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Matsumoto SS, Koizumi H, Shimazu H, Goto S. Therapeutic Effects of Dual Dopaminergic Modulation With l-DOPA and Chlorpromazine in Patients With Idiopathic Cervical Dystonia. Neurol Clin Pract 2024; 14:e200254. [PMID: 38223351 PMCID: PMC10783972 DOI: 10.1212/cpj.0000000000200254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024]
Abstract
Objectives Imbalanced activities between dopamine D1 and D2 signals in striatal striosome-matrix system have been proposed as a cause of dystonia symptoms. The aim of this study was to assess the therapeutic effects of dual dopaminergic modulation (DDM) with l-DOPA and chlorpromazine (CPZ) in patients with idiopathic cervical dystonia (CD). Methods We enrolled 21 patients with CD who responded poorly to botulinum toxin treatment. The severities of CD motor symptoms and CD-associated pain were determined using the Toronto Western Spasmodic Torticollis Rating Scale and the visual analog scale, respectively. Results In patients with CD (n = 7), oral administration of l-DOPA combined with CPZ significantly attenuated both CD motor symptoms and CD-associated pain in a dose-related manner. By contrast, there was no improvement of CD symptoms in patients (n = 7) who ingested l-DOPA alone nor in those (n = 7) who ingested CPZ alone. Discussion DDM with l-DOPA and CPZ may be an effective tool to treat dystonia symptoms in patients with botulinum toxin-resistant idiopathic CD. Our results may also indicate that CD dystonia symptoms could be attenuated through DDM inducing an increase in striosomal D1-signaling. Classification of Evidence This study provides Class III evidence that treatment of botulinum toxin-resistant idiopathic cervical dystonia with l-DOPA and chlorpromazine is superior to either one alone.
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Affiliation(s)
- Shinichi S Matsumoto
- Department of Neurology (SSM), Osaka Neurological Institute; Department of Neurology (HK), Kyoto Prefectural Rehabilitation Hospital for the Disabled, Nakaashihara; Department of Pharmacology (HS), School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Hyogo; Center for Drug Discovery and Development Sciences (SG), Research Organization of Science and Technology, Ritsumeikan University, Kyoto; and Department of Clinical Neuroscience (SG), Institute of Biomedical Sciences, Tokushima University, Japan
| | - Hidetaka Koizumi
- Department of Neurology (SSM), Osaka Neurological Institute; Department of Neurology (HK), Kyoto Prefectural Rehabilitation Hospital for the Disabled, Nakaashihara; Department of Pharmacology (HS), School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Hyogo; Center for Drug Discovery and Development Sciences (SG), Research Organization of Science and Technology, Ritsumeikan University, Kyoto; and Department of Clinical Neuroscience (SG), Institute of Biomedical Sciences, Tokushima University, Japan
| | - Hideki Shimazu
- Department of Neurology (SSM), Osaka Neurological Institute; Department of Neurology (HK), Kyoto Prefectural Rehabilitation Hospital for the Disabled, Nakaashihara; Department of Pharmacology (HS), School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Hyogo; Center for Drug Discovery and Development Sciences (SG), Research Organization of Science and Technology, Ritsumeikan University, Kyoto; and Department of Clinical Neuroscience (SG), Institute of Biomedical Sciences, Tokushima University, Japan
| | - Satoshi Goto
- Department of Neurology (SSM), Osaka Neurological Institute; Department of Neurology (HK), Kyoto Prefectural Rehabilitation Hospital for the Disabled, Nakaashihara; Department of Pharmacology (HS), School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Hyogo; Center for Drug Discovery and Development Sciences (SG), Research Organization of Science and Technology, Ritsumeikan University, Kyoto; and Department of Clinical Neuroscience (SG), Institute of Biomedical Sciences, Tokushima University, Japan
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Chaudhary A, Mehra P, Keshri AK, Rawat SS, Mishra A, Prasad A. The Emerging Role of Toll-Like Receptor-Mediated Neuroinflammatory Signals in Psychiatric Disorders and Acquired Epilepsy. Mol Neurobiol 2024; 61:1527-1542. [PMID: 37725212 DOI: 10.1007/s12035-023-03639-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
The new and evolving paradigms of psychiatric disorders pathogenesis are deeply inclined toward chronic inflammation that leads to disturbances in the neuronal networks of patients. A strong association has been established between the inflammation and neurobiology of depression which is mediated by different toll-like receptors (TLRs). TLRs and associated signalling pathways are identified as key immune regulators to stress and infections in neurobiology. They are a special class of transmembrane proteins, which are one of the broadly studied members of the Pattern Recognition Patterns family. This review focuses on summarizing the important findings on the role of TLRs associated with psychotic disorders and acquired epilepsy. This review also shows the promising potential of TLRs in immune response mediated through antidepressant therapies and TLRs polymorphism associated with various psychotic disorders. Moreover, this also sheds light on future directions to further target TLRs as a therapeutic approach for psychiatric disorders.
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Affiliation(s)
- Anubha Chaudhary
- School of Biosciences and Bioengineering, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, 175005, India
| | - Parul Mehra
- School of Biosciences and Bioengineering, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, 175005, India
| | - Anand K Keshri
- School of Biosciences and Bioengineering, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, 175005, India
| | - Suraj S Rawat
- School of Biosciences and Bioengineering, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, 175005, India
| | - Amit Mishra
- Cellular and Molecular Neurobiology Unit, Indian Institute of Technology Jodhpur, Jodhpur, Rajasthan, 342011, India
| | - Amit Prasad
- School of Biosciences and Bioengineering, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, 175005, India.
- Indian Knowledge System and Mental Health Application Centre, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, 175005, India.
- Human Computer Interface Centre, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, 175005, India.
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Matsumoto S, Koizumi H, Shimazu H, Kaji R, Goto S. A dual dopaminergic therapy with L-3,4-dihydroxyphenylalanine and chlorpromazine for the treatment of blepharospasm, a focal dystonia: Possible implications for striosomal D1 signaling. Front Neurol 2022. [DOI: 10.3389/fneur.2022.922333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Impairment of balanced activity between dopamine D1 and D2 receptor functions in the striatum, particularly in striatal functional subdivisions (i.e., striosome and matrix compartments), has been proposed to underlie dystonia genesis. This study was undertaken to examine the therapeutic effect of dual dopaminergic modulation with L-3,4-dihydroxyphenylalanine (L-DOPA) and chlorpromazine (CPZ) in patients with blepharospasm, a focal dystonia. For this purpose, Dopacol tablets™ (L-DOPA 50 mg plus carbidopa 5 mg) and Wintermin™ (CPZ phenolphthalinate 180 mg/g) were used. Clinical evaluations were performed before and after an 8-week drug treatment interval using the Visual Analog Scale (VAS), Blepharospasm Disability Index (BSDI), modified VAS (mVAS), and Jankovic Rating Scale (JRS). The data were analyzed using non-parametric statistics. Results showed that in patients (n = 7) with blepharospasm, dystonia symptoms were significantly alleviated by the administration of both Dopacol tablets™ (one tablet × 3/day) and CPZ (5 mg × 3/day), as determined using the VAS, BSDI, mVAS, and JRS. In contrast, there was no improvement of dystonia symptoms in patients (n = 7) who ingested Dopacol tablets™ (one tablet × 3/day) alone, nor in those (n = 7) who ingested CPZ (5 mg × 3/day) alone. Thus, dual pharmacotherapy with L-DOPA and CPZ can exert a therapeutic effect on blepharospasm, suggesting that dystonia symptoms can be attenuated through dopaminergic modulation with inducing an increase in striatal D1-signals. Since dopamine D1 receptors are heavily enriched in the striosome compartment in the “human” striatum, our results also suggest that striosomal loss of D1-signaling may be important in the pathogenesis of dystonia.
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Eslami Shahrbabaki M, Dehnavieh R, Vali L, Sharafkhani R. Chlorpromazine versus piperacetazine for schizophrenia. Cochrane Database Syst Rev 2018; 10:CD011709. [PMID: 30378678 PMCID: PMC6517193 DOI: 10.1002/14651858.cd011709.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Schizophrenia is a severe mental disorder with a prevalence of about 1% among the general population. It is listed among the top 10 causes of disability-adjusted life years (DALYs) worldwide. Antipsychotics are the mainstay treatment. Piperacetazine has been reported to be as clinically effective as chlorpromazine, a well established 'benchmark' antipsychotic, for people with schizophrenia. However, the side effect profiles of these antipsychotics differ and it is important that an evidence base is available comparing the benefits, and potential harms of these two antipsychotics. OBJECTIVES To assess the clinical and side effects of chlorpromazine for people with schizophrenia and schizophrenia-like psychoses in comparison with piperacetazine. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (6 June 2015 and 8 October 2018) which is based on regular searches of CINAHL, CENTRAL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO and registries of clinical trials. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA We included randomised controlled trials (RCTs) focusing on chlorpromazine versus piperacetazine for people with schizophrenia, reporting useable data. DATA COLLECTION AND ANALYSIS We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS We found 12 records referring to six trials. We included five trials, all from the 1970s, randomising 343 participants. We excluded one trial. The overall methodology and data reporting by the trials was poor. Only short-term data were available.Results from the included trials found that, in terms of global state improvement, when rated by a psychiatrist, there was no clear difference between chlorpromazine and piperacetazine (RR 0.90, 95% CI 0.80 to 1.02; participants = 208; studies = 2; very low-quality evidence). One trial reported change scores on the mental state scale Brief Psychiatric Rating Scale (BPRS); no clear difference was observed (MD -0.40, 95% CI -1.41 to 0.61; participants = 182; studies = 1; very low-quality evidence). Chlorpromazine appears no worse or better than piperacetazine regarding adverse effects. In both treatment groups, around 60% of participants experienced some sort of adverse effect (RR 1.00, 95% CI 0.75 to 1.33; participants = 74; studies = 3; very low-quality evidence), with approximately 40% of these participants experiencing some parkinsonism-type movement disorder (RR 0.95, CI 0.61 to 1.49; participants = 106; studies = 3; very low-quality evidence). No clear difference in numbers of participants leaving the study early for any reason was observed (RR 0.50, 95% CI 0.10 to 2.56; participants = 256; studies = 4; very low-quality evidence). No trial reported data for change in negative symptoms or economic costs. AUTHORS' CONCLUSIONS The results of this review show chlorpromazine and piperacetazine may have similar clinical efficacy, but data are based on very small numbers of participants and the evidence is very low quality. We can not make firm conclusions based on such data. Currently, should clinicians and people with schizophrenia need to choose between chlorpromazine and piperacetazine they should be aware there is no good quality evidence to base decisions. More high quality research is needed.
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Affiliation(s)
- Mahin Eslami Shahrbabaki
- Kerman University of Medical Sciences, Afzalipour School of MedicineNeuroscience Research Centre, Institute of Neuropharmacology, Department of PsychiatryKermanIran7618834115
| | - Reza Dehnavieh
- Kerman University of Medical SciencesHealth Services Management Research Centre, Institute for Futures Studies in HealthHaft Bagh RoadKermanIran
| | - Leila Vali
- Kerman University of Medical SciencesEnvironmental Health Engineering Research CentreKermanIran
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Rothe PH, Heres S, Leucht S. Dose equivalents for second generation long-acting injectable antipsychotics: The minimum effective dose method. Schizophr Res 2018; 193:23-28. [PMID: 28735640 DOI: 10.1016/j.schres.2017.07.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/11/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The concept of dose equivalence of depot medication is important for many scientific and clinical purposes. METHODS A systematic literature search on four second-generation antipsychotics available as long-acting injectable drugs and haloperidol was conducted. We used the minimum effective dose method which is based on randomized fixed dose studies where the smallest dose which was significantly more efficacious than placebo in the primary outcome was declared as minimum effective dose. We calculated equivalent doses from acute phase studies but we also reported the minimum effective doses found in relapse prevention studies. RESULTS The acute phase minimum effective doses/olanzapine equivalents were: aripiprazole lauroxil 441mg (300mg aripiprazole)/4wks/0.71; aripiprazole 400mg/4weeks/0.95 (aripiprazole maintena); paliperidone palmitate 25mg/4weeks/0,06; risperidone 25mg/2weeks/0,12; RBP-7000 90mg/4weeks/0,21; olanzapine 210mg/2weeks/1. CONCLUSIONS The minimum effective dose method is an operationalized and evidence-based approach for determining antipsychotic dose equivalence which can also be applied to long-acting injectable formulations. Doses may not have been chosen low enough to find the truly minimum effective dose. Comparisons with other methods will be necessary to come to ultimate conclusions.
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Affiliation(s)
- Philipp H Rothe
- kbo-Klinik Taufkirchen (Vils), Departement of Forensic Psychiatry, Taufkirchen (Vils), Germany; Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany.
| | - Stephan Heres
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
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Turk T, Zuhri Yafi R, Namous L, Alkhaledi A, Salahia S, Haider AY, Essali A. Fluphenazine (dose) for people with schizophrenia. Hippokratia 2017. [DOI: 10.1002/14651858.cd012848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tarek Turk
- Damascus University; Faculty of Medicine; Mazzeh Street Damascus Syrian Arab Republic
| | - Ruba Zuhri Yafi
- Damascus University; Faculty of Medicine; Mazzeh Street Damascus Syrian Arab Republic
| | - Lubaba Namous
- Cairo University; Faculty of Medicine; Gamal Abdelnaser St Giza Cairo Egypt 11562
| | - Ahmad Alkhaledi
- Damascus University; Faculty of Medicine; Mazzeh Street Damascus Syrian Arab Republic
| | - Sami Salahia
- Ain Shams University; Faculty of Medicine; 391 Ramsis St, Al Abbaseya Cairo Abbasseya Egypt
| | - Al Yaman Haider
- Damascus University; Faculty of Medicine; Mazzeh Street Damascus Syrian Arab Republic
| | - Adib Essali
- Waikato District Health Board; Manaaki Centre; crn Rolleston and Mary Streets Thames New Zealand 3575
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Yazici E, S Cilli A, Yazici AB, Baysan H, Ince M, Bosgelmez S, Bilgic S, Aslan B, Erol A. Antipsychotic Use Pattern in Schizophrenia Outpatients: Correlates of Polypharmacy. Clin Pract Epidemiol Ment Health 2017; 13:92-103. [PMID: 29081826 PMCID: PMC5633702 DOI: 10.2174/1745017901713010092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 05/24/2017] [Accepted: 06/22/2017] [Indexed: 02/03/2023]
Abstract
Background: This study investigates the antipsychotic use patterns of patients with schizophrenia and its correlations in their daily drug use patterns. Methods: Patients with schizophrenia who have regular records at two different community counselling centres (CCS) were included in the study. Information about their medications and sociodemographic data was recorded through face-to-face interviews and supporting information about their drug use patterns was obtained from their relatives/caregivers/nurse. The Clinical Global Impression Scale (severity of illness) and the General Assessment of Functionality scales were also administered. Results: Patients with schizophrenia used 2.0 ± 0.81 antipsychotics daily and 3.52 ± 2.55 pills (1–18). Seventy-one percent of the patients used two or more kinds of psychotropic drugs. The most frequently used antipsychotics were quetiapine, a second generation antipsychotic, and haloperidol, a typical antipsychotic. Clinical severity, regular visits to a CCS and use of depot antipsychotics were independent predictors for polypharmacy. Conclusion: The rate of polypharmacy use is high in Turkey. There are multiple risk factors related with polipharmacy. New studies should focus risk factors for preventing polypharmacy.
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Affiliation(s)
- Esra Yazici
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Ali S Cilli
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Ahmet B Yazici
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Hayriye Baysan
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Mustafa Ince
- Kocaeli Derince Training and Research Hospital - Psychiatry Kocaeli, Kocaeli, Turkey
| | - Sukriye Bosgelmez
- Kocaeli Derince Training and Research Hospital - Psychiatry Kocaeli, Kocaeli, Turkey
| | - Serkan Bilgic
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Betul Aslan
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Atila Erol
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
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Abstract
BACKGROUND The World Health Organization (WHO) Model Lists of Essential Medicines lists chlorpromazine as one of its five medicines used in psychotic disorders. OBJECTIVES To determine chlorpromazine dose response and dose side-effect relationships for schizophrenia and schizophrenia-like psychoses. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (December 2008; 2 October 2014; 19 December 2016). SELECTION CRITERIA All relevant randomised controlled trials (RCTs) comparing low doses of chlorpromazine (≤ 400 mg/day), medium dose (401 mg/day to 800 mg/day) or higher doses (> 800 mg/day) for people with schizophrenia, and which reported clinical outcomes. DATA COLLECTION AND ANALYSIS We included studies meeting review criteria and providing useable data. Review authors extracted data independently. For dichotomous data, we calculated fixed-effect risk ratios (RR) and their 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MD) and their 95% CIs based on a fixed-effect model. We assessed risk of bias for included studies and graded trial quality using GRADE (Grading of Recommendations Assessment, Development and Evaluation). MAIN RESULTS As a result of searches undertaken in 2014, we found one new study and in 2016 more data for already included studies. Five relevant studies with 1132 participants (585 are relevant to this review) are now included. All are hospital-based trials and, despite over 60 years of chlorpromazine use, have durations of less than six months and all are at least at moderate risk of bias. We found only data on low-dose (≤ 400 mg/day) versus medium-dose chlorpromazine (401 mg/day to 800 mg/day) and low-dose versus high-dose chlorpromazine (> 800 mg/day).When low-dose chlorpromazine (≤ 400 mg/day) was compared to medium-dose chlorpromazine (401 mg/day to 800 mg/day), there was no clear benefit of one dose over the other for both global and mental state outcomes (low-quality and very low-quality evidence). There was also no clear evidence for people in one dosage group being more likely to leave the study early, over the other dosage group (moderate-quality evidence). Similar numbers of participants from each group experienced agitation and restlessness (very low-quality evidence). However, significantly more people in the medium-dose group (401 mg/day to 800 mg/day) experienced extrapyramidal symptoms in the short term (2 RCTS, n = 108, RR 0.47, 95% CI 0.30 to 0.74, moderate-quality evidence). No data for death were available.When low-dose chlorpromazine (≤ 400 mg/day) was compared to high-dose chlorpromazine (> 800 mg/day), data from one study with 416 patients were available. Clear evidence of a benefit of the high dose was found with regards to global state. The low-dose group had significantly fewer people improving (RR 1.13, 95% CI 1.01 to 1.25, moderate-quality evidence). There was also a marked difference between the number of people leaving the study from each group for any reason, with significantly more people leaving from the high-dose group (RR 0.60, 95% CI 0.40 to 0.89, moderate-quality evidence). More people in the low-dose group had to leave the study due to deterioration in behaviour (RR 2.70, 95% CI 1.34 to 5.44, low-quality evidence). There was clear evidence of a greater risk of people experiencing extrapyramidal symptoms in general in the high-dose group (RR 0.43, 95% CI 0.32 to 0.59, moderate-quality evidence). One death was reported in the high-dose group yet no effect was shown between the two dosage groups (RR 0.33, 95% CI 0.01 to 8.14, moderate-quality evidence). No data for mental state were available. AUTHORS' CONCLUSIONS The dosage of chlorpromazine has changed drastically over the past 50 years with lower doses now being the preferred of choice. However, this change was gradual and arose not due to trial-based evidence, but due to clinical experience and consensus. Chlorpromazine is one of the most widely used antipsychotic drugs yet appropriate use of lower levels has come about after many years of trial and error with much higher doses. In the absence of high-grade evaluative studies, clinicians have had no alternative but to learn from experience. However, such an approach can lack scientific rigor and does not allow for proper dissemination of information that would assist clinicians find the optimum treatment dosage for their patients. In the future, data for recently released medication should be available from high-quality trials and studies to provide optimum treatment to patients in the shortest amount of time.
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Affiliation(s)
| | - Xiaomeng Liu
- Utrecht UniversityPostbus 85500UtrechtNetherlands3508 GA
| | - Saskia De Haan
- GGZ Noord Holland NoordOude Hoeverweg 10AlkmaarNetherlands1816 BT
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Mazhari S, Esmailian S, Shah‐Esmaeili A, Goughari AS, Bazrafshan A, Zare M. Chlorpromazine versus clotiapine for schizophrenia. Cochrane Database Syst Rev 2017; 4:CD011810. [PMID: 28387925 PMCID: PMC6478072 DOI: 10.1002/14651858.cd011810.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Schizophrenia is a chronic, disabling and severe mental disorder, characterised by disturbance in perception, thought, language, affect and motor behaviour. Chlorpromazine and clotiapine are among antipsychotic drugs used for the treatment of people with schizophrenia. OBJECTIVES To determine the clinical effects, safety and cost-effectiveness of chlorpromazine compared with clotiapine for adults with schizophrenia. SEARCH METHODS We searched Cochrane Schizophrenia's Trials Register (last update search 16/01/2016), which is based on regular searches of CINAHL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO and clinical trials registries. There are no language, date, document type, or publication status limitations for inclusion of records in the Register. SELECTION CRITERIA All randomised clinical trials focusing on chlorpromazine versus clotiapine for schizophrenia. We included trials meeting our selection criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses. We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE. MAIN RESULTS We have included four studies, published between 1974 and 2003, randomising 276 people with schizophrenia to receive either chlorpromazine or clotiapine. The studies were poor at concealing allocation of treatment and blinding of outcome assessment. Our main outcomes of interest were clinically important change in global and mental state, specific change in negative symptoms, incidence of movement disorder (dyskinesia), leaving the study early for any reason, and costs. All reported data were short-term (under six months' follow-up).The trials did not report data for the important outcomes of clinically important change in global or mental state, or cost of care. Improvement in mental state was reported using the Positive and Negative Syndrome Scale (PANSS). When chlorpromazine was compared with clotiapine the average improvement scores for mental state using the PANSS total was higher in the clotiapine group (1 RCT, N = 31, MD 11.50 95% CI 9.42 to 13.58, very low-quality evidence). The average change scores on the PANSS negative sub-scale were similar between treatment groups (1 RCT, N = 21, MD -0.97 95% CI -2.76 to 0.82, very low-quality evidence). There was no clear difference in incidence of dyskinesia (1 RCT, N = 68, RR 3.00 95% CI 0.13 to 71.15, very low-quality evidence). Similar numbers of participants left the study early from each treatment group (3 RCTs, N = 158, RR 0.68 95% CI 0.24 to 1.88, very low-quality evidence). AUTHORS' CONCLUSIONS Clinically important changes in global and mental state were not reported. Only one trial reported the average change in overall mental state; results favour clotiapine but these limited data are very difficult to trust due to methodological limitations of the study. The comparative effectiveness of chlorpromazine compared to clotiapine on change in global state remains unanswered. Results in this review suggest chlorpromazine and clotiapine cause similar adverse effects, although again, the quality of evidence for this is poor, making firm conclusions difficult.
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Affiliation(s)
- Shahrzad Mazhari
- Kerman University of Medical SciencesNeuroscience Research Center, Institute of NeuropharmacologyKermanIran
| | - Saeed Esmailian
- Kerman University of Medical SciencesDepartment of MedicineJahad BlvdEbn Sina AvenueKermanIran7619813159
| | - Armita Shah‐Esmaeili
- Kerman University of Medical SciencesResearch Center for Modeling in Health, Institute for Futures Studies in HealthHaft Bagh AvenueBlock CKermanIran7616911317
| | - Ali S Goughari
- Kerman University of Medical SciencesDepartment of MedicineJahad BlvdEbn Sina AvenueKermanIran7619813159
| | - Azam Bazrafshan
- Kerman University of Medical SciencesNeuroscience Research Center, Institute of NeuropharmacologyKermanIran
| | - Morteza Zare
- Shiraz University of Medical SciencesNutrition Research Center, School of Nutrition and Food SciencesShirazIran
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10
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Abstract
BACKGROUND Chlorpromazine, a widely available and inexpensive antipsychotic drug, is considered the benchmark treatment for schizophrenia worldwide. Metiapine, a dibenzothiazepine derivative, has been reported to have potent antipsychotic characteristics. However, no evidence currently exists on the effectiveness of chlorpromazine in treatment of people with schizophrenia compared to metiapine, a newer antipsychotic. OBJECTIVES To compare the effect of chlorpromazine versus metiapine for the treatment of people with schizophrenia SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials in November 2015 and 2016. SELECTION CRITERIA All randomised controlled trials (RCTs) focusing on chlorpromazine versus metiapine for adults with schizophrenia. We included trials meeting our selection criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference between groups and its 95% CI. We employed a random-effects model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS We included three studies randomising 161 people with schizophrenia. Data were available for only two of our seven prestated main outcomes. Clinically important improvement in global state was measured using the Clinical Global Impression (CGI). There was no clear difference between chlorpromazine and metiapine groups (2 RCTs, n = 120, RR 1.11, 95% CI 0.84 to 1.47, very low quality evidence) and numbers of participants with parkinsonism at eight weeks were similar (2 RCTs, n = 70, RR 0.97, 95% CI 0.46 to 2.03, very low quality evidence). There were no useable data available for the other key outcomes of clinically important improvement in mental state, readmission due to relapse, satisfaction with treatment, aggressive or violent behaviour, or cost of care. AUTHORS' CONCLUSIONS Chlorpromazine has been the mainstay treatment for schizophrenia for decades, yet available evidence comparing this drug to metiapine fails to provide high-quality trial based data. However, the need to determine whether metiapine is more or less effective than chlorpromazine seems to be lacking in clinical relevance and future research on this comparison seems unlikely.
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Affiliation(s)
- Morteza Zare
- Shiraz University of Medical SciencesNutrition Research Center, School of Nutrition and Food SciencesShirazIran
| | - Azam Bazrafshan
- Kerman University of Medical SciencesNeuroscience Research Center, Institute of NeuropharmacologyKermanIran
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Crespo-Facorro B, Pelayo-Teran JM, Mayoral-van Son J. Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review. Neurol Ther 2016; 5:105-130. [PMID: 27553839 PMCID: PMC5130917 DOI: 10.1007/s40120-016-0050-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Indexed: 12/15/2022] Open
Abstract
Implementing the most suitable treatment strategies and making appropriate clinical decisions about individuals with a first episode of psychosis (FEP) is a complex and crucial task, with relevant impact in illness outcome. Treatment approaches in the early stages should go beyond choosing the right antipsychotic drug and should also address tractable factors influencing the risk of relapse. Effectiveness and likely metabolic and endocrine disturbances differ among second-generation antipsychotics (SGAs) and should guide the choice of the first-line treatment. Clinicians should be aware of the high risk of cardiovascular morbidity and mortality in schizophrenia patients, and therefore monitoring weight and metabolic changes across time is mandatory. Behavioral and counseling interventions might be partly effective in reducing weight gain and metabolic disturbances. Ziprasidone and aripiprazole have been described to be least commonly associated with weight gain or metabolic changes. In addition, some of the SGAs (risperidone, amisulpride, and paliperidone) have been associated with a significant increase of plasma prolactin levels. Overall, in cases of FEP, there should be a clear recommendation of using lower doses of the antipsychotic medication. If no or minimal clinical improvement is found after 2 weeks of treatment, such patients may benefit from a change or augmentation of treatment. Clinicians should provide accurate information to patients and relatives about the high risk of relapse if antipsychotics are discontinued, even if patients have been symptom free and functionally recovered on antipsychotic treatment for a lengthy period of time.
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Affiliation(s)
- Benedicto Crespo-Facorro
- Department of Psychiatry, IDIVAL, School of Medicine, University Hospital Marqués de Valdecilla. CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Edificio IDIVAL, planta 2 | Avda. Cardenal Herrera Oria, s/n. |, 39011, Santander, Spain.
| | - Jose Maria Pelayo-Teran
- Department of Psychiatry, IDIVAL, School of Medicine, University Hospital Marqués de Valdecilla. CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Edificio IDIVAL, planta 2 | Avda. Cardenal Herrera Oria, s/n. |, 39011, Santander, Spain
| | - Jacqueline Mayoral-van Son
- Department of Psychiatry, IDIVAL, School of Medicine, University Hospital Marqués de Valdecilla. CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Edificio IDIVAL, planta 2 | Avda. Cardenal Herrera Oria, s/n. |, 39011, Santander, Spain
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Short-Term Effects of Chlorpromazine on Oxidative Stress in Erythrocyte Functionality: Activation of Metabolism and Membrane Perturbation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:2394130. [PMID: 27579150 PMCID: PMC4992801 DOI: 10.1155/2016/2394130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/05/2016] [Accepted: 07/14/2016] [Indexed: 11/17/2022]
Abstract
The purpose of this paper is to focus on the short-term effects of chlorpromazine on erythrocytes because it is reported that the drug, unstable in plasma but more stable in erythrocytes, interacts with erythrocyte membranes, membrane lipids, and hemoglobin. There is a rich literature about the side and therapeutic effects or complications due to chlorpromazine, but most of these studies explore the influence of long-term treatment. We think that evaluating the short-term effects of the drug may help to clarify the sequence of chlorpromazine molecular targets from which some long-term effects derive. Our results indicate that although the drug is primarily intercalated in the innermost side of the membrane, it does not influence band 3 anionic flux, lipid peroxidation, and protein carbonylation processes. On the other hand, it destabilizes and increases the autooxidation of haemoglobin, induces activation of caspase 3, and, markedly, influences the ATP and reduced glutathione levels, with subsequent exposure of phosphatidylserine at the erythrocyte surface. Overall our observations on the early stage of chlorpromazine influence on erythrocytes may contribute to better understanding of new and interesting characteristics of this compound improving knowledge of erythrocyte metabolism.
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Saha KB, Bo L, Zhao S, Xia J, Sampson S, Zaman RU. Chlorpromazine versus atypical antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev 2016; 4:CD010631. [PMID: 27045703 PMCID: PMC7081571 DOI: 10.1002/14651858.cd010631.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chlorpromazine is an aliphatic phenothiazine, which is one of the widely-used typical antipsychotic drugs. Chlorpromazine is reliable for its efficacy and one of the most tested first generation antipsychotic drugs. It has been used as a 'gold standard' to compare the efficacy of older and newer antipsychotic drugs. Expensive new generation drugs are heavily marketed worldwide as a better treatment for schizophrenia, but this may not be the case and an unnecessary drain on very limited resources. OBJECTIVES To compare the effects of chlorpromazine with atypical or second generation antipsychotic drugs, for the treatment of people with schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register up to 23 September 2013. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared chlorpromazine with any other atypical antipsychotic drugs for treating people with schizophrenia. Adults (as defined in each trial) diagnosed with schizophrenia, including schizophreniform, schizoaffective and delusional disorders were included in this review. DATA COLLECTION AND ANALYSIS At least two review authors independently screened the articles identified in the literature search against the inclusion criteria and extracted data from included trials. For homogeneous dichotomous data, we calculated the risk ratio (RR) and the 95% confidence intervals (CIs). For continuous data, we determined the mean difference (MD) values and 95% CIs. We assessed the risk of bias in included studies and rated the quality of the evidence using the GRADE approach. MAIN RESULTS This review includes 71 studies comparing chlorpromazine to olanzapine, risperidone or quetiapine. None of the included trials reported any data on economic costs. 1. Chlorpromazine versus olanzapineIn the short term, there appeared to be a significantly greater clinical response (as defined in each study) in people receiving olanzapine (3 RCTs, N = 204; RR 2.34, 95% CI 1.37 to 3.99, low quality evidence). There was no difference between drugs for relapse (1 RCT, N = 70; RR 1.5, 95% CI 0.46 to 4.86, very low quality evidence), nor in average endpoint score using the Brief Psychiatric Rating Scale (BPRS) for mental state (4 RCTs, N = 245; MD 3.21, 95% CI -0.62 to 7.05,very low quality evidence). There were significantly more extrapyramidal symptoms experienced amongst people receiving chlorpromazine (2 RCTs, N = 298; RR 34.47, 95% CI 4.79 to 248.30,very low quality evidence). Quality of life ratings using the general quality of life interview (GQOLI) - physical health subscale were more favourable with people receiving olanzapine (1 RCT, N = 61; MD -10.10, 95% CI -13.93 to -6.27, very low quality evidence). There was no difference between groups for people leaving the studies early (3 RCTs, N = 139; RR 1.69, 95% CI 0.45 to 6.40, very low quality evidence). 2. Chlorpromazine versus risperidoneIn the short term, there appeared to be no difference in clinical response (as defined in each study) between chlorpromazine or risperidone (7 RCTs, N = 475; RR 0.84, 95% CI 0.53 to 1.34, low quality of evidence), nor in average endpoint score using the BPRS for mental state 4 RCTs, N = 247; MD 0.90, 95% CI -3.49 to 5.28, very low quality evidence), or any observed extrapyramidal adverse effects (3 RCTs, N = 235; RR 1.7, 95% CI 0.85 to 3.40,very low quality evidence). Quality of life ratings using the QOL scale were significantly more favourable with people receiving risperidone (1 RCT, N = 100; MD -14.2, 95% CI -20.50 to -7.90, very low quality evidence). There was no difference between groups for people leaving the studies early (one RCT, N = 41; RR 0.21, 95% CI 0.01 to 4.11, very low quality evidence). 3. Chlorpromazine versus quetiapineIn the short term, there appeared to be no difference in clinical response (as defined in each study) between chlorpromazine or quetiapine (28 RCTs, N = 3241; RR 0.93, 95% CI 0.81 to 1.06, moderate quality evidence) nor in average endpoint score using the BPRS for mental state (6 RCTs, N = 548; MD -0.18, 95% CI -1.23 to 0.88, very low quality evidence). Quality of life ratings using the GQOL1-74 scale were significantly more favourable with people receiving quetiapine (1 RCT, N = 59; MD -6.49, 95% CI -11.30 to -1.68, very low quality evidence). Significantly more people receiving chlorpromazine experienced extrapyramidal adverse effects (8 RCTs, N = 644; RR 8.03, 95% CI 4.78 to 13.51, low quality of evidence). There was no difference between groups for people leaving the studies early in the short term (12 RCTs, N = 1223; RR 1.04, 95% CI 0.77 to 1.41,moderate quality evidence). AUTHORS' CONCLUSIONS Most included trials included inpatients from hospitals in China. Therefore the results of this Cochrane review are more applicable to the Chinese population. Mostincluded trials were short term studies, therefore we cannot comment on the medium and long term use of chlorpromazine compared to atypical antipsychotics. Low qualityy evidence suggests chlorpromazine causes more extrapyramidal adverse effects. However, all studiesused varying dose ranges, and higher doses would be expected to be associated with more adverse events.
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Affiliation(s)
- Kumar B Saha
- Leeds and York Partnerships NHS Foundation TrustAddiction PsychiatryLeeds Addiction Unit19 Springfield MountLeedsUKLS2 9NG
| | - Li Bo
- Xiyuan HospitalChina Academy of Chinese Medical Sciences1 Xi Yuan Cao ChangHaidian DistrictBeijingChina100091
| | - Sai Zhao
- Systematic Review Solutions Ltd5‐6 West Tashan RoadYan TaiTianjinChina264000
| | - Jun Xia
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph Road,NottinghamUKNG7 2TU
| | - Stephanie Sampson
- The University of NottinghamInstitute of Mental HealthUniversity of Nottingham Innovation Park, Jubilee CampusNottinghamUKNG7 2TU
| | - Rashid U Zaman
- Oxford Policy ManagementHealth Portfolio6 St Aldates Courtyard38 St AldatesOxfordOxfordshireUKOX1 1BN
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14
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Nur S, Adams CE. Chlorpromazine versus reserpine for schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Osman S, Taylor KA, Allcock N, Rainbow RD, Mahaut-Smith MP. Detachment of surface membrane invagination systems by cationic amphiphilic drugs. Sci Rep 2016; 6:18536. [PMID: 26725955 PMCID: PMC4698757 DOI: 10.1038/srep18536] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/19/2015] [Indexed: 12/22/2022] Open
Abstract
Several cell types develop extensive plasma membrane invaginations to serve a specific physiological function. For example, the megakaryocyte demarcation membrane system (DMS) provides a membrane reserve for platelet production and muscle transverse (T) tubules facilitate excitation:contraction coupling. Using impermeant fluorescent indicators, capacitance measurements and electron microscopy, we show that multiple cationic amphiphilic drugs (CADs) cause complete separation of the DMS from the surface membrane in rat megakaryocytes. This includes the calmodulin inhibitor W-7, the phospholipase-C inhibitor U73122, and anti-psychotic phenothiazines. CADs also caused loss of T tubules in rat cardiac ventricular myocytes and the open canalicular system of human platelets. Anionic amphiphiles, U73343 (a less electrophilic U73122 analogue) and a range of kinase inhibitors were without effect on the DMS. CADs are known to accumulate in the inner leaflet of the cell membrane where they bind to anionic lipids, especially PI(4,5)P2. We therefore propose that surface detachment of membrane invaginations results from an ability of CADs to interfere with PI(4,5)P2 interactions with cytoskeletal or BAR domain proteins. This establishes a detubulating action of a large class of pharmaceutical compounds.
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Affiliation(s)
- Sangar Osman
- Department of Molecular and Cell Biology, University of Leicester, Leicester, UK, LE1 9HN
| | - Kirk A Taylor
- Department of Molecular and Cell Biology, University of Leicester, Leicester, UK, LE1 9HN
| | - Natalie Allcock
- Centre for Core Biotechnology Services, University of Leicester, Leicester, UK, LE1 9HN
| | - Richard D Rainbow
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK, LE1 9HN
| | - Martyn P Mahaut-Smith
- Department of Molecular and Cell Biology, University of Leicester, Leicester, UK, LE1 9HN
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Breitborde NJK, Bell EK, Dawley D, Woolverton C, Ceaser A, Waters AC, Dawson SC, Bismark AW, Polsinelli AJ, Bartolomeo L, Simmons J, Bernstein B, Harrison-Monroe P. The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service. BMC Psychiatry 2015; 15:266. [PMID: 26511605 PMCID: PMC4625429 DOI: 10.1186/s12888-015-0650-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 10/14/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There is growing evidence that specialized clinical services targeted toward individuals early in the course of a psychotic illness may be effective in reducing both the clinical and economic burden associated with these illnesses. Unfortunately, the United States has lagged behind other countries in the delivery of specialized, multi-component care to individuals early in the course of a psychotic illness. A key factor contributing to this lag is the limited available data demonstrating the clinical benefits and cost-effectiveness of early intervention for psychosis among individuals served by the American mental health system. Thus, the goal of this study is to present clinical and cost outcome data with regard to a first-episode psychosis treatment center within the American mental health system: the Early Psychosis Intervention Center (EPICENTER). METHODS Sixty-eight consecutively enrolled individuals with first-episode psychosis completed assessments of symptomatology, social functioning, educational/vocational functioning, cognitive functioning, substance use, and service utilization upon enrollment in EPICENTER and after 6 months of EPICENTER care. All participants were provided with access to a multi-component treatment package comprised of cognitive behavioral therapy, family psychoeducation, and metacognitive remediation. RESULTS Over the first 6 months of EPICENTER care, participants experienced improvements in symptomatology, social functioning, educational/vocational functioning, cognitive functioning, and substance abuse. The average cost of care during the first 6 months of EPICENTER participation was lower than the average cost during the 6-months prior to joining EPICENTER. These savings occurred despite the additional costs associated with the receipt of EPICENTER care and were driven primarily by reductions in the utilization of inpatient psychiatric services and contacts with the legal system. CONCLUSIONS The results of our study suggest that multi-component interventions for first-episode psychosis provided in the US mental health system may be both clinically-beneficial and cost-effective. Although additional research is needed, these findings provide preliminary support for the growing delivery of specialized multi-component interventions for first-episode psychosis within the United States. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011.
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Affiliation(s)
- Nicholas J. K. Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio USA ,Department of Psychiatry, The University of Arizona, Tucson, Arizona USA
| | - Emily K. Bell
- Department of Psychiatry, The University of Arizona, Tucson, Arizona USA
| | - David Dawley
- Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA.
| | - Cindy Woolverton
- Department of Psychology, The University of Arizona, Tucson, Arizona, USA.
| | - Alan Ceaser
- Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA. .,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.
| | - Allison C. Waters
- Department of Psychiatry, The University of Arizona, Tucson, Arizona USA ,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia USA
| | - Spencer C. Dawson
- Department of Psychology, The University of Arizona, Tucson, Arizona USA
| | - Andrew W. Bismark
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, California USA
| | | | - Lisa Bartolomeo
- Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA.
| | - Jessica Simmons
- Department of Education, The University of Arizona, Tucson, Arizona, USA.
| | - Beth Bernstein
- Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA.
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Khalili N, Vahedian M, Nikvarz N, Piri M. Chlorpromazine versus penfluridol for schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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18
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Mazhari S, S. Goughari A, Esmailian S, Shah-Esmaili A. Chlorpromazine versus clotiapine for schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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19
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Eslami Shahrbabaki M, Sharafkhani R, Dehnavieh R, Vali L. Chlorpromazine versus piperacetazine for schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011709] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Mahin Eslami Shahrbabaki
- Kerman University of Medical Sciences; Department of Psychiatry; Shahid Beheshti Hospital Jomhori Blv Kerman Iran 7618834115
| | - Rahim Sharafkhani
- Kerman University of Medical Sciences; Department of Biostatistics and Epidemiology; Haft Bagh Avenue Block C Kerman Iran 7616911317
| | - Reza Dehnavieh
- Kerman University of Medical Sciences; Institute for Futures Studies in Health; Haft Bagh Road Kerman Iran
| | - Leila Vali
- Kerman University of Medical Sciences; Health Administration; Haft Bagh Avenue Block C, Departmet of Health Administration Kerman Iran
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Zare M, Bazrafshan A, Okhovati M, Mazhari S, Mousavi R. Chlorpromazine versus metiapine for schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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21
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Bazrafshan A, Zare M, Okhovati M, Shamsi Meimandi M. Acetophenazine versus chlorpromazine for schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011662] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Azam Bazrafshan
- Kerman University of Medical Sciences; Neuroscience Research Center, Institute of Neuropharmacology; Jahad St Kerman Iran
| | - Morteza Zare
- Kerman University of Medical Sciences; Neuroscience Research Center, Institute of Neuropharmacology; Jahad St Kerman Iran
| | - Maryam Okhovati
- Kerman University of Medical Sciences; Neuroscience Research Center, Institute of Neuropharmacology; Jahad St Kerman Iran
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Leucht S, Samara M, Heres S, Patel MX, Woods SW, Davis JM. Dose equivalents for second-generation antipsychotics: the minimum effective dose method. Schizophr Bull 2014; 40:314-26. [PMID: 24493852 PMCID: PMC3932104 DOI: 10.1093/schbul/sbu001] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clinicians need to know the right antipsychotic dose for optimized treatment, and the concept of dose equivalence is important for many clinical and scientific purposes. METHODS We refined a method presented in 2003, which was based on the minimum effective doses found in fixed-dose studies. We operationalized the selection process, updated the original findings, and expanded them by systematically searching more recent literature and by including 13 second-generation antipsychotics. To qualify for the minimum effective dose, a dose had to be significantly more efficacious than placebo in the primary outcome of at least one randomized, double-blind, fixed-dose trial. In a sensitivity analysis, 2 positive trials were required. The minimum effective doses identified were subsequently used to derive olanzapine, risperidone, haloperidol, and chlorpromazine equivalents. RESULTS We reviewed 73 included studies. The minimum effective daily doses/olanzapine equivalents based on our primary approach were: aripiprazole 10 mg/1.33, asenapine 10 mg/1.33, clozapine 300 mg/40, haloperidol 4 mg/0.53, iloperidone 8 mg/1.07, lurasidone 40 mg/5.33, olanzapine 7.5 mg/1, paliperidone 3 mg/0.4, quetiapine 150 mg/20, risperidone 2 mg/0.27, sertindole 12 mg/1.60, and ziprasidone 40 mg/5.33. For amisulpride and zotepine, reliable estimates could not be derived. CONCLUSIONS This method for determining antipsychotic dose equivalence entails an operationalized and evidence-based approach that can be applied to the various antipsychotic drugs. As a limitation, the results are not applicable to specific populations such as first-episode or refractory patients. We recommend that alternative methods also be updated in order to minimize further differences between the methods and risk of subsequent bias.
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Affiliation(s)
- Stefan Leucht
- *To whom correspondence should be addressed; Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany; tel: +49-89-4140-4249, fax: +49-89-4140-4888, e-mail:
| | - Myrto Samara
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Stephan Heres
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Maxine X. Patel
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Scott W. Woods
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT;,Connecticut Mental Health Center, New Haven, CT
| | - John M. Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL;,Maryland Psychiatric Research Center, Baltimore, MD
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Chien WT, Yip ALK. Current approaches to treatments for schizophrenia spectrum disorders, part I: an overview and medical treatments. Neuropsychiatr Dis Treat 2013; 9:1311-32. [PMID: 24049446 PMCID: PMC3775702 DOI: 10.2147/ndt.s37485] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
During the last three decades, an increasing understanding of the etiology, psychopathology, and clinical manifestations of schizophrenia spectrum disorders, in addition to the introduction of second-generation antipsychotics, has optimized the potential for recovery from the illness. Continued development of various models of psychosocial intervention promotes the goal of schizophrenia treatment from one of symptom control and social adaptation to an optimal restoration of functioning and/or recovery. However, it is still questionable whether these new treatment approaches can address the patients' needs for treatment and services and contribute to better patient outcomes. This article provides an overview of different treatment approaches currently used in schizophrenia spectrum disorders to address complex health problems and a wide range of abnormalities and impairments resulting from the illness. There are different treatment strategies and targets for patients at different stages of the illness, ranging from prophylactic antipsychotics and cognitive-behavioral therapy in the premorbid stage to various psychosocial interventions in addition to antipsychotics for relapse prevention and rehabilitation in the later stages of the illness. The use of antipsychotics alone as the main treatment modality may be limited not only in being unable to tackle the frequently occurring negative symptoms and cognitive impairments but also in producing a wide variety of adverse effects to the body or organ functioning. Because of varied pharmacokinetics and treatment responsiveness across agents, the medication regimen should be determined on an individual basis to ensure an optimal effect in its long-term use. This review also highlights that the recent practice guidelines and standards have recommended that a combination of treatment modalities be adopted to meet the complex health needs of people with schizophrenia spectrum disorders. In view of the heterogeneity of the risk factors and the illness progression of individual patients, the use of multifaceted illness management programs consisting of different combinations of physical, psychological, and social interventions might be efficient and effective in improving recovery.
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Affiliation(s)
- Wai Tong Chien
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Annie LK Yip
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Cullen BA, McGinty EE, Zhang Y, dosReis SC, Steinwachs DM, Guallar E, Daumit GL. Guideline-concordant antipsychotic use and mortality in schizophrenia. Schizophr Bull 2013; 39:1159-68. [PMID: 23112292 PMCID: PMC3756776 DOI: 10.1093/schbul/sbs097] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine if care concordant with 2009 Schizophrenia Patient Outcomes Research Team (PORT) pharmacological recommendations for schizophrenia is associated with decreased mortality. METHODS We conducted a retrospective cohort study of adult Maryland Medicaid beneficiaries with schizophrenia and any antipsychotic use from 1994 to 2004 (N = 2132). We used Medicaid pharmacy data to measure annual and average antipsychotic continuity, to calculate chlorpromazine (CPZ) dosing equivalents, and to examine anti-Parkinson medication use. Cox proportional hazards regression models were used to examine the relationship between antipsychotic continuity, antipsychotic dosing, and anti-Parkinson medication use and mortality. RESULTS Annual antipsychotic continuity was associated with decreased mortality. Among patients with annual continuity greater than or equal to 90%, the hazard ratio [HR] for mortality was 0.75 (95% confidence interval [CI] 0.57-0.99) compared with patients with annual medication possession ratios (MPRs) of less than 10%. The HRs for mortality associated with continuous annual and average antipsychotic continuity were 0.75 (95% CI 0.58-0.98) and 0.84 (95% CI 0.58-1.21), respectively. Among users of first-generation antipsychotics, doses greater than or equal to 1500 CPZ dosing equivalents were associated with increased risk of mortality (HR 1.88, 95% CI 1.10-3.21), and use of anti-Parkinson medication was associated with decreased risk of mortality (HR 0.72, 95% CI 0.55-0.95). Mental health visits were also associated with decreased mortality (HR 0.96, 95% CI 0.93-0.98). CONCLUSIONS Adherence to PORT pharmacological guidelines is associated with reduced mortality among patients with schizophrenia. Adoption of outcomes monitoring systems and innovative service delivery programs to improve adherence to the PORT guidelines should be considered.
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Affiliation(s)
- Bernadette A. Cullen
- Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - Emma E. McGinty
- Department of Health Policy and Management and Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - Yiyi Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan C. dosReis
- Departments of Epidemiology and Psychiatry and Behavioral Sciences
| | - Donald M. Steinwachs
- Department of Health Policy and Management and Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine, Baltimore, MD
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gail L. Daumit
- To whom correspondence should be addressed; 2024 East Monument Street, Room 2-513, Baltimore 21205, MD, USA; tel: 410-614-6460, fax: 410-614-0588, e-mail:
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Saha KB, Sampson S, Zaman RU. Chlorpromazine versus atypical antipsychotic drugs for schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010631] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gandhi A, Guo T, Shah P, Moorthy B, Ghose R. Chlorpromazine-induced hepatotoxicity during inflammation is mediated by TIRAP-dependent signaling pathway in mice. Toxicol Appl Pharmacol 2012; 266:430-8. [PMID: 23238562 DOI: 10.1016/j.taap.2012.11.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 11/14/2012] [Accepted: 11/17/2012] [Indexed: 12/11/2022]
Abstract
Inflammation is a major component of idiosyncratic adverse drug reactions (IADRs). To understand the molecular mechanism of inflammation-mediated IADRs, we determined the role of the Toll-like receptor (TLR) signaling pathway in idiosyncratic hepatotoxicity of the anti-psychotic drug, chlorpromazine (CPZ). Activation of TLRs recruits the first adaptor protein, Toll-interleukin 1 receptor domain containing adaptor protein (TIRAP) to the TIR domain of TLRs leading to the activation of the downstream kinase, c-Jun-N-terminal kinase (JNK). Prolonged activation of JNK leads to cell-death. We hypothesized that activation of TLR2 by lipoteichoic acid (LTA) or TLR4 by lipopolysaccharide (LPS) will augment the hepatotoxicity of CPZ by TIRAP-dependent mechanism involving prolonged activation of JNK. Adult male C57BL/6, TIRAP(+/+) and TIRAP(-/-) mice were pretreated with saline, LPS (2 mg/kg) or LTA (6 mg/kg) for 30 min or 16 h followed by CPZ (5 mg/kg) or saline (vehicle) up to 24h. We found that treatment of mice with CPZ in presence of LPS or LTA leads to ~3-4 fold increase in serum ALT levels, a marked reduction in hepatic glycogen content, significant induction of serum tumor necrosis factor (TNF) α and prolonged JNK activation, compared to LPS or LTA alone. Similar results were observed in TIRAP(+/+) mice, whereas the effects of LPS or LTA on CPZ-induced hepatotoxicity were attenuated in TIRAP(-/-) mice. For the first time, we show that inflammation-mediated hepatotoxicity of CPZ is dependent on TIRAP, and involves prolonged JNK activation in vivo. Thus, TIRAP-dependent pathways may be targeted to predict and prevent inflammation-mediated IADRs.
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Affiliation(s)
- Adarsh Gandhi
- University of Houston, Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, 1441 Moursund Street, Room 517, Houston, TX 77030, USA.
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Affiliation(s)
| | - Xiaomeng Liu
- University of Utrecht, UMC Utrecht, The Netherlands
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