates, more hospitalizations, and higher risk of homelessness and of suicide attempts when compared to those with a serious mental illness without substance misuse. Moreover, many individuals presenting with comorbid disorders also present with other psychological difficulties as well, such as personality disorders or anxiety and depression, also known as complex comorbid disorders. Transdiagnostic treatments that focus on core difficulties found in people with complex dual disorders, such as emotional regulation, are direly needed. Emotional regulation skills can help reduce distress related to psychotic symptoms and maintain abstinence in substance use disorders. New technologies in the field of communications have developed considerably over the past decade and have the potential to improve access to such treatments, a major problem in many health care settings. As such, this paper aims at: presenting core difficulties present in many individuals with dual disorders, reviewing the scientific literature pertaining to the use of mobile applications in mental health and addictions, and presenting the development and potential of a new application for emotional regulation for people with dual disorders.
Collapse
Affiliation(s)
- Antoine Pennou
- Schizophrenia and Psychoses Study Laboratory for Intervention and Recovery, Department of Psychology, University of Montreal, Montreal, QC, Canada
- Research Center of the Montreal Mental Health University Institute, Intervention Axis and Services & Neurobiology and Cognition, Mental Health University Institute of Montreal, Montreal, QC, Canada
| | - Tania Lecomte
- Schizophrenia and Psychoses Study Laboratory for Intervention and Recovery, Department of Psychology, University of Montreal, Montreal, QC, Canada
- Research Center of the Montreal Mental Health University Institute, Intervention Axis and Services & Neurobiology and Cognition, Mental Health University Institute of Montreal, Montreal, QC, Canada
| | - Stéphane Potvin
- Research Center of the Montreal Mental Health University Institute, Intervention Axis and Services & Neurobiology and Cognition, Mental Health University Institute of Montreal, Montreal, QC, Canada
| | - Yasser Khazaal
- Research Center of the Montreal Mental Health University Institute, Intervention Axis and Services & Neurobiology and Cognition, Mental Health University Institute of Montreal, Montreal, QC, Canada
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
8
|
Stroup TS, Gerhard T, Crystal S, Huang C, Tan Z, Wall MM, Mathai C, Olfson M. Comparative Effectiveness of Adjunctive Psychotropic Medications in Patients With Schizophrenia. JAMA Psychiatry 2019; 76:508-515. [PMID: 30785609 PMCID: PMC6495353 DOI: 10.1001/jamapsychiatry.2018.4489] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE People with schizophrenia are commonly treated with psychotropic medications in addition to antipsychotics, but there is little evidence about the comparative effectiveness of these adjunctive treatment strategies. OBJECTIVE To study the comparative real-world effectiveness of adjunctive psychotropic treatments for patients with schizophrenia. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study used US national Medicaid data from January 1, 2001, to December 31, 2010, to examine the outcomes of initiating treatment with an antidepressant, a benzodiazepine, a mood stabilizer, or another antipsychotic among adult outpatients (aged 18-64 years) diagnosed with schizophrenia who were stably treated with a single antipsychotic. Data analysis was performed from January 1, 2017, to June 30, 2018. Multinomial logistic regression models were used to estimate propensity scores to balance covariates across the 4 medication groups. Weighted Cox proportional hazards regression models were used to compare treatment outcomes during 365 days on an intention-to-treat basis. MAIN OUTCOMES AND MEASURES Risk of hospitalization for a mental disorder (primary), emergency department (ED) visits for a mental disorder, and all-cause mortality. RESULTS The study cohort included 81 921 adult outpatients diagnosed with schizophrenia (mean [SD] age, 40.7 [12.4] years; 37 515 women [45.8%]) who were stably treated with a single antipsychotic and then initiated use of an antidepressant (n = 31 117), a benzodiazepine (n = 11 941), a mood stabilizer (n = 12 849), or another antipsychotic (n = 26 014) (reference treatment). Compared with initiating use of another antipsychotic, initiating use of an antidepressant was associated with a lower risk (hazard ratio [HR], 0.84; 95% CI, 0.80-0.88) of psychiatric hospitalization, whereas initiating use of a benzodiazepine was associated with a higher risk (HR, 1.08; 95% CI, 1.02-1.15); the risk associated with initiating use of a mood stabilizer (HR, 0.98; 95% CI, 0.94-1.03) was not significantly different from initiating use of another antipsychotic. A similar pattern of associations was observed in psychiatric ED visits for initiating use of an antidepressant (HR, 0.92; 95% CI, 0.88-0.96), a benzodiazepine (HR, 1.12; 95% CI, 1.07-1.19), and a mood stabilizer (HR, 0.99; 95% CI, 0.94-1.04). Initiating use of a mood stabilizer was associated with an increased risk of mortality (HR, 1.31; 95% CI, 1.04-1.66). CONCLUSIONS AND RELEVANCE In the treatment of schizophrenia, initiating adjunctive treatment with an antidepressant was associated with reduced risk of psychiatric hospitalization and ED visits compared with initiating use of alternative psychotropic medications. Associations of benzodiazepines and mood stabilizers with poorer outcomes warrant clinical caution and further investigation.
Collapse
Affiliation(s)
- T. Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York
| | - Tobias Gerhard
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Cecilia Huang
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Zhiqiang Tan
- Department of Statistics and Biostatistics, Rutgers University, Piscataway, New Jersey
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York
| | - Chacku Mathai
- Mental Health Association of Rochester, Rochester, New York
| | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York
| |
Collapse
|
9
|
Lago SG, Bahn S. Clinical Trials and Therapeutic Rationale for Drug Repurposing in Schizophrenia. ACS Chem Neurosci 2019; 10:58-78. [PMID: 29944339 DOI: 10.1021/acschemneuro.8b00205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
There is a paucity of efficacious novel drugs to address high rates of treatment resistance and refractory symptoms in schizophrenia. The identification of novel therapeutic indications for approved drugs-drug repurposing-has the potential to expedite clinical trials and reduce the costly risk of failure which currently limits central nervous system drug discovery efforts. In the present Review we discuss the historical role of drug repurposing in schizophrenia drug discovery and review the main classes of repurposing candidates currently in clinical trials for schizophrenia in terms of their therapeutic rationale, mechanisms of action, and preliminary results from clinical trials. Subsequently we outline the challenges and limitations which face the clinical repurposing pipeline and how novel technologies might serve to address these.
Collapse
Affiliation(s)
- Santiago G. Lago
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge CB3 0AS, U.K
| | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge CB3 0AS, U.K
| |
Collapse
|
10
|
Correll CU, Rubio JM, Inczedy-Farkas G, Birnbaum ML, Kane JM, Leucht S. Efficacy of 42 Pharmacologic Cotreatment Strategies Added to Antipsychotic Monotherapy in Schizophrenia: Systematic Overview and Quality Appraisal of the Meta-analytic Evidence. JAMA Psychiatry 2017; 74:675-684. [PMID: 28514486 PMCID: PMC6584320 DOI: 10.1001/jamapsychiatry.2017.0624] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Limited treatment responses in schizophrenia prompted the testing of combining an antipsychotic drug treatment with a second psychotropic medication. A comprehensive evaluation of the efficacy of multiple medication combinations is missing. OBJECTIVE To summarize and compare the meta-analytically determined efficacy of pharmacologic combination strategies of antipsychotic drugs in adults with schizophrenia. DATA SOURCES Systematic search of PubMed and PsycInfo until May 13, 2016. STUDY SELECTION Meta-analyses of randomized clinical trials comparing the efficacy of antipsychotic drugs combined with other antipsychotic or nonantipsychotic medications vs placebos or antipsychotic monotherapy among adults with schizophrenia. DATA EXTRACTION AND SYNTHESIS Independent reviewers extracted the data and assessed the quality of the methods of the included meta-analyses using A Measurement Tool to Assess Systematic Reviews (AMSTAR), adding 6 new items to rate their quality. Effect sizes, expressed as standardized mean difference /Hedges g or risk ratio, were compared separately for combinations with any antipsychotic drug and for combinations with clozapine. MAIN OUTCOMES AND MEASURES The primary outcome was total symptom reduction. Secondary outcomes included positive and negative symptoms, treatment recommendations by authors, study-defined inefficacies, cognitive and depressive symptoms, discontinuation of treatment because of any cause, and inefficacies or intolerabilities. RESULTS Of 3397 publications, 29 meta-analyses testing 42 combination strategies in 381 individual trials and among 19 833 participants were included. For total symptom reductions, 32 strategies that augmented any antipsychotic drug and 5 strategies that augmented clozapine were examined. Fourteen combination treatments outperformed controls (standard mean difference/Hedges g, -1.27 [95% CI, -2.35 to -0.19] to -0.23 [95% CI, -0.44 to -0.02]; P = .05). No combination strategies with clozapine outperformed controls. The quality of the methods of the meta-analyses was generally high (mean score, 9 of a maximum score of 11) but the quality of the meta-analyzed studies was low (mean score, 2.8 of a maximum score of 8). Treatment recommendations correlated with the effect size (correlation coefficient, 0.22; 95% CI, 0.35-0.10; P < .001), yet effect sizes were inversely correlated with study quality (correlation coefficient, -0.06; 95% CI, 0.01 to -0.12; P = .02). CONCLUSIONS AND RELEVANCE Meta-analyses of 21 interventions fully or partially recommended their use, with recommendations being positively correlated with the effect sizes of the pooled intervention. However, the effect sizes were inversely correlated with meta-analyzed study quality, reducing confidence in these recommendations. Higher-quality trials and patient-based meta-analyses are needed to determine whether subpopulations might benefit from combination treatment, as no single strategy can be recommended for patients with schizophrenia based on the current meta-analytic literature.
Collapse
Affiliation(s)
- Christoph U. Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York,Hofstra Northwell School of Medicine, Hempstead, New York,The Feinstein Institute for Medical Research, Manhasset, New York
| | - Jose M. Rubio
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York
| | | | - Michael L. Birnbaum
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York,Hofstra Northwell School of Medicine, Hempstead, New York,The Feinstein Institute for Medical Research, Manhasset, New York
| | - John M. Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York,Hofstra Northwell School of Medicine, Hempstead, New York,The Feinstein Institute for Medical Research, Manhasset, New York
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| |
Collapse
|
11
|
Factors associated with expression of extrapyramidal symptoms in users of atypical antipsychotics. Eur J Clin Pharmacol 2016; 73:351-355. [DOI: 10.1007/s00228-016-2166-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/18/2016] [Indexed: 02/06/2023]
|
12
|
Abstract
BACKGROUND Many people with schizophrenia do not achieve a satisfactory treatment response with ordinary anti-psychotic drug treatment. In these cases, various add-on medications are used, among them lithium. OBJECTIVES To assess whether:1. Lithium alone is an effective treatment for schizophrenia, schizophrenia-like psychoses and schizoaffective psychoses; and2. Lithium augmentation of antipsychotic medication is an effective treatment for the same illnesses. SEARCH METHODS In July 2012, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. This search was updated on January 20, 2015. For the first version of the review, we also contacted pharmaceutical companies and authors of relevant studies to identify further trials and obtain original participant data. SELECTION CRITERIA Randomised controlled trials (RCTs) of lithium compared with antipsychotics or placebo (or no intervention), whether as sole treatment or as an adjunct to antipsychotic medication, in the treatment of schizophrenia or schizophrenia-like psychoses or both. DATA COLLECTION AND ANALYSIS We extracted data independently. For dichotomous data, we calculated random-effects meta-analyses, risk ratios (RRs), and 95% confidence intervals (CI) on an intention-to-treat basis. For continuous data, we calculated mean differences (MD) and 95% confidence intervals. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to create 'Summary of findings' tables and assessed risk of bias for included studies. MAIN RESULTS The update search in 2012 detected two further studies that met our inclusion criteria. We did not find any further studies that met our inclusion criteria in the 2015 search. This review now includes 22 studies, with a total of 763 participants (median mean age: 35 years, range: 26 to 72 years). Most studies were small, of short duration, and incompletely reported. As we detected a high risk of bias in many studies, the overall methodological quality of the included sample was rather low.Three small studies comparing lithium with placebo as the sole treatment showed no difference in any of the outcomes we analysed.In eight studies comparing lithium with antipsychotic drugs as the sole treatment, more participants in the lithium group left the studies early (eight RCTs; n = 270, RR 1.77, 95% CI 1.01 to 3.11, low quality evidence).Thirteen studies examined whether the augmentation of antipsychotic drugs with lithium salts is more effective than antipsychotic drugs alone. More participants who received lithium augmentation had a clinically significant response (10 RCTs; n = 396, RR 1.81, 95% CI 1.10 to 2.97, low quality evidence). However, this effect became non-significant when we excluded participants with schizoaffective disorders in a sensitivity analysis (seven RCTs; n = 272, RR 1.64, 95% CI 0.95 to 2.81), when we excluded non-double-blind studies (seven RCTs; n = 224, RR 1.82, 95% CI 0.84 to 3.96), or when we excluded studies with high attrition (nine RCTs; n = 355, RR 1.67, CI 0.93 to 3.00). The overall acceptability of treatment (measured by the number of participants leaving the studies early) was not significantly different between groups (11 RCTs; n = 320, RR 1.89, CI 0.93 to 3.84, very low quality evidence). Few studies reported on side effects. There were no significant differences, but the database is too limited to make any judgement in this regard. For example, there were no data on thyroid dysfunction and kidney problems - two major and well-known side effects of lithium. AUTHORS' CONCLUSIONS The evidence base for the use of lithium in schizophrenia is limited to 22 studies of overall low methodological quality. There is no randomised trial-based evidence that lithium on its own is an effective treatment for people with schizophrenia. There is some GRADE low quality evidence that augmentation of antipsychotics with lithium is effective, but the effects are not significant when more prone-to-bias open RCTs are excluded. Nevertheless, further large and well-designed trials are justified. These should concentrate on two target groups: (1) people with no affective symptoms, so that trialists can determine whether lithium has an effect on the core symptoms of schizophrenia, and (2) people with schizoaffective disorders for whom lithium is widely used in clinical practice, although there is no evidence to support this use.
Collapse
Affiliation(s)
- Stefan Leucht
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieIsmaninger Straße 22MünchenGermany81675
| | - Bartosz Helfer
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieIsmaninger Straße 22MünchenGermany81675
| | - Markus Dold
- Medical University of ViennaDepartment of Psychiatry and PsychotherapyWähringer Gürtel 18‐20ViennaAustria1090
| | - Werner Kissling
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieIsmaninger Straße 22MünchenGermany81675
| | - John J McGrath
- The Park Centre for Mental HealthQueensland Centre for Mental Health ResearchWolston Park RoadWacolBrisbaneQueenslandAustralia4076
| | | |
Collapse
|
13
|
Sinclair D, Adams CE. Treatment resistant schizophrenia: a comprehensive survey of randomised controlled trials. BMC Psychiatry 2014; 14:253. [PMID: 25227719 PMCID: PMC4177431 DOI: 10.1186/s12888-014-0253-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 08/28/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Schizophrenia is a common serious mental health condition which has significant morbidity and financial consequences. The mainstay of treatment has been antipsychotic medication but one third of people will have a 'treatment resistant' and most disabling and costly illness. The aim of this survey was to produce a broad overview of available randomised evidence for interventions for people whose schizophrenic illness has been designated 'treatment resistant'. METHOD We searched the Cochrane Schizophrenia Group's comprehensive Trials Register, selected all relevant randomised trials and, taking care not to double count, extracted the number of people randomised within each study. Finally we sought relevant reviews on the Cochrane Library and investigated how data on this subgroup of people had been presented. RESULTS We identified 542 relevant papers based on 268 trials (Average size 64.8 SD 61.6, range 7-526, median 56 IQR 47.3, mode 60). The most studied intervention is clozapine with 82 studies (total n = 6299) comparing it against other anti-psychotic medications. Cognitive behavioural therapy (CBT), electroconvulsive therapy (ECT), or transcranial magnetic stimulation (TMS) supplementing a standard care and risperidone supplementation of clozapine has also been extensively evaluated within trials. Many approaches, however, were clearly under researched. There were only four studies investigating combinations of non-clozapine antipsychotics. Only two psychological approaches (CBT and Family Rehabilitation Training) had more than two studies. Cochrane reviews rarely presented data specific to this important clinical sub-group. CONCLUSIONS This survey provides a broad taxonomy of how much evaluative research has been carried out investigating interventions for people with treatment resistant schizophrenia. Over 280 trials have been undertaken but, with a few exceptions, most treatment approaches--and some in common use--have only one or two relevant but small trials. Too infrequently the leading reviews fail to highlight the paucity of evidence in this area--as these reviews are maintained this shortcoming should be addressed.
Collapse
Affiliation(s)
- Diarmid Sinclair
- />Sheffield Health and Social Care NHS Foundation Trust, Fullwood House, 5 Old Fulwood Rd, Sheffield, South Yorkshire S10 3TG UK
| | - Clive E Adams
- />Cochrane Schizophrenia Group, Institute of Mental Health, University of Nottingham, Nottingham, UK
| |
Collapse
|