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Xue F, Wang X, Kong F, Yin T, Wang Y, Shi L, Liu X, Yu H, Liu L, Zhu P, Qi X, Xu X, Hu H, Li S. Effects of bilateral repetitive transcranial magnetic stimulation on prospective memory in patients with schizophrenia: A double-blind randomized controlled clinical trial. Neuropsychopharmacol Rep 2024; 44:97-108. [PMID: 38053478 PMCID: PMC10932802 DOI: 10.1002/npr2.12397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 12/07/2023] Open
Abstract
AIMS To investigate effects of repetitive transcranial magnetic stimulation (rTMS) on the prospective memory (PM) in patients with schizophrenia (SCZ). METHODS Fifty of 71 patients completed this double-blind placebo-controlled randomized trial and compared with 18 healthy controls' (HCs) PM outcomes. Bilateral 20 Hz rTMS to the dorsolateral prefrontal cortex at 90% RMT administered 5 weekdays for 4 weeks for a total of 20 treatments. The Positive and Negative Symptom Scale (PANSS), the Scale for the Assessment of Negative Symptoms (SANS), and PM test were assessed before and after treatment. RESULTS Both Event-based PM (EBPM) and Time-based PM (TBPM) scores at baseline were significantly lower in patients with SCZ than that in HCs. After rTMS treatments, the scores of EBPM in patients with SCZ was significantly improved and had no differences from that in HCs, while the scores of TBPM did not improved. The negative symptom scores on PANSS and the scores of almost all subscales and total scores of SANS were significantly improved in both groups. CONCLUSIONS Our findings indicated that bilateral high-frequency rTMS treatment can alleviate EBPM but not TBPM in patients with SCZ, as well as improve the negative symptoms. SIGNIFICANCE Our results provide one therapeutic option for PM in patients with SCZ.
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Affiliation(s)
- Fen Xue
- Mental Health Hospital, Dongcheng districtBeijingChaci communityChina
| | - Xin‐Fu Wang
- Rong Jun Hospital, Hebei ProvinceBaodingLianchi DistrictChina
| | - Fan‐Ni Kong
- National Institute on Drug Dependence and Beijing Key laboratory of Drug Dependence ResearchPeking UniversityBeijingHaidian DistrictChina
| | - Tian‐Lu Yin
- Institute of Medical InformationChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yu‐Hong Wang
- Rong Jun Hospital, Hebei ProvinceBaodingLianchi DistrictChina
| | - Li‐Da Shi
- Rong Jun Hospital, Hebei ProvinceBaodingLianchi DistrictChina
| | - Xiao‐Wen Liu
- Rong Jun Hospital, Hebei ProvinceBaodingLianchi DistrictChina
| | - Hui‐Jing Yu
- Rong Jun Hospital, Hebei ProvinceBaodingLianchi DistrictChina
| | - Li‐Jun Liu
- Rong Jun Hospital, Hebei ProvinceBaodingLianchi DistrictChina
| | - Ping Zhu
- Mental Health Hospital, Dongcheng districtBeijingChaci communityChina
| | - Xiao‐Xue Qi
- Mental Health Hospital, Dongcheng districtBeijingChaci communityChina
| | - Xue‐Jing Xu
- College of EducationTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Hong‐Pu Hu
- Institute of Medical InformationChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Su‐Xia Li
- National Institute on Drug Dependence and Beijing Key laboratory of Drug Dependence ResearchPeking UniversityBeijingHaidian DistrictChina
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Tandon R, Nasrallah H, Akbarian S, Carpenter WT, DeLisi LE, Gaebel W, Green MF, Gur RE, Heckers S, Kane JM, Malaspina D, Meyer-Lindenberg A, Murray R, Owen M, Smoller JW, Yassin W, Keshavan M. The schizophrenia syndrome, circa 2024: What we know and how that informs its nature. Schizophr Res 2024; 264:1-28. [PMID: 38086109 DOI: 10.1016/j.schres.2023.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024]
Abstract
With new data about different aspects of schizophrenia being continually generated, it becomes necessary to periodically revisit exactly what we know. Along with a need to review what we currently know about schizophrenia, there is an equal imperative to evaluate the construct itself. With these objectives, we undertook an iterative, multi-phase process involving fifty international experts in the field, with each step building on learnings from the prior one. This review assembles currently established findings about schizophrenia (construct, etiology, pathophysiology, clinical expression, treatment) and posits what they reveal about its nature. Schizophrenia is a heritable, complex, multi-dimensional syndrome with varying degrees of psychotic, negative, cognitive, mood, and motor manifestations. The illness exhibits a remitting and relapsing course, with varying degrees of recovery among affected individuals with most experiencing significant social and functional impairment. Genetic risk factors likely include thousands of common genetic variants that each have a small impact on an individual's risk and a plethora of rare gene variants that have a larger individual impact on risk. Their biological effects are concentrated in the brain and many of the same variants also increase the risk of other psychiatric disorders such as bipolar disorder, autism, and other neurodevelopmental conditions. Environmental risk factors include but are not limited to urban residence in childhood, migration, older paternal age at birth, cannabis use, childhood trauma, antenatal maternal infection, and perinatal hypoxia. Structural, functional, and neurochemical brain alterations implicate multiple regions and functional circuits. Dopamine D-2 receptor antagonists and partial agonists improve psychotic symptoms and reduce risk of relapse. Certain psychological and psychosocial interventions are beneficial. Early intervention can reduce treatment delay and improve outcomes. Schizophrenia is increasingly considered to be a heterogeneous syndrome and not a singular disease entity. There is no necessary or sufficient etiology, pathology, set of clinical features, or treatment that fully circumscribes this syndrome. A single, common pathophysiological pathway appears unlikely. The boundaries of schizophrenia remain fuzzy, suggesting the absence of a categorical fit and need to reconceptualize it as a broader, multi-dimensional and/or spectrum construct.
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Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, WMU Homer Stryker School of Medicine, Kalamazoo, MI 49008, United States of America.
| | - Henry Nasrallah
- Department of Psychiatry, University of Cincinnati College of Medicine Cincinnati, OH 45267, United States of America
| | - Schahram Akbarian
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America
| | - Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA 02139, United States of America
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Dusseldorf, Heinrich-Heine University, Dusseldorf, Germany
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute of Neuroscience and Human Behavior, UCLA, Los Angeles, CA 90024, United States of America; Greater Los Angeles Veterans' Administration Healthcare System, United States of America
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, United States of America
| | - Stephan Heckers
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN 37232, United States of America
| | - John M Kane
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY 11004, United States of America
| | - Dolores Malaspina
- Department of Psychiatry, Neuroscience, Genetics, and Genomics, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, United States of America
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannhein/Heidelberg University, Mannheim, Germany
| | - Robin Murray
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College, London, UK
| | - Michael Owen
- Centre for Neuropsychiatric Genetics and Genomics, and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jordan W Smoller
- Center for Precision Psychiatry, Department of Psychiatry, Psychiatric and Neurodevelopmental Unit, Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States of America
| | - Walid Yassin
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States of America
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Hudon A, Lammatteo V, Rodrigues-Coutlée S, Dellazizzo L, Giguère S, Phraxayavong K, Potvin S, Dumais A. Exploration of the role of emotional expression of treatment-resistant schizophrenia patients having followed virtual reality therapy: a content analysis. BMC Psychiatry 2023; 23:420. [PMID: 37308864 DOI: 10.1186/s12888-023-04861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/10/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Emotional responses are an important component of psychotherapeutic processes. Avatar therapy (AT) is a virtual reality-based therapy currently being developed and studied for patients suffering from treatment resistant schizophrenia. Considering the importance of identifying emotions in therapeutical processes and their impact on the therapeutic outcome, an exploration of such emotions is needed. METHODS The aim of this study is to identify the underlying emotions at the core of the patient-Avatar interaction during AT by content analysis of immersive sessions transcripts and audio recordings. A content analysis of AT transcripts and audio recordings using iterative categorization was conducted for 16 patients suffering from TRS who underwent AT between 2017 and 2022 (128 transcripts and 128 audio recordings). An iterative categorization technique was conducted to identify the different emotions expressed by the patient and the Avatar during the immersive sessions. RESULTS The following emotions were identified in this study: Anger, Contempt/ Disgust, Fear, Sadness, Shame/ Embarrassment, Interest, Surprise, Joy and Neutral. Patients expressed mostly neutral, joy and anger emotions whereas the Avatar expressed predominantly interest, disgust/contempt, and neutral emotions. CONCLUSIONS This study portrays a first qualitative insight on the emotions that are expressed in AT and serves as a steppingstone for further investigation in the role of emotions in the therapeutic outcomes of AT.
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Affiliation(s)
- Alexandre Hudon
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | | | - Laura Dellazizzo
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Sabrina Giguère
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.
- Services et Recherches Psychiatriques AD, Montreal, QC, Canada.
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada.
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Alisauskiene R, Johnsen E, Gjestad R, Kroken RA, Kjelby E, Sinkeviciute I, Fathian F, Joa I, Reitan SK, Rettenbacher M, Løberg EM. Does drug use affect the efficacy of amisulpride, aripiprazole and olanzapine in patients with schizophrenia spectrum disorders? Results from a pragmatic, randomised study. Gen Hosp Psychiatry 2023; 83:185-193. [PMID: 37269769 DOI: 10.1016/j.genhosppsych.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Drug use is prevalent in patients with schizophrenia spectrum disorders (SSD) but there is limited knowledge about the influence of drug use on the effectiveness of antipsychotic medication. This secondary explorative study compared the effectiveness of three antipsychotics in patients with SSD, with and without drug use. METHODS The BeSt InTro multi-centre, head to head, rater-blinded randomised study compared amisulpride, aripiprazole and olanzapine over a 1-year follow-up period. All patients (n = 144) were aged ≥18 years and met the ICD-10 criteria for SSD (F20-29). Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). The primary outcome was reduction of a PANSS positive subscale score. RESULTS At baseline, 38% of all patients reported drug use in the last 6 months before inclusion, with cannabis as the main drug (85%), followed by amphetamine-type stimulants (45%), sedatives (26%), hallucinogens (19%), cocaine (13%), opiates (4%), GHB (4%), solvents (4%), analgesics (4%) and anabolic steroids (2%). The predominant pattern was the use of several drugs. There were no significant overall differences in the PANSS positive subscale score reduction for the three studied antipsychotics among patients either with or without drug use. In the drug use group, older patients treated with amisulpride showed a greater PANSS positive subscale score reduction during the treatment period compared to younger patients. CONCLUSION The current study showed that drug use does not appear to affect the overall effectiveness of amisulpride, aripiprazole and olanzapine in patients with SSD. However, amisulpride may be a particularly suitable choice for older patients with drug use.
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Affiliation(s)
- Renata Alisauskiene
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Postbox 7804, N-5020 Bergen, Norway.
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway.
| | - Rune A Kroken
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Postbox 7804, N-5020 Bergen, Norway.
| | - Eirik Kjelby
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Igne Sinkeviciute
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Farivar Fathian
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Inge Joa
- Network for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.
| | - Solveig Klæbo Reitan
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway.
| | - Maria Rettenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innrain, 52, Innsbruck, Austria.
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Christies gate 12, N-5015 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
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Plazas E, Faraone N. Indole Alkaloids from Psychoactive Mushrooms: Chemical and Pharmacological Potential as Psychotherapeutic Agents. Biomedicines 2023; 11:biomedicines11020461. [PMID: 36830997 PMCID: PMC9953455 DOI: 10.3390/biomedicines11020461] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Neuropsychiatric diseases such as depression, anxiety, and post-traumatic stress represent a substantial long-term challenge for the global health systems because of their rising prevalence, uncertain neuropathology, and lack of effective pharmacological treatments. The approved existing studies constitute a piece of strong evidence whereby psychiatric drugs have shown to have unpleasant side effects and reduction of sustained tolerability, impacting patients' quality of life. Thus, the implementation of innovative strategies and alternative sources of bioactive molecules for the search for neuropsychiatric agents are required to guarantee the success of more effective drug candidates. Psychotherapeutic use of indole alkaloids derived from magic mushrooms has shown great interest and potential as an alternative to the synthetic drugs currently used on the market. The focus on indole alkaloids is linked to their rich history, their use as pharmaceuticals, and their broad range of biological properties, collectively underscoring the indole heterocycle as significant in drug discovery. In this review, we aim to report the physicochemical and pharmacological characteristics of indole alkaloids, particularly those derived from magic mushrooms, highlighting the promising application of such active ingredients as safe and effective therapeutic agents for the treatment of neuropsychiatric disorders.
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Kang D, Lu J, Liu W, Shao P, Wu R. Association between olanzapine concentration and metabolic dysfunction in drug-naive and chronic patients: similarities and differences. SCHIZOPHRENIA 2022; 8:9. [PMID: 35228573 PMCID: PMC8885747 DOI: 10.1038/s41537-022-00211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/02/2022] [Indexed: 11/09/2022]
Abstract
AbstractSecond-generation antipsychotics are widely used to treat schizophrenia but their use could induce metabolic dysfunction. To balance efficacy and side effects, various guidelines recommend the use of therapeutic drug monitoring. Given the controversial relationship between olanzapine serum concentration and metabolic dysfunction, its use in clinical practice is still debated. To address this issue, we conducted a prospective cohort study to explore the associations in patients with schizophrenia. Specifically, first-episode drug-naive patients and patients with chronic schizophrenia were recruited. All participants received olanzapine monotherapy for 8 weeks. Anthropometric parameters and metabolic indices were tested at baseline and at week 8, and olanzapine serum concentration was tested at week 4. After 8 weeks of observation, body weight and BMI increased significantly in drug-naive patients. Moreover, triglycerides and LDL increased significantly in both drug-naive and chronic patients. Among chronic patients, those who have never used olanzapine/clozapine before had a significantly higher increase in weight and BMI than those who have previously used olanzapine/clozapine. Furthermore, olanzapine concentration was associated with changes in weight, BMI, and LDL levels in the drug-naive group and glucose, triglyceride and LDL levels in chronic patients who have not used olanzapine/clozapine previously. In conclusion, the metabolic dysfunction induced by olanzapine is more severe and dose-dependent in drug-naive patients but independent in patients with chronic schizophrenia. Future studies with a longer period of observation and a larger sample are warranted.
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Atanasovska E, Jakjovski K, Pavlovska K, Gjorgjievska K, Zafirov D, Zendelovska D, Petrushevska M, Labachevski N. Comparative, Single-Dose, 2-Way Cross-Over Bioavailability Study of Two Olanzapine 10 Mg Tablet Formulations in Healthy Volunteers Under Fasting Conditions. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:135-143. [PMID: 35843923 DOI: 10.2478/prilozi-2022-0026] [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] [Indexed: 06/15/2023]
Abstract
Objectives: Olanzapine is an atypical antipsychotic that is approved across Europe, the USA, and in many other countries for oral treatment of schizophrenia and acute manic episodes in patients with bipolar disorder as well as for maintenance therapy to prevent recurrence in responders. The objective of the present study was to compare the pharmacokinetics of two 10 mg tablet formulations of Olanzapine following a single oral dose in healthy volunteers under fasting conditions, as per the European Medicine Agency (EMA) guidelines to grant marketing authorization. Methods: This study was a randomized, open-label, two-treatment, two-period, two-sequences, single-dose, cross-over design with a washout period of 14 days. Both the test and the reference products were administered as 10 mg tablets with 240 mL of water after an overnight fast in each study period. A total of twenty blood samples were collected before dosing and within 144 hours after drug administration. Adverse events were monitored, recorded, and evaluated by investigators throughout the study. Results: Of the 24 healthy adult male subjects enrolled, all of them completed both study periods. The geometric mean ratio 90% confidence intervals (CI) for fasting Cmax, AUC0-t, and AUC0-infinity were 94.83-113.71%, 95.04-105.69% and 95.94-107.00%, respectively. The 90% CI for the ratios of the three primary pharmacokinetic parameters (using log-transformed data) were within the range of 80-125%, meeting the regulatory criteria for bioequivalence. Conclusions: The generic Olanzapine was bioequivalent to the reference formulation. It was well tolerated and provides an acceptable alternative to the reference drug.
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Affiliation(s)
- Emilija Atanasovska
- Department of Preclinical and Clinical Pharmacology & Toxicology, Faculty of Medicine, University "Ss. Cyril and Methodius", 50 Divizija 6, 1000 Skopje, Republic of North Macedonia
| | - Krume Jakjovski
- Department of Preclinical and Clinical Pharmacology & Toxicology, Faculty of Medicine, University "Ss. Cyril and Methodius", 50 Divizija 6, 1000 Skopje, Republic of North Macedonia
| | - Kristina Pavlovska
- Department of Preclinical and Clinical Pharmacology & Toxicology, Faculty of Medicine, University "Ss. Cyril and Methodius", 50 Divizija 6, 1000 Skopje, Republic of North Macedonia
| | - Kalina Gjorgjievska
- Department of Preclinical and Clinical Pharmacology & Toxicology, Faculty of Medicine, University "Ss. Cyril and Methodius", 50 Divizija 6, 1000 Skopje, Republic of North Macedonia
| | - Dimche Zafirov
- Department of Preclinical and Clinical Pharmacology & Toxicology, Faculty of Medicine, University "Ss. Cyril and Methodius", 50 Divizija 6, 1000 Skopje, Republic of North Macedonia
| | - Dragica Zendelovska
- Department of Preclinical and Clinical Pharmacology & Toxicology, Faculty of Medicine, University "Ss. Cyril and Methodius", 50 Divizija 6, 1000 Skopje, Republic of North Macedonia
| | - Marija Petrushevska
- Department of Preclinical and Clinical Pharmacology & Toxicology, Faculty of Medicine, University "Ss. Cyril and Methodius", 50 Divizija 6, 1000 Skopje, Republic of North Macedonia
| | - Nikola Labachevski
- Department of Preclinical and Clinical Pharmacology & Toxicology, Faculty of Medicine, University "Ss. Cyril and Methodius", 50 Divizija 6, 1000 Skopje, Republic of North Macedonia
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8
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Lewins A, Morant N, Akther-Robertson J, Crellin NE, Stansfeld JL, Smith R, Moncrieff J. A qualitative exploration of family members' perspectives on reducing and discontinuing antipsychotic medication. J Ment Health 2022:1-8. [PMID: 35521675 DOI: 10.1080/09638237.2022.2069710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Antipsychotics are routinely prescribed to people diagnosed with schizophrenia or psychosis on a long-term basis. Considerable literature explores service users' opinions and experiences of antipsychotics, but studies investigating family members' views are lacking. AIMS To explore family members' perspectives on antipsychotics, particularly their views on long-term use, reduction and discontinuation of antipsychotics. METHODS Semi-structured interviews were conducted with 11 family members of people experiencing psychosis. Participants were recruited through community support groups and mental health teams. Interviews were analysed thematically. RESULTS The majority of family members valued antipsychotic medication primarily in supporting what they saw as a fragile stability in the person they cared for. Their views of medication were ambivalent, combining concerns about adverse effects with a belief in the importance of medication due to fears of relapse. They described a need for constant vigilance in relation to medication to ensure it was taken consistently, and often found changes, particularly reduction in medication difficult to contemplate. CONCLUSIONS Findings highlight that family members' attitudes to medication sometimes conflict with those of the people they care for, impacting on their health and the caring relationship. Family members may need more support and could be usefully involved in medication decision-making.
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Affiliation(s)
- Amy Lewins
- Population Policy and Practice, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, United Kingdom of Great Britain and Northern Ireland
| | - Nicola Morant
- Division of Psychiatry, University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Johura Akther-Robertson
- Division of Psychiatry, University College London, London, United Kingdom of Great Britain and Northern Ireland
- NELFT Research & Development Department, North East London NHS Foundation Trust Maggie Lilley Suite, Goodmayes Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Nadia E Crellin
- Division of Psychiatry, University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Jacki L Stansfeld
- Division of Psychiatry, University College London, London, United Kingdom of Great Britain and Northern Ireland
- NELFT Research & Development Department, North East London NHS Foundation Trust Maggie Lilley Suite, Goodmayes Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Ruth Smith
- Independent consultant, Brighton, United Kingdom of Great Britain and Northern Ireland
| | - Joanna Moncrieff
- Division of Psychiatry, University College London, London, United Kingdom of Great Britain and Northern Ireland
- Havering Community Recovery Team, Harold Wood, United Kingdom of Great Britain and Northern Ireland
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9
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Brand BA, Haveman YRA, de Beer F, de Boer JN, Dazzan P, Sommer IEC. Antipsychotic medication for women with schizophrenia spectrum disorders. Psychol Med 2022; 52:649-663. [PMID: 34763737 PMCID: PMC8961338 DOI: 10.1017/s0033291721004591] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Abstract
There are significant differences between men and women in the efficacy and tolerability of antipsychotic drugs. Here, we provide a comprehensive overview of what is currently known about the pharmacokinetics and pharmacodynamics of antipsychotics in women with schizophrenia spectrum disorders (SSDs) and translate these insights into considerations for clinical practice. Slower drug absorption, metabolism and excretion in women all lead to higher plasma levels, which increase the risk for side-effects. Moreover, women reach higher dopamine receptor occupancy compared to men at similar serum levels, since oestrogens increase dopamine sensitivity. As current treatment guidelines are based on studies predominantly conducted in men, women are likely to be overmedicated by default. The risk of overmedicating generally increases when sex hormone levels are high (e.g. during ovulation and gestation), whereas higher doses may be required during low-hormonal phases (e.g. during menstruation and menopause). For premenopausal women, with the exceptions of quetiapine and lurasidone, doses of antipsychotics should be lower with largest adjustments required for olanzapine. Clinicians should be wary of side-effects that are particularly harmful in women, such as hyperprolactinaemia which can cause oestrogen deficiency and metabolic symptoms that may cause cardiovascular diseases. Given the protective effects of oestrogens on the course of SSD, oestrogen replacement therapy should be considered for postmenopausal patients, who are more vulnerable to side-effects and yet require higher dosages of most antipsychotics to reach similar efficacy. In conclusion, there is a need for tailored, female-specific prescription guidelines, which take into account adjustments required across different phases of life.
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Affiliation(s)
- Bodyl A. Brand
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yudith R. A. Haveman
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Franciska de Beer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Janna N. de Boer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Iris E. C. Sommer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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10
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Changes of Mental State and Serum Prolactin Levels in Patients with Schizophrenia and Depression after Receiving the Combination Therapy of Amisulpride and Chloroprothixol Tablets. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6580030. [PMID: 35242209 PMCID: PMC8888067 DOI: 10.1155/2022/6580030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/20/2021] [Accepted: 01/29/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the changes in mental state and serum prolactin levels in patients with schizophrenia and depression after receiving the combination therapy of amisulpride and chloroprothixol tablets. METHODS A total of 148 schizophrenic patients with depression were randomly divided into control group (N = 73) and study group (N = 75). The control group was treated with clopidothiol, and the study group was treated with amisulpride. Symptom scores, sleep quality, adverse reactions, therapeutic effects, prolactin, and progesterone levels, HAMD, PANSS, and PSP scores were compared between the two groups. RESULTS The symptom scores of both groups were significantly reduced, but when compared to the control group, the symptom scores of the research group were significantly reduced more significantly (P < 0.05); serum GDNF levels of both groups were significantly increased, while serum NSE, IL-1, and MBP levels were significantly reduced (P < 0.05). However, the research group altered more substantially (P < 0.05) than the control group; the overall PSQI score of the research group was lower (P < 0.05) than the control group; and the incidence of adverse responses in the control and study groups was 12.3 percent and 4.0 percent. The research group had a lower rate of adverse responses (P < 0.05) than the control group, and the effective treatment of the control and research groups was 82.2 percent and 98.7%, respectively. The research group had a lower rate of adverse reactions (P < 0.05) than the control group, while the control and research groups' successful treatment rates were 82.2 percent and 98.7%, respectively. When compared to the control group, the research group had a greater treatment efficiency (P < 0.05); blood prolactin and progesterone levels were considerably lowered in both groups, but the reductions in the research group were more evident (P < 0.05). Both groups had considerably lower HAMD and PANSS scores, and both had significantly higher PSP scores, although the difference in the research group was more evident (P < 0.05). CONCLUSION For people with schizophrenia and depression, a combination of amisulpride and chloroprothixol pills has a considerable effect. It can help patients with their clinical symptoms and sleep quality while also lowering their serum prolactin levels, which is favorable to their illness recovery. As a result, the combined treatment of amisulpride and chloroprothixol pills deserves to be promoted and used.
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Abstract
OBJECTIVE Previous work has demonstrated significant declines in the provision of outpatient psychotherapy by U.S. psychiatrists. The objective of this study was to characterize patterns and trends of psychotherapy by U.S. psychiatrists from 1996 to 2016. METHODS A retrospective, nationally representative analysis of psychiatrist visits from 21 waves of the U.S. National Ambulatory Medical Care Survey between 1996 and 2016 (N=29,673) was conducted to assess rates of outpatient psychotherapy provision by U.S. psychiatrists. Provision was modeled as risk differences and adjusted by clinical, sociodemographic, geographic, and financial characteristics. RESULTS Between 1996 and 2016, the weighted percentage of visits involving psychotherapy declined significantly from 44.4% in 1996-1997 to 21.6% in 2015-2016. Declines were most marked among patients diagnosed with social phobia (29% to 8%), dysthymic disorder (65% to 30%), and personality disorders (68% to 17%). For patients diagnosed with schizophrenia, psychotherapy provision remained stable (10%-12%). In the 2010-2016 period, about half of psychiatrists (53%) no longer provided psychotherapy at all. Antidepressant, antipsychotic, and sedative-hypnotic prescriptions were negatively associated with psychotherapy provision. During the study period, sociodemographic disparities grew, with older, White patients residing in metropolitan areas in the Northeast or West increasingly becoming the most likely to receive psychotherapy. Self-pay predicted access to solo-practice psychiatrists, who saw fewer patients but more frequently, and were more likely to provide psychotherapy. CONCLUSIONS Previously reported declines in psychiatrist provision of psychotherapy continued through 2016, affecting nearly all clinical categories. In the 2010s, about half of psychiatrists practiced no psychotherapy at all, creating new challenges to the integration of neurobiological and psychosocial elements of clinical care.
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Affiliation(s)
- Daniel Tadmon
- Interdisciplinary Center for Innovative Theory and Empirics (INCITE), Columbia University, New York (Tadmon); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson)
| | - Mark Olfson
- Interdisciplinary Center for Innovative Theory and Empirics (INCITE), Columbia University, New York (Tadmon); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson)
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12
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Abstract
Guidelines for the treatment of schizophrenia limit the use of antipsychotic agents to clinically-established maximum doses. This acknowledges both the absence of additional efficacy of dopamine D2 receptor antagonists above a receptor occupancy threshold, and the increases in side effects that can occur at higher doses. These limits restrict the dosing of combinations of antipsychotics as they do single agents; drugs sharing the major antipsychotic mechanism of D2 receptor antagonism will act additively in blocking these receptors.Several newer antipsychotic drugs, including aripiprazole and cariprazine, act as partial agonists at the D2 receptor site and avoid action at several other receptors, effects at which are responsible for some non-dopaminergic adverse effects. This pharmacology imparts different characteristics to the drugs resulting often in a more favourable side effect profile. Their partial agonism, along with high affinities for the D2 receptor, also means that these drugs given adjunctively may in part replace, rather than enhance, the D2 antagonism of other antipsychotic agents. This can result in an improvement in certain side effects without loss of antipsychotic efficacy.This article makes the case for distinguishing the D2 partial agonists from antagonists in defining maximum doses of combined treatments, which would increase the options available to the prescriber, emphasising that pharmacological mechanisms need to be understood in identifying optimal treatments for psychotic illness.
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Affiliation(s)
- Gavin P Reynolds
- Gavin P Reynolds, Biomolecular Sciences Research Centre, Sheffield Hallam University, Howard Street, Sheffield S1 1WB, United Kingdom.
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13
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Atypical antipsychotics and oxidative cardiotoxicity: review of literature and future perspectives to prevent sudden cardiac death. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:663-685. [PMID: 34527032 PMCID: PMC8390928 DOI: 10.11909/j.issn.1671-5411.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Oxidative stress is considered the principal mediator of myocardial injury under pathological conditions. It is well known that reactive oxygen (ROS) or nitrogen species (RNS) are involved in myocardial injury and repair at the same time and that cellular damage is generally due to an unbalance between generation and elimination of the free radicals due to an inadequate mechanism of antioxidant defense or to an increase in ROS and RNS. Major adverse cardiovascular events are often associated with drugs with associated findings such as fibrosis or inflammation of the myocardium. Despite efforts in the preclinical phase of the development of drugs, cardiotoxicity still remains a great concern. Cardiac toxicity due to second-generation antipsychotics (clozapine, olanzapine, quetiapine) has been observed in preclinical studies and described in patients affected with mental disorders. A role of oxidative stress has been hypothesized but more evidence is needed to confirm a causal relationship. A better knowledge of cardiotoxicity mechanisms should address in the future to establish the right dose and length of treatment without impacting the physical health of the patients.
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14
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Mouaffak F, Ferreri F, Bourgin-Duchesnay J, Baloche E, Blin O, Vandel P, Garay RP, Vidailhet P, Corruble E, Llorca PM. Dosing antipsychotics in special populations of patients with schizophrenia: severe psychotic agitation, first psychotic episode and elderly patients. Expert Opin Pharmacother 2021; 22:2507-2519. [PMID: 34338130 DOI: 10.1080/14656566.2021.1958781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Antipsychotic (AP) dosing is well established in nonelderly patients with acute exacerbations of schizophrenia, but not in special populations.This review describes the AP dosing procedures that have been used in clinical studies for acute psychotic agitation, a first episode of psychosis (FEP), and elderly patients. AP dosing data was extracted from the databases of drug regulatory authorities, and from clinical studies available in the medical literature. In acute psychotic agitation, intramuscular and oral APs are frequently prescribed in higher doses than those that saturate D2 receptors. Supersaturating doses of APs should be avoided due to an increased risk of adverse effects. In FEP, many studies showed efficacy of low doses of APs. Studies with risperidone and haloperidol suggested a dose reduction of approximately one third. Titration with a lower starting dose is recommended in elderly patients, due to possible decreases in pharmacokinetic clearance, and due to the risk of concomitant diseases and drug interactions. Exposure to some APs has been associated with QTc prolongation and arrhythmias, and a small but significant increase in the risk of stroke and mortality with APs has been seen, particularly in older people with dementia-related psychosis.
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Affiliation(s)
- Fayçal Mouaffak
- Emergency Psychiatry Unit, Ville Evrard Psychiatric Hospital, Seine-Saint-Denis, France
| | - Florian Ferreri
- Sorbonne University. APHP. Department of Adult Psychiatry and Medical Psychology, ICRIN, Saint-Antoine Hospital, Paris, France
| | - Julie Bourgin-Duchesnay
- Department Head of the Department of Child and Adolescent Psychiatry, Orsay Hospital, University Paris Saclay, France
| | - Emmanuelle Baloche
- Department of Neurosciences, Medical Advisor Neurosciences, Eisai SAS, La Défense, France
| | - Olivier Blin
- Institute of Neurosciences, Aix-Marseille University, Marseille, France
| | - Pierre Vandel
- Department of Adult Psychiatry, University Hospital of Besançon, EA-481, Laboratory of Neurosciences, UBFC, Besançon, France
| | - Ricardo P Garay
- Department of Pharmacology and Therapeutics, Craven, France; CNRS, National Centre of Scientific Research, Paris, France
| | - Pierre Vidailhet
- Department of Psychiatry, Strasbourg University Hospital, Strasbourg, France
| | - Emmanuelle Corruble
- Head of the Department of Psychiatry, Bicetre Hospital, APHP, INSERM UMR-1018, MOODS Team, Saclay School of Medicine, University Paris Saclay, Paris, France
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15
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de Filippis R, Gaetano R, Schoretsanitis G, Verde G, Oliveti CA, Kane JM, Segura-Garcia C, De Fazio P. Clozapine Management in Schizophrenia Inpatients: A 5-Year Prospective Observational Study of Its Safety and Tolerability Profile. Neuropsychiatr Dis Treat 2021; 17:2141-2150. [PMID: 34234440 PMCID: PMC8257059 DOI: 10.2147/ndt.s312095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/15/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Clozapine is well known for its efficacy and clinical superiority compared to other antipsychotics in treatment-resistant schizophrenia (TRS). However, it is frequently underutilized worldwide because of its acute adverse events, as well as for its long-term cardiometabolic and hematological consequences. OBJECTIVE The aim of the study was to evaluate 5-year safety in chronic TRS inpatients with continuous clozapine use. METHODS Patients with TRS and clozapine treatment were evaluated for 5 years. All participants were assessed using the Brief Psychiatric Rating Scale (BPRS), Glasgow Antipsychotic Side-effect Scale for Clozapine (GASS-C), Social Performance Scale (PSP) and Short Portable Mental Status Questionnaire (SPMSQ). Clinical, cardiometabolic and hematological data were collected periodically. General linear models (GLM) repeated measures controlling for CLZ dose were utilized to determine differences in variables across the time. RESULTS Overall, 189 inpatients were screened for study participation. The final sample included twenty-one TRS patients (16 males, 76%) with an average age of 57.6 years, all with 5-year continuous use of clozapine (mean dose 266 mg/day). There was not a significant effect of time on BPRS (p=0.774), PSP (p=0.855) and SPMSQ (p=0.066); differences remained not significant after controlling for CLZ dose (p=0.585, p=0.467 and p=0.105, respectively). No changes were found in blood and clinical parameters except for red blood cell count, which decreased over time (p=0.024; η2= 0.952). Patients reported a significant BMI decrease (-8.98 kg, p=0.008) between baseline and 5 years last observation. CONCLUSION The findings show how the application of a structured dietary, clinical and therapeutic monitoring program in psychiatric care facilities could allow the safe and effective long-term cardiometabolic and hematological management of clozapine. The unique role that clozapine plays in the current treatment of patients with TRS requires greater clinical awareness. Although its acute and chronic side effects are notorious, its safety management is feasible and broadens its potential practical application.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Gaetano
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Giuseppe Verde
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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16
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Cummings MA, O'Day JA. Should electroconvulsive therapy (ECT) be banned for schizophrenia? CNS Spectr 2021:1-3. [PMID: 33517952 DOI: 10.1017/s1092852921000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michael A Cummings
- Department of Psychiatry, University of California, Riverside, California, USA
| | - Jennifer A O'Day
- Department of Psychiatry, University of California, Riverside, California, USA
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17
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Zhang Y, Li X, Yao X, Yang Y, Ning X, Zhao T, Xia L, Zhang Y, Zhang K, Liu H. Do Leptin Play a Role in Metabolism-Related Psychopathological Symptoms? Front Psychiatry 2021; 12:710498. [PMID: 34566714 PMCID: PMC8460901 DOI: 10.3389/fpsyt.2021.710498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/17/2021] [Indexed: 01/21/2023] Open
Abstract
Objectives: Leptin is a crucial regulator of energy balance and is associated with obesity. In recent years, it has also been recognized as involved in the psychopathological mechanism. Our study aimed to elucidate the relationships between serum leptin levels, body mass index (BMI), and psychopathology symptoms in patients with schizophrenia. Methods: A cross-sectional assessment of 324 inpatients with schizophrenia was conducted. Schizophrenia symptoms were measured using the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS). Serum leptin levels were assessed by the Enzyme-Linked Immunosorbent Assay (ELISA). Results: Significant differences in sex, BMI, and negative symptom subscale (PANSS-N) scores were found between the groups with high and low leptin levels in the study. Leptin levels were positively correlated with BMI (B = 2.322, t = 9.557, P < 0.001) and negatively correlated with PANSS-N scores (B = -0.303, t = -2.784, P = 0.006). Conclusions: Our results suggest that the increase in leptin levels is responsible for antipsychotic-induced weight gain and improved psychopathological symptoms.
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Affiliation(s)
- Yelei Zhang
- Department of Psychiatry, Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Xiaoyue Li
- Department of Psychiatry, Chaohu Hospital, Anhui Medical University, Hefei, China
| | - Xianhu Yao
- Maanshan Fourth People's Hospital, Maanshan, China
| | - Yating Yang
- Department of Psychiatry, Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Xiaoshuai Ning
- Department of Psychiatry, Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Tongtong Zhao
- Department of Psychiatry, Chaohu Hospital, Anhui Medical University, Hefei, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital, Anhui Medical University, Hefei, China
| | - Yulong Zhang
- Department of Psychiatry, Chaohu Hospital, Anhui Medical University, Hefei, China
| | - Kai Zhang
- Department of Psychiatry, Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital, Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
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18
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Correll CU, Kim E, Sliwa JK, Hamm W, Gopal S, Mathews M, Venkatasubramanian R, Saklad SR. Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview. CNS Drugs 2021; 35:39-59. [PMID: 33507525 PMCID: PMC7873121 DOI: 10.1007/s40263-020-00779-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
The availability of long-acting injectable (LAI) antipsychotics for the treatment of schizophrenia provides clinicians with options that deliver continuous drug exposure and may improve adherence compared with daily oral antipsychotics. However, all LAI antipsychotics have unique formulations and pharmacokinetic characteristics that have implications for medication selection, administration interval, and injection site. This review outlines key differences in drug formulations and pharmacokinetics among LAI antipsychotics. A systematic search of the PubMed database was conducted to identify physical and formulation properties and pharmacokinetic data of commercially available LAI antipsychotics, including flupentixol decanoate, fluphenazine decanoate, haloperidol decanoate, zuclopenthixol decanoate, aripiprazole monohydrate, aripiprazole lauroxil, olanzapine pamoate, paliperidone palmitate, risperidone microspheres, and risperidone polymeric microspheres. Additional information was obtained from package inserts and product monographs. Relevant data on drug properties, administration details, pharmacokinetic parameters, and oral dose equivalencies of LAI antipsychotics are summarized. Based on our analysis, formulation characteristics (e.g., vehicle medium) and administration characteristics (e.g., injection site) can affect rate of absorption and adverse effects and may factor into whether oral supplementation or an additional injection is needed. Dose adjustments may be necessary based on potential drug-drug interactions, and approximate dose equivalence with oral formulations can help inform titration when switching from oral to LAI formulations. Clinicians administering LAI antipsychotics should consider these formulation and pharmacokinetic factors to maximize clinical impact and to adjust to an individual patient's needs and treatment goals.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Division of Psychiatric Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Edward Kim
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | - Wayne Hamm
- Janssen Scientific Affairs, LLC, Spring Hill, TN, USA
| | - Srihari Gopal
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | - Maju Mathews
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | | | - Stephen R Saklad
- College of Pharmacy, Pharmacotherapy Division, The University of Texas at Austin, 7703 Floyd Curl Drive, MC 6220, San Antonio, TX, 78229-3900, USA.
- Long School of Medicine, Pharmacotherapy Education and Research Center, UT Health San Antonio, San Antonio, TX, 78229-3900, USA.
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19
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Barbosa WB, Gomes RM, Godman B, Acurcio FDA, Guerra Júnior AA. Real-world effectiveness of olanzapine and risperidone in the treatment of schizophrenia in Brazil over a 16-year follow-up period; findings and implications. Expert Rev Clin Pharmacol 2020; 14:269-279. [PMID: 33331189 DOI: 10.1080/17512433.2021.1865799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Antipsychotics are widely prescribed for patients with schizophrenia. The Brazilian public health system provides these patients free of charge to patients and it is pertinent to evaluate their benefits.Objective: To evaluate the effectiveness of olanzapine and risperidone in the treatment of patients with schizophrenia in the real-world and assessing risk factors for their discontinuation through a national non-concurrent cohort with 16 years of follow-up.Methods: Three SUS administrative databases were integrated by deterministic-probabilistic linkage. After patients were matched (1:1) for psychiatric hospitalization, year of receiving the antipsychotic, sex, and age, considering either olanzapine or risperidone at study entry. Kaplan-Meier was used to estimate the cumulative probabilities of discontinuation of treatment and associated factors were identified. Sensitivity analyses were performed.Results: 3416 pairs of patients were included. Olanzapine had a longer time until discontinuation of treatment (p = 0.021), and risperidone had a higher risk of discontinuation (p = 0.021). Among patients persistent for at least 24 months, there was no statistically significant difference.Conclusion: Olanzapine demonstrated superior real-world effectiveness over risperidone, in terms of survival and psychiatric hospitalization. This superiority was not sustained in all analyses.
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Affiliation(s)
- Wallace Breno Barbosa
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,, SUS Collaborating Centre‑Technology Assessment and Excellence in Health (CCATES/UFMG), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rosângela Maria Gomes
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,, SUS Collaborating Centre‑Technology Assessment and Excellence in Health (CCATES/UFMG), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska, Karolinska Institute, Stockholm, Sweden.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Francisco de Assis Acurcio
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,, SUS Collaborating Centre‑Technology Assessment and Excellence in Health (CCATES/UFMG), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Augusto Afonso Guerra Júnior
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,, SUS Collaborating Centre‑Technology Assessment and Excellence in Health (CCATES/UFMG), Federal University of Minas Gerais, Belo Horizonte, Brazil
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20
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Isohanni M, Jääskeläinen E, Miller BJ, Hulkko A, Tiihonen J, Möller H, Hartikainen S, Huhtaniska S, Lieslehto J. Medication management of antipsychotic treatment in schizophrenia—A narrative review. Hum Psychopharmacol 2020. [DOI: 10.1002/hup.2765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Matti Isohanni
- Center for Life Course Health Research University of Oulu Oulu Finland
| | | | - Brian J. Miller
- Department of Psychiatry Augusta University Augusta Georgia USA
| | - Anja Hulkko
- Center for Life Course Health Research University of Oulu Oulu Finland
| | - Jari Tiihonen
- Karolinska Institutet Stockholm Sweden
- University of Eastern Finland Kuopio Finland
| | | | - Sirpa Hartikainen
- Kuopio Research Center of Geriatric Care School of Pharmacy University of Eastern Finland Kuopio Finland
| | - Sanna Huhtaniska
- Center for Life Course Health Research University of Oulu Oulu Finland
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21
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Johnsen E, Kroken RA, Løberg EM, Rettenbacher M, Joa I, Larsen TK, Reitan SK, Walla B, Alisauskiene R, Anda LG, Bartz-Johannessen C, Berle JØ, Bjarke J, Fathian F, Hugdahl K, Kjelby E, Sinkeviciute I, Skrede S, Stabell L, Steen VM, Fleischhacker WW. Amisulpride, aripiprazole, and olanzapine in patients with schizophrenia-spectrum disorders (BeSt InTro): a pragmatic, rater-blind, semi-randomised trial. Lancet Psychiatry 2020; 7:945-954. [PMID: 33069317 DOI: 10.1016/s2215-0366(20)30341-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/14/2020] [Accepted: 07/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Amisulpride, aripiprazole, and olanzapine are first-line atypical antipsychotics that have not previously been compared head-to-head in a pragmatic trial. We aimed to compare the efficacy and safety of these agents in a controlled trial. METHODS This pragmatic, rater-blind, randomised controlled trial was done in three academic centres of psychiatry in Norway, and one in Austria. Eligible patients were aged 18 years or older, met ICD-10 criteria for schizophrenia-spectrum disorders (F20-29), and had symptoms of active psychosis. Eligible patients were randomly assigned to receive oral amisulpride, aripiprazole, or olanzapine. Treatment allocation was open to patients and staff, and starting dose, treatment changes, and adjustments were left to the discretion of the treating physician. Computer-generated randomisation lists for each study centre were prepared by independent statisticians. Patients were followed up for 52 weeks after random assignment, during which assessments were done 8 times by researchers masked to treatment. The primary outcome was reduction of the Positive And Negative Syndrome Scale (PANSS) total score at 52 weeks, and primary analyses were done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01446328. FINDINGS Between Oct 20, 2011, and Dec 30, 2016, we assessed 359 patients for eligibility. 215 patients were excluded (107 did not meet inclusion criteria, 82 declined to participate, 26 other reasons). 144 patients (mean baseline PANSS total estimated score 78·4 [SD 1·4]) were randomly assigned 1:1:1 to receive amisulpride (44 patients), aripiprazole (48 patients) or olanzapine (52 patients). After 52 weeks, the patients allocated to amisulpride had a PANSS total score reduction of 32·7 points (SD 3·1) compared with 21·9 points reduction with aripiprazole (SD 3·9, p=0·027) and 23·3 points with olanzapine (2·9, p=0·025). We observed weight gain and increases of serum lipids and prolactin in all groups. 26 serious adverse events (SAEs) among 20 patients were registered (four [9%] of 44 patients allocated to amisulpride, ten [21%] of 48 patients allocated to aripiprazole, and six [12%] of 52 patients allocated to olanzapine), with no statistically significant differences between the study drugs. 17 (65%) of the 26 SAEs occurred during the use of the study drug, with readmission or protracted hospital admission accounting for 13 SAEs. One death by suicide, one unspecified death, and one life-threatening accident occurred during follow-up, after cessation of treatment. INTERPRETATION Amisulpride was more efficacious than aripiprazole or olanzapine for reducing the PANSS total scores in adults with schizophrenia-spectrum disorders. Side-effect differences among the groups were generally small. This study supports the notion that clinically relevant efficacy differences exist between antipsychotic drugs. Future research should aim to compare first-line antipsychotics directly in pragmatic clinical trials that reflect everyday clinical practice. FUNDING The Research Council of Norway, the Western Norway Regional Health Trust, and participating hospitals and universities.
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Affiliation(s)
- Erik Johnsen
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research Centre of Excellence, Bergen, Norway.
| | - Rune A Kroken
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research Centre of Excellence, Bergen, Norway
| | - Else-Marie Løberg
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research Centre of Excellence, Bergen, Norway
| | | | - Inge Joa
- Stavanger University Hospital, Stavanger, Norway
| | - Tor Ketil Larsen
- Stavanger University Hospital, Stavanger, Norway; University of Bergen, Bergen, Norway
| | - Solveig Klæbo Reitan
- St Olav's University Hospital, Trondheim, Norway; Norges teknisk-naturvitenskapelige universitet, Trondheim, Norway
| | - Berit Walla
- St Olav's University Hospital, Trondheim, Norway
| | - Renata Alisauskiene
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway
| | | | | | - Jan Øystein Berle
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research Centre of Excellence, Bergen, Norway
| | - Jill Bjarke
- Haukeland University Hospital, Bergen, Norway
| | - Farivar Fathian
- Norske Kvinners Sanitetsforening Olaviken Gerontopsychiatric Hospital, Erdal, Norway; The Norwegian Centre for Mental Disorders Research Centre of Excellence, Bergen, Norway
| | - Kenneth Hugdahl
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway
| | - Eirik Kjelby
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research Centre of Excellence, Bergen, Norway
| | - Igne Sinkeviciute
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research Centre of Excellence, Bergen, Norway
| | - Silje Skrede
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway
| | - Lena Stabell
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research Centre of Excellence, Bergen, Norway
| | - Vidar M Steen
- Haukeland University Hospital, Bergen, Norway; University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research Centre of Excellence, Bergen, Norway
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Progress in Schizophrenia Research and Treatment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:440-442. [PMID: 33343257 PMCID: PMC7725148 DOI: 10.1176/appi.focus.18310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Introduction: Psychosis is a multifaceted clinical phenomenon in which the various symptoms may show a differential response to treatment. Important information may be lost when heterogeneous symptoms are grouped together in global sum scores when studying treatment effects.Aims: The aim of this study was to compare the level and rate of change in the two separate symptoms hallucinations and delusions during the acute psychotic phase, and to explore whether potential temporal differences depend on diagnosis or patients being previously medicated with antipsychotics or not.Method: Patients admitted with active symptoms of schizophrenia or related psychotic disorders were included in the Bergen Psychosis Project (BPP) (N = 226), a prospective, pragmatic, study of four second-generation antipsychotics. The Positive and Negative Syndrome Scale were assessed at baseline, one, three and six months.Results: Over the total follow-up period, latent growth curve models showed greater reductions in delusions than in hallucinations. However, the percentage of the total reduction was found to be larger in hallucinations than that of delusions in the first interval (91% vs. 64%). The levels and changes in these variables were dependent on diagnosis and whether or not patients had a life-time history of antipsychotic use.Conclusion: Focusing on separate symptoms rather than general symptom clusters could offer clinicians a useful approach when evaluating the early response of antipsychotics.ClinicalTrials.gov ID: NCT00932529; URL: http://www.clinicaltrials.gov/.
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Park SC, Lee BJ, Park JH, Kawasaki H, Avasthi A, Grover S, Tanra AJ, Lin SK, Javed A, Tan CH, Sartorius N, Shinfuku N, Park YC. QT interval prolongation noted in one percent of 2553 Asian patients with schizophrenia: Findings from the REAP-AP survey. Kaohsiung J Med Sci 2020; 36:1030-1037. [PMID: 32772489 DOI: 10.1002/kjm2.12280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/16/2020] [Accepted: 07/05/2020] [Indexed: 11/08/2022] Open
Abstract
Although the association between antipsychotic use and corrected QT interval (QTc) prolongation has been repeatedly confirmed, the relationship has been rarely studied in a practical setting. Using data from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP) survey, our study aimed to investigate the prevalence and clinical correlates of QTc prolongation in 2553 Asian patients with schizophrenia. After adjusting for the potential effect of confounding factors, the baseline and clinical characteristics of the schizophrenia patients with and without QTc prolongation were compared using analyses of covariance and binary logistic analyses. In addition, a binary logistic analysis model with a forward selection method was used to identify the distinctive clinical correlates of QTc prolongation. QTc prolongation was noted in 1.1% of Asian patients with schizophrenia. Schizophrenia patients were characterized by lower proportions of disorganized speech and negative symptoms; higher use of amisulpride and clozapine; and higher proportions of rigidity, hypercholesterolemia, and sedation than those without QTc prolongation. Finally, a binary logistic mode showed that amisulpride, clozapine, rigidity, and hypercholesterolemia might be the distinctive clinical correlates of QTc prolongation in Asian patients with schizophrenia. These findings indicate the clinical implications that the uses of amisulpride and clozapine and the occurrences of rigidity and hypercholesterolemia may be potential risk factors for QTc prolongation of schizophrenia patients.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Bong Ju Lee
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jae Hong Park
- Department of Psychiatry, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Hiroaki Kawasaki
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Andi J Tanra
- Department of Psychiatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Shih-Ku Lin
- Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | - Chay Hoon Tan
- Department of Pharmacology, National University Hospital, Singapore, Singapore
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Naotaka Shinfuku
- Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
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Khan TA, Hussain S, Ikram A, Mahmood S, Riaz H, Jamil A, Amin A, Haider YG, Sandhu M, Mushtaq A, Barbui C, Johnson CF, Godman B. Prevalence and treatment of neurological and psychiatric disorders among tertiary hospitals in Pakistan; findings and implications. Hosp Pract (1995) 2020; 48:145-160. [PMID: 32343632 DOI: 10.1080/21548331.2020.1762366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mental health and neurological disorders are prevalent in Pakistan. However, there are considerable concerns with their management due to issues of access, availability of trained personnel and stigma alongside paucity of such data. Consequently, there is a need to document current treatment approaches starting with tertiary hospitals in Pakistan where patients with more severe mental and neurological disorders are typically treated. Subsequently, use the findings to help direct future policies and initiatives. METHODS Multi-centered, cross-sectional, prospective study principally evaluating current medicine usage among patients attending tertiary hospitals in Pakistan with psychiatric and neurological disorders. In addition, possible factors contributing to the prevalence of these disorders in this population to help with future care. All 23 tertiary care hospitals in the ten major Districts in Pakistan were included, which cover 75% of the population. RESULTS 57,664 patients were evaluated of which 35.3% were females. Both females and males had multiple brain disorders and multiple co-morbidities. Schizophrenia was the most prevalent disorder overall among both females (25.2%) and males (30.4%). A median of six medicines were prescribed per patient, with antipsychotics and antidepressants the most prescribed medicines. Clozapine was the most prescribed medicine in males (12.25%) and females (11.83%) including for psychiatric disorders, with sodium valproate the most prescribed medicine in epilepsy in males (42.44% of all anti-epileptic medicines) as well as females (46.38%). There was a greater prevalence of both disorders among the lower classes. A greater prevalence of schizophrenia was seen in patients abusing alcohol and smokers. The divorce rate was higher among the studied patients and the prevalence of depression was higher among the widowed population. CONCLUSIONS There were concerns with the quality of prescribing including the extent of polypharmacy as well as possible overuse of clozapine especially in patients with epilepsy, both of which need addressing.
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Affiliation(s)
- Tanveer Ahmed Khan
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Shahzad Hussain
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Aamer Ikram
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Sidra Mahmood
- Department of Pharmacy, Quaid-e-Azam University , Islamabad, Pakistan
| | - Humayun Riaz
- Department of Pharmaceutics, Rashid Latif College of Pharmacy , Lahore, Pakistan
| | - Ayesha Jamil
- Faculty of Pharmacy, Hajvery University , Lahore, Pakistan
| | - Amina Amin
- Faculty of Pharmacy, Hajvery University , Lahore, Pakistan
| | | | - Marva Sandhu
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Atifa Mushtaq
- Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad, Pakistan
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona , Verona, Italy
| | - Chris F Johnson
- Pharmacy Services, National Health Service Greater Glasgow and Clyde (NHS GGC) , Glasgow, UK
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm, Sweden.,Department of Pharmacoepidemiolgy, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK.,Health Economics Centre, Liverpool University , Liverpool, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University , Pretoria, South Africa
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Gómez-Revuelta M, Pelayo-Terán JM, Juncal-Ruiz M, Vázquez-Bourgon J, Suárez-Pinilla P, Romero-Jiménez R, Setién Suero E, Ayesa-Arriola R, Crespo-Facorro B. Antipsychotic Treatment Effectiveness in First Episode of Psychosis: PAFIP 3-Year Follow-Up Randomized Clinical Trials Comparing Haloperidol, Olanzapine, Risperidone, Aripiprazole, Quetiapine, and Ziprasidone. Int J Neuropsychopharmacol 2020; 23:217-229. [PMID: 31974576 PMCID: PMC7177160 DOI: 10.1093/ijnp/pyaa004] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/25/2019] [Accepted: 01/22/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Different effectiveness profiles among antipsychotics may be a key point to optimize treatment in patients suffering a first episode of psychosis to impact on long-term outcome. The aim of this study is to compare the clinical effectiveness of olanzapine, risperidone, haloperidol, aripiprazole, ziprasidone, and quetiapine in the treatment of first episode of psychosis at 3-year follow-up. METHOD From February 2001 to January 2011, 2 phases of a prospective, randomized, open-label study were undertaken. A total of 376 first-episode drug-naïve patients were randomly assigned to olanzapine (n = 55), risperidone (n = 63), haloperidol (n = 56), aripiprazole (n = 78), ziprasidone (n = 62), or quetiapine (n = 62) and followed up for 3 years. The primary effectiveness measure was all cause of treatment discontinuation. In addition, an analysis based on intention-to-treat principle was conducted in the analysis for clinical efficacy. RESULTS The overall dropout rate at 3 years reached 20.75%. Treatment discontinuation rates were significantly different among treatment groups (olanzapine = 69.09, risperidone = 71.43, aripiprazole = 73.08%, ziprasidone = 79.03%, haloperidol = 89.28%, and quetiapine = 95.53%) (χ2 = 79.86; P = .000). Statistically significant differences in terms of lack of efficacy, adherence, and tolerability were observed among treatment groups along the 3-year follow-up, determining significant differences in time to all-cause discontinuation (log-rank = 92.240; P = .000). Significant differences between treatments were found in the categories of sleepiness/sedation, increased sleep duration, akinesia, weight gain, ejaculatory dysfunction, extrapyramidal-symptoms, and amenorrhea. CONCLUSIONS Olanzapine, risperidone, and aripiprazole presented advantages for the first-line treatment of first episode of psychosis in terms of effectiveness. Identifying different discontinuation patterns may contribute to optimize treatment selection after first episode of psychosis.ClinicalTrials.gov Identifier: NCT02526030 https://clinicaltrials.gov/show/NCT02526030.
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Affiliation(s)
- Marcos Gómez-Revuelta
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - José María Pelayo-Terán
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Servicio de Psiquiatría y Salud Mental. Hospital El Bierzo. Servicio de Salud de Castilla y León (SACYL), Ponferrada (León), Spain
| | - María Juncal-Ruiz
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Sierrallana Hospital, Department of Psychiatry, IDIVAL, School of Medicine, University of Cantabria, Torrelavega, Spain
| | - Javier Vázquez-Bourgon
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Paula Suárez-Pinilla
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Rodrigo Romero-Jiménez
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Esther Setién Suero
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Rosa Ayesa-Arriola
- University Hospital Marqués de Valdecilla, IDIVAL, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Hospital Universitario Virgen del Rocío, Department of Psychiatry, Universidad de Sevilla, Sevilla, Spain. Instituto de Investigacion Sanitaria de Sevilla, IBiS
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