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Salazar de Pablo G, Rodriguez V, Besana F, Civardi SC, Arienti V, Maraña Garceo L, Andrés-Camazón P, Catalan A, Rogdaki M, Abbott C, Kyriakopoulos M, Fusar-Poli P, Correll CU, Arango C. Umbrella Review: Atlas of the Meta-Analytical Evidence of Early-Onset Psychosis. J Am Acad Child Adolesc Psychiatry 2024; 63:684-697. [PMID: 38280414 DOI: 10.1016/j.jaac.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/13/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE Early-onset psychosis (EOP) refers to the development of psychosis before the age of 18 years. We aimed to summarize, for the first time, the meta-analytical evidence in the field of this vulnerable population and to provide evidence-based recommendations. METHOD We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant, pre-registered (PROSPERO: CRD42022350868) systematic review of several databases and registers to identify meta-analyses of studies conducted in EOP individuals to conduct an umbrella review. Literature search, screening, data extraction, and quality assessment were carried out independently. Results were narratively reported, clustered across core domains. Quality assessment was performed with the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool. RESULTS A total of 30 meta-analyses were included (373 individual studies, 25,983 participants, mean age 15.1 years, 38.3% female). Individuals with EOP showed more cognitive impairments compared with controls and individuals with adult/late-onset psychosis. Abnormalities were observed meta-analytically in neuroimaging markers but not in oxidative stress and inflammatory response markers. In all, 60.1% of EOP individuals had a poor prognosis. Clozapine was the antipsychotic with the highest efficacy for overall, positive, and negative symptoms. Tolerance to medication varied among the evaluated antipsychotics. The risk of discontinuation of antipsychotics for any reason or side effects was low or equal compared to placebo. CONCLUSION EOP is associated with cognitive impairment, involuntary admissions, and poor prognosis. Antipsychotics can be efficacious in EOP, but tolerability and safety need to be taken into consideration. Clozapine should be considered in EOP individuals who are resistant to 2 non-clozapine antipsychotics. Further meta-analytical research is needed on response to psychological interventions and other prognostic factors. PLAIN LANGUAGE SUMMARY This umbrella review summarized the meta-analytical knowledge from 30 meta-analyses on early-onset psychosis. Early-onset psychosis refers to the development of psychosis before the age of 18 years and is associated with cognitive impairment, hospitalization, and poor prognosis. Individuals with early-onset psychosis show more cognitive impairments and abnormalities compared with controls. Clozapine was the antipsychotic with the highest efficacy for positive, negative, and overall symptoms and should be considered in individuals with early-onset psychosis. STUDY PREREGISTRATION INFORMATION Early Onset Psychosis: Umbrella Review on Diagnosis, Prognosis and Treatment factors; https://www.crd.york.ac.uk/PROSPERO/; CRD42022350868.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain; Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, United Kingdom.
| | - Victoria Rodriguez
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | | | | | | | - P Andrés-Camazón
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Ana Catalan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Biobizkaia Health Research Institute. Basurto University Hospital, OSI Bilbao-Basurto, and the University of the Basque Country UPV/EHU. Centro de Investigación en Red de Salud Mental (CIBERSAM), Vizcaya, Spain
| | - Maria Rogdaki
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Francis Crick Institute, London, United Kingdom
| | - Chris Abbott
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Marinos Kyriakopoulos
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, United Kingdom; National and Kapodistrian University of Athens, Athens, Greece
| | - Paolo Fusar-Poli
- University of Pavia, Pavia, Italy; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; LMU Munich, Munich, Germany; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK; and National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Christoph U Correll
- Charité Universitätsmedizin, Berlin, Germany; The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York; Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, New York; and the German Center for Mental Health (DZPG), partner site Berlin, Germany
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
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Chen P, Yang HD, Wang JJ, Zhu ZH, Zhao HM, Yin XY, Cai Y, Zhu HL, Fu JL, Zhang XZ, Sun WX, Hui L, Zhang XB. Association of serum interleukin-6 with negative symptoms in stable early-onset schizophrenia. World J Psychiatry 2024; 14:794-803. [PMID: 38984340 PMCID: PMC11230098 DOI: 10.5498/wjp.v14.i6.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/28/2024] [Accepted: 05/17/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Accumulating evidence suggests that the inflammatory cytokine interleukin-6 (IL-6) contributes to the pathophysiology of psychiatric disorders. However, there was no study concerning the relationship between IL-6 concentrations and clinical features in the chronic phase of early-onset schizophrenia (EOS). AIM To investigate the relationship between serum IL-6 concentration and the clinical features of EOS. METHODS We measured serum IL-6 Levels from 74 patients with chronic schizophrenia, including 33 with age at onset < 21 years (EOS group) and 41 with onset ≥ 21 years in [adult-onset schizophrenia (AOS) group], and from 41 healthy controls. Symptom severities were evaluated using the Positive and Negative Syndrome Scale (PANSS). RESULTS Serum IL-6 concentrations were higher in both EOS and AOS groups than healthy controls (F = 22.32, P < 0.01), but did not differ significantly between EOS and AOS groups (P > 0.05) after controlling for age, body mass index, and other covariates. Negative symptom scores were higher in the EOS group than the AOS group (F = 6.199, P = 0.015). Serum IL-6 concentrations in the EOS group were negatively correlated with both total PANSS-negative symptom score (r = -0.389, P = 0.032) and avolition/asociality subscore (r = -0.387, P = 0.026). CONCLUSION Patients with EOS may have more severe negative symptoms than those with adult-onset schizophrenia during the chronic phase of the illness. IL-6 signaling may regulate negative symptoms and its avolition/asociality subsymptoms among the early-onset chronic schizophrenic patients.
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Affiliation(s)
- Peng Chen
- Suzhou Medical College of Soochow University, Suzhou 215123, Jiangsu Province, China
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Hai-Dong Yang
- Department of Psychiatry, The Fourth People’s Hospital of Lianyungang, The Affiliated Kangda College of Nanjing Medical University, Lianyungang 222003, Jiangsu Province, China
| | - Jun-Jie Wang
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Zhen-Hua Zhu
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Hui-Min Zhao
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou 215002, Jiangsu Province, China
| | - Xu-Yuan Yin
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Yuan Cai
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Hong-Liang Zhu
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Jia-Lin Fu
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Xin-Zhu Zhang
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Wen-Xi Sun
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Li Hui
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Xiao-Bin Zhang
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
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Muyambi K, Walsh S, Dettwiller P, Tan KL, Dennis S, Bressington D, Gray RJ, McCall A, Jones M. Australian trial of behavioural activation for people with schizophrenia experiencing negative symptoms: a feasibility randomised controlled trial protocol. BMJ Open 2024; 14:e080245. [PMID: 38719282 PMCID: PMC11086511 DOI: 10.1136/bmjopen-2023-080245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Negative symptoms are frequently experienced by people with schizophrenia. People with negative symptoms often have impaired social functioning and reduced quality of life. There is some evidence that cognitive-behavioural therapy results in a modest reduction in negative symptoms. Behavioural activation may be an effective alternative treatment for negative symptoms.The study aims to examine the feasibility and acceptability of implementing a behavioural activation trial delivered in three community mental health services in South Australia to support adult consumers experiencing negative symptoms of schizophrenia. METHOD AND ANALYSIS This randomised controlled study will recruit a total of 60 consumers aged 18 years or above with mild-moderate negative symptoms of schizophrenia. The consumers will be randomly allocated to receive behavioural activation plus usual mental healthcare or usual mental healthcare alone. The intervention group will receive twelve 30 min sessions of behavioural activation, which will be delivered twice weekly over 6 weeks. In addition, we aim to recruit nine mental health workers from the three rural mental health services who will complete a 10-week online training programme in behavioural activation. Changes in negative symptoms of schizophrenia and depressive symptoms will be assessed at three time points: (a) at baseline, at 6 weeks and 3 month follow-ups. Changes in health-related quality of life (Short Form F36; secondary outcome) will be assessed at two time points: (a) at baseline and (b) immediately at postintervention after 6 weeks. At the end of the trial, interviews will be conducted with purposively selected mental health workers and consumers. Descriptive statistics and thematic analysis will be used to assess feasibility and acceptability. ETHICS AND DISSEMINATION The findings from our feasibility study will inform the design of a fully powered randomised controlled trial to test the effectiveness of behavioural activation as a treatment for negative symptoms in schizophrenia. The study protocol was approved by the Central Adelaide Local Health Network Human Research Ethics Committee. The findings from this study will be disseminated through peer-reviewed scientific journals and conferences. TRIAL REGISTRATION NUMBER ACTRN12623000348651p.
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Affiliation(s)
- Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Pascale Dettwiller
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Kuan Liung Tan
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Shaun Dennis
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
- Rural and Remote Mental Health Service, Barossa Hills Fleurieu Local Health Network, Whyalla, South Australia, Australia
| | - Daniel Bressington
- Charles Darwin University College of Nursing & Midwifery, Casuarina, Odisha, Australia
| | - Richard John Gray
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia
| | - Audrey McCall
- Flinders and Upper North Local Health Network, Whyalla, South Australia, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
- School of Nursing, La Trobe University, Bundoora, Victoria, Australia
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Biswas T, Mishra BR, Maiti R, Padhy SK, Mishra A. Efficacy and safety of low-dose amisulpride versus olanzapine-fluoxetine combination in post-schizophrenic depression: A randomized controlled trial. J Psychiatr Res 2024; 173:302-308. [PMID: 38560960 DOI: 10.1016/j.jpsychires.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/27/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
Post-schizophrenic depression (PSD) increases the morbidity, mortality, and health burden in patients with schizophrenia. However, treatment of PSD is challenging due to the lack of substantial evidence of standard clinical practice. This study was aimed at comparing the efficacy and safety of low-dose amisulpride versus olanzapine-fluoxetine combination (OFC) in PSD. This was a randomized controlled trial conducted in sixty patients with PSD fulfilling the eligibility criteria. Recruited patients were randomized to receive either amisulpride at low dose (i.e., 100-300 mg/day) or OFC (5/10 mg + 20 mg) for eight weeks. The Calgary Depression Scale for Schizophrenia (CDSS), the Clinical Global Impression-Severity (CGI-S) and serum BDNF levels were assessed at baseline and after eight weeks of treatment. The change in the CDSS scores from baseline over eight weeks was significant in both the amisulpride and OFC groups. However, the changes were not significant when compared between the groups. Similarly, the changes in CGI-S scores and serum BDNF levels were significant in each group; but non-significant between the groups. A significant negative correlation was found between the changes in the CDSS scores and the serum BDNF levels in each group. No significant adverse events were noted in either group. Thus, to conclude, low-dose amisulpride can be a potential monotherapy in PSD with a favourable clinical outcome and safety profile (ClinicalTrials.gov ID: NCT04876521).
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Affiliation(s)
- Tathagata Biswas
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
| | - Biswa Ranjan Mishra
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Susanta Kumar Padhy
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Zhang T, Gan R, Zeng J, Ye J, Hu Y, Xu L, Wei Y, Tang X, Li C, Liu H, Chen T, Wang J. Attenuated niacin response is associated with a subtype of first-episode drug-naïve psychosis characterized as serious negative symptoms. Eur Arch Psychiatry Clin Neurosci 2023; 273:1725-1736. [PMID: 36688979 DOI: 10.1007/s00406-023-01556-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023]
Abstract
Although the phenomenon of attenuated niacin response (ANR) has been widely replicated in some patients with first-episode psychosis (FEP), its relevance to the negative symptoms (NS) of psychosis remains unclear. Total of 240 patients with drug-naïve FEP and 101 healthy controls (HCs) were recruited, and 209 were followed up for 1 year. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), and niacin-induced responses were measured using laser Doppler flowmetry. We calculated the log-transform EC50 [concentration of methyl nicotinate required to elicit a half-maximal blood flow (MBF) response] and MBF values. Core-NS was generated by factor analysis of the PANSS-NS subscale and cluster analysis to produce subtypes. Significant differences were found in the log10 (EC50) values between the FEP and HC groups (p < 0.001), supporting the ANR in patients with FEP. A higher NS severity was found in the ANR subgroup than that in other patients. Factor analysis determined that a two-dimensional model included core NS and rigidity of thinking. The log10 (EC50) value was significantly associated with only the core NS. Cluster analysis revealed three subtypes-36.7% (cluster-1, n = 88), 16.7% (cluster-2, n = 40), and 46.7% (cluster-3, n = 112). Cluster-2 characterized by extensive NS appeared to have a more remarkable ANR and less symptomatic improvement than those with other clusters during follow-up. No significant changes were found in the niacin response trajectories between the baseline and follow-up. Our findings indicate a significant correlation between ANR and core NS in patients with FEP. ANR may be a potential biomarker for certain subtypes with NS-dominated characteristics and poor symptomatic remission.
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Affiliation(s)
- TianHong Zhang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, China.
| | - RanPiao Gan
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, China
| | - JiaHui Zeng
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, China
| | - JiaYi Ye
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, China
| | - YeGang Hu
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, China
| | - LiHua Xu
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, China
| | - YanYan Wei
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, China
| | - XiaoChen Tang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, China
| | - ChunBo Li
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai, 200240, People's Republic of China
| | - Tao Chen
- Department of Automation, Shanghai Jiao Tong University, Shanghai, 200240, People's Republic of China
- Big Data Research Lab, University of Waterloo, Waterloo, ON, Canada
- Labor and Worklife Program, Harvard University, Cambridge, MA, USA
| | - JiJun Wang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, Shanghai, 200030, China.
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Beijing, People's Republic of China.
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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Rotolo RA, Ecevitoglu A, Presby RE, Lindgren H, Mombereau C, Nicholas C, Moore A, Edelstein GA, Correa M, Salamone JD. Effort-related effects of chronic administration of the DA D 2 receptor antagonist haloperidol via subcutaneous programmable minipumps: Reversal by co-administration of the adenosine A2A antagonist istradefylline. Psychopharmacology (Berl) 2023; 240:2173-2185. [PMID: 37615683 DOI: 10.1007/s00213-023-06439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023]
Abstract
RATIONALE Long-acting antipsychotics such as haloperidol decanoate are becoming more commonly used. Long-acting depot formulations have several advantages, but secondary negative effects of prolonged delivery, including motivational dysfunctions, could have debilitating effects. Assessing the behavioral changes that emerge during chronic antipsychotic administration in rats could provide insight regarding the development of motivational dysfunctions and drug tolerance. OBJECTIVES Acute administration of dopamine D2 antagonists such as haloperidol induce motivational deficits in rats, as marked by a shift towards a low-effort bias during effort-based choice tasks. In the present studies, programmable subcutaneous infusion pumps provided continuous and controlled drug delivery of haloperidol. Animals were assessed using a fixed ratio (FR) 5 lever pressing schedule and the FR5/chow feeding test of effort-based choice. The adenosine A2A antagonist istradefylline was studied for its ability to reverse the effects of chronic haloperidol. RESULTS Continuous chronic infusions of haloperidol produced significant reductions in FR5 performance and a shift from lever pressing to chow intake in rats tested on FR5/chow feeding choice, with no evidence of tolerance over the 4-week infusion period. Behavior returned to baseline during the vehicle-infusion washout period. Istradefylline significantly reversed the effects of haloperidol, increasing lever pressing and decreasing chow intake in haloperidol-treated rats. CONCLUSIONS These studies provide an important behavioral characterization of the effects of chronically infused haloperidol, and demonstrate that A2A antagonism reverses the effects of chronic haloperidol. This research could contribute to the understanding and treatment of motivational dysfunctions seen in schizophrenia, Parkinson's disease, and other disorders involving dopamine.
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Affiliation(s)
- Renee A Rotolo
- Behavioral Neuroscience, Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
- Present Address: Sage Therapeutics, Cambridge, MA, USA
| | - Alev Ecevitoglu
- Behavioral Neuroscience, Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Rose E Presby
- Behavioral Neuroscience, Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
- Present Address: Scintillon Institute, San Diego, CA, USA
| | - Hanna Lindgren
- Symptom Biology, H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
| | | | - Cyrene Nicholas
- Behavioral Neuroscience, Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Alana Moore
- Behavioral Neuroscience, Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Gayle A Edelstein
- Behavioral Neuroscience, Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Merce Correa
- Area de Psicobiologia, Universitat Jaume I, Castelló, Spain
| | - John D Salamone
- Behavioral Neuroscience, Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA.
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Jaśkowska J, Drabczyk AK, Kułaga D, Zaręba P, Majka Z, Jodłowski P. A new synthetic ultrasound-assisted method for dibenzoepines. Heliyon 2023; 9:e18319. [PMID: 37539205 PMCID: PMC10395526 DOI: 10.1016/j.heliyon.2023.e18319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023] Open
Abstract
In this study, we have developed a new ultrasonic synthesis method of dibenzoepines using olanzapine and quetiapine, which are well-known drugs for the treatment of schizophrenia and bipolar disorder. The method is based on the N-alkylation reaction of the piperazine fragment in tricyclic compounds with methyl iodide or 2-(2-chloroethoxy)ethanol as the alkylating agent, respectively. The synthesis reactions were carried out in an ultrasonic bath with solvents such as acetonitrile or dimethylformamide in the presence of potassium or sodium carbonate or sodium hydroxide and metal-free, ecological phase transfer catalyst at a temperature of 40-50 °C. This allowed us to obtain olanzapine in 1 h (Y = 67%), and quetiapine in 3 h (Y = 72%). An ultrasonic reactor (Qsonica Q700) was used in the synthesis of olanzapine and made it possible to shorten the reaction time to 10 min and obtain 90% yield with very high purity. The developed method allows obtaining compounds in mild conditions and in a short time, thanks to which the process is more ecological than others described in the literature.
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Affiliation(s)
- Jolanta Jaśkowska
- Department of Organic Chemistry and Technology, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. 24 Warszawska, 31-155 Cracow, Poland
| | - Anna Karolina Drabczyk
- Department of Organic Chemistry and Technology, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. 24 Warszawska, 31-155 Cracow, Poland
| | - Damian Kułaga
- Department of Organic Chemistry and Technology, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. 24 Warszawska, 31-155 Cracow, Poland
| | - Przemysław Zaręba
- Department of Chemical Technology and Environmental Analytics, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. 24 Warszawska, Cracow, 31-155, Poland
| | - Zbigniew Majka
- Department of Analytical Chemistry and Biomaterials, Faculty of Pharmacy, Medical University of Warsaw, ul. Banacha 1, 02-093 Warsaw, Poland
| | - Przemysław Jodłowski
- Department of Organic Chemistry and Technology, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. 24 Warszawska, 31-155 Cracow, Poland
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Yin Y, Li S, Tong J, Huang J, Tian B, Chen S, Cui Y, Tan S, Wang Z, Yang F, Tong Y, Hong LE, Tan Y. Short-term antipsychotic treatment response in early-onset, typical-onset, and late-onset first episode schizophrenia. Schizophr Res 2023; 257:58-63. [PMID: 37290277 DOI: 10.1016/j.schres.2023.05.015] [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: 06/23/2022] [Revised: 01/12/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
In schizophrenia, the age at illness onset may reflect genetic loading and predict prognosis. We aimed to compare the pre-treatment symptom profiles and clinical symptom responses to antipsychotic treatment of individuals with late-onset schizophrenia (LOS; onset age: 40-59 years) with individuals with early-onset schizophrenia (EOS; onset age < 18 years) or typical-onset schizophrenia (TOS; onset age: 18-39 years). We conducted an 8-week cohort study in inpatient departments of five mental health hospitals in five cities in China. We included 106 individuals with LOS, 80 with EOS, and 214 with TOS. Their onset of schizophrenia was within three years and the disorders were minimally treated. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate clinical symptoms at baseline and after 8 weeks of antipsychotic treatment. Mixed effect models were used to compare symptom improvement within eight weeks. Antipsychotic therapy reduced all PANSS factor scores in all three groups. LOS had significantly better improvement in PANSS positive factor scores than EOS at week 8 after adjusting for sex, duration of illness, dose equivalents of antipsychotics at baseline, sites as fixed effects, and individuals as random effects. LOS was associated with reduced positive factor scores at week 8 when receiving 1 mg olanzapine dose equivalent per 1 kg body weight compared with EOS or TOS. In conclusion, LOS had better early improvement of positive symptoms than EOS and TOS. Thus, personalized treatment for schizophrenia should consider the age of onset.
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Affiliation(s)
- Yi Yin
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, PR China
| | - Shuangshuang Li
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, PR China
| | - Jinghui Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, PR China
| | - Junchao Huang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, PR China
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, PR China
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, PR China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, PR China
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, PR China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, PR China
| | - Fude Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, PR China
| | - Yongsheng Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, PR China; Beijing Suicide Research and Prevention Center, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, PR China
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, USA
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, PR China.
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Ramos Alves M, Bergamaschi CDC, Barberato-Filho S, de Melo DO, Mayer RCF, de Oliveira JC, Gabriel FC, Sekercioglu N, Abdala CVM, Lopes LC. Critical appraisal and comparison of recommendations of clinical practice guidelines for the treatment of schizophrenia in children and adolescents: a methodological survey. BMJ Open 2023; 13:e070332. [PMID: 36746538 PMCID: PMC9906266 DOI: 10.1136/bmjopen-2022-070332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The production of clinical practice guidelines (CPGs) has grown in the past years. Notwithstanding, the quality of these documents and their recommendations for the treatment of schizophrenia in children and adolescents is still unknown. OBJECTIVE To assess the quality of the guidelines and recommendations for the treatment of schizophrenia in this population. METHODS CPGs from 2004 to December 2020 were identified through a systematic search on EMBASE, MEDLINE, PsycINFO, PubMed, Epistemonikos, VHL, Global Index Medicus and specific CPG databases. The CPGs' quality was independently assessed by three reviewers using AGREE II and they were considered of high quality if they scored ≥60% in domains 3 and 6. The evidence classification systems were described, the quality of recommendations was assessed in pairs using AGREE-REX and the recommendations were compared. RESULTS The database search retrieved 3182 results; 2030 were screened and 29 were selected for full-text reading. Four guidelines were selected for extraction. Two CPGs were considered of high quality in the AGREE II assessment. We described the commonly agreed recommendations for each treatment phase. The pharmacological recommendations were described in all treatment phases. Scores of AGREE-REX were lower for psychosocial recommendations. CONCLUSION There are still few clinical studies and CPGs regarding schizophrenia in children and adolescents. The quality of the documents was overall low, and the quality of the recommendations report has much to improve. There is also a lack of transparency about the quality of the evidence and the strength of the recommendations. PROTOCOL REGISTRATION NUMBER CRD42020164899.
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Affiliation(s)
- Maíra Ramos Alves
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | | | | | | | | | - Jardel Corrêa de Oliveira
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
- Family Physician, Florianópolis Family Medicine Residency Program, Florianópolis, Brazil
| | | | - Nigar Sekercioglu
- Health Research Methodology, McMaster University, Mississauga, Ontario, Canada
| | | | - Luciane Cruz Lopes
- Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
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Allé MC, Rubin DC, Berntsen D. Autobiographical memory and the self on the psychosis continuum: investigating their relationship with positive- and negative-like symptoms. Memory 2023; 31:518-529. [PMID: 36724996 DOI: 10.1080/09658211.2023.2173236] [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: 02/03/2023]
Abstract
Autobiographical memory is severely impaired in schizophrenia, but previous work has largely treated both as unitary concepts. Here, we examined how various dimensions of autobiographical memory relate to different aspects of psychosis. Participants were recruited from the general population (Study 1, N = 264) and a university subject pool (Study 2, N = 305). We examined different measures of autobiographical memory and self (i.e., involuntary memory, autobiographical recollection, self-knowledge and self-awareness), at the trait level in Study 1 and both trait and state levels in Study 2, as a function of positive-and negative-like symptoms of psychosis. Across both studies, positive and negative dimensions of psychosis were found to be related to an increase in involuntary memories (i.e., the spontaneous recall of personal memories), and to lower self-concept clarity and insight. Positive and negative dimensions of psychosis correlated differently with autobiographical recollection characteristics, measured at both trait (Studies 1 and 2) and state levels (Study 2). Positive-like symptoms (in particular hallucination-proneness) showed a stronger and more consistent pattern of correlations than negative-like symptoms. These findings call for a dimensional approach to the relationship between autobiographical memory and psychosis symptoms in clinical and non-clinical individuals, to better understand the breakdown of autobiographical memory in the psychopathology of psychosis.
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Affiliation(s)
- Mélissa C Allé
- CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, University of Lille, Lille, France.,Center on Autobiographical Memory Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - David C Rubin
- Center on Autobiographical Memory Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.,Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Dorthe Berntsen
- Center on Autobiographical Memory Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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What Role for Long-Acting Injectable Antipsychotics in Managing Schizophrenia Spectrum Disorders in Children and Adolescents? A Systematic Review. Paediatr Drugs 2023; 25:135-149. [PMID: 36662369 PMCID: PMC9931829 DOI: 10.1007/s40272-023-00558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Long-acting injectable antipsychotics (LAIAs) are an efficacious and well-tolerated treatment in adults with schizophrenia spectrum disorders (SSD). However, there is less evidence for their use in children and adolescents. OBJECTIVES The aim of this systematic review was to summarize findings regarding the effectiveness and side effects of LAIA in children and adolescents with SSD. METHODS Four databases (Web of Science, PubMed, MEDES, and Dialnet) were systematically searched for articles published between inception and 12 March, 2022, with the following inclusion criteria: (1) original articles or case reports; (2) providing data on efficacy/effectiveness or safety/tolerability of LAIA treatment in children and adolescents diagnosed with SSD (schizophrenia, schizoaffective disorder, schizophreniform disorder, non-affective psychotic disorder); (3) mean age of samples ≤ 18 years; and (4) written in English or Spanish. Exclusion criteria were review articles, clinical guides, expert consensus as well as posters or oral communication in conferences. The risk of bias was assessed using the ROBIS tool. RESULTS From 847 articles found, 13 met the inclusion criteria. These included seven single case reports or case series, four retrospective chart reviews, a 24-week open-label trial, and one observational prospective study, covering a total of 119 adolescents (aged 12-17 years) with SSD. Almost all the articles described data on second-generation LAIA (53 patients on risperidone [once every other week], 33 on paliperidone palmitate [once monthly], 10 on aripiprazole [once monthly], and two on olanzapine pamoate [once monthly]). Twenty-one patients were reported to be only on first-generation LAIAs. Non-adherence was the main reason for starting an LAIA. In all of the studies, the use of LAIAs was associated with improvement in the patients' symptoms. CONCLUSIONS There are few studies assessing the use of LAIAs in adolescents with SSD. Overall, these treatments have suggested good effectiveness and acceptable safety and tolerability. However, we found no studies examining their use in children aged < 12 years. The problems and benefits linked to this type of antipsychotic formulation in the child and adolescent population require further study, ideally with prospective, controlled designs.
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Could psychedelic drugs have a role in the treatment of schizophrenia? Rationale and strategy for safe implementation. Mol Psychiatry 2023; 28:44-58. [PMID: 36280752 DOI: 10.1038/s41380-022-01832-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/02/2022] [Accepted: 10/07/2022] [Indexed: 01/07/2023]
Abstract
Schizophrenia is a widespread psychiatric disorder that affects 0.5-1.0% of the world's population and induces significant, long-term disability that exacts high personal and societal cost. Negative symptoms, which respond poorly to available antipsychotic drugs, are the primary cause of this disability. Association of negative symptoms with cortical atrophy and cell loss is widely reported. Psychedelic drugs are undergoing a significant renaissance in psychiatric disorders with efficacy reported in several conditions including depression, in individuals facing terminal cancer, posttraumatic stress disorder, and addiction. There is considerable evidence from preclinical studies and some support from human studies that psychedelics enhance neuroplasticity. In this Perspective, we consider the possibility that psychedelic drugs could have a role in treating cortical atrophy and cell loss in schizophrenia, and ameliorating the negative symptoms associated with these pathological manifestations. The foremost concern in treating schizophrenia patients with psychedelic drugs is induction or exacerbation of psychosis. We consider several strategies that could be implemented to mitigate the danger of psychotogenic effects and allow treatment of schizophrenia patients with psychedelics to be implemented. These include use of non-hallucinogenic derivatives, which are currently the focus of intense study, implementation of sub-psychedelic or microdosing, harnessing of entourage effects in extracts of psychedelic mushrooms, and blocking 5-HT2A receptor-mediated hallucinogenic effects. Preclinical studies that employ appropriate animal models are a prerequisite and clinical studies will need to be carefully designed on the basis of preclinical and translational data. Careful research in this area could significantly impact the treatment of one of the most severe and socially debilitating psychiatric disorders and open an exciting new frontier in psychopharmacology.
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13
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Ni P, Ma Y, Chung S. Mitochondrial dysfunction in psychiatric disorders. Schizophr Res 2022:S0920-9964(22)00333-4. [PMID: 36175250 DOI: 10.1016/j.schres.2022.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
Psychiatric disorders are a heterogeneous group of mental disorders with abnormal mental or behavioral patterns, which severely distress or disable affected individuals and can have a grave socioeconomic burden. Growing evidence indicates that mitochondrial function plays an important role in developing psychiatric disorders. This review discusses the neuropsychiatric consequences of mitochondrial abnormalities in both animal models and patients. We also discuss recent studies associated with compromised mitochondrial function in various psychiatric disorders, such as schizophrenia (SCZ), major depressive disorder (MD), and bipolar disorders (BD). These studies employ various approaches including postmortem studies, imaging studies, genetic studies, and induced pluripotent stem cells (iPSCs) studies. We also summarize the evidence from animal models and clinical trials to support mitochondrial function as a potential therapeutic target to treat various psychiatric disorders. This review will contribute to furthering our understanding of the metabolic etiology of various psychiatric disorders, and help guide the development of optimal therapies.
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Affiliation(s)
- Peiyan Ni
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.
| | - Yao Ma
- The Psychiatric Laboratory and Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Sangmi Chung
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY 10595, USA.
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Oxidative Stress and Emergence of Psychosis. Antioxidants (Basel) 2022; 11:antiox11101870. [PMID: 36290593 PMCID: PMC9598314 DOI: 10.3390/antiox11101870] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/22/2022] Open
Abstract
Treatment and prevention strategies for schizophrenia require knowledge about the mechanisms involved in the psychotic transition. Increasing evidence suggests a redox imbalance in schizophrenia patients. This narrative review presents an overview of the scientific literature regarding blood oxidative stress markers’ evolution in the early stages of psychosis and chronic patients. Studies investigating peripheral levels of oxidative stress in schizophrenia patients, first episode of psychosis or UHR individuals were considered. A total of 76 peer-reviewed articles published from 1991 to 2022 on PubMed and EMBASE were included. Schizophrenia patients present with increased levels of oxidative damage to lipids in the blood, and decreased levels of non-enzymatic antioxidants. Genetic studies provide evidence for altered antioxidant functions in patients. Antioxidant blood levels are decreased before psychosis onset and blood levels of oxidative stress correlate with symptoms severity in patients. Finally, adjunct treatment of antipsychotics with the antioxidant N-acetyl cysteine appears to be effective in schizophrenia patients. Further studies are required to assess its efficacy as a prevention strategy. Redox imbalance might contribute to the pathophysiology of emerging psychosis and could serve as a therapeutic target for preventive or adjunctive therapies, as well as biomarkers of disease progression.
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15
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Mayer J, Vasic N, Wolf V, Steiner I, Klein V, Fritz M, Rothe P, Streb J, Dudeck M. Gender Differences in the Psychopharmacological Treatment of Forensic In-Patients With Schizophrenia. Front Psychiatry 2022; 13:907123. [PMID: 35911248 PMCID: PMC9334521 DOI: 10.3389/fpsyt.2022.907123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background In forensic psychiatry, psychopharmacological treatment plays a crucial role for patients with schizophrenia in improving their medical as well as legal prognosis. However, an increase in the number of females entering forensic treatment has yet to yield empirical research on the outcome of psychopharmacological treatment of female patients with schizophrenia in terms of efficacy and tolerability. Aims The aim of the present study is to elucidate pharmacological treatment strategies of women with schizophrenia in forensic psychiatry in comparison with men. Methods This study compares psychopharmacological treatment strategies, psychopathological features, as well as neurological and metabolic side effects of treatment between 29 female and 29 male in-patients with schizophrenia in three forensic facilities in Bavaria, Germany. Results Results show significant differences between genders. Poorer psychopathological and neurological features were found in the female sample, while men registered worse metabolic parameters. In terms of psychopharmacological treatment strategies, female in-patients were more often prescribed second-generation depot antipsychotics. Surprisingly, the potency of the dosages did not differ between genders. The results suggest that female forensic patients with schizophrenia have more severe and refractory diseases than their male counterparts. Conclusion Recommendations for gender-specific treatment strategies are derived.
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Affiliation(s)
- Juliane Mayer
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen, Germany
| | - Nenad Vasic
- Clinic for Psychiatry and Psychotherapy, Clinic Centre Christophsbad, Göppingen, Germany
| | - Viviane Wolf
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Clinic Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ivonne Steiner
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen, Germany
| | - Verena Klein
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen, Germany
| | - Michael Fritz
- Department of Forensic Psychiatry and Psychotherapy, District Hospital Günzburg, Ulm University, Günzburg, Germany
- School of Health and Social Sciences, AKAD University of Applied Sciences, Stuttgart, Germany
| | - Philipp Rothe
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen, Germany
- kbo-Lech-Mangfall-Clinic Agatharied, Hausham, Germany
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, District Hospital Günzburg, Ulm University, Günzburg, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, District Hospital Günzburg, Ulm University, Günzburg, Germany
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Lopez-Morinigo JD, Leucht S, Arango C. Pharmacological Treatment of Early-Onset Schizophrenia: A Critical Review, Evidence-Based Clinical Guidance and Unmet Needs. PHARMACOPSYCHIATRY 2022; 55:233-245. [PMID: 35777418 PMCID: PMC9458343 DOI: 10.1055/a-1854-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Early-onset schizophrenia (EOS) – onset before age 18 – is linked
with great disease burden and disability. Decision-making for EOS
pharmacological treatment may be challenging due to conflicting information from
evidence and guidelines and unidentified care needs may remain unmet. We searched for systematic reviews, meta-analyses and umbrella reviews of EOS
pharmacological treatment published in PubMed over the past 10 years and
selected five clinical guidelines from Europe, North-America and Australia.
Based on predefined outcomes, we critically compared the evidence supporting
EOS-approved drugs in Europe and/or North-America with guidelines
recommendations. We also evaluated the coverage of these outcomes to identify
unmet needs. One systematic review, nine meta-analyses and two umbrella reviews (k=203
trials, N=81,289 participants, including duplicated samples across
selected articles) were retrieved. Evidence supported the efficacy of
aripiprazole, clozapine, haloperidol, lurasidone, molindone, olanzapine,
quetiapine, risperidone and paliperidone in EOS, all of which obtained approval
for EOS either in Europe and/or in North-America. Cognition, functioning
and quality of life, suicidal behaviour and mortality and services utilisation
and cost-effectiveness were poorly covered/uncovered. Among the antipsychotics approved for EOS, aripiprazole, lurasidone, molindone,
risperidone, paliperidone and quetiapine emerged as efficacious and comparably
safe options. Olanzapine is known for a high risk of weight gain and haloperidol
for extrapyramidal side-effects. Treatment-resistant patients should be offered
clozapine. Future long-term trials looking at cognition, functioning, quality of
life, suicidal behaviour, mortality, services utilisation and cost-effectiveness
are warranted. Closer multi-agency collaboration may bridge the gap between
evidence, guidelines and approved drugs.
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Affiliation(s)
- Javier-David Lopez-Morinigo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaninger Straße 22, Munich, Germany
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Comparative Efficacy and Tolerability of Antipsychotics for Juvenile Psychotic Disorders: A Systematic Review and Network Meta-Analysis. J Clin Psychopharmacol 2022; 42:198-208. [PMID: 35020712 DOI: 10.1097/jcp.0000000000001506] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psychotic disorders produce important morbidity and disability in children and adolescents. There have been few relevant treatment trials, encouraging assessment of research aimed at testing efficacy and safety of antipsychotics for juveniles. We aimed to compare the short- and long-term efficacy and safety of antipsychotics to treat psychotic disorders among children and adolescents. METHODS Four major bibliographic databases (PubMed, MEDLINE, PsycINFO, and EMBASE) were searched for clinical trials of antipsychotics in children or adolescents, from database inception to May 2021. We searched for clinical trials comparing antipsychotics with control conditions for juvenile psychosis based on blinded review by 2 independent investigators (C.S.Y. and M.L.). We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and applied the Cochrane risk-of-bias tool to appraise study quality. One reviewer (A.B.) performed data abstraction which was confirmed by 2 independent, blinded reviewers (C.S.Y. and M.L.). Primary outcomes were scores rating psychosis symptoms and dichotomized retention in treatment protocols versus dropouts because of adverse events. Effect sizes were pooled using frequentist random-effects network meta-analysis modeling to generate summary rate ratios (RRs) and Cohen d standardized mean differences. RESULTS Systematic searching generated 1330 unique records. Of these, short-term (n = 15, for 6 [3-12] weeks) and long-term (n = 10, for 12 [6-60] months) treatment trials involved 2208 (39.2% females; median age, 15.3 years), and 1366 subjects (35.0% females; median age, 15.6 years), respectively. Short-term reduction of psychosis scores ranked clozapine (d = -1.35; 95% confidence interval [CI], -1.97 to -0.73]), molindone (-1.22; 95% CI, -1.68 to -0.75), olanzapine (-1.12; 95% CI, -1.44 to -0.81), and risperidone (-0.93; 95% CI, -1.22 to -0.63) as the most effective agents. In longer-term treatment, only lurasidone was effective. Clozapine (RR, 12.8) and haloperidol (RR, 5.15) led to more all-cause and adverse event-related dropouts. There were few trials/drug (1 each for aripiprazole, asenapine, lurasidone, molindone, paliperidone, and ziprasidone, short term; aripiprazole, clozapine, haloperidol, lurasidone, and molindone, long-term). Heterogeneity and inconsistency were high, especially in long-term trials, without evidence of publication bias. CONCLUSIONS Some antipsychotics were effective and tolerated short term, but longer-term evidence was very limited. The overall paucity of trials and of adequate controls indicates that more well-designed randomized controlled trials are required for adequate assessment of antipsychotic drug treatment for juveniles. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021232937.
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Saito T, Sugimoto S, Sakaguchi R, Nakamura H, Ishigooka J. Efficacy and Safety of Blonanserin Oral Tablet in Adolescents with Schizophrenia: A 6-Week, Randomized Placebo-Controlled Study. J Child Adolesc Psychopharmacol 2022; 32:12-23. [PMID: 35133884 PMCID: PMC8884167 DOI: 10.1089/cap.2021.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives: To evaluate the short-term efficacy and safety of blonanserin in adolescents with schizophrenia. Methods: This 6-week multicenter, double-blind, randomized, placebo-controlled study investigated fixed-dose blonanserin (8 or 16 mg/day) in patients 12-18 years of age diagnosed with schizophrenia, as indicated by a Positive and Negative Syndrome Scale (PANSS) total score of 60-120 and a Clinical Global Impressions-Severity score of ≥3. The primary endpoint was change from baseline to week 6 in the PANSS total score, using a mixed model for repeated measures analysis. Safety was assessed by the incidence and severity of adverse events (AEs). Results: Among 151 randomized patients, 150 were included in the primary analysis population. Demographic and clinical characteristics were similar across groups at baseline. The rate of study discontinuation was 14.9%, 23.5%, and 28.3% in patients administered with placebo, blonanserin 8 mg/day, and blonanserin 16 mg/day, respectively. The least-squares mean change (95% confidence interval [CI]) from baseline to week 6 in PANSS total score was -10.6 (-16.10 to -5.10), -15.3 (-20.80 to -9.86), and -20.5 (-25.89 to -15.16) in patients administered placebo, 8 mg/day blonanserin, and 16 mg/day blonanserin, respectively. The 16-mg/day blonanserin group showed significantly greater reduction in the PANSS total score than the placebo group (least-squares mean difference [95% CI]: -9.9 [-17.61 to -2.25], p = 0.012, effect size: 0.538), although the 8-mg/day group showed no significant difference. The incidence of AEs such as akathisia, somnolence, and hyperprolactinemia was higher in the blonanserin groups than in the placebo group. AEs associated with blonanserin were generally mild and were consistent with its known profile in adults with schizophrenia. Conclusions: Blonanserin achieved a sufficient efficacy in adolescent patients, and the safety profile was similar to that in adults, which suggests that blonanserin may be a safe treatment option for adolescents with schizophrenia. Study registration number: Japic CTI-111724.
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Affiliation(s)
- Takuya Saito
- Department of Child and Adolescent Psychiatry, Hokkaido University Hospital, Sapporo, Japan
| | - Saori Sugimoto
- Sumitomo Dainippon Pharma Co., Ltd., Chuo-ku, Tokyo, Japan
| | | | - Hiroshi Nakamura
- Sumitomo Dainippon Pharma Co., Ltd., Chuo-ku, Tokyo, Japan.,Address correspondence to: Hiroshi Nakamura, MS, Sumitomo Dainippon Pharma Co., Ltd., 1-13-1 Kyobashi, Chuo-Ku, Tokyo 104-8356, Japan
| | - Jun Ishigooka
- Institute of CNS Pharmacology, Shibuya-ku, Tokyo, Japan
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Saito T, Hyodo Y, Sakaguchi R, Nakamura H, Ishigooka J. Long-Term Safety and Efficacy of Blonanserin Oral Tablet in Adolescents with Schizophrenia: A 52-Week, Multicenter, Open-Label Extension Study. J Child Adolesc Psychopharmacol 2022; 32:24-35. [PMID: 34612724 PMCID: PMC8884169 DOI: 10.1089/cap.2021.0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives: To evaluate the long-term efficacy and safety/tolerability of oral blonanserin in adolescents with schizophrenia (Study registration number: JapicCTI-111725). Methods: This 52-week, multicenter, open-label extension study enrolled adolescent patients with schizophrenia who opted to enter in this study after the completion of the preceding placebo-controlled study. Blonanserin tablet was orally administered twice daily, after morning and evening meals, for 52 weeks using dose-titration method within a range between 4 and 24 mg/day. The primary end point was the change from baseline to the end of the study in the Positive and Negative Syndrome Scale (PANSS) total score. Safety/tolerability was assessed by the incidence and severity of adverse events. Results: Of 117 patients who completed the preceding placebo-controlled study, 109 entered this extension study and 43 (39.4%) of them discontinued the study treatment. The safety analysis set comprised 106 patients who received the study drug at least once, including 36 and 70 patients treated with placebo (DB-placebo group) and blonanserin tablet (DB-blonanserin group), respectively, in the placebo-controlled study. At the last assessment, the mean change in PANSS total score overall [mean (standard deviation)] was -24.9 (20.76) from the baseline of the placebo-controlled study, which was similar in the DB-placebo and DB-blonanserin groups. The overall incidence of adverse events was 90.6%, and most of them were mild or moderate in severity, with similar incidence of extrapyramidal symptoms (38.7%) to that in adults receiving long-term blonanserin oral tablet treatment and minimal change in weight and metabolic parameters. Conclusions: This long-term extension study showed that 52 weeks of oral blonanserin treatment improved or stabilized psychiatric symptoms in patients with adolescent schizophrenia. There were no major issues with the safety or tolerability of blonanserin administration in this study. Considering relatively less adverse effects on weight increase and metabolic parameters, blonanserin is expected to be a safe/tolerable treatment option for adolescent schizophrenia that can be used seamlessly from adolescence to adulthood.
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Affiliation(s)
- Takuya Saito
- Department of Child and Adolescent Psychiatry, Hokkaido University Hospital, Sapporo, Japan
| | - Yohei Hyodo
- Sumitomo Dainippon Pharma Co., Ltd., Chuo-Ku, Tokyo, Japan
| | | | - Hiroshi Nakamura
- Sumitomo Dainippon Pharma Co., Ltd., Chuo-Ku, Tokyo, Japan.,Address correspondence to: Hiroshi Nakamura, MS, Sumitomo Dainippon Pharma Co., Ltd., 1-13-1 Kyobashi, Chuo-Ku, Tokyo 104-8356, Japan
| | - Jun Ishigooka
- Institute of CNS Pharmacology, Shibuya-ku, Tokyo, Japan
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20
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Duque-Yemail JD, Avila JC. Switching Clozapine to Cariprazine in Three Patients with Persistent Symptoms of Schizophrenia: A Case Series. Neuropsychiatr Dis Treat 2022; 18:1433-1440. [PMID: 35859803 PMCID: PMC9289754 DOI: 10.2147/ndt.s367922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Despite many available treatments for schizophrenia, several unmet needs persist in treating individuals with this disorder, and the response rate to first-line antipsychotics remains relatively low. Clozapine has shown efficacy in treating schizophrenia patients who failed to respond to previous antipsychotics. However, side effects and the need for routine blood tests have limited its use as a first-line treatment. Cariprazine is a D2/D3 partial agonist antipsychotic with a mechanism of action that differs from other antipsychotics due to its higher affinity for D3 receptors. Several trials have demonstrated the efficacy of cariprazine on positive and negative symptoms of schizophrenia and have shown that it is a well-tolerated treatment. In this series, we present 3 cases of patients diagnosed with schizophrenia who were initially under treatment with clozapine. Despite some initial improvement, the patients showed persisting positive and negative symptoms or developed limiting side effects while in treatment with clozapine. Cariprazine treatment was titrated concurrently with clozapine tapering until its discontinuation. Significant improvement in both positive and negative symptoms was observed up to 14 months after starting cariprazine, and resolution of side effects was reported in all cases. Our case series supports cariprazine as an effective treatment for positive and negative symptoms in patients who failed to adequately respond or poorly tolerated treatment with clozapine, as well as a potential treatment in dual disorders, specifically psychotic disorders and cocaine use disorder.
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Affiliation(s)
- Juan D Duque-Yemail
- Psychiatry Resident, Department of Mental Health, Vall d'Hebron University Hospital, Barcelona, Spain
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21
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Li H, Wang C, Zhao J, Guo C. JNK downregulation improves olanzapine-induced insulin resistance by suppressing IRS1 Ser307 phosphorylation and reducing inflammation. Biomed Pharmacother 2021; 142:112071. [PMID: 34449309 DOI: 10.1016/j.biopha.2021.112071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/08/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
AIMS c-jun N-terminal kinase (JNK) plays pivotal roles in many physiological processes, including inflammation and glucose metabolism. However, the effects of JNK on olanzapine-induced insulin resistance and the underlying mechanisms have not been fully elucidated. The aim of our study was to explore the role of JNK in olanzapine-induced insulin resistance and the underlying mechanisms. METHODS We studied glucose metabolism in olanzapine-treated female C57B/J mice and mice with adeno-associated virus (AAV)-mediated downregulation of JNK1 in epididymal white adipose tissue (eWAT). 3T3-L1 adipocytes were used to investigate the mechanism of JNK1 regulating insulin signaling after olanzapine treatment. RESULTS JNK was activated in eWAT after olanzapine treatment. JNK1 downregulation in eWAT ameliorated the insulin resistance and adipose tissue inflammation in olanzapine-treated mice. Furthermore, overexpression of JNK1 in adipocytes exacerbated the glucose disorder while JNK1 knockdown alleviated the impaired insulin signaling on olanzapine challenge, which was likely mediated by the reduced inflammation and insulin receptor substrate 1 (IRS1) phosphorylation. Moreover, the effect of JNK1 was attenuated by downregulation of IRS1 in adipocytes. Finally, the JNK1-IRS1 interaction and IRS1S307 phosphorylation were required for JNK1-regulated olanzapine-induced insulin resistance in adipocytes. CONCLUSIONS Our results demonstrated that JNK1 activation by olanzapine induced insulin resistance by promoting IRS1Ser307 phosphorylation and inflammation in eWAT. These results highlighted the importance of JNK1 in eWAT as a promising drug target for olanzapine-induced insulin resistance.
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Affiliation(s)
- Huqun Li
- Department of Pharmacy, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
| | - Chongshu Wang
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiefang Zhao
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cuilian Guo
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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22
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Amerio A, Giacomini C, Fusar-Poli L, Aguglia A, Costanza A, Serafini G, Aguglia E, Amore M. Efficacy and safety of lurasidone in children and adolescents: Recommendations for clinical management and future research. Curr Pharm Des 2021; 27:4062-4069. [PMID: 34348620 DOI: 10.2174/1381612827666210804110853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Abstract
Lurasidone is a novel azapirone derivative, and atypical antipsychotic agent with a high binding affinity for dopaminergic (D2), serotoninergic (5-HT2A), and 5-HT7 receptors (antagonist), a moderate affinity for 5-HT1A receptors (partial agonist), and no appreciable affinity for histaminergic (H1) and muscarinic (M1) receptors. It was recently included by the European Medication Agency among the in-label pharmacological treatments for children and adolescents affected by early onset schizophrenia. As a dopamine and serotonin antagonist, lurasidone acts on a variety of receptors and showed its efficacy both as an antipsychotic and an activating compound. Administered with food or within 30 minutes from a meal, it presents sufficient bioavailability and does not interact ith most of the other drugs during metabolism. With little effects on hormones and weight gain, potential procognitive profile due to its 5-HT7 antagonism, and reduced extrapyramidal side effects, lurasidone could be a good choice in terms of both effectiveness and tolerability, particularly for patients headed towards a long-term treatment. This article aims to summarize the available scientific evidence from the literature on the use of lurasidone in children and adolescents and to provide recommendations for clinical management and future research.
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Affiliation(s)
- Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Costanza Giacomini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania. Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva. Switzerland
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania. Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa. Italy
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23
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Dipta P, Sarsenbayeva A, Shmuel M, Forno F, Eriksson JW, Pereira MJ, Abalo XM, Wabitsch M, Thaysen-Andersen M, Tirosh B. Macrophage-derived secretome is sufficient to confer olanzapine-mediated insulin resistance in human adipocytes. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 7:100073. [PMID: 35757056 PMCID: PMC9216267 DOI: 10.1016/j.cpnec.2021.100073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/22/2021] [Indexed: 12/15/2022] Open
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El-Haroun H, Ewida SF, Mohamed WMY, Bashandy MA. Atypical Antipsychotic Lumateperone Effects on the Adrenal Gland With Possible Beneficial Effect of Quercetin Co-administration. Front Physiol 2021; 12:674550. [PMID: 34276400 PMCID: PMC8279776 DOI: 10.3389/fphys.2021.674550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022] Open
Abstract
Schizophrenia remains one of the most chronic and highly disabling mental disorders. Lumateperone is a recent FDA-approved atypical antipsychotic drug for the treatment of schizophrenia. However, the internal FDA pathologist raised concerns regarding pigment deposition associated with degeneration in different tissue in animal studies with lumateperone treatment. The adrenal gland may be implicated in lumateperone side effects, and quercetin may have the ability to fulfill this treatment gap. To prove this hypothesis, 40 male guinea pigs were used and divided into four groups; control, quercetin-treated, lumateperone-treated, and quercetin/lumateperone cotreated orally for 28 consecutive days. Behavioral forced swim (FST) and open field (OF) tests were done at the end of treatment. Retro-orbital blood samples were taken to assess hormones: adrenocorticotropic hormone (ACTH), cortisol, dehydroepiandrosterone acetate (DHEA), and aldosterone, along with an assessment of oxidative stress parameters: malondialdehyde (MDA), glutathione (GSH), and superoxide dismutase (SOD). Adrenal glands were extracted for histopathological assessment with H&E, Mallory trichome staining, immunostaining, and electron microscopy studies. Lumateperone-treated group showed a significant reduction in the activity in FST and OF with histopathological deterioration in adrenal secretory function and structure and increased expression of interleukin-6 (IL-6), CASPASE-3, collagen deposition, and decreased proliferating cell nuclear antigen (PCNA). Cytoplasmic vacuolation, pyknosis of the nuclei, increase in the lysosome, lipofuscin pigment, and cellular infiltration with diminishing in the number of secretory granules could all be observed in lumateperone-treated group. Coadministration of quercetin and lumateperone showed improvement of the previously deteriorated parameters. Quercetin had a prophylactic effect against lumateperone depressive-like effect on animal behavior and its possible adrenal damage. Conceptual framework for the proposed mechanism of action of coadministration of quercetin and lumateperone. ![]()
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Affiliation(s)
- Hala El-Haroun
- Department of Histology, Faculty of Medicine, Menoufia University, Shebin El-kom, Egypt
| | - Suzy Fayez Ewida
- Department of Medical Physiology, Faculty of Medicine, Menoufia University, Shebin El-kom, Egypt
| | - Wael M Y Mohamed
- Department of Clinical Pharmacology, Faculty of Medicine, Menoufia University, Shebin El-kom, Egypt.,Department of Basic Medical Science, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM), Pahang, Malaysia
| | - Manar Ali Bashandy
- Department of Anatomy Faculty of Medicine, Menoufia University, Shebin El-kom, Egypt
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25
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Fulone I, Silva MT, Lopes LC. Gender differences in the use of atypical antipsychotics in early-onset schizophrenia: a nationwide population-based study in Brazil. BMC Psychiatry 2021; 21:320. [PMID: 34187418 PMCID: PMC8243572 DOI: 10.1186/s12888-021-03327-7] [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: 12/22/2020] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The use of atypical antipsychotics for the treatment of schizophrenia and other mental disorders in populations under 18 years of age is increasing worldwide. Little is known about treatment patterns and the influence of gender differences, which may be a predictor of clinical outcomes. The aim of this study was to investigate gender differences in the use of atypical antipsychotics in patients with early-onset schizophrenia (EOS) assisted by the public health system in Brazil. METHODS We conducted a cross-sectional study of outpatients with EOS aged 10 to 17 years who received at least one provision of atypical antipsychotics (clozapine, olanzapine, risperidone, quetiapine or ziprasidone) from a large Brazilian pharmaceutical assistance programme. Data were retrieved from a nationwide administrative database from 2008 to 2017. RESULTS Of the 49,943 patients with EOS, 63.5% were males, and the mean age was 13.6 years old. The patients were using risperidone (62.5%), olanzapine (19.6%), quetiapine (12.4%), ziprasidone (3.3%) and clozapine (2.2%). We found gender differences, especially in the 13-17 year age group (65.1% for males vs. 34.9% for females, p < 0.001), in the use of risperidone (72.1% for males vs. 27.9% for females, p < 0.001) and olanzapine (66.5% for males vs. 33.5% for females, p < 0.001). Only in the 13 to 17 years age group were the prescribed doses of olanzapine (p = 0.012) and quetiapine (p = 0.041) slightly higher for males than for females. CONCLUSIONS Our findings showed gender differences among patients diagnosed with EOS and who received atypical antipsychotics. More attention should be devoted to gender differences in research and clinical practice.
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Affiliation(s)
- Izabela Fulone
- grid.442238.b0000 0001 1882 0259Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba/State of São Paulo, Brazil
| | - Marcus Tolentino Silva
- grid.442238.b0000 0001 1882 0259Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba/State of São Paulo, Brazil
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba/State of São Paulo, Brazil.
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Chang CH, Liu CY, Chen SJ, Tsai HC. Hepatitis C virus and hepatitis B virus in patients with schizophrenia. Medicine (Baltimore) 2021; 100:e26218. [PMID: 34087899 PMCID: PMC8183751 DOI: 10.1097/md.0000000000026218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
This study evaluated the severe hepatic outcome (SHO) in patients with schizophrenia and viral hepatitis who received antipsychotics.Using the nationwide Taiwan National Health Insurance Research Database, patients first diagnosed with schizophrenia between 2002 and 2013 were identified. Patients diagnosed with schizophrenia who had viral hepatitis, including hepatitis B virus (HBV) or hepatitis C virus (HCV), were designated as the viral hepatitis group. A control group without viral hepatitis was matched for age, sex, and index year in a 2:1 ratio. Patients with severe hepatic outcomes before enrollment were excluded. The 2 cohorts were observed until December 31, 2013. The primary endpoint was occurrence of a SHO, including liver cancer, liver failure, liver decompensation, or transplantation.Among the 16,365 patients newly diagnosed with schizophrenia between January 2002 and December 2013, we identified 614 patients with viral hepatitis and 1228 matched patients without viral hepatitis. Of these 1842 patients, 41 (2.22%) developed SHOs, including 26 (4.23%) in the viral hepatitis group and 15 (1.22%) in the control group, during the mean follow-up period of 3.71 ± 2.49 years. Cox proportional hazard analysis indicated that the SHO risk increased by 3.58 (95% confidence interval [CI]: 1.859-6.754; P < .001) in patients with schizophrenia and viral hepatitis. Moreover, patients with schizophrenia having HCV had a higher SHO risk than those without viral hepatitis (hazard ratio: 5.07, 95% CI: 1.612-15.956; P < .0001). Patients having both schizophrenia and viral hepatitis, especially HCV, had a higher risk of SHOs.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University
- Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung
- An Nan Hospital, China Medical University, Tainan
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei
| | - Shaw-Ji Chen
- Department of Psychiatry, Taitung MacKay Memorial Hospital, Taitung
- Department of Medicine, Mackay Medical College, New Taipei
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien City
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, R.O.C
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Rampino A, Falcone RM, Giannuzzi A, Masellis R, Antonucci LA, Torretta S. Strategies for Psychiatric Rehabilitation and their Cognitive Outcomes in Schizophrenia: Review of Last Five-year Studies. Clin Pract Epidemiol Ment Health 2021; 17:31-47. [PMID: 34249137 PMCID: PMC8227533 DOI: 10.2174/1745017902117010031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/15/2021] [Accepted: 02/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cognitive deficits are core features of Schizophrenia, showing poor response to antipsychotic treatment, therefore non-pharmacological rehabilitative approaches to such a symptom domain need to be identified. However, since not all patients with Schizophrenia exhibit the same cognitive impairment profile, individualized rehabilitative approaches should be set up. OBJECTIVES We explored the last five-year literature addressing the issue of cognitive dysfunction response to rehabilitative methodologies in Schizophrenia to identify possible predictors of response and individualized strategies to treat such a dysfunction. CONCLUSION A total of 76 studies were reviewed. Possible predictors of cognitive rehabilitation outcome were identified among patient-specific and approach-specific variables and a general overview of rehabilitative strategies used in the last five years has been depicted. Studies suggest the existence of multifaced and multi-domain variables that could significantly predict pro-cognitive effects of cognitive rehabilitation, which could also be useful for identifying individual-specific rehabilitation trajectories over time.An individualized rehabilitative approach to cognitive impairment in Schizophrenia is possible if taking into account both patient and approach specific predictors of outcomes.
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Affiliation(s)
- Antonio Rampino
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
- Azienda Ospedaliero-Universitaria Policlinico di Bari, 70124 Bari, Italy
| | - Rosa M. Falcone
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Arianna Giannuzzi
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Rita Masellis
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Linda A. Antonucci
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, 70122 Bari, Italy
| | - Silvia Torretta
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
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Onishi Y, Mikami K, Kimoto K, Watanabe N, Takahashi Y, Akama F, Yamamoto K, Matsumoto H. Second-Generation Antipsychotic Drugs for Children and Adolescents. J NIPPON MED SCH 2021; 88:10-16. [PMID: 32999174 DOI: 10.1272/jnms.jnms.2021_88-108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The effectiveness and safety of antipsychotics have not been fully established in children and adolescents. Many antipsychotics approved for use in adults are prescribed off-label to children and adolescents. We investigated the effectiveness and tolerability of antipsychotics for children and adolescents with schizophrenia and bipolar disorder. A literature review of the empirical evidence regarding the use of antipsychotics, particularly second-generation antipsychotics, in children and adolescents showed that these drugs were safe and effective for this population. Antipsychotics were similarly effective for treatment of schizophrenia and bipolar disorder in children and adolescents. When prescribing antipsychotics to this population, clinicians should consider adverse events and the discontinuation rate in treated patients. However, the current evidence shows a lack of consensus regarding the use of antipsychotics in children and adolescents.
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Affiliation(s)
- Yuichi Onishi
- Department of Psychiatry, Tokai University School of Medicine
| | | | - Keitaro Kimoto
- Department of Psychiatry, Tokai University School of Medicine
| | | | - Yuki Takahashi
- Department of Psychiatry, Tokai University School of Medicine
| | - Fumiaki Akama
- Department of Psychiatry, Tokai University School of Medicine
| | - Kenji Yamamoto
- Department of Psychiatry, Tokai University School of Medicine
| | - Hideo Matsumoto
- Department of Psychiatry, Tokai University School of Medicine
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29
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Zhang T, Xu L, Li H, Cui H, Tang Y, Wei Y, Tang X, Hu Y, Hui L, Li C, Niznikiewicz MA, Shenton ME, Keshavan MS, Stone WS, Wang J. Individualized risk components guiding antipsychotic delivery in patients with a clinical high risk of psychosis: application of a risk calculator. Psychol Med 2021; 52:1-10. [PMID: 33593473 DOI: 10.1017/s0033291721000064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Antipsychotics are widely used for treating patients with psychosis, and target threshold psychotic symptoms. Individuals at clinical high risk (CHR) for psychosis are characterized by subthreshold psychotic symptoms. It is currently unclear who might benefit from antipsychotic treatment. Our objective was to apply a risk calculator (RC) to identify people that would benefit from antipsychotics. METHODS Drawing on 400 CHR individuals recruited between 2011 and 2016, 208 individuals who received antipsychotic treatment were included. Clinical and cognitive variables were entered into an individualized RC for psychosis; personal risk was estimated and 4 risk components (negative symptoms-RC-NS, general function-RC-GF, cognitive performance-RC-CP, and positive symptoms-RC-PS) were constructed. The sample was further stratified according to the risk level. Higher risk was defined based on the estimated risk score (20% or higher). RESULTS In total, 208 CHR individuals received daily antipsychotic treatment of an olanzapine-equivalent dose of 8.7 mg with a mean administration duration of 58.4 weeks. Of these, 39 (18.8%) developed psychosis within 2 years. A new index of factors ratio (FR), which was derived from the ratio of RC-PS plus RC-GF to RC-NS plus RC-CP, was generated. In the higher-risk group, as FR increased, the conversion rate decreased. A small group (15%) of CHR individuals at higher-risk and an FR >1 benefitted from the antipsychotic treatment. CONCLUSIONS Through applying a personal risk assessment, the administration of antipsychotics should be limited to CHR individuals with predominantly positive symptoms and related function decline. A strict antipsychotic prescription strategy should be introduced to reduce inappropriate use.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - HuiJun Li
- Department of Psychology, Florida A & M University, Tallahassee, Florida32307, USA
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - Li Hui
- Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou215137, Jiangsu, PR China
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - Margaret A Niznikiewicz
- Harvard Medical School Department of Psychiatry, Veteran's Administration Medical Center, Boston, MA02130, USA
| | - Martha E Shenton
- Brigham and Women's Hospital, Departments of Psychiatry and Radiology, and Harvard Medical School, and VA Boston Healthcare System, Boston, MA, USA
| | - Matcheri S Keshavan
- Harvard Medical School Department of Psychiatry, Veteran's Administration Medical Center, Boston, MA02130, USA
| | - William S Stone
- Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, Boston, MA02115, USA
| | - JiJun Wang
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China
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30
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Chestnykh DA, Amato D, Kornhuber J, Müller CP. Pharmacotherapy of schizophrenia: Mechanisms of antipsychotic accumulation, therapeutic action and failure. Behav Brain Res 2021; 403:113144. [PMID: 33515642 DOI: 10.1016/j.bbr.2021.113144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
Schizophrenia is a multi-dimensional disorder with a complex and mostly unknown etiology, leading to a severe decline in life quality. Antipsychotic drugs (APDs) remain beneficial interventions in the treatment of the disorder, but vary significantly in binding profile, clinical effects and adverse reactions. The present review summarizes the main principles of APD mechanisms of action with a particular focus on recent findings in APD accumulation and its role in the therapeutic efficacy and treatment failure. High and low doses of APDs were shown to be effective in different dimensions of antipsychotic-like behaviour in rodent models. Efficacy of the APDs correlates with high dopamine D2 receptor occupancy, which occurs quickly after drug administration. However, onset and peak of action are delayed up to several days or weeks. APD accumulation via acidic trapping in synaptic vesicles is considered to underlie the time course of APD action. Use-dependent exocytosis, co-release with dopamine and serotonin and inhibition of ion channels impact on the neuronal transmission and determine effects of APDs. Disruption in accumulating properties leads to diminished APD effects. In addition, long-term APD administration at therapeutic doses leads to treatment failure both in animal models and in humans. APD failure was associated with treatment induced neuroadaptations, including a decline in extracellular dopamine levels, dopamine transporter upregulation, and altered neuronal firing. However, enhanced synaptic vesicle release has also been reported. APD loss of efficacy may be reversed through inhibition of the dopamine transporter or switching the administration regimen from continuous to intermittent. Thus, manipulating the accumulation properties of APDs, changes in the administration regimen and doses, or co-administration with dopamine transporter inhibitors may be considered to yield benefits in the development of new effective strategies in the treatment of schizophrenia.
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Affiliation(s)
- Daria A Chestnykh
- Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Davide Amato
- Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany; Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, University Clinic, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
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Sun Q, Zhou J, Guo H, Gou N, Lin R, Huang Y, Guo W, Wang X. EEG Microstates and Its Relationship With Clinical Symptoms in Patients With Schizophrenia. Front Psychiatry 2021; 12:761203. [PMID: 34777062 PMCID: PMC8581189 DOI: 10.3389/fpsyt.2021.761203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
Schizophrenia is a complex and devastating disorder with unclear pathogenesis. Electroencephalogram (EEG) microstates have been suggested as a potential endophenotype for this disorder. However, no clear dynamic pattern of microstates has been found. This study aims to identify the dynamics of EEG microstates in schizophrenia and to test whether schizophrenia patients with altered clinical symptoms severity showed different microstates abnormalities compared with healthy controls. Resting-state EEG data in 46 individuals who met the ICD-10 diagnostic criteria for schizophrenia and 39 healthy controls was recorded. The patients with schizophrenia were divided into subgroups based on the level of their negative or positive symptoms assessed using the Positive and Negative Syndrome Scale. Microstate parameters (contribution, occurrence, and duration) of four prototypical microstate classes (A-D) were investigated. Compared with healthy controls, individuals with schizophrenia showed increased duration and contribution of microstate class C, decreased contribution and occurrence of microstate class B. Different microstate patterns were found between subgroups and healthy controls. Results in this study support the consistent observation of abnormal EEG microstates patterns in patients with schizophrenia and highlight the necessity to divide subjects into subgroups according to their clinical symptoms.
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Affiliation(s)
- Qiaoling Sun
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiansong Zhou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Huijuan Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ningzhi Gou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ruoheng Lin
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Huang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Weilong Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoping Wang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
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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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Arasteh O, Nomani H, Baharara H, Sadjadi SA, Mohammadpour AH, Ghavami V, Sathyapalan T, Sahebkar A. Antipsychotic Drugs and Risk of Developing Venous Thromboembolism and Pulmonary Embolism: A Systematic Review and Meta-Analysis. Curr Vasc Pharmacol 2020; 18:632-643. [DOI: 10.2174/1570161118666200211114656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/20/2023]
Abstract
Background:Antipsychotic (AP) medications are the cornerstone treatment for schizophrenia and some other psychiatric diseases. However, some observational studies suggest that these medications might increase the risk of venous thromboembolism (VTE) and pulmonary embolism (PE).Objectives:The aim of this study was to assess whether AP medications are associated with the development of VTE or PE, and to assess the risk based on any type of AP drugs, quality of studies and after adjustment of risk factors.Data sources:To identify relevant studies, we searched PubMed and EMBASE databases up to February 2019. We also searched the reference lists of relevant articles for related studies.Study Selection:Twenty studies fulfilled the eligibility criteria and were included in our meta-analysis after screening relevant observational cohort and case-control studies.Primary Outcome:The primary outcome of our meta-analysis was the occurrence of all VTE or PE only attributed to exposure to AP medications compared with non-exposure to AP medications.Results:Exposure to AP drugs was associated with a significant increase in the risk of VTE (RR 1.53, 95% CI 1.30-1.80, I2 = 85%) and PE (RR 3.69, 95% CI 1.23-11.07, I2 = 90%). In the subgroup metaanalysis, the use of low-potency AP drugs was associated with a higher risk of VTE, (RR 1.90, 95% CI 1.04-3.47, I2 = 78%).Conclusion:AP exposure was associated with a 1.5-fold increase in the risk of VTE and a 3.7-fold increase in the risk of PE. Low-potency AP drugs were associated with a higher risk of VTE. However, high heterogeneity among studies limits the generalizability of the results.
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Affiliation(s)
- Omid Arasteh
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Homa Nomani
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Baharara
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed A. Sadjadi
- Department of Psychiatry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir H. Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Ghavami
- Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Thozhukat Sathyapalan
- Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Hull HU3 2RW, United Kingdom
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Alves MR, Bergamaschi CDC, Sorrilha FB, Fulone I, Barberato-Filho S, Mayer RCF, Melo DOD, Lopes L. Critical appraisal and comparison of recommendations of clinical practice guidelines for treatment of schizophrenia in children and adolescents: a methodological survey protocol. BMJ Open 2020; 10:e038646. [PMID: 32938601 PMCID: PMC7497528 DOI: 10.1136/bmjopen-2020-038646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The number of clinical practice guidelines (CPGs) have increased substantially mainly in the paediatric area of mental health. However, little is known about the quality or how recommendations for the treatment of disorders such as schizophrenia in children and adolescents have changed over time. The aim of this study will be to assess the quality of the development of CPGs for the treatment and management of schizophrenia in children and adolescents over time using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to compare the recommendations and interventions described in these documents. METHODS AND ANALYSIS CPGs will be identified using a prospective protocol through a systematic search of multiple databases (Medline, Embase, Health Systems Evidence, Epistemonikos, Lilacs, etc) and guideline websites from 2004 to December 2020. The quality of the guidelines will be assessed by three reviewers, independently using the AGREE II. CPGs will be considered of high-quality if they scored ≥60% in four or more domains of the AGREE II instrument. Non-parametric tests will be used to test for the change of quality over time. We will summarise the different evidence grading systems and compare the recommendations. ETHICS AND DISSEMINATION Ethical approval is not required since it is a literature-based study. Future results of the research can be submitted for publication in scientific journals of high impact, peer reviewed and also published in national and international conferences. The results derived from this study will contribute to the improvement of health institutions and policies, informing about existing recommendation guidelines and about deficiencies and qualities found in those. This study may also identify key areas for future research. This study may guide the search and choice for high quality CPGs by health policy makers and health professionals and subsidise future adaptations. PROTOCOL REGISTRATION NUMBER CRD42020164899.
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Affiliation(s)
- Maíra Ramos Alves
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Flávia Blaseck Sorrilha
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | - Izabela Fulone
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | - Silvio Barberato-Filho
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
| | | | - Daniela Oliveira de Melo
- Graduate Course of Pharmaceutical Sciences, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Luciane Lopes
- Graduate Course of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, São Paulo, Brazil
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Baandrup L, Allerup P, Nielsen MØ, Bak N, Düring SW, Leucht S, Galderisi S, Mucci A, Bucci P, Arango C, Díaz-Caneja CM, Dazzan P, McGuire P, Demjaha A, Ebdrup BH, Kahn RS, Glenthøj BY. Rasch analysis of the PANSS negative subscale and exploration of negative symptom trajectories in first-episode schizophrenia - data from the OPTiMiSE trial. Psychiatry Res 2020; 289:112970. [PMID: 32438207 DOI: 10.1016/j.psychres.2020.112970] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 03/22/2020] [Accepted: 03/29/2020] [Indexed: 02/03/2023]
Abstract
The observed heterogeneity in negative symptom treatment response may be partly attributable to inadequate measurement tools or limitations in methods of analysis. Previous Item Response Theory models of the Positive and Negative Syndrome Scale (PANSS) have only examined samples of chronic patients and with mixed results. We examined the scalability of the negative subscale embedded in the PANSS and subsequently explored negative symptom trajectories across four weeks of amisulpride treatment. Data were derived from the OPTiMiSE trial comprising 446 patients with first-episode schizophrenia or schizophreniform disorder. Using the Rasch Model to examine psychometric properties of the PANSS negative subscale, we found that the composite score across items was not an adequate measure of negative symptom severity. Consequently, we chose an exploratory statistical approach involving Principal Component Analysis which yielded one significant component clustering into two significant symptom trajectories: 1) Subtle but constant decrease in negative symptom severity (N = 323; 72%), and 2) symptom instability across visits (N = 19; 4%). Explorative analytic methods as presented here may pave the way for more efficient and sensitive methods of analyzing negative symptom response in research and in clinical practice.
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Affiliation(s)
- Lone Baandrup
- Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Nordstjernevej 41, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - Peter Allerup
- Aarhus University, Tuborgvej 164, Copenhagen NV, Denmark
| | - Mette Ø Nielsen
- Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Nordstjernevej 41, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | | | - Signe W Düring
- Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Nordstjernevej 41, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Stefan Leucht
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, München, Germany
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vantivelli, Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vantivelli, Naples, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania Luigi Vantivelli, Naples, Italy
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Arsime Demjaha
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Nordstjernevej 41, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - René S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht, Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Birte Y Glenthøj
- Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Nordstjernevej 41, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
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36
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Ni P, Chung S. Mitochondrial Dysfunction in Schizophrenia. Bioessays 2020; 42:e1900202. [PMID: 32338416 DOI: 10.1002/bies.201900202] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/29/2020] [Indexed: 02/05/2023]
Abstract
Schizophrenia (SCZ) is a severe neurodevelopmental disorder affecting 1% of populations worldwide with a grave disability and socioeconomic burden. Current antipsychotic medications are effective treatments for positive symptoms, but poorly address negative symptoms and cognitive symptoms, warranting the development of better treatment options. Further understanding of SCZ pathogenesis is critical in these endeavors. Accumulating evidence has pointed to the role of mitochondria and metabolic dysregulation in SCZ pathogenesis. This review critically summarizes recent studies associating a compromised mitochondrial function with people with SCZ, including postmortem studies, imaging studies, genetic studies, and induced pluripotent stem cell studies. This review also discusses animal models with mitochondrial dysfunction resulting in SCZ-relevant neurobehavioral abnormalities, as well as restoration of mitochondrial function as potential therapeutic targets. Further understanding of mitochondrial dysfunction in SCZ may open the door to develop novel therapeutic strategies that can address the symptoms that cannot be adequately addressed by current antipsychotics alone.
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Affiliation(s)
- Peiyan Ni
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Sangmi Chung
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, 10595, USA
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37
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Butcher I, Berry K, Haddock G. Understanding individuals' subjective experiences of negative symptoms of schizophrenia: A qualitative study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:319-334. [PMID: 32242945 DOI: 10.1111/bjc.12248] [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: 08/08/2019] [Revised: 03/10/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Individuals with a diagnosis of schizophrenia often experience both positive and negative symptoms. Negative symptoms can be disabling and have a serious impact on everyday functioning. Despite the range of clinician-rated measurement tools used to assess negative symptoms, very little is known about how individuals subjectively experience these symptoms. This study sought to examine, using qualitative methods, how people living with a diagnosis of schizophrenia subjectively experience negative symptoms. DESIGN Qualitative study. METHOD Semi-structured interviews were carried out with individuals with a diagnosis of schizophrenia who were experiencing negative symptoms. The sample was recruited from community and inpatient National Health Service mental health settings in the United Kingdom. Interviews were analysed using thematic analysis. RESULTS Twenty individuals took part. Individuals highlighted the persistent and enduring nature of their negative symptoms. Two central themes were identified: What it is like to experience negative symptoms and where have my negative symptoms come from? Within the first theme, four sub-themes emerged: loss of concentration, loss of motivation, withdrawal, and 'feeling but not feeling'. Within the second theme, four sub-themes emerged related to the causes of negative symptoms: impact of traumatic life events, positive psychotic symptoms, impact of social network, and recreational and prescribed drug use. CONCLUSION Individuals, who experience negative symptoms, were able to articulate the persistent and disabling nature of negative symptoms and clearly described factors which they believed contributed to the onset, exacerbation, and amelioration of the experiences. PRACTITIONER POINTS Negative symptoms for people diagnosed with schizophrenia are persistent and enduring and impact an individual's life. There has been little research conducted qualitatively on individuals' subjective experiences of negative symptoms. Individuals who experience negative symptoms attribute these to a number of factors, including adverse life events, recreational and prescribed drug use, an absence of social support, and positive psychotic symptoms. Understanding negative symptoms is important for services, clinicians, and family members, where misattributions made about negative symptoms can lead to such experiences being dismissed.
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Affiliation(s)
- Isabelle Butcher
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Manchester Academic Health Sciences Centre, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Manchester Academic Health Sciences Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK.,Manchester Academic Health Sciences Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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38
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Chun CA, Cooper S, Ellman LM. Associations of psychotic-like experiences, related symptoms, and working memory with functioning. Eur Psychiatry 2020; 63:e20. [PMID: 32093801 PMCID: PMC7315866 DOI: 10.1192/j.eurpsy.2020.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This study examined the association of spatial working memory and attenuated psychotic-like experiences and related symptoms with social and role functioning. Findings from this study suggest that symptom dimensions and working memory impairment were associated with diminished functioning across a variety of domains. Specifically, negative symptoms and working memory impairment were inversely associated with both social and role functioning, whereas positive and disorganized symptoms showed inverse associations with social functioning only. Symptom dimensions did not moderate cognitive and functional variables, although working memory and attenuated clinical symptoms had an additive effect on functioning. Post-hoc analyses examining symptom dimensions simultaneously showed negative symptoms to be the variable most strongly predictive of overall functioning. These findings suggest that even in a non-clinical sample, sub-threshold psychosis symptoms and cognition may influence people’s social and role functioning.
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Affiliation(s)
- Charlotte A Chun
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Shanna Cooper
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
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39
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Ivashchenko DV, Buromskaya NI, Tazagulova MK, Tutova AD, Savchenko LM, Shevchenko YS, Sychev DA. [Evidence-based treatment of acute psychotic episode and schizophrenia in children and adolescents]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:132-138. [PMID: 31994526 DOI: 10.17116/jnevro2019119121132] [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: 11/17/2022]
Abstract
Children and adolescents are a special group in the context of psychopharmacotherapy. Given the limited choice of registered antipsychotics permitted in childhood, caution should be exercised in the choice of medication. This literature review reviews the current evidence base for pharmacotherapy of acute psychotic episode and schizophrenia in children and adolescents. The results of major systematic reviews and meta-analyses are compared. Meta-analyses of pharmacotherapy studies of the first psychotic episode are considered separately. Antipsychotics of the first and second generation are comparable in effectiveness for children and adolescents with acute psychotic episode. Olanzapine demonstrates higher efficacy in reducing negative symptoms. Ziprasidone and asenapine are less effective in treating schizophrenia in children and adolescents than other antipsychotics. Compared to adults, children and adolescents are at higher risk of metabolic impairments when taking antipsychotics.
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Affiliation(s)
- D V Ivashchenko
- Russian Medical Academy for Continuing Professional Education, Moscow, Russia
| | - N I Buromskaya
- Sukhareva Research Practical Center of Children and Adolescents Mental Health, Moscow, Russia
| | - M Kh Tazagulova
- Russian Medical Academy for Continuing Professional Education, Moscow, Russia
| | - A D Tutova
- Sukhareva Research Practical Center of Children and Adolescents Mental Health, Moscow, Russia
| | - L M Savchenko
- Russian Medical Academy for Continuing Professional Education, Moscow, Russia
| | - Yu S Shevchenko
- Russian Medical Academy for Continuing Professional Education, Moscow, Russia
| | - D A Sychev
- Russian Medical Academy for Continuing Professional Education, Moscow, Russia
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40
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Martínez-Hernáez Á, Pié-Balaguer A, Serrano-Miguel M, Morales-Sáez N, García-Santesmases A, Bekele D, Alegre-Agís E. The collaborative management of antipsychotic medication and its obstacles: A qualitative study. Soc Sci Med 2020; 247:112811. [PMID: 32032839 DOI: 10.1016/j.socscimed.2020.112811] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 12/27/2022]
Abstract
Antipsychotic medication is the primary treatment for psychotic conditions such as schizophrenia and schizoaffective disorders; nevertheless, its administration is not free from conflicts. Despite taking their medication regularly, 25-50% of patients report no benefits or perceive this type of treatment as an imposition. Following in the footsteps of a previous initiative in Quebec (Canada), the Gestion Autonome de la Médication en Santé Mentale (GAM), this article ethnographically analyses the main obstacles to the collaborative management of antipsychotics in Catalonia (Spain) as a previous step for the implementation of this initiative in the Catalan mental healthcare network. We conducted in-depth interviews with patients (38), family caregivers (18) and mental health professionals (19), as well as ten focus groups, in two public mental health services, and patients' and caregivers' associations. Data were collected between February and December 2018. We detected three main obstacles to collaboration among participants. First, different understanding of the patient's distress, either as deriving from the symptoms of the disorder (professionals) or the adverse effects of the medication (patients). Second, differences in the definition of (un)awareness of the disorder. Whereas professionals associated disorder awareness with treatment compliance, caregivers understood it as synonymous with self-care, and among patients "awareness of suffering" emerged as a comprehensive category of a set of discomforts (i.e., symptoms, adverse effects of medication, previous admissions, stigma). Third, discordant expectations regarding clinical communication that can be condensed in the differences in meaning between the Spanish words "trato" and "tratamiento", where the first denotes having a pleasant manner and agreement, and the second handling and management. We conclude that these three obstacles pave the way for coercive practices and promote patients' de-subjectivation, named here as the "total patient" effect. This study is the first GAM initiative in Europe.
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Affiliation(s)
- Ángel Martínez-Hernáez
- Medical Anthropology Research Center, Rovira I Virgili University, Avinguda Catalunya, 35, 43002, Tarragona, Catalonia, Spain.
| | - Asun Pié-Balaguer
- Department of Psychology and Education, Open University of Catalonia, Rambla Del Poblenou, 156, 08018, Barcelona, Spain.
| | - Mercedes Serrano-Miguel
- Medical Anthropology Research Center, Rovira I Virgili University, Avinguda Catalunya, 35, 43002, Tarragona, Catalonia, Spain; Department of Social Work, University of Barcelona, Campus de Mundet; Passeig de La Vall D'Hebron, 171, 08035, Barcelona, Spain.
| | - Nicolás Morales-Sáez
- Medical Anthropology Research Center, Rovira I Virgili University, Avinguda Catalunya, 35, 43002, Tarragona, Catalonia, Spain.
| | - Andrea García-Santesmases
- Internet Interdisciplinary Institute (IN3), Open University of Catalonia, Avinguda Carl Friedrich Gauss, 5, 08060 Castelldefels, Barcelona, Spain.
| | - Deborah Bekele
- Medical Anthropology Research Center, Rovira I Virgili University, Avinguda Catalunya, 35, 43002, Tarragona, Catalonia, Spain.
| | - Elisa Alegre-Agís
- Medical Anthropology Research Center, Rovira I Virgili University, Avinguda Catalunya, 35, 43002, Tarragona, Catalonia, Spain.
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Li ZT, Li SB, Wen JF, Zhang XY, Hummel T, Zou LQ. Early-Onset Schizophrenia Showed Similar but More Severe Olfactory Identification Impairment Than Adult-Onset Schizophrenia. Front Psychiatry 2020; 11:626. [PMID: 32695034 PMCID: PMC7338585 DOI: 10.3389/fpsyt.2020.00626] [Citation(s) in RCA: 4] [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: 12/20/2019] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND "Early-onset schizophrenia" (EOS) is defined as disease with onset before the age of 18 years. This subset of schizophrenia exhibits worse cognitive function and carries a worse prognosis than adult-onset schizophrenia (AOS). Olfactory impairment has been found in patients with schizophrenia-spectrum disorders. However, most research has focused on olfactory impairment in patients with AOS: olfactory function in EOS is not known. The aim of this study was to investigate the olfactory identification ability in EOS, and its relationship with negative symptoms. METHODS We compared olfactory function between two independent samples: 40 patients with EOS and 40 age- and sex-matched healthy controls (HCs); as well as 40 patients with AOS and 40 age- and sex-matched HCs. The University of Pennsylvania Smell Identification Test was administered. RESULTS The EOS group and AOS group exhibited worse olfactory identification ability than HCs; impairment correlated significantly with negative symptoms. Olfactory identification was worse in patients suffering EOS compared with those suffering AOS. CONCLUSION Olfactory identification impairment may be a trait marker of schizophrenia.
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Affiliation(s)
- Ze-Tian Li
- Chemical Senses and Mental Health Lab, Department of Psychology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
| | - Shu-Bin Li
- Chemical Senses and Mental Health Lab, Department of Psychology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
| | - Jin-Feng Wen
- Department of Psychology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Xiao-Yuan Zhang
- Chemical Senses and Mental Health Lab, Department of Psychology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
| | - Lai-Quan Zou
- Chemical Senses and Mental Health Lab, Department of Psychology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden, Germany
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Arango C, Ng-Mak D, Finn E, Byrne A, Loebel A. Lurasidone compared to other atypical antipsychotic monotherapies for adolescent schizophrenia: a systematic literature review and network meta-analysis. Eur Child Adolesc Psychiatry 2020; 29:1195-1205. [PMID: 31758359 PMCID: PMC7497364 DOI: 10.1007/s00787-019-01425-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 10/12/2019] [Indexed: 02/07/2023]
Abstract
This network meta-analysis assessed the efficacy and tolerability of lurasidone versus other oral atypical antipsychotic monotherapies in adolescent schizophrenia. A systematic literature review identified 13 randomized controlled trials of antipsychotics in adolescents with schizophrenia-spectrum disorders. A Bayesian network meta-analysis compared lurasidone to aripiprazole, asenapine, clozapine, olanzapine, paliperidone extended-release (ER), quetiapine, risperidone, and ziprasidone. Outcomes included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions-Severity (CGI-S), weight gain, all-cause discontinuation, extrapyramidal symptoms (EPS), and akathisia. Results were reported as median differences for continuous outcomes and odds ratios (ORs) for binary outcomes, along with 95% credible intervals (95% CrI). Lurasidone was significantly more efficacious than placebo on the PANSS (- 7.95, 95% CrI - 11.76 to - 4.16) and CGI-S (- 0.44, 95% CrI - 0.67 to - 0.22) scores. Lurasidone was associated with similar weight gain to placebo and statistically significantly less weight gain versus olanzapine (- 3.62 kg, 95% CrI - 4.84 kg to - 2.41 kg), quetiapine (- 2.13 kg, 95% CrI - 3.20 kg to - 1.08 kg), risperidone (- 1.16 kg, 95% CrI - 2.14 kg to - 0.17 kg), asenapine (- 0.98 kg, 95% CrI - 1.71 kg to - 0.24 kg), and paliperidone ER (- 0.85 kg, 95% CrI - 1.57 kg to - 0.14 kg). The odds of all-cause discontinuation were significantly lower for lurasidone than aripiprazole (OR = 0.28, 95% CrI 0.10-0.76) and paliperidone ER (OR = 0.25, 95% CrI 0.08-0.81) and comparable to other antipsychotics. Rates of EPS and akathisia were similar for lurasidone and other atypical antipsychotics. In this network meta-analysis of atypical antipsychotics in adolescent schizophrenia, lurasidone was associated with similar efficacy, less weight gain, and lower risk of all-cause discontinuation compared to other oral atypical antipsychotics.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón. IiSGM, School of Medicine, Universidad Complutense, CIBERSAM. Av. Séneca 2, 28040 Madrid, Spain
| | - Daisy Ng-Mak
- Sunovion Pharmaceuticals Inc, 84 Waterford Drive, Marlborough, MA, 01752, USA.
| | - Elaine Finn
- IQVIA, 210 Pentonville Rd, London, N1 9JY UK
| | - Aidan Byrne
- IQVIA, 210 Pentonville Rd, London, N1 9JY UK
| | - Antony Loebel
- Sunovion Pharmaceuticals Inc, One Bridge Plaza North, Suite 510, Fort Lee, NJ 07024 USA
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Ibrahim I, Tobar S, Fathi W, ElSayed H, Yassein A, Eissa A, Elsheshtawy E, Elboraei H, Shahda M, Elwasify M, Ibrahim A, Chen K, Wood J, Dickerson F, Yolken RH, El Chennawi F, Gur R, Gur R, El Bahaey W, Nimgaonkar V, Mansour H. Randomized controlled trial of adjunctive Valproate for cognitive remediation in early course schizophrenia. J Psychiatr Res 2019; 118:66-72. [PMID: 31494376 DOI: 10.1016/j.jpsychires.2019.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 08/13/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Schizophrenia (SZ) is associated with cognitive impairment that contributes to disability, but the cognitive dysfunction is relatively refractory to pharmacologic intervention. Though Valproate augmentation is reported to improve psychopathology among patients with SZ, its effects on cognitive functions have not been investigated systematically. METHODS Using a randomized double blind placebo controlled design, the effects of Valproate or placebo as adjuncts to risperidone (RISP) treatment were evaluated among patients with early course SZ (N = 109). Domains of cognitive function, estimated using the Arabic version of the Penn Computerized Neurocognitive Battery, were the prime outcomes. Clinical severity and social function were secondary outcomes. We also explored the effects of valproate treatment on serological responses to Toxoplama Gondii (TOXO), a putative risk factor for cognitive dysfunction in SZ. RESULTS There were no significant differences between Valproate and placebo (PLA) treated groups with respect to changes in cognitive functions, positive or negative symptom scores or daily function scores at the beginning and end of the study. No significant Valproate/PLA differences were noted on TOXO serostatus or TOXO-related cognitive dysfunction. CONCLUSION Valproate treatment may not be beneficial for cognitive dysfunction in SZ or for TOXO infection.
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Affiliation(s)
- Ibtihal Ibrahim
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Salwa Tobar
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Warda Fathi
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Hanan ElSayed
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Amal Yassein
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Ahmed Eissa
- Department of Psychiatry, Port-said University School of Medicine, Port-said, Egypt
| | - Eman Elsheshtawy
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Hala Elboraei
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Mohamed Shahda
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Mahmoud Elwasify
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Ahmed Ibrahim
- Clinical pathology department, Mansoura university student Hospital, Egypt
| | - Kehui Chen
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel Wood
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | | | - Robert H Yolken
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, USA
| | - Farha El Chennawi
- Department of Clinical Pathology, Mansoura University School of Medicine, Mansoura, Egypt
| | - Raquel Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wafaa El Bahaey
- Department of Psychiatry, Mansoura University School of Medicine, Mansoura, Egypt
| | - Vishwajit Nimgaonkar
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA; Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. nimga+@pitt.edu
| | - Hader Mansour
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
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Chang CH, Lane HY, Liu CY, Chen SJ, Lin CH. Paliperidone is associated with reduced risk of severe hepatic outcome in patients with schizophrenia and viral hepatitis: A nationwide population-based cohort study. Psychiatry Res 2019; 281:112597. [PMID: 31629300 DOI: 10.1016/j.psychres.2019.112597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Paliperidone, a second-generation antipsychotic, has been found to have minimal hepatotoxicity in patients with schizophrenia. However, long-term hepatic outcome in patients with schizophrenia and viral hepatitis remains unclear. METHODS Data obtained from the Taiwan National Health Insurance Research Database was used to enroll newly diagnosed schizophrenic patients between January 2007 and December 2013. Patients with schizophrenia and viral hepatitis who were receiving paliperidone were allocated to the paliperidone group while those who were not receiving paliperidone were allocated to the control group. Using a 1:2 ratio, we matched the age, sex, and index year to select the control participants. Patients with severe hepatic outcomes (SHOs) before enrollment were excluded. The two groups were studied until December 31, 2013. The primary endpoint was the occurrence of SHOs including liver failure, liver decompensation, liver transplantation, or liver cancer. RESULTS We identified 134 patients with schizophrenia and viral hepatitis who received paliperidone and 268 matched patients who did not receive paliperidone. Of the 402 patients, 22 (5.47%) developed SHOs during a mean follow-up period of 3.57 ± 1.62 years, including 2 (1.49%) from the paliperidone cohort and 20 (7.46%) from the control group. Furthermore, the Cox multivariate proportional hazards analysis revealed that the risk decreased with paliperidone use (adjusted hazard ratio [HR]: 0.155, 95% confidence interval [CI]: 0.032-0.737, p = 0.019) after adjusted for confounding factors. CONCLUSION Paliperidone treatment was associated with a reduced risk of SHOs in patients with schizophrenia and viral hepatitis.
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Affiliation(s)
- Chun-Hung Chang
- Department of Psychiatry, Institute of Clinical Medical Science, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan; Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan; An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Hsien-Yuan Lane
- Department of Psychiatry, Institute of Clinical Medical Science, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan; Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan.
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab,Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Chieh-Hsin Lin
- Department of Psychiatry, Institute of Clinical Medical Science, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No 123, Dapi Rd, Niaosong District, Kaohsiung 833, Taiwan.
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Hsu CW, Lee SY, Wang LJ. Gender differences in the prevalence, comorbidities and antipsychotic prescription of early-onset schizophrenia: a nationwide population-based study in Taiwan. Eur Child Adolesc Psychiatry 2019; 28:759-767. [PMID: 30382356 DOI: 10.1007/s00787-018-1242-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 10/20/2018] [Indexed: 01/13/2023]
Abstract
Early-onset schizophrenia (EOS) is defined as patients diagnosed with schizophrenia before the age of 18. Whether the EOS population has gender differences is currently a matter of considerable debate. This study used a representative nationwide sample to examine potential gender differences in the prevalence, comorbidities, and prescription of antipsychotics among the EOS population. We identified a total of 401 patients with EOS (200 males and 201 females) from Taiwan's National Health Insurance Database between 2000 and 2012. The annual prevalence rate of overall patients with EOS increased significantly from 17.1 to 41.8 per 100,000 persons among the youth population (≤ 18 years). Sulpiride, Risperidone, and Aripiprazole were the most common antipsychotics of first choice for treating EOS. Compared to female patients, male patients were more likely to experience the following comorbidities: attention deficit hyperactivity disorder (15.5% vs. 5.5%), autism spectrum disorder (10.0% vs. 3.0%), intellectual disability (19.0% vs. 10.4%), developmental disorder (8.0% vs. 3.0%), and history of physical injury (65.5% vs. 48.8%), prior to being diagnosed with schizophrenia. We observed no significant gender differences with regard to incidence, prevalence, age of onset, and categories and doses of patients' first antipsychotic prescription. Our findings did not support the empirical opinion that males with EOS experience the onset earlier or are more prevalent than EOS female patients. However, male patients were more likely to have neurodevelopmental comorbidities and a history of physical injury. These results can function as an important reference for planning services that target real-world patient treatment.
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Affiliation(s)
- Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Liang-Jen Wang
- Chang Gung University College of Medicine, Kaohsiung, Taiwan.
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, No. 123, Ta-Pei Road, Kaohsiung, Taiwan.
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Jena M, Ranjan R, Mishra BR, Mishra A, Nath S, Sahu P, Meher BR, Srinivasan A, Maiti R. Effect of lurasidone vs olanzapine on neurotrophic biomarkers in unmedicated schizophrenia: A randomized controlled trial. J Psychiatr Res 2019; 112:1-6. [PMID: 30782512 DOI: 10.1016/j.jpsychires.2019.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 11/19/2022]
Abstract
Neurotrophic factors like Brain-Derived Neurotrophic Factor (BDNF), Neurotrophin 3 (NT3) and Nerve Growth Factor (NGF), play a role in neuroplasticity and neurogenesis contributing to the pathogenesis of schizophrenia. The objective of the present study was to investigate and compare the effect of olanzapine and lurasidone on the change in serum neurotrophins in patients with schizophrenia. The present study was a randomized, open-label, active-controlled, parallel design clinical trial. After randomization baseline evaluations of serum BDNF, NGF, NT3, Positive and Negative Syndrome Scale (PANSS) scoring, Social and Occupational Functioning Assessment Scale (SOFAS) scoring of 101 unmedicated schizophrenia patients were done. Patients were reassessed after 6 weeks of monotherapy with olanzapine or lurasidone. Serum BDNF increased after treatment with both the drug groups but rise with olanzapine was found to be significantly higher (916.22; 95 %CI: 866.07 to 966.37; p < 0.001) in comparison to lurasidone. Increase in levels NGF and NT3 was also observed but there was no significant difference between the groups (NGF: 2.32; CI: 3.54 to -3.53; p = 0.57 and NT3: 0.99; CI: 2.11 to 0.14; p = 0.086). The difference in improvement in PANSS and SOFASS with both the drugs was not statistically significant. Both the drugs alleviate the symptoms of schizophrenia but olanzapine was better tolerated. Our findings suggest that increase in serum BDNF with olanzapine monotherapy is significantly higher than that with lurasidone but there is no significant difference in change in serum NGF and NT3. TRIAL REGISTRATION: ClinicalTrials.gov identifier: (NCT03304457).
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Affiliation(s)
- Monalisa Jena
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
| | - Rajeev Ranjan
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Patna, India.
| | - Biswa Ranjan Mishra
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
| | | | - Santanu Nath
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
| | - Pallabi Sahu
- Department of Psychiatry, KIMS, Bhubaneswar, India.
| | | | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
| | - Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
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Chronic Antipsychotic Treatment Modulates Aromatase (CYP19A1) Expression in the Male Rat Brain. J Mol Neurosci 2019; 68:311-317. [PMID: 30968339 PMCID: PMC6511348 DOI: 10.1007/s12031-019-01307-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/20/2019] [Indexed: 01/20/2023]
Abstract
Antipsychotic drugs, known as the antagonists of dopaminergic receptors, may also affect a large spectrum of other molecular signaling pathways in the brain. Despite the numerous ongoing studies on neurosteroid action and regulation, there are no reports regarding the influence of extended treatment with typical and atypical neuroleptics on brain aromatase (CYP19A1) expression. In the present study, we assessed for the first time aromatase mRNA and protein levels in the brain of rats chronically (28 days) treated with olanzapine, clozapine, and haloperidol using quantitative real-time PCR, end-point RT-PCR, and Western blotting. Both clozapine and haloperidol, but not olanzapine treatment, led to an increase of aromatase mRNA expression in the rat brain. On the other hand, aromatase protein level remained unchanged after drug administration. These results cast a new light on the pharmacology of examined antipsychotics and contribute to a better understanding of the mechanisms responsible for their action. The present report also underlines the complex nature of potential interactions between neuroleptic pharmacological effects and physiology of brain neurosteroid pathways.
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Chronic olanzapine administration causes metabolic syndrome through inflammatory cytokines in rodent models of insulin resistance. Sci Rep 2019; 9:1582. [PMID: 30733507 PMCID: PMC6367387 DOI: 10.1038/s41598-018-36930-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 11/23/2018] [Indexed: 01/16/2023] Open
Abstract
Olanzapine is a second-generation anti-psychotic drug used to prevent neuroinflammation in patients with schizophrenia. However, the long-term administration of olanzapine leads to insulin resistance (IR); the mechanisms of this effect remains poorly understood. Using cellular and rodent models of IR induced by olanzapine, we found that chronic olanzapine treatment induces differential inflammatory cytokine reactions in peripheral adipose and the central nervous system. Long-term treatment of olanzapine caused metabolic symptoms, including IR, by markedly elevating the plasma levels of pro-inflammatory cytokines, including IL-1ß, IL-6, IL-8 and TNFα; these findings are consistent with observations from schizophrenia patients chronically treated with olanzapine. Our observations of differential inflammatory cytokine responses in white adipose tissues from the prefrontal cortex in the brain indicated cell type-specific effects of the drug. These cytokines induced IR by activating NF-kB through the suppression of IkBα. Functional blockade of the components p50/p65 of NF-kB rescued olanzapine-induced IR in NIH-3T3 L1-derived adipocytes. Our findings demonstrate that olanzapine induces inflammatory cytokine reactions in peripheral tissues without adversely affecting the central nervous system and suggest that chronic olanzapine treatment of schizophrenia patients may cause inflammation-mediated IR with minimal or no adverse effects in the brain.
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The evidence-based choice for antipsychotics in children and adolescents should be guaranteed. Eur J Clin Pharmacol 2019; 75:769-776. [PMID: 30729258 DOI: 10.1007/s00228-019-02641-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/28/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Drug use in the pediatric population still often features off-label prescriptions, particularly for psychotropic drugs. We reviewed the registration status, scientific evidence, and recommendations from the guidelines for antipsychotics used for psychiatric disorders in children. METHODS Antipsychotic drugs marketed in Italy, the United Kingdom (UK) and United States (US) were identified with the ATC Classification System. The licensing status and Summary of Product Characteristics (SPC) were taken from the national formularies. We analyzed reviews and guidelines on antipsychotics use in children and adolescents in the MEDLINE, EMBASE, and PsycINFO databases. RESULTS Out of 67 drugs, 19 were marketed with a pediatric license in at least one country: three in all the selected countries, and only paliperidone with the same indications. Haloperidol was the only antipsychotic authorized for autism in Italy and the UK, and as well as risperidone and aripiprazole in the US. Aripiprazole and paliperidone were licensed in all three countries for schizophrenia. Aripiprazole was licensed for bipolar disorders in all three countries. Haloperidol was licensed for Tourette syndrome in Italy and the UK, and pimozide and aripiprazole in the US. We retrieved 21 pertinent reviews and 13 guidelines for the management of neuropsychiatric disorders in pediatrics. There was a complete overlap between the authorized therapeutic indications and the available scientific evidence for autism in the US, for conduct disorders and bipolar disorders in the UK, and for Tourette syndrome and tics in the UK and Italy. CONCLUSIONS These results highlight the different regulatory processes that deny to many children and adolescents the most appropriate and rational antipsychotic therapy.
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Cortese S, Tomlinson A, Cipriani A. Meta-Review: Network Meta-Analyses in Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 2019; 58:167-179. [PMID: 30738544 DOI: 10.1016/j.jaac.2018.07.891] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/25/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Network meta-analyses (NMAs) are gaining traction as the preferred method for evidence synthesis of intervention studies. This review aimed to summarize the basics of NMAs and conduct a meta-review of available NMAs on the treatment of child and adolescent psychiatric disorders by appraising their quality. METHOD PubMed (Medline), PsycInfo, Embase, Ovid Medline, and Web of Knowledge were systematically searched (last update January 9, 2018). The quality of each included NMA was appraised using the AMSTAR-2 tool and the PRISMA-NMA checklist, which includes specific items for NMAs. RESULTS Eighteen NMAs (6 on attention-deficit/hyperactivity disorder; 4 on psychotic disorders; 2 on depression; 2 on anxiety disorders; 1 on obsessive-compulsive disorder; 1 on disruptive behavior disorder, 1 on bipolar disorder, and 1 on antipsychotics across disorders) were retrieved. Results from the AMSTAR-2 assessment showed that only 27% of appraised NMAs were rated as moderate quality; most were rated as low (33%) or critically low (40%) quality. Only 3 of the appraised NMAs reported on all PRISMA-NMA items specific for NMAs; the network structure was graphically presented in most NMAs (80%), and inconsistency was described in only 47%. CONCLUSION Given the paucity of head-to-head trials in child and adolescent psychiatry, NMAs have the potential to contribute to the field, because they provide evidence-based hierarchies for treatment decision making, even in the absence of trials directly comparing at least 2 treatments. However, because of important limitations in the included NMAs, additional methodologically sound NMAs are needed to inform future guidelines and clinical practice in child and adolescent psychiatry.
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Affiliation(s)
- Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology and Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; the Solent NHS Trust, Southampton; the New York University Child Study Center, New York, NY; and the Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, UK.
| | | | - Andrea Cipriani
- Warneford Hospital and Oxford Health NHS Foundation Trust, University of Oxford, UK
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