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Cipolla S, Catapano P, D’Amico D, Monda R, Sallusto NP, Perris F, De Santis V, Catapano F, Luciano M, Fiorillo A. Combination of Two Long-Acting Antipsychotics in Schizophrenia Spectrum Disorders: A Systematic Review. Brain Sci 2024; 14:433. [PMID: 38790412 PMCID: PMC11117856 DOI: 10.3390/brainsci14050433] [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: 03/21/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Up to 34% of patients with schizophrenia are resistant to several treatment trials. Lack of continuous and adequate treatment is associated with relapse, rehospitalization, a lower effect of antipsychotic therapy, and higher risk of side effects. Long-acting injectables antipsychotics (LAI APs) enhance compliance and improve clinical outcomes and quality of life in patients with schizophrenia, and thus it may be advisable to administer two LAI APs at the same time in cases of treatment-resistant schizophrenia. The purpose of this review is to summarize the available literature regarding the combined use of two LAI APs in patients with schizophrenia or other psychotic spectrum disorders. METHODS An extensive literature search for relevant articles regarding any combination of two long-acting injectable antipsychotics has been performed from inception up to 9 February 2024, on PubMed, Scopus and APA PsycInfo, according to the PRISMA statement. Only studies reporting combination of two LAI APs and its clinical outcome in patients with schizophrenia and related disorders were selected. RESULTS After the selection process, nine case reports, four case series and two observational retrospective studies were included in the final analysis. All patients treated with dual LAI APs reported a good response, and no new or unexpected adverse effects due to the combination of two LAIs were reported. Different drug combinations were used, and the most frequent association resulted in aripiprazole monohydrate + paliperidone palmitate once monthly (32 times). CONCLUSIONS Our review highlights that the treatment regimen with two concurrent LAI APs is already widely used in clinical practice and is recognized as providing a promising, effective, and relatively safe therapeutic strategy for treating the schizophrenia spectrum disorders.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mario Luciano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (S.C.); (P.C.); (D.D.); (R.M.); (N.P.S.); (F.P.); (V.D.S.); (F.C.); (A.F.)
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Parrilla GE, Gupta V, Wall RV, Salkar A, Basavarajappa D, Mirzaei M, Chitranshi N, Graham SL, You Y. The role of myelin in neurodegeneration: implications for drug targets and neuroprotection strategies. Rev Neurosci 2024; 35:271-292. [PMID: 37983528 DOI: 10.1515/revneuro-2023-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
Myelination of axons in the central nervous system offers numerous advantages, including decreased energy expenditure for signal transmission and enhanced signal speed. The myelin sheaths surrounding an axon consist of a multi-layered membrane that is formed by oligodendrocytes, while specific glycoproteins and lipids play various roles in this formation process. As beneficial as myelin can be, its dysregulation and degeneration can prove detrimental. Inflammation, oxidative stress, and changes in cellular metabolism and the extracellular matrix can lead to demyelination of these axons. These factors are hallmark characteristics of certain demyelinating diseases including multiple sclerosis. The effects of demyelination are also implicated in primary degeneration in diseases such as glaucoma and Alzheimer's disease, as well as in processes of secondary degeneration. This reveals a relationship between myelin and secondary processes of neurodegeneration, including resultant degeneration following traumatic injury and transsynaptic degeneration. The role of myelin in primary and secondary degeneration is also of interest in the exploration of strategies and targets for remyelination, including the use of anti-inflammatory molecules or nanoparticles to deliver drugs. Although the use of these methods in animal models of diseases have shown to be effective in promoting remyelination, very few clinical trials in patients have met primary end points. This may be due to shortcomings or considerations that are not met while designing a clinical trial that targets remyelination. Potential solutions include diversifying disease targets and requiring concomitant interventions to promote rehabilitation.
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Affiliation(s)
- Gabriella E Parrilla
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Vivek Gupta
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Roshana Vander Wall
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Akanksha Salkar
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Devaraj Basavarajappa
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Mehdi Mirzaei
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Nitin Chitranshi
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Stuart L Graham
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
- Save Sight Institute, University of Sydney, 8 Macquarie St, Sydney, NSW 2000, Australia
| | - Yuyi You
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
- Save Sight Institute, University of Sydney, 8 Macquarie St, Sydney, NSW 2000, Australia
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Ma LY, Ou YN, Gao PY, Fu Y, Zhang DD, Yang L, Feng JF, Cheng W, Tan L, Yu JT. Associations between antipsychotics exposure and dementia risk: A prospective cohort study of 415,100 participants. J Affect Disord 2024; 349:201-209. [PMID: 38199419 DOI: 10.1016/j.jad.2024.01.029] [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: 07/27/2023] [Revised: 12/04/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Antipsychotics (APs) are among the most widely prescribed medications, and have been shown to cause cognitive decline. But previous studies on their effects on dementia risk are controversial and scarce. We aimed to examine the relationships of APs exposure with the risk of dementia. METHODS Data were obtained from a prospective cohort of 415,100 UK Biobank (UKB) participants. We investigated the effects of APs exposure and their various classes on dementia risk by using multivariable Cox proportional hazard models and further the dose-response effects of oral APs. RESULTS After a mean follow-up of 8.64 years, 5235 (1.3 %) participants developed all-cause dementia (ACD), among whom 2313 (0.6 %) developed Alzheimer's disease (AD), and 1213 (0.3 %) developed vascular dementia (VaD). Exposure to any APs conferred increased risks of ACD (HR: 1.33, 95 % CI = 1.17-1.51, P < 0.001) and VaD (HR: 1.90, 95 % CI = 1.51-2.40, P < 0.001), but not AD (HR: 1.22, 95 % CI = 1.00-1.48, P = 0.051). Cumulative dose-response relationships of oral APs with the risks of ACD and VaD were observed (P for trend, P < 0.05). LIMITATIONS Our study is observational and does not show evidence of causality. Since there are relatively few cases of dementia in the UKB, APs exposure may be higher than estimated in our study. CONCLUSIONS APs exposure increased the risk of developing dementia. Dose-response relationships were found between oral APs and dementia risk. Efforts to raise awareness of doctors and patients about this potential drug-related risk are critical to reducing APs use.
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Affiliation(s)
- Li-Yun Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Pei-Yang Gao
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Yan Fu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Dan-Dan Zhang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Liu Yang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai 200040, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai 200040, China; Fudan ISTBI-ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua 321004, China; MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200032, China; Zhangjiang Fudan International Innovation Center, Shanghai 200433, China
| | - Wei Cheng
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai 200040, China; Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai 200040, China; Fudan ISTBI-ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua 321004, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China.
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai 200040, China.
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Højlund M, Correll CU. Switching to long-acting injectable antipsychotics: pharmacological considerations and practical approaches. Expert Opin Pharmacother 2023; 24:1463-1489. [PMID: 37345508 DOI: 10.1080/14656566.2023.2228686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/20/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Long-acting injectable antipsychotics (LAIs) are an effective, but potentially underutilized treatment option in schizophrenia and other severe mental illnesses. Prescribing information typically focuses on how to initiate treatment from the corresponding oral formulations. However, in clinical practice other scenarios, such as switching from other oral antipsychotics or other LAIs, occur frequently, requiring guidance. AREAS COVERED Pharmacodynamic properties of antipsychotics and their relation to rebound symptoms. Pharmacokinetic properties of LAIs and their implications for switching approaches. Specific approaches to switching to LAIs. EXPERT OPINION The LAI landscape has evolved significantly in the last decade with more formulations available, longer dosing intervals, and extended indications. However, currently available LAIs have various shortcomings, e.g. short dosing intervals, need for oral supplementation, loading regimens, deep intramuscular injection and/or restricted indications. Recent improvements include a one-day initiation option for aripiprazole lauroxil, aripiprazole monohydrate once-monthly, risperidone in situ microparticles and subcutaneous risperidone. Future LAI developments should focus on longer dosing intervals, subcutaneous administration, expansion of LAIs beyond currently available antipsychotic agents and indications beyond schizophrenia and bipolar disorder. In the future, LAIs might become a first-line treatment after initial oral stabilization for chronic mental disorders with need for maintenance treatment and presence of significant non-adherence.
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Affiliation(s)
- Mikkel Højlund
- Department of Psychiatry Aabenraa, Mental Health Services Region of Southern Denmark, Aabenraa, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA
- Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Wang C, Tishler TA, Nuechterlein KH, Ellingson BM. Cortical thickness, gray-white matter contrast, and intracortical myelin in first-episode schizophrenia patients treated with long-acting paliperidone palmitate versus oral antipsychotics. Psychiatry Res 2023; 326:115364. [PMID: 37494877 DOI: 10.1016/j.psychres.2023.115364] [Citation(s) in RCA: 1] [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: 12/20/2022] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023]
Abstract
This longitudinal study evaluated the cortical thickness, gray-to-white matter contrast (GWC), and frontal lobe intracortical myelin (ICM) volume in first-episode schizophrenia (FES) patients treated with oral antipsychotics (OAP) versus a long-acting injectable antipsychotic, paliperidone palmitate (PP). 2D proton density and inversion recovery images, and 3D T1-weighted MPRAGE images were acquired at 3T from 68 FES patients in a randomized clinical trial with PP vs OAP. At baseline, no differences in GWC and ICM were observed between FES patients and HCs, but the thickness of the left precuneus, the right transverse temporal gyrus, and the bilateral superior temporal gyri was found to be thinner in FES patients relative to HCs. Following 9 months of antipsychotics, OAP treatment, compared to PP treatment, resulted in a more widespread cortical thickness reduction including the right lateral occipital and orbitofrontal gyri. No significant ICM and GWC changes were observed in the PP group, whereas OAP treatment led to a significant ICM volume decrease and GWC increase. A negative correlation was found between ICM changes and GWC changes within multiple frontal regions after 9 months of OAP treatment. These preliminary findings suggest that PP treatment might aid preservation of brain morphology.
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Affiliation(s)
- C Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - T A Tishler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - K H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - B M Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Neuroscience Interdisciplinary Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Wang C, Tishler TA, Oughourlian T, Nuechterlein KH, de la Fuente-Sandoval C, Ellingson BM. Prospective, randomized, multicenter clinical trial evaluating longitudinal changes in brain function and microstructure in first-episode schizophrenia patients treated with long-acting injectable paliperidone palmitate versus oral antipsychotics. Schizophr Res 2023; 255:222-232. [PMID: 37019033 DOI: 10.1016/j.schres.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 02/23/2023] [Accepted: 03/18/2023] [Indexed: 04/07/2023]
Abstract
Widespread anatomical alterations and abnormal functional connectivity have shown strong association with symptom severity in first-episode schizophrenia (FES) patients. Second-generation antipsychotic treatment might slow disease progression and possibly modify the cerebral plasticity in FES patients. However, whether a long-acting injectable antipsychotic (paliperidone palmitate [PP]), available in monthly and every-3-months formulations, is more effective than oral antipsychotics (OAP) in improving cerebral organization has been unclear. Therefore, in the current longitudinal study, we evaluated the differences in functional and microstructural changes of 68 FES patients in a randomized clinical trial of PP vs OAP. When compared to OAP treatment, PP treatment was more effective in decreasing abnormally high fronto-temporal and thalamo-temporal connectivity, as well as increasing fronto-sensorimotor and thalamo-insular connectivity. Consistent with previous studies, multiple white matter pathways showed larger changes in fractional anisotropy (FA) and mean diffusivity (MD) in response to PP compared with OAP treatment. These findings suggest that PP treatment might reduce regional abnormalities and improve cerebral connectivity networks compared with OAP treatment, and identified changes that may serve as reliable imaging biomarkers associated with medication treatment efficacy.
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Affiliation(s)
- Chencai Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America.
| | - Todd A Tishler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Talia Oughourlian
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Camilo de la Fuente-Sandoval
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico; Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Benjamin M Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Neuroscience Interdisciplinary Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
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Tishler TA, Ellingson BM, Salvadore G, Baker P, Turkoz I, Subotnik KL, de la Fuente-Sandoval C, Nuechterlein KH, Alphs L. Effect of treatment with paliperidone palmitate versus oral antipsychotics on frontal lobe intracortical myelin volume in participants with recent-onset schizophrenia: Magnetic resonance imaging results from the DREaM study. Schizophr Res 2023; 255:195-202. [PMID: 37004331 DOI: 10.1016/j.schres.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 02/10/2023] [Accepted: 03/11/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE We investigated changes in brain intracortical myelin (ICM) volume in the frontal lobe after 9 months of treatment with paliperidone palmitate (PP) compared with 9 months of treatment with oral antipsychotics (OAP) in participants with recent-onset schizophrenia or schizophreniform disorder from the Disease Recovery Evaluation and Modification (DREaM) study, a randomized, open-label, delayed-start trial. METHODS DREaM included 3 phases: Part I, a 2-month oral run-in; Part II, a 9-month disease progression phase (PP or OAP); and Part III, 9 months of additional treatment (participants receiving PP continued PP [PP/PP] and participants receiving OAP were rerandomized to receive either PP [OAP/PP] or OAP [OAP/OAP]). In Part II, magnetic resonance imaging (MRI) and functional and symptomatic assessment was performed at baseline, day 92, and day 260. ICM volume as a fraction of the entire brain volume was quantified by subtraction of a proton density image from an inversion recovery image. Within-treatment-group changes from baseline were assessed by paired t-tests. Analysis of covariance was used to analyze ICM volume changes between treatment groups, adjusting for country. RESULTS The MRI analysis sample size included 71 DREaM participants (PP, 23; OAP, 48) and 64 healthy controls. At baseline, mean adjusted ICM fraction values did not differ between groups (PP, 0.057; OAP, 0.058, p = 0.79). By day 92, the adjusted ICM fraction in the OAP group had decreased significantly (change from baseline, -0.002; p = 0.001), whereas the adjusted ICM fraction remained unchanged from baseline in the PP group (0.000; p = 0.80). At day 260, the change from baseline in adjusted ICM fraction was -0.004 (p = 0.004) in the OAP group and -0.001 (p = 0.728) in the PP group. The difference between treatment groups did not reach statistical significance (p = 0.147). CONCLUSIONS In participants with recent-onset schizophrenia or schizophreniform disorder, frontal ICM volume was preserved at baseline levels in those treated with PP over 9 months. However, a decrease of frontal ICM volume was observed among participants treated with OAPs. TRIAL REGISTRATION clinicaltrials.gov identifier NCT02431702.
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Affiliation(s)
- T A Tishler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
| | - B M Ellingson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; UCLA Center for Computer Vision and Imaging Biomarkers, Departments of Radiological Sciences and Psychiatry, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
| | - G Salvadore
- Janssen Research and Development, LLC, Titusville, NJ, USA.
| | - P Baker
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
| | - I Turkoz
- Janssen Research and Development, LLC, Titusville, NJ, USA.
| | - K L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
| | - C de la Fuente-Sandoval
- Laboratory of Experimental Psychiatry, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico; Neuropsychiatry Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.
| | - K H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA.
| | - L Alphs
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
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Milz R, Benson C, Knight K, Antunes J, Najarian D, Lopez Rengel PM, Wang S, Richarz U, Gopal S, Kane JM. The Effect of Longer Dosing Intervals for Long-Acting Injectable Antipsychotics on Outcomes in Schizophrenia. Neuropsychiatr Dis Treat 2023; 19:531-545. [PMID: 36915909 PMCID: PMC10008005 DOI: 10.2147/ndt.s395383] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/12/2023] [Indexed: 03/16/2023] Open
Abstract
Medication nonadherence in schizophrenia can have serious implications including relapses and hospitalization. Long-acting injectable (LAI) antipsychotics require fewer administrations, while ensuring sustained medication coverage. In this review, we summarize the expected real-world benefits of longer dosing intervals in the management of schizophrenia. LAIs are associated with improved clinical outcomes of less frequent relapses and reduced functional impairment, encouraging patients to regain control of their lives. Aripiprazole lauroxil and paliperidone palmitate three-monthly (PP3M) LAIs have longer dosing intervals of 2-3 months and provide improved outcomes in patients with schizophrenia. Paliperidone palmitate six-monthly (PP6M) LAI provides the longest dosing interval, twice-yearly dosing, among existing LAIs. Decreasing the frequency of LAI administrations has the potential to reduce occurrence of serious outcomes associated with poor medication adherence. By eliminating the need for daily oral antipsychotic dosing, LAIs could increase the likelihood of patient acceptance, decrease stigma, and promote self-esteem. Longer intervals of medication coverage may be desirable for patients with higher risk of relapse including adults with recent-onset schizophrenia, those living in circumstances that may deprive them of regular access (eg, homeless), those that are in transitions between care settings or to reduce interpersonal contact during public health emergencies (eg, COVID-19 pandemic).
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Affiliation(s)
- Ruth Milz
- Janssen Research & Development LLC, Titusville, NJ, USA
| | | | - Karl Knight
- Janssen Research & Development LLC, Titusville, NJ, USA
| | | | | | | | - Steven Wang
- Janssen Research & Development LLC, Titusville, NJ, USA
| | - Ute Richarz
- Janssen Global Medical Affairs, Cilag, Zug, Switzerland
| | - Srihari Gopal
- Janssen Research & Development LLC, Titusville, NJ, USA
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Queens, NY, USA.,Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
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Rubio JM, Perez-Rodriguez M. Chronic Use of Antipsychotics in Schizophrenia: Are We Asking the Right Question? SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac059. [PMID: 36277256 PMCID: PMC9577501 DOI: 10.1093/schizbullopen/sgac059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is an ongoing debate about the potential risks and benefits of long-term antipsychotic treatment in schizophrenia. The data for and against the chronic use of these medicines is mostly indirect, either from observational studies potentially exposed to reverse causation bias or randomized controlled studies that do not cover beyond 2–3 years. We propose that perseverating on the question of what positive or negative outcomes are causally associated with chronic antipsychotic treatment may not lead to better answers than the limited ones that we have, given the limited feasibility of more conclusive studies. Rather, we argue that addressing the research question of the risks and benefits of antipsychotic discontinuation from a perspective of personalized medicine, can be more productive and meaningful to people living with schizophrenia. To this end, research that can quantify the risk of relapse after treatment continuation for a given individual should be prioritized. We make the case that clinically feasible neuroimaging biomarkers have demonstrated promise in related paradigms, and that could be offering a way past this long debate on the risks and benefits of chronic antipsychotic use.
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Affiliation(s)
- Jose M Rubio
- To whom correspondence should be addressed; Donald and Barbara Zucker School of Medicine at Hofstra/Nortwhell, Hempstead, NY, USA; tel: 7184705912, e-mail:
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Sehmbi M, Suh JS, Rowley CD, Minuzzi L, Kapczinski F, Bock NA, Frey BN. Network properties of intracortical myelin associated with psychosocial functioning in bipolar I disorder. Bipolar Disord 2022; 24:539-548. [PMID: 35114029 DOI: 10.1111/bdi.13181] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Psychosocial functioning in bipolar disorder (BD) persists even during euthymia and has repeatedly been associated with illness progression and cognitive function. Its neurobiological correlates remain largely unexplored. Using a structural covariance approach, we explored whole cortex intracortical myelin (ICM) and psychosocial functioning in 39 BD type I and 58 matched controls. METHOD T1 -weighted images (3T) optimized for ICM measurement were analyzed using a surface-based approach. The ICM signal was sampled at cortical mid-depth using the MarsAtlas parcellation, and psychosocial functioning was measured via the Functioning Assessment Short Test (FAST). Following construction of structural covariance matrices, graph theoretical measures were calculated for each subject. Within BD and HC groups separately, correlations between network measures and FAST were explored. After accounting for multiple comparisons, significant correlations were tested formally using rank-based regressions accounting for sex differences. RESULTS In BD only, psychosocial functioning was associated with global efficiency (β = -0.312, pcorr = 0.03), local efficiency in the right rostral dorsolateral prefrontal cortex (β = 0.545, pcorr = 0.001) and clustering coefficient in this region (β = 0.497, pcorr = 0.0002) as well as in the right ventromedial prefrontal cortex (β = 0.428, pcorr = 0.002). All results excepting global efficiency remained significant after accounting for severity of depressive symptoms. In contrast, no significant associations between functioning and network measures were observed in the HC group. CONCLUSION These results uncovered a novel brain-behaviour relationship between intracortical myelin signal changes and psychosocial functioning in BD.
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Affiliation(s)
- Manpreet Sehmbi
- Mood Disorders Program, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jee Su Suh
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | | | - Luciano Minuzzi
- Mood Disorders Program, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Flavio Kapczinski
- Mood Disorders Program, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Nicholas A Bock
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Benicio N Frey
- Mood Disorders Program, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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11
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Nuechterlein KH, Ventura J, Subotnik KL, Gretchen-Doorly D, Turner LR, Casaus LR, Luo J, Boucher ML, Hayata JN, Bell MD, Medalia A. A randomized controlled trial of cognitive remediation and long-acting injectable risperidone after a first episode of schizophrenia: improving cognition and work/school functioning. Psychol Med 2022; 52:1517-1526. [PMID: 32981534 DOI: 10.1017/s0033291720003335] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive deficits at the first episode of schizophrenia are predictive of functional outcome. Interventions that improve cognitive functioning early in schizophrenia are critical if we hope to prevent or limit long-term disability in this disorder. METHODS We completed a 12-month randomized controlled trial of cognitive remediation and of long-acting injectable (LAI) risperidone with 60 patients with a recent first episode of schizophrenia. Cognitive remediation involved programs focused on basic cognitive processes as well as more complex, life-like situations. Healthy behavior training of equal treatment time was the comparison group for cognitive remediation, while oral risperidone was the comparator for LAI risperidone in a 2 × 2 design. All patients were provided supported employment/education to encourage return to work or school. RESULTS Both antipsychotic medication adherence and cognitive remediation contributed to cognitive improvement. Cognitive remediation was superior to healthy behavior training in the LAI medication condition but not the oral medication condition. Cognitive remediation was also superior when medication adherence and protocol completion were covaried. Both LAI antipsychotic medication and cognitive remediation led to significantly greater improvement in work/school functioning. Effect sizes were larger than in most prior studies of first-episode patients. In addition, cognitive improvement was significantly correlated with work/school functional improvement. CONCLUSIONS These results indicate that consistent antipsychotic medication adherence and cognitive remediation can significantly improve core cognitive deficits in the initial period of schizophrenia. When combined with supported employment/education, cognitive remediation and LAI antipsychotic medication show separate significant impact on improving work/school functioning.
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Affiliation(s)
- Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
- Department of Psychology, University of California, Los Angeles, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Denise Gretchen-Doorly
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Luana R Turner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Laurie R Casaus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - John Luo
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Michael L Boucher
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Jacqueline N Hayata
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, USA
| | - Morris D Bell
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Alice Medalia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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12
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Okoli CTC, Kappi A, Wang T, Makowski A, Cooley AT. The effect of long-acting injectable antipsychotic medications compared with oral antipsychotic medications among people with schizophrenia: A systematic review and meta-analysis. Int J Ment Health Nurs 2022; 31:469-535. [PMID: 34931437 DOI: 10.1111/inm.12964] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Long-acting injectable (LAI) antipsychotic medications may be an important modality of reducing costs, improving symptoms, and fostering quality of life outcomes for those with schizophrenia. Our objective was to systematically review and conduct a meta-analysis of the effectiveness of LAIs compared with oral antipsychotics on medication adherence, symptom remission/relapse, rehospitalization, outpatient visits, emergency department visits, healthcare costs, and social functioning. We performed a systematic search of PsycInfo, CINAHL, PubMed, and Scopus databases to examine studies meeting inclusion criteria prior to August 30th, 2020. Randomized controlled trials, retrospective studies, prospective studies among people with schizophrenia with at least 6-month follow-up data were obtained. Overall effect sizes and associated 95% confidence intervals (CI) were estimated with random-effects modeling. We found 75 articles meeting our inclusion criteria, including 341 730 individuals with schizophrenia. Systematic review results indicated that LAIs compared with orals improved medication adherence (25/29 studies), symptom remission/relapse (10/18 studies), rehospitalizations (26/49 studies), emergency department visits (9/17 studies), medical costs (11/15 studies), and social functioning (5/9 studies); however, LAIs also increased outpatient visits (7/16 studies) and pharmacy costs (10/10 studies). Meta-analytic results of studies with similar outcome measures did not find differences between LAIs and orals in respect to outcomes, except lowering emergency department visits and increasing pharmacy costs. The differences between the results of the narrative synthesis and the meta-analyses were possibly because of the low availability of studies with similar outcomes in the pooled analyses. Our overall results suggest that LAIs are at least comparable to orals in supporting important healthcare outcomes for those with schizophrenia. These findings support clinical practice in encouraging providers to prescribe LAIs when indicated.
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Affiliation(s)
| | - Amani Kappi
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Tianyi Wang
- Department of Statistics, University of Kentucky College of Arts and Sciences, Lexington, Kentucky, USA
| | - Andrew Makowski
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Andrew T Cooley
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
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13
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Alphs L, Brown B, Turkoz I, Baker P, Fu DJ, Nuechterlein KH. The Disease Recovery Evaluation and Modification (DREaM) study: Effectiveness of paliperidone palmitate versus oral antipsychotics in patients with recent-onset schizophrenia or schizophreniform disorder. Schizophr Res 2022; 243:86-97. [PMID: 35247794 DOI: 10.1016/j.schres.2022.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
We report primary results of the Disease Recovery Evaluation and Modification (DREaM) study, a randomized, open-label, delayed-start trial designed to compare the effectiveness of paliperidone palmitate (PP) versus oral antipsychotics (OAP) in delaying time to first treatment failure (TtFTF) in participants with recent-onset schizophrenia or schizophreniform disorder. DREaM included: Part I, 2-month oral run-in; Part II, 9-month disease progression phase (PP or OAP); Part III, 9 months of additional treatment (PP/PP; OAP rerandomized: OAP/OAP or OAP/PP). PP/PP and OAP/OAP comprised the 18-month extended disease progression (EDP) analysis. A total of 235 participants were randomized to PP (n = 78) or OAP (n = 157) in Part II. No statistically significant differences in TF between treatment groups were identified during Part II (PP 29.5%, OAP 24.8%; P = 0.377), Part III (PP/PP 14.3%, OAP/PP 15.8%, OAP/OAP 28.6%; P = 0.067) or the EDP analysis (PP/PP 28.6%, OAP/OAP 44.4%; NNT = 6; P = 0.080). Using a modified definition of TF excluding treatment supplementation with another antipsychotic, a common approach to managing dose adjustments, significant differences were observed between treatment groups in Part III (PP/PP 4.1%, OAP/PP 14.0%, OAP/OAP 27.0%; P = 0.002) and EDP (PP/PP 14.3%, OAP/OAP 42.9%; P = 0.001). Safety results were consistent with the known safety profile of PP. Although significant treatment differences were not observed during the first 9 months of DREaM, numerical differences favoring PP emerged in the last 9 months and significant differences were observed when TF criteria were limited to their most impactful components. These results highlight the potential benefit of initiating PP early in the course of schizophrenia and provide valuable insights for future clinical trials in recent-onset schizophrenia or schizophreniform disorder. Clinicaltrials.gov identifier: NCT02431702.
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Affiliation(s)
- Larry Alphs
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA
| | - Brianne Brown
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Ibrahim Turkoz
- Janssen Research and Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Pamela Baker
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Dong-Jing Fu
- Janssen Research and Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Keith H Nuechterlein
- Departments of Psychiatry and Psychology, University of California at Los Angeles, 150 Medical Plaza Driveway, Los Angeles, CA 90095, USA.
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14
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Perlstein I, Merenlender Wagner A, Gomeni R, Lamson M, Harary E, Spiegelstein O, Kalmanczhelyi A, Tiver R, Loupe P, Levi M, Elgart A. Population Pharmacokinetic Modeling and Simulation of TV-46000: A Long-Acting Injectable Formulation of Risperidone. Clin Pharmacol Drug Dev 2022; 11:865-877. [PMID: 35245409 PMCID: PMC9315033 DOI: 10.1002/cpdd.1078] [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: 11/04/2021] [Accepted: 12/29/2021] [Indexed: 12/05/2022]
Abstract
TV‐46000 is a long‐acting subcutaneous antipsychotic that uses a novel copolymer drug delivery technology in combination with a well‐characterized molecule, risperidone, that is in clinical development as a treatment for schizophrenia. A population pharmacokinetic (PPK) modeling and simulation approach was implemented to identify TV‐46000 doses and dosing schedules for clinical development that would provide the best balance between clinical efficacy and safety. The PPK model was created by applying pharmacokinetic data from a phase 1 study of 97 patients with a diagnosis of schizophrenia or schizoaffective disorder who received either single or repeated doses of TV‐46000. The PPK model was used to characterize the complex release profile of the total active moiety (TAM; the sum of the risperidone and 9‐OH risperidone concentrations) concentration following subcutaneous injections of TV‐46000. The PK profile was best described by a double Weibull function of the in vivo release rate and by a 2‐compartment disposition and elimination model. Simulations were performed to determine TV‐46000 doses and dosing schedules that maintained a median profile of TAM concentrations similar to published TAM exposure following oral risperidone doses that have been correlated to a 40% to 80% dopamine‐D2 receptor occupancy therapeutic window. The simulations showed that therapeutic dose ranges for TV‐46000 are 50 to 125 mg for once‐monthly and 100 to 250 mg for the once every 2 months regimens. This PPK model provided a basis for prediction of patient‐specific exposure and dopamine‐D2 receptor occupancy estimates to support further clinical development and dose selection for the phase 3 studies.
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Affiliation(s)
- Itay Perlstein
- Magic Wand Research LLC, Philadelphia, Pennsylvania, USA
| | | | | | | | - Eran Harary
- Teva Branded Pharmaceutical Products Inc. Research and Development, Netanya, Israel
| | - Ofer Spiegelstein
- Teva Branded Pharmaceutical Products Inc. Research and Development, Netanya, Israel
| | | | - Ryan Tiver
- Teva Branded Pharmaceutical Products Inc., West Chester, Pennsylvania, USA
| | - Pippa Loupe
- Teva Branded Pharmaceutical Products Inc., West Chester, Pennsylvania, USA
| | - Micha Levi
- Formerly Teva Branded Pharmaceutical Products, currently Bill & Melinda Gates Medical Research Institute, Cambridge, MA, USA
| | - Anna Elgart
- Teva Branded Pharmaceutical Products Inc. Research and Development, Netanya, Israel
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15
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Pappaianni E, Borsarini B, Doucet GE, Hochman A, Frangou S, Micali N. Initial evidence of abnormal brain plasticity in anorexia nervosa: an ultra-high field study. Sci Rep 2022; 12:2589. [PMID: 35173174 PMCID: PMC8850617 DOI: 10.1038/s41598-022-06113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/05/2022] [Indexed: 11/09/2022] Open
Abstract
Anorexia Nervosa has been associated with white matter abnormalities implicating subcortical abnormal myelination. Extending these findings to intracortical myelin has been challenging but ultra-high field neuroimaging offers new methodological opportunities. To test the integrity of intracortical myelin in AN we used 7 T neuroimaging to acquire T1-weighted images optimized for intracortical myelin from seven females with AN (age range: 18-33) and 11 healthy females (age range: 23-32). Intracortical T1 values (inverse index of myelin concentration) were extracted from 148 cortical regions at ten depth-levels across the cortical ribbon. Across all cortical regions, these levels were averaged to generate estimates of total intracortical myelin concentration and were clustered using principal component analyses into two clusters; the outer cluster comprised T1 values across depth-levels ranging from the CSF boundary to the middle of the cortical regions and the inner cluster comprised T1 values across depth-levels ranging from the middle of the cortical regions to the gray/white matter boundary. Individuals with AN exhibited higher T1 values (i.e., decreased intracortical myelin concentration) in all three metrics. It remains to be established if these abnormalities result from undernutrition or specific lipid nutritional imbalances, or are trait markers; and whether they may contribute to neurobiological deficits seen in AN.
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Affiliation(s)
- Edoardo Pappaianni
- Department of Psychiatry, Faculty of Medicine, University of Geneva, 2 Rue Verte, 1205, Geneva, Switzerland
| | - Bianca Borsarini
- Department of Psychiatry, Faculty of Medicine, University of Geneva, 2 Rue Verte, 1205, Geneva, Switzerland
| | | | - Ayelet Hochman
- Department of Psychology, St. John's University, Queens, NY, USA
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, 2 Rue Verte, 1205, Geneva, Switzerland. .,Great Ormond Street Institute of Child Health, University College London, London, UK. .,Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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16
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Wei W, Yin Y, Zhang Y, Li X, Li M, Guo W, Wang Q, Deng W, Ma X, Zhao L, Palaniyappan L, Li T. Structural Covariance of Depth-Dependent Intracortical Myelination in the Human Brain and Its Application to Drug-Naïve Schizophrenia: A T1w/T2w MRI Study. Cereb Cortex 2021; 32:2373-2384. [PMID: 34581399 DOI: 10.1093/cercor/bhab337] [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: 06/02/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 02/05/2023] Open
Abstract
Aberrations in intracortical myelination are increasingly being considered as a cardinal feature in the pathophysiology of schizophrenia. We investigated the network-level distribution of intracortical myelination across various cortex depths. We enrolled 126 healthy subjects and 106 first-episode drug-naïve schizophrenia patients. We used T1w/T2w ratio as a proxy of intracortical myelination, parcellated cortex into several equivolumetric surfaces based on cortical depths and mapped T1w/T2w ratios to each surface. Non-negative matrix factorization was used to generate depth-dependent structural covariance networks (dSCNs) of intracortical myelination from 2 healthy controls datasets-one from our study and another from 100-unrelated dataset of the Human Connectome Project. For patient versus control comparisons, partial least squares approach was used; we also related myelination to clinical features of schizophrenia. We found that dSCNs were highly reproducible in 2 independent samples. Network-level myelination was reduced in prefrontal and cingulate cortex and increased in perisylvian cortex in schizophrenia. The abnormal network-level myelination had a canonical correlation with symptom burden in schizophrenia. Moreover, myelination of prefrontal cortex correlated with duration of untreated psychosis. In conclusion, we offer a feasible and sensitive framework to study depth-dependent myelination and its relationship with clinical features.
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Affiliation(s)
- Wei Wei
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, China
| | - Yubing Yin
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, China
| | - Yamin Zhang
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, China
| | - Xiaojing Li
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, China
| | - Mingli Li
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, China
| | - Wanjun Guo
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, China
| | - Qiang Wang
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, China
| | - Wei Deng
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, China
| | - Xiaohong Ma
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, China
| | - Liansheng Zhao
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, China
| | - Lena Palaniyappan
- Department of Psychiatry, University of Western Ontario, London, Ontario N6A 3K7, Canada.,Robarts Research Institute, University of Western Ontario, London, Ontario N6A 3K7, Canada.,Lawson Health Research Institute, London, Ontario N6C 2R5, Canada
| | - Tao Li
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, China.,Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310013, China
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17
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Jiang Y, Wang Y, Huang H, He H, Tang Y, Su W, Xu L, Wei Y, Zhang T, Hu H, Wang J, Yao D, Wang J, Luo C. Antipsychotics Effects on Network-Level Reconfiguration of Cortical Morphometry in First-Episode Schizophrenia. Schizophr Bull 2021; 48:231-240. [PMID: 34313782 PMCID: PMC8781340 DOI: 10.1093/schbul/sbab082] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Cortical thickness reductions are evident in schizophrenia (SZ). Associations between antipsychotic medications (APMs) and cortical morphometry have been explored in SZ patients. This raises the question of whether the reconfiguration of morphological architecture by APM plays potential compensatory roles for abnormalities in the cerebral cortex. Structural magnetic resonance imaging was obtained from 127 medication-naive first-episode SZ patients and 133 matched healthy controls. Patients received 12 weeks of APM and were categorized as responders (n = 75) or nonresponders (NRs, n = 52) at follow-up. Using surface-based morphometry and structural covariance (SC) analysis, this study investigated the short-term effects of antipsychotics on cortical thickness and cortico-cortical covariance. Global efficiency was computed to characterize network integration of the large-scale structural connectome. The relationship between covariance and cortical thinning was examined by SC analysis among the top-n regions with thickness reduction. Widespread cortical thickness reductions were observed in pre-APM patients. Post-APM patients showed more reductions in cortical thickness, even in the frontotemporal regions without baseline reductions. Covariance analysis revealed strong cortico-cortical covariance and higher network integration in responders than in NRs. For the NRs, some of the prefrontal and temporal nodes were not covariant between the top-n regions with cortical thickness reduction. Antipsychotic effects are not restricted to a single brain region but rather exhibit a network-level covariance pattern. Neuroimaging connectomics highlights the positive effects of antipsychotics on the reconfiguration of brain architecture, suggesting that abnormalities in regional morphology may be compensated by increasing interregional covariance when symptoms are controlled by antipsychotics.
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Affiliation(s)
- Yuchao Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yingchan Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Huan Huang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Hui He
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Wenjun Su
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Lihua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yanyan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Hao Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jinhong Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,Research Unit of NeuroInformation (2019RU035), Chinese Academy of Medical Sciences, Chengdu, PR China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, PR China,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, PR China,High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, PR China,Research Unit of NeuroInformation (2019RU035), Chinese Academy of Medical Sciences, Chengdu, PR China,To whom correspondence should be addressed; University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu 610054, PR China; tel: 86-28-83201018, fax: 86-28-83208238, e-mail:
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18
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Sui YV, Bertisch H, Lee HH, Storey P, Babb JS, Goff DC, Samsonov A, Lazar M. Quantitative Macromolecular Proton Fraction Mapping Reveals Altered Cortical Myelin Profile in Schizophrenia Spectrum Disorders. Cereb Cortex Commun 2021; 2:tgab015. [PMID: 34296161 PMCID: PMC8271044 DOI: 10.1093/texcom/tgab015] [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: 12/08/2020] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 01/12/2023] Open
Abstract
Myelin abnormalities have been reported in schizophrenia spectrum disorders (SSD) in white matter. However, in vivo examinations of cortical myeloarchitecture in SSD, especially those using quantitative measures, are limited. Here, we employed macromolecular proton fraction (MPF) obtained from quantitative magnetization transfer imaging to characterize intracortical myelin organization in 30 SSD patients versus 34 healthy control (HC) participants. We constructed cortical myelin profiles by extracting MPF values at various cortical depths and quantified their shape using a nonlinearity index (NLI). To delineate the association of illness duration with myelin changes, SSD patients were further divided into 3 duration groups. Between-group comparisons revealed reduced NLI in the SSD group with the longest illness duration (>5.5 years) compared with HC predominantly in bilateral prefrontal areas. Within the SSD group, cortical NLI decreased with disease duration and was positively associated with a measure of spatial working memory capacity as well as with cortical thickness (CT). Layer-specific analyses suggested that NLI decreases in the long-duration SSD group may arise in part from significantly increased MPF values in the midcortical layers. The current study reveals cortical myelin profile changes in SSD with illness progression, which may reflect an abnormal compensatory mechanism of the disorder.
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Affiliation(s)
- Yu Veronica Sui
- Department of Radiology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Hilary Bertisch
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Hong-Hsi Lee
- Department of Radiology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Pippa Storey
- Department of Radiology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - James S Babb
- Department of Radiology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Donald C Goff
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Alexey Samsonov
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Mariana Lazar
- Department of Radiology, NYU Grossman School of Medicine, New York, NY 10016, USA
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19
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Rubio JM, Taipale H, Tanskanen A, Correll CU, Kane JM, Tiihonen J. Long-term Continuity of Antipsychotic Treatment for Schizophrenia: A Nationwide Study. Schizophr Bull 2021; 47:1611-1620. [PMID: 34129663 PMCID: PMC8530382 DOI: 10.1093/schbul/sbab063] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Schizophrenia often requires long-term treatment with antipsychotic medication. This study aims to measure the continuity of antipsychotic treatment over the course of illness in schizophrenia, as well as factors involved in the interruption of treatment. For this, we followed up a national cohort of first-episode psychosis patients in Finland for up to 18 years. Stratified Cox proportional hazards regressions were conducted for "within-participant" risk of discontinuation of subsequent treatments compared to the first, and by specific antipsychotic compared to oral olanzapine, the most prescribed antipsychotic in this cohort. Adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated. Among 3343 participants followed up for a mean of 8 years (SD = 4.93), the median number of continuous treatment episodes was 6 (interquartile range [IQR] = 3-11) with a median duration of 11.4 months (IQR = 5.3-25.6). In the first year after diagnosis, the incidence rate of treatment discontinuation was 30.12 (95% CI = 29.89-30.35) events per 100 participant-years, decreasing to 8.90 (95% CI = 8.75-9.05) in the 10th year. The risk of discontinuation progressively decreased over successive treatment episodes (aHR = 0.30; 95% CI = 0.20-0.46 for episodes after the 15th compared to the first). Individuals were 67% less likely to interrupt treatment with long-acting injectable than oral antipsychotics (aHR = 0.33; 95% CI = 0.27-0.41). Treatment for schizophrenia over the long term is often characterized by recurrent cycles of interruptions and reintroductions of antipsychotic medication, which is typically not recommended by management guidelines. Greater utilization of long-acting injectable formulations earlier in the course of illness may facilitate the continuity of antipsychotic treatment in schizophrenia.
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Affiliation(s)
- Jose M Rubio
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Institute of Behavioral Science, The Feinstein Institute for Medical Research, Manhasset, NY, USA,To whom correspondence should be addressed; Research Division—Ambulatory Care Pavilion (PRA-17), Zucker Hillside Hospital, Glen Oaks, NY 11004 , USA; tel: 718-470-5912, fax: 718-343-1659, e-mail:
| | - Heidi Taipale
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,School of Pharmacy, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Institute of Behavioral Science, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Department of Child and Adolescent Psychiatry, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA,Institute of Behavioral Science, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
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20
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Wong MMC, Chung AKK, Yeung TMH, Wong DTW, Lee CK, Lai E, Chan GFY, Mak GKL, Wong JOY, Ng RMK, Mak KY. Guidance on the clinical understanding and use of long-acting injectable antipsychotics in Schizophrenia: Hong Kong Consensus Statements. CNS Neurosci Ther 2021; 27 Suppl 1:5-11. [PMID: 33555614 PMCID: PMC7869935 DOI: 10.1111/cns.13374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
AIMS There is increasing evidence showing the importance of long-acting injectable antipsychotics in the management of schizophrenia, especially in terms of improving patient medication compliance. A panel of experienced clinicians in Hong Kong mapped out a set of consensus statements with an aim to facilitate the understanding and use of long-acting injectable antipsychotics among local physicians. METHODS Eight discussion areas regarding long-acting injectable antipsychotics were selected by the chairman of the consensus group. A series of meetings were held for the panelists to discuss the published literature and their clinical experience, followed by the drafting of consensus statements. At the final meeting, each consensus statement was voted on anonymously by all members based on its practicability of recommendation in Hong Kong. RESULTS A total of 12 consensus statements on the rational use of long-acting injectable antipsychotics were established and accepted by the consensus group. CONCLUSION The consensus statements aim to provide practical guidance for Hong Kong physicians on the use of long-acting injectable antipsychotics in schizophrenia patients. These statements may also serve as a reference for doctors in other parts of the Asia-Pacific region.
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Affiliation(s)
| | | | | | | | - Che Kin Lee
- Department of PsychiatryKowloon HospitalKowloonHong Kong
| | - Eric Lai
- Department of Child and Adolescent PsychiatryCastle Peak HospitalTuen MunNew TerritoriesHong Kong
| | | | | | | | | | - Ki Yan Mak
- Private PracticeHong Kong CityHong Kong
- The Mental Health Association of Hong KongPrivate PracticeHong Kong
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21
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Edinoff AN, Doppalapudi PK, Orellana C, Ochoa C, Patti S, Ghaffar Y, Cornett EM, Kaye AJ, Viswanath O, Urits I, Kaye AM, Kaye AD. Paliperidone 3-Month Injection for Treatment of Schizophrenia: A Narrative Review. Front Psychiatry 2021; 12:699748. [PMID: 34621193 PMCID: PMC8490677 DOI: 10.3389/fpsyt.2021.699748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Given the typical age onset of schizophrenia, there are tremendous economic and social impacts that extend beyond the person and their families. One critical determinant of the diseases' impact is the patient's adherence to antipsychotic drug treatment. Approved in 2015 for the treatment of schizophrenia, paliperidone palmitate (Invega Trinza, a 3-month injection, noted as PP3M) is a second-generation long-acting injectable antipsychotic medication. Among the different formulations offered for palmitate paliperidone, including the 1 and 3-month formulations, the longer duration 3-month formulation was better at preventing relapse in schizophrenic patients. To date, different formulations of palmitate paliperidone that have been studied on relapse episodes of schizophrenia include once-daily extended-release oral paliperidone (ORAL paliperidone), once-monthly paliperidone palmitate (PP1M), and once-every-3-months paliperidone palmitate (PP3M). Post-hoc analyses show that patients who were withdrawn from PP1M paliperidone had the least risk of relapse, followed by patients withdrawn from PP3M and patients withdrawn from ORAL paliperidone. PP3M was better at preventing relapse compared to ORAL paliperidone. The results demonstrated that 50% of patients who were withdrawn from ORAL paliperidone, PP1M, or PP3M remained relapse-free for ~2, 6, and 13 months, respectively. Compared to PP1M, PP3M is just as safe and effective and has the added advantage of increased adherence related to a longer dose interval, decreasing the risk of relapse.
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Affiliation(s)
- Amber N Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - Prithvi K Doppalapudi
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - Claudia Orellana
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA, United States
| | - Caroline Ochoa
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA, United States
| | - Shelby Patti
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA, United States
| | - Yahya Ghaffar
- School of Medicine, Louisiana State University Shreveport, Shreveport, LA, United States
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, United States
| | - Aaron J Kaye
- Department of Anesthesiology, Medical University of South Carolina, Charleston, SC, United States
| | - Omar Viswanath
- College of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, United States.,Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ, United States
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, United States.,Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA, United States
| | - Adam M Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, Department of Pharmacy Practice, University of the Pacific, Stockton, CA, United States
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, United States
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22
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Brown B, Turkoz I, Mancevski B, Mathews M. Evaluation of paliperidone palmitate long-acting injectable antipsychotic therapy as an early treatment option in patients with schizophrenia. Early Interv Psychiatry 2020; 14:428-438. [PMID: 31515972 PMCID: PMC7384107 DOI: 10.1111/eip.12868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 02/19/2019] [Accepted: 08/06/2019] [Indexed: 01/08/2023]
Abstract
AIM This exploratory post hoc analysis of a randomized, double-blind (DB), multicentre, non-inferiority study (NCT01515423) evaluated the effects of the long-acting injectable antipsychotic therapies once-monthly paliperidone palmitate (PP1M) and once-every-3-months paliperidone palmitate (PP3M) on symptom severity and functional remission in patients with schizophrenia with differing durations of illness (≤5, 6-10 and >10 years). METHODS Endpoints included Personal and Social Performance (PSP) scale and Positive and Negative Syndrome Scale (PANSS) total scores during the DB phase (DB baseline and DB endpoint) and the proportion of patients meeting PSP or PANSS remission criteria at any time during the open-label (OL) or DB phases that were maintained for ≥3, ≥6, ≥9 or ≥12 months. RESULTS In both the OL and DB phases, significant improvements in PSP scale and PANSS scores were observed from baseline in all duration-of-illness groups, with significantly greater improvements observed in the ≤5-year and 6-10-year groups compared with the >10-year group. The proportion of patients who maintained PSP or PANSS remission criteria for ≥3, ≥6, ≥9 and ≥12 months was higher in the ≤5-year and 6-10-year groups than in the >10-year group. Safety profiles were similar across duration-of-illness groups in the DB phase. CONCLUSIONS Symptomatic and functional improvements were observed with PP1M/PP3M in patients with differing durations of schizophrenia, but the magnitude of the effects was greater in those with early illness vs chronic illness. These findings advocate implementation of PP1M and PP3M in all stages of schizophrenia, including early illness.
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Affiliation(s)
- Brianne Brown
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Ibrahim Turkoz
- Janssen Research and Development, LLC, Titusville, New Jersey
| | | | - Maju Mathews
- Janssen Research and Development, LLC, Titusville, New Jersey
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23
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Chwa WJ, Tishler TA, Raymond C, Tran C, Anwar F, Villablanca JP, Ventura J, Subotnik KL, Nuechterlein KH, Ellingson BM. Association between cortical volume and gray-white matter contrast with second generation antipsychotic medication exposure in first episode male schizophrenia patients. Schizophr Res 2020; 222:397-410. [PMID: 32487466 PMCID: PMC7572538 DOI: 10.1016/j.schres.2020.03.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/06/2020] [Accepted: 03/31/2020] [Indexed: 01/19/2023]
Abstract
This cross-sectional study examines the differences in cortical volume and gray-to-white matter contrast (GWC) in first episode schizophrenia patients (SCZ) compared to healthy control participants (HC) and in SCZ patients as a function of exposure to second generation antipsychotic medication. We hypothesize 1) SCZ exhibit regionally lower cortical volumes relative to HCs, 2) cortical volume will be greater with longer exposure to second generation antipsychotics prior to the MRI scan, and 3) lower GWC with longer exposure to second generation antipsychotics prior to the MRI scan, suggesting more blurring from greater intracortical myelin. To accomplish this, MRI scans from 71 male SCZ patients treated with second generation oral risperidone and 42 male HCs were examined. 3D T1-weighted MPRAGE images collected at 1.5T were used to estimate cortical volume and GWC by sampling signal intensity at 30% within the cortical ribbon. Average cortical volume and GWC were calculated and compared between SCZ and HC. Cortical volume and GWC in SCZ patients were correlated with duration of medication exposure for the time period prior to the scan. First-episode SCZ patients had significantly lower cortical volume compared to HCs in bilateral temporal, superior and rostral frontal, postcentral gyral, and parahippocampal regions. In SCZ patients, greater cortical volume was associated with (log-transformed) duration of second-generation antipsychotic medication exposure in bilateral precuneus, right lingual, and right superior parietal regions. Lower GWC was correlated with longer duration of medication exposure bilaterally in the superior frontal lobes. In summary, second generation antipsychotics may increase cortical volume and decrease GWC in first episode SCZ patients.
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Affiliation(s)
- Won Jong Chwa
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Todd A. Tishler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Catalina Raymond
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Cathy Tran
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Faizan Anwar
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - J. Pablo Villablanca
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Benjamin M. Ellingson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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24
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Lieberman JA, Small SA, Girgis RR. Early Detection and Preventive Intervention in Schizophrenia: From Fantasy to Reality. Am J Psychiatry 2019; 176:794-810. [PMID: 31569988 DOI: 10.1176/appi.ajp.2019.19080865] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Scientific progress in understanding human disease can be measured by the effectiveness of its treatment. Antipsychotic drugs have been proven to alleviate acute psychotic symptoms and prevent their recurrence in schizophrenia, but the outcomes of most patients historically have been suboptimal. However, a series of findings in studies of first-episode schizophrenia patients transformed the psychiatric field's thinking about the pathophysiology, course, and potential for disease-modifying effects of treatment. These include the relationship between the duration of untreated psychotic symptoms and outcome; the superior responses of first-episode patients to antipsychotics compared with patients with chronic illness, and the reduction in brain gray matter volume over the course of the illness. Studies of the effectiveness of early detection and intervention models of care have provided encouraging but inconclusive results in limiting the morbidity and modifying the course of illness. Nevertheless, first-episode psychosis studies have established an evidentiary basis for considering a team-based, coordinated specialty approach as the standard of care for treating early psychosis, which has led to their global proliferation. In contrast, while clinical high-risk research has developed an evidence-based care model for decreasing the burden of attenuated symptoms, no treatment has been shown to reduce risk or prevent the transition to syndromal psychosis. Moreover, the current diagnostic criteria for clinical high risk lack adequate specificity for clinical application. What limits our ability to realize the potential of early detection and intervention models of care are the lack of sensitive and specific diagnostic criteria for pre-syndromal schizophrenia, validated biomarkers, and proven therapeutic strategies. Future research requires methodologically rigorous studies in large patient samples, across multiple sites, that ideally are guided by scientifically credible pathophysiological theories for which there is compelling evidence. These caveats notwithstanding, we can reasonably expect future studies to build on the research of the past four decades to advance our knowledge and enable this game-changing model of care to become a reality.
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Affiliation(s)
- Jeffrey A Lieberman
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Scott A Small
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
| | - Ragy R Girgis
- Department of Psychiatry (Lieberman, Small, Girgis) and Department of Neurology (Small), College of Physicians and Surgeons, Columbia University, New York; New York State Psychiatric Institute, New York (Lieberman, Small, Girgis)
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25
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Reduced oligodendrocyte density in layer 5 of the prefrontal cortex in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2019; 269:379-386. [PMID: 29572659 DOI: 10.1007/s00406-018-0888-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/16/2018] [Indexed: 12/11/2022]
Abstract
Neuroimaging and post-mortem studies have implicated altered myelin integrity and oligodendrocyte abnormalities in the dysfunction of neuronal network in schizophrenia, including the prefrontal cortex, Brodmann area (BA) 10. Pyramidal neurons in layer 5 of BA10 are the important link of reciprocal frontal cortical-basal ganglia-thalamic circuits altered in schizophrenia. Previously, we found ultrastructural dystrophic and degenerative alterations of oligodendrocytes in layer 5 of BA10 in schizophrenia. The aim of the study was to estimate the numerical density (Nv) of oligodendrocytes in layer 5 of BA10 in schizophrenia as compared to normal controls. 17 chronic schizophrenia subjects and 22 healthy matched controls were studied in Nissl-stained sections using optical disector method. Group differences were analyzed using ANCOVA followed by post hoc Duncan's test. The Nv of oligodendrocytes was significantly lower (- 32%, p < 0.001) in the schizophrenia group as compared to the control group. Young controls (age < 50 years old) showed significantly higher Nv of oligodendrocytes as compared to elderly controls (age > 50 years old). Young and elderly schizophrenia subgroups did not differ significantly. Both control subgroups have significantly higher Nv of oligodendrocytes as compared to the schizophrenia subgroups. Decreased Nv of oligodendrocytes found in layer 5 of BA10 may be the result of dystrophic and destructive alterations and/or disrupted development of oligodendrocytes in schizophrenia.
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27
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Mamah D, Ji A, Rutlin J, Shimony JS. White matter integrity in schizophrenia and bipolar disorder: Tract- and voxel-based analyses of diffusion data from the Connectom scanner. NEUROIMAGE-CLINICAL 2018; 21:101649. [PMID: 30639179 PMCID: PMC6411967 DOI: 10.1016/j.nicl.2018.101649] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/06/2018] [Accepted: 12/26/2018] [Indexed: 11/22/2022]
Abstract
Background Diffusion imaging abnormalities have been associated with schizophrenia (SZ) and bipolar disorder (BD), indicating impaired structural connectivity. Newer methods permit the automated reconstruction of major white matter tracts from diffusion-weighted MR images in each individual's native space. Using high-definition diffusion data from SZ and BP subjects, we investigated brain white matter integrity using both an automated tract-based and voxel-based methods. Methods Using a protocol matched to the NIH (Young-Adult) Human Connectome Project (and collected on the same customized ‘Connectom’ scanner), diffusion scans were acquired from 87 total participants (aged 18–30), grouped as SZ (n = 24), BD (n = 33) and healthy controls (n = 30). Fractional anisotropy (FA) of eighteen white matter tracks were analyzed using the TRACULA software. Voxel-wise statistical analyses of diffusion data was carried out using the tract-based spatial statistics (TBSS) software. TRACULA group effects and clinical correlations were investigated using analyses of variance and multiple regression. Results TRACULA analysis identified a trend towards lower tract FA in SZ patients, most significantly in the left anterior thalamic radiation (ATR; p = .04). TBSS results showed significantly lower FA voxels bilaterally within the cerebellum and unilaterally within the left ATR, posterior thalamic radiation, corticospinal tract, and superior longitudinal fasciculus in SZ patients compared to controls (FDR corrected p < .05). FA in BD patients did not significantly differ from controls using either TRACULA or TBSS. Multiple regression showed FA of the ATR as predicting chronic mania (p = .0005) and the cingulum-angular bundle as predicting recent mania (p = .02) in patients. TBSS showed chronic mania correlating with FA voxels within the left ATR and corpus callosum. Conclusions White matter abnormality in SZ varies in severity across different white matter tract regions. Our results indicate that voxel-based analysis of diffusion data is more sensitive than tract-based analysis in identifying such abnormalities. Absence of white matter abnormality in BD may be related to medication effects and age. Our study investigated white matter integrity in 87 young schizophrenia, bipolar disorder and control subjects with a tract-based (TRACULA) and a voxel-based (TBSS) approach, using high-definition diffusion imaging data obtained from the Human Connectome Project ‘Connectom’ scanner. TRACULA evaluated fractional anisotropy (FA) from 18 white matter tracts. TBSS evaluated regional white matter FA. TRACULA identified a trend towards lower tract FA in schizophrenia subjects across multiple tracts. TBSS results showed mainly unilaterally decreased FA voxels in schizophrenia subjects. FA in bipolar patients did not significantly differ from controls with either method. With TRACULA, multiple regression showed that anterior thalamic radiation FA predicted chronic affectivity and cingulum-angular bundle FA predicted recent mania in patients. With TBSS, chronic mania correlated with FA voxels within the left anterior thalamic radiation and corpus callosum.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.
| | - Andrew Ji
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Jerrel Rutlin
- Department Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Joshua S Shimony
- Department Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
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28
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Gjerde PB, Jørgensen KN, Steen NE, Melle I, Andreassen OA, Steen VM, Agartz I. Association between olanzapine treatment and brain cortical thickness and gray/white matter contrast is moderated by cholesterol in psychotic disorders. Psychiatry Res Neuroimaging 2018; 282:55-63. [PMID: 30415175 DOI: 10.1016/j.pscychresns.2018.10.001] [Citation(s) in RCA: 6] [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: 05/07/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 01/21/2023]
Abstract
Altered cortical brain morphology is observed in psychotic disorders. Despite the importance of lipid homeostasis for healthy brain functioning, knowledge about its role in cortical alterations in psychosis is limited. In a sample of patients with psychotic disorders, we investigated the relationship between treatment with olanzapine (OLZ), and cortical thickness and gray/white matter intensity contrast, and the association between these measures and serum lipid levels. We included 33 OLZ users, 19 unmedicated psychotic patients and 76 healthy controls (HC). Data on serum lipids and cortical measures based on MR brain images processed with FreeSurfer were analyzed with General Linear Models. We found that intensity contrast was similar in OLZ users as compared to HC and that the cortex (frontal, orbitofrontal, medial temporal) was thinner in OLZ users (p < 0.05, Bonferroni corrected). An OLZ-specific HDL interaction effect was further found for the pericentral cortical thickness measure (p < 0.05, Bonferroni corrected). Additionally, nominally significant findings indicated similar OLZ-specific interaction effects for cortical thickness in several regions, and an OLZ-specific interaction with LDL for occipital lobe contrast (p < 0.05, uncorrected). Our findings may suggest a drug-related lipid-effect on brain myelination. Experimental studies and replications in different study samples are needed to clarify these complex relationships further.
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Affiliation(s)
- Priyanthi B Gjerde
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway.
| | - Kjetil N Jørgensen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Vinderen, 0373 Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Nils E Steen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Vidar M Steen
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway.
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Vinderen, 0373 Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden.
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29
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Cho SJ, Kim MK, Bang SY, Bang M, Lee SH. White matter integrity associated with severity reductions in positive symptoms after amisulpride treatment in drug-free patients with schizophrenia. Neurosci Lett 2018; 685:131-136. [PMID: 30157448 DOI: 10.1016/j.neulet.2018.08.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/19/2018] [Accepted: 08/25/2018] [Indexed: 01/25/2023]
Abstract
Amisulpride is an effective antipsychotic for the treatment of schizophrenia with a lower propensity for extrapyramidal adverse effects than conventional antipsychotics. However, no study has investigated white matter (WM) integrity in patients with schizophrenia in relation to treatment response after amisulpride administration. Here, we investigated the associations of WM integrity with severity reductions in clinical symptoms in drug-free patients with schizophrenia at an early stage of amisulpride treatment. Nineteen patients with schizophrenia (SZ) and 15 healthy controls (HCs) participated in the present study. Diffusion tensor imaging data were acquired from all participants at baseline. All SZ participants began treatment with 200 mg of amisulpride per day. The dose was increased up to 1200 mg/day within 2 weeks depending on the severity of clinical symptoms, and maintained for the subsequent 6 weeks. Initially, and after 8 weeks of amisulpride treatment, SZ participants were assessed for the severity of overall illness, positive and negative symptoms, and motor side effects. SZ participants showed lower integrity in several WM regions, including the corpus callosum and fronto-temporal connections, when compared to HCs. Furthermore, lower WM integrity in fronto-temporo-limbic regions at baseline was found to be associated with severity reductions in positive symptoms after 8 weeks. Our findings suggest that WM integrity at the early stage of treatment may serve as a possible predictive marker for treatment response.
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Affiliation(s)
- Sung Joon Cho
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min-Kyoung Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Seong Yun Bang
- Department of Public Health, Graduate School of Health and Welfare, CHA University, Seongnam, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Clinical Pharmacology and Therapeutics, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
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Gjerde PB, Dieset I, Simonsen C, Hoseth EZ, Iversen T, Lagerberg TV, Lyngstad SH, Mørch RH, Skrede S, Andreassen OA, Melle I, Steen VM. Increase in serum HDL level is associated with less negative symptoms after one year of antipsychotic treatment in first-episode psychosis. Schizophr Res 2018; 197:253-260. [PMID: 29129510 DOI: 10.1016/j.schres.2017.10.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/16/2017] [Accepted: 10/29/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND A potential link between increase in total cholesterol and triglycerides and clinical improvement has been observed during antipsychotic drug treatment in chronic schizophrenia patients, possibly due to drug related effects on lipid biosynthesis. We examined whether changes in serum lipids are associated with alleviation of psychosis symptoms after one year of antipsychotic drug treatment in a cohort of first-episode psychosis (FEP) patients. METHODS A total of 132 non-affective antipsychotic-treated FEP patients were included through the Norwegian Thematically Organized Psychosis (TOP) project. Data on antipsychotic usage, serum lipids (total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides (TG)), body mass index (BMI) and clinical state were obtained at baseline and after 12months. The Positive and Negative Syndrome Scale (PANSS) was used to assess psychotic symptoms. Mixed-effects models were employed to examine the relationship between serum lipids and psychotic symptoms while controlling for potential confounders including BMI. RESULTS An increase in HDL during one year of antipsychotic treatment was associated with reduction in PANSS negative subscores (B=-0.48, p=0.03). This relationship was not affected by concurrent change in BMI (adjusted HDL: B=-0.54, p=0.02). No significant associations were found between serum lipids, BMI and PANSS positive subscores. CONCLUSION We found that an increase in HDL level during antipsychotic treatment is associated with improvement in negative symptoms in FEP. These findings warrant further investigation to clarify the interaction between lipid pathways and psychosis.
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Affiliation(s)
- Priyanthi B Gjerde
- NORMENT, K.G. Jebsen Center for Psychosis Research, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021 Bergen, Norway.
| | - Ingrid Dieset
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, 0424 Oslo, Norway.
| | - Carmen Simonsen
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, 0424 Oslo, Norway.
| | - Eva Z Hoseth
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, 0424 Oslo, Norway; Division of Mental Health and Addiction, Møre and Romsdal Health Trust, Kristiansund, Norway.
| | - Trude Iversen
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, 0424 Oslo, Norway.
| | - Trine V Lagerberg
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, 0424 Oslo, Norway.
| | - Siv Hege Lyngstad
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, 0424 Oslo, Norway.
| | - Ragni H Mørch
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, 0424 Oslo, Norway.
| | - Silje Skrede
- NORMENT, K.G. Jebsen Center for Psychosis Research, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021 Bergen, Norway.
| | - Ole A Andreassen
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, 0424 Oslo, Norway; Department of Clinical Medicine, University of Oslo, 0424 Oslo, Norway.
| | - Ingrid Melle
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, 0424 Oslo, Norway.
| | - Vidar M Steen
- NORMENT, K.G. Jebsen Center for Psychosis Research, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, 5021 Bergen, Norway.
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Nasrallah HA. Triple advantages of injectable long acting second generation antipsychotics: Relapse prevention, neuroprotection, and lower mortality. Schizophr Res 2018; 197:69-70. [PMID: 29506767 DOI: 10.1016/j.schres.2018.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Henry A Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA.
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Sajatovic M, Ross R, Legacy SN, Correll CU, Kane JM, DiBiasi F, Fitzgerald H, Byerly M. Identifying patients and clinical scenarios for use of long-acting injectable antipsychotics - expert consensus survey part 1. Neuropsychiatr Dis Treat 2018; 14:1463-1474. [PMID: 29922062 PMCID: PMC5997124 DOI: 10.2147/ndt.s167394] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess expert consensus on barriers and facilitators for long-acting injectable antipsychotic (LAI) use and provide clinical recommendations on issues where clinical evidence is lacking, including identifying appropriate clinical situations for LAI use. METHODS A 50-question survey comprising 916 response options was distributed to 42 research experts and high prescribers with extensive LAI experience. Respondents rated options on relative appropriateness/importance using a 9-point scale. Consensus was determined using chi-square test of score distributions. Mean (standard deviation) ratings were calculated. Responses to 29 questions (577 options) relating to appropriate patients and clinical scenarios for LAI use are reported. RESULTS Recommendations aligned with research on risk factors for nonadherence and poor outcomes for patients with schizophrenia/schizoaffective or bipolar disorder. Findings suggested, contrary to general practice patterns, that LAI use may be appropriate earlier in the disease course and in younger patients. Results for bipolar disorder were similar to those for schizophrenia but with less consensus. Numerous facilitators of LAI prescribing were considered important, particularly that LAIs may reduce relapses and improve outcomes. CONCLUSION Findings support wider use of LAIs in patients with schizophrenia/schizoaffective and bipolar disorders beyond the setting of poor adherence and earlier use in the disease course.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Departments of Psychiatry and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ruth Ross
- Ross Editorial, Port Townsend, WA, USA
| | - Susan N Legacy
- US Medical Affairs Neuroscience, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Christoph U Correll
- Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY, USA
| | - John M Kane
- Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, NY, USA
| | - Faith DiBiasi
- Scientific Communications, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA
| | | | - Matthew Byerly
- Cell Biology and Neuroscience, Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, USA
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Girardi P, Del Casale A, Rapinesi C, Kotzalidis GD, Splendori F, Verzura C, Trovini G, Sorice S, Carrus D, Mancinelli I, Comparelli A, De Filippis S, Francomano A, Ballerini A, Marcellusi A, Mennini FS, Ducci G, Sani G, Pompili M, Brugnoli R. Predictive factors of overall functioning improvement in patients with chronic schizophrenia and schizoaffective disorder treated with paliperidone palmitate and aripiprazole monohydrate. Hum Psychopharmacol 2018; 33:e2658. [PMID: 29766576 DOI: 10.1002/hup.2658] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/22/2018] [Accepted: 04/09/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Long-acting injectable (LAI) antipsychotics can improve medication adherence and reduce hospitalisation rates compared with oral treatments. Paliperidone palmitate (PAL) and aripiprazole monohydrate (ARI) LAI treatments were associated with improvements in global functioning in patients with schizophrenia. OBJECTIVE The objective of this study was to assess the predictive factors of better overall functioning in patients with chronic schizophrenia and schizoaffective disorder treated with PAL and ARI. METHOD Enrolled were 143 (97 males, 46 females, mean age 38.24 years, SD = 12.65) patients with a diagnosis of schizophrenia or schizoaffective disorder, whom we allocated in two groups (PAL and ARI treatments). We assessed global functioning, amount of oral medications, adherence to oral treatment, and number of hospitalisations before LAI introduction and at assessment time point. RESULTS Longer treatment time with LAIs (p < .001), lower number of oral drugs (p < .001), and hospitalisations (p = .002) before LAI introduction, and shorter duration of illness (p = .038) predicted better Global Assessment of Functioning scores in the whole sample (R2 = 0.337). CONCLUSION Early administration and longer duration of ARI or PAL treatments could play a significant role in improving global functioning of patients with schizophrenia and schizoaffective disorder. Better improvement in functioning could be achieved with ARI in young individuals with recent illness onset and PAL in patients at risk for recurrent hospitalisations.
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Affiliation(s)
- Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Antonio Del Casale
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Chiara Rapinesi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Francesca Splendori
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Claudio Verzura
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Giada Trovini
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Serena Sorice
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Dario Carrus
- Mental Health Department, Azienda Sanitaria Locale Viterbo, Viterbo, Italy
| | - Iginia Mancinelli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Anna Comparelli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | | | - Antonio Francomano
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Andrea Ballerini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Section of Neuroscience, University of Florence, Florence, Italy
| | - Andrea Marcellusi
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), Tor Vergata University, Rome, Italy
| | - Francesco S Mennini
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), Tor Vergata University, Rome, Italy
| | - Giuseppe Ducci
- Mental Health Department, Azienda Sanitaria Locale Roma 1, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Roberto Brugnoli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
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Vostrikov VM, Uranova NA. Deficit of oligodendrocytes in the frontal cortex in schizophrenia. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:100-103. [DOI: 10.17116/jnevro201811851100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Long-Acting Injectable Second-Generation Antipsychotics Improve Negative Symptoms and Suicidal Ideation in Recent Diagnosed Schizophrenia Patients: A 1-Year Follow-up Pilot Study. SCHIZOPHRENIA RESEARCH AND TREATMENT 2018; 2018:4834135. [PMID: 30245878 PMCID: PMC6136552 DOI: 10.1155/2018/4834135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/31/2018] [Accepted: 08/14/2018] [Indexed: 12/18/2022]
Abstract
Long-acting injectable second-generation antipsychotics (LAI-SGA) are typically used to maintain treatment adherence in patients with chronic schizophrenia. Recent research suggests that they may also provide an effective treatment strategy for patients with early-phase disease. The aim of this study is to evaluate clinical and psychosocial outcomes among recent and long-term diagnosed schizophrenia outpatients treated with LAI-SGA during a follow-up period of 12 months. Stable schizophrenia patients receiving LAI-SGA with 5 or less years of illness duration (n = 10) were compared to those with more than 5 years of illness duration (n = 15). Clinical data was assessed through the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), the Columbia Suicide Severity Rating Scale (C-SSRS), the Recovery Style Questionnaire (RSQ), and the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) Managing Emotion branch. Recently diagnosed patients showed greater improvement versus patients diagnosed for more than 5 years in adjusted mean GAF score, in PANSS factor score for negative and depressive symptoms, and in severity and intensity of suicidal ideation. Our preliminary findings support the hypothesis that LAI-SGA may influence the course of the illness if administered at the early phase of the illness. However, replicate studies are needed, possibly with larger samples.
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Brown B, Alphs L, Turkoz I, Yue Y. Baseline Demographics and Characteristics From a Paliperidone Palmitate Study in Subjects with Recent-Onset Schizophrenia or Schizophreniform Disorder. PSYCHOPHARMACOLOGY BULLETIN 2017; 47:8-16. [PMID: 28839335 PMCID: PMC5546555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Brianne Brown
- Drs. Brown, Alphs, Yue, Janssen Scientific Affairs, LLC, Titusville, NJ; Dr. Turkoz, Janssen Research & Development, LLC, Titusville, NJ
| | - Larry Alphs
- Drs. Brown, Alphs, Yue, Janssen Scientific Affairs, LLC, Titusville, NJ; Dr. Turkoz, Janssen Research & Development, LLC, Titusville, NJ
| | - Ibrahim Turkoz
- Drs. Brown, Alphs, Yue, Janssen Scientific Affairs, LLC, Titusville, NJ; Dr. Turkoz, Janssen Research & Development, LLC, Titusville, NJ
| | - Yong Yue
- Drs. Brown, Alphs, Yue, Janssen Scientific Affairs, LLC, Titusville, NJ; Dr. Turkoz, Janssen Research & Development, LLC, Titusville, NJ
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Sreeraj VS, Shivakumar V, Rao NP, Venkatasubramanian G. A critical appraisal of long acting injectable antipsychotics: Translating research to clinics. Asian J Psychiatr 2017; 28:57-64. [PMID: 28784398 DOI: 10.1016/j.ajp.2017.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 12/27/2022]
Abstract
Long acting injections (LAI) are an effective alternative mode of administration of antipsychotics, less commonly used in clinical practice. Gap in knowledge base is an important source of attitudinal bias. Current article is focused on reviewing the literature for the principles underlying the choice, initiation, maintenance, switch and termination of an LAI; historical, pharmacological and clinical factors implicating the rationale of using LAI against oral agents and older against newer LAIs. Evidences available in clinical and basic psychopharmacological researches are critically appraised, highlighting the lacunae in our understanding. It is endeavored to open the window for the studies to be carried forward in the future answering critical questions which could lay a stronger base for clinical utility of different LAIs. Thus, this article tries to acquaint clinicians with the translatable knowledge imparted from the research and riposte queries for the researchers to explore in relation to LAI.
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Affiliation(s)
- Vanteemar S Sreeraj
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Venkataram Shivakumar
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Naren P Rao
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ganesan Venkatasubramanian
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Lake EMR, Steffler EA, Rowley CD, Sehmbi M, Minuzzi L, Frey BN, Bock NA. Altered intracortical myelin staining in the dorsolateral prefrontal cortex in severe mental illness. Eur Arch Psychiatry Clin Neurosci 2017; 267:369-376. [PMID: 27629158 DOI: 10.1007/s00406-016-0730-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/02/2016] [Indexed: 11/26/2022]
Abstract
Imaging and postmortem studies into the severe mental illnesses of major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SZ) have revealed deficiencies in the myelination of deep white matter tracts of the brain. Recent studies have further suggested that deficits could extend to myelinated fibers running through the cortex in those illnesses. Disruptions in this intracortical myelin may underlie functional symptomology in MDD, BD, and SZ; thus, in this study, we hypothesized that individuals with these illnesses may have reduced myelin staining relative to controls in the cerebral cortex. We stained 60 sections of dorsolateral prefrontal cortex for myelin with Luxol® fast blue in four groups: 15 BD, 15 MDD, 15 SZ, and 15 controls with no psychiatric illness. We digitally measured optical tissue attenuation reflecting the amount of myelin staining across six cortical depths in the middle frontal gyrus (MFG), in superficial white matter in the crown of the MFG, and in deep white matter. We found that a diagnosis of MDD or SZ meant that optical tissue attenuation was significantly reduced in the shallowest depths of the cortex. Furthermore, there was a trend toward reduced optical tissue attenuation in all illnesses across all myelinated regions we studied. These results encourage future studies into potential reductions in intracortical myelin in severe mental illness.
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Affiliation(s)
- Evelyn M R Lake
- Imaging Research, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Eric A Steffler
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Psychology Complex, Room 304, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Christopher D Rowley
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Psychology Complex, Room 304, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Manpreet Sehmbi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Nicholas A Bock
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Psychology Complex, Room 304, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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Steen VM, Skrede S, Polushina T, López M, Andreassen OA, Fernø J, Hellard SL. Genetic evidence for a role of the SREBP transcription system and lipid biosynthesis in schizophrenia and antipsychotic treatment. Eur Neuropsychopharmacol 2017; 27:589-598. [PMID: 27492885 DOI: 10.1016/j.euroneuro.2016.07.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 12/21/2022]
Abstract
Schizophrenia is a serious psychotic disorder, with disabling symptoms and markedly reduced life expectancy. The onset is usually in late adolescence or early adulthood, which in time overlaps with the maturation of the brain including the myelination process. Interestingly, there seems to be a link between myelin abnormalities and schizophrenia. The oligodendrocyte-derived myelin membranes in the CNS are highly enriched for lipids (cholesterol, phospholipids and glycosphingolipids), thereby pointing at lipid homeostasis as a relevant target for studying the genetics and pathophysiology of schizophrenia. The biosynthesis of fatty acids and cholesterol is regulated by the sterol regulatory element binding protein (SREBP) transcription factors SREBP1 and SREBP2, which are encoded by the SREBF1 and SREBF2 genes on chromosome 17p11.2 and 22q13.2, respectively. Here we review the evidence for the involvement of SREBF1 and SREBF2 as genetic risk factors in schizophrenia and discuss the role of myelination and SREBP-mediated lipid biosynthesis in the etiology, pathophysiology and drug treatment of schizophrenia.
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Affiliation(s)
- Vidar M Steen
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Silje Skrede
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Tatiana Polushina
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Miguel López
- Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela 15782, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Santiago de Compostela 15706, Spain
| | - Ole A Andreassen
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Johan Fernø
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Stephanie Le Hellard
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
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Rowley CD, Sehmbi M, Bazin PL, Tardif CL, Minuzzi L, Frey BN, Bock NA. Age-related mapping of intracortical myelin from late adolescence to middle adulthood using T 1 -weighted MRI. Hum Brain Mapp 2017; 38:3691-3703. [PMID: 28462512 DOI: 10.1002/hbm.23624] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 12/11/2022] Open
Abstract
Magnetic resonance imaging (MRI) studies in humans have reported that the T1 -weighted signal in the cerebral cortex follows an inverted "U" trajectory over the lifespan. Here, we investigated the T1 -weighted signal trajectory from late adolescence to middle adulthood in humans to characterize the age range when mental illnesses tend to present, and efficacy of treatments are evaluated. We compared linear to quadratic predictors of age on signal in 67 healthy individuals, 17-45 years old. We investigated ¼, ½, and ¾ depths in the cortex representing intracortical myelin (ICM), in the superficial white matter (SWM), and in a reference deep white matter tract. We found that the quadratic fit was superior in all regions of the cortex, while signal in the SWM and deep white matter showed no global dependence on age over this range. The signal trajectory in any region followed a similar shape regardless of cortical depth. The quadratic fit was analyzed in 70 cortical regions to obtain the age of maximum signal intensity. We found that visual, cingulate, and left ventromedial prefrontal cortices peak first around 34 years old, whereas motor and premotor areas peak latest at ∼38 years. Our analysis suggests that ICM trajectories over this range can be modeled well in small cohorts of subjects using quadratic functions, which are amenable to statistical analysis, thus suitable for investigating regional changes in ICM with disease. This study highlights a novel approach to map ICM trajectories using an age range that coincides with the onset of many mental illnesses. Hum Brain Mapp 38:3691-3703, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Christopher D Rowley
- McMaster Integrative Neuroscience Discovery and Study Program, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
| | - Manpreet Sehmbi
- McMaster Integrative Neuroscience Discovery and Study Program, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
| | - Pierre-Louis Bazin
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, 04103, Germany
| | - Christine L Tardif
- Brain Imaging Centre, Douglas Mental Health Institute; Department of Psychiatry, McGill University, Montreal, Quebec, H4H 1R3, Canada
| | - Luciano Minuzzi
- McMaster Integrative Neuroscience Discovery and Study Program, McMaster University, Hamilton, Ontario, L8S 4K1, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, L8S 4K1, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, L8K 3K7, Canada
| | - Benicio N Frey
- McMaster Integrative Neuroscience Discovery and Study Program, McMaster University, Hamilton, Ontario, L8S 4K1, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, L8S 4K1, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, Ontario, L8K 3K7, Canada
| | - Nicholas A Bock
- McMaster Integrative Neuroscience Discovery and Study Program, McMaster University, Hamilton, Ontario, L8S 4K1, Canada.,Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
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Abnormal Trajectory of Intracortical Myelination in Schizophrenia Implicates White Matter in Disease Pathophysiology and the Therapeutic Mechanism of Action of Antipsychotics. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 3:454-462. [PMID: 29735155 DOI: 10.1016/j.bpsc.2017.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/08/2017] [Accepted: 03/05/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Postmortem and imaging studies provide converging evidence that the frontal lobe myelination trajectory is dysregulated in schizophrenia (SZ) and suggest that early in treatment, antipsychotic medications increase intracortical myelin (ICM). We used magnetic resonance imaging to examine whether the ICM trajectory in SZ is dysregulated and altered by antipsychotic treatment. METHODS We examined 93 subjects with SZ (64 men and 29 women) taking second-generation oral antipsychotics with medication exposures of 0-333 months in conjunction with 80 healthy control subjects (52 men and 28 women). Frontal lobe ICM volume was estimated using a novel dual contrast magnetic resonance imaging method that combines two images that track different tissue components. RESULTS When plotted against oral antipsychotic exposure duration, ICM of subjects with SZ was higher as a function of medication exposure during the first year of treatment but declined thereafter. In the age range examined, ICM of subjects with SZ was lower with increased age, while ICM of healthy control subjects was not. CONCLUSIONS In adults with SZ, the relationship between length of exposure to oral second-generation antipsychotics and ICM was positive during the first year of treatment but was negative after this initial period, consistent with suboptimal later adherence after initial adherence. This ICM trajectory resembles clinically observed antipsychotic response trajectory with high rates of remission in the first year followed by progressively lower response rates. The results support postmortem evidence that SZ pathophysiology involves ICM deficits and suggest that correcting these deficits may be an important mechanism of action for antipsychotics.
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Dean DC, Sojkova J, Hurley S, Kecskemeti S, Okonkwo O, Bendlin BB, Theisen F, Johnson SC, Alexander AL, Gallagher CL. Alterations of Myelin Content in Parkinson's Disease: A Cross-Sectional Neuroimaging Study. PLoS One 2016; 11:e0163774. [PMID: 27706215 PMCID: PMC5051727 DOI: 10.1371/journal.pone.0163774] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/14/2016] [Indexed: 12/11/2022] Open
Abstract
Alterations to myelin may be a core pathological feature of neurodegenerative diseases. Although white matter microstructural differences have been described in Parkinson's disease (PD), it is unknown whether such differences include alterations of the brain’s myelin content. Thus, the objective of the current study is to measure and compare brain myelin content between PD patients and age-matched controls. In this cross-sectional study, 63 participants from the Longitudinal MRI in Parkinson's Disease study underwent brain MRI, Unified Parkinson's Disease Rating Scale (UPDRS) scoring, and cognitive asessments. Subjects were imaged with the mcDEPSOT (multi-component driven equilibrium single pulse observation of T1 and T2), a multicomponent relaxometry technique that quantifies longitudinal and transverse relaxation rates (R1 and R2, respectively) and the myelin water fraction (VFM), a surrogate for myelin content. A voxel-wise approach was used to compare R1, R2, and VFM measures between PD and control groups, and to evaluate relationships with age as well as disease duration, UPDRS scores, and daily levodopa equivalent dose. PD subjects had higher VFM than controls in frontal and temporal white matter and bilateral thalamus. Greater age was strongly associated with lower VFM in both groups, while an age-by-group interaction suggested a slower rate of VFM decline in the left putamen with aging in PD. Within the PD group, measures of disease severity, including UPDRS, daily levodopa equivalent dose, and disease duration, were observed to be related with myelin content in diffuse brain regions. The age-by-group interaction suggests that either PD or dopaminergic therapies allay observed age-related myelin changes. The relationships between VFM and disease severity measures suggests that VFM may provide a surrogate marker for microstructural changes related to Parkinson’s disease.
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Affiliation(s)
- Douglas C Dean
- Waisman Center, University of Wisconsin Madison, Madison, Wisconsin, United States of America
| | - Jitka Sojkova
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America.,Department of Neurology, University of Wisconsin Madison, Madison, Wisconsin, United States of America
| | - Samuel Hurley
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Steven Kecskemeti
- Waisman Center, University of Wisconsin Madison, Madison, Wisconsin, United States of America
| | - Ozioma Okonkwo
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Frances Theisen
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America.,Department of Neurology, University of Wisconsin Madison, Madison, Wisconsin, United States of America
| | - Sterling C Johnson
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Andrew L Alexander
- Waisman Center, University of Wisconsin Madison, Madison, Wisconsin, United States of America.,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America.,Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Catherine L Gallagher
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, United States of America.,Department of Neurology, University of Wisconsin Madison, Madison, Wisconsin, United States of America.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
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Potkin SG, Preda A. Aripiprazole once-monthly long-acting injectable for the treatment of schizophrenia. Expert Opin Pharmacother 2016; 17:395-407. [PMID: 26864352 DOI: 10.1517/14656566.2015.1114100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Patient non-adherence increases the risk for relapse and the long-term care of schizophrenia. Long-acting injectable (LAI) antipsychotics can decrease this risk by ensuring adherence. An extended formulation, aripiprazole 400 mg once-monthly (AOM 400) LAI (AOM LAI), received regulatory approval in the year 2013 for the treatment of schizophrenia. AOM LAI is the first dopamine D2 partial agonist available in a long-acting formulation for the treatment of schizophrenia. AREAS COVERED This review covers data on the efficacy and tolerability/safety of AOM LAI. AOM LAI is a lyophilized powder of aripiprazole, with an elimination half-life of 29.9 - 46.5 days, allowing for a 4-week injection interval. Antipsychotic efficacy was documented in a 12-week double-blind trial (n = 340) and in two maintenance-of-effect trials: a 38-week trial (n = 662) and a 52-week trial (n = 403). The side effect profile is similar to that of oral aripiprazole. Adverse events (≥5% and at least twice that for placebo) were typically mild or moderate and did not lead to discontinuation: increased weight, akathisia, injection site pain and sedation. The 400 mg dose is tolerated by >90% of patients. Injection does not require additional training of health personnel or post-injection observation. EXPERT OPINION AOM LAI is an efficacious and well-tolerated antipsychotic treatment for schizophrenia.
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Affiliation(s)
- Steven G Potkin
- a Psychiatry and Human Behavior, Robert R. Sprague Chair in Brain Imaging , UC Irvine , Irvine , CA 92617 , USA
| | - Adrian Preda
- b Heath Sciences Clinical Professor of Psychiatry , UC Irvine School of Medicine , Orange , CA 92868 , USA
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44
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Azorin JM, Simon N, Adida M, Belzeaux R. Pharmacological treatment of schizophrenia with comorbid substance use disorder. Expert Opin Pharmacother 2015; 17:231-53. [DOI: 10.1517/14656566.2016.1114101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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45
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Rowley CD, Bazin PL, Tardif CL, Sehmbi M, Hashim E, Zaharieva N, Minuzzi L, Frey BN, Bock NA. Assessing intracortical myelin in the living human brain using myelinated cortical thickness. Front Neurosci 2015; 9:396. [PMID: 26557052 PMCID: PMC4615825 DOI: 10.3389/fnins.2015.00396] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/08/2015] [Indexed: 01/08/2023] Open
Abstract
Alterations in the myelination of the cerebral cortex may underlie abnormal cortical function in a variety of brain diseases. Here, we describe a technique for investigating changes in intracortical myelin in clinical populations on the basis of cortical thickness measurements with magnetic resonance imaging (MRI) at 3 Tesla. For this, we separately compute the thickness of the shallower, lightly myelinated portion of the cortex and its deeper, heavily myelinated portion (referred to herein as unmyelinated and myelinated cortex, respectively). Our expectation is that the thickness of the myelinated cortex will be a specific biomarker for disruptions in myeloarchitecture. We show representative atlases of total cortical thickness, T, unmyelinated cortical thickness, G, and myelinated cortical thickness, M, for a healthy group of 20 female subjects. We further demonstrate myelinated cortical thickness measurements in a preliminary clinical study of 10 bipolar disorder type-I subjects and 10 healthy controls, and report significant decreases in the middle frontal gyrus in T, G, and M in the disorder, with the largest percentage change occurring in M. This study highlights the potential of myelinated cortical thickness measurements for investigating intracortical myelin involvement in brain disease at clinically relevant field strengths and resolutions.
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Affiliation(s)
- Christopher D Rowley
- Department of Psychology, Neuroscience and Behaviour, McMaster University Hamilton, ON, Canada ; MiNDS Neuroscience Graduate Program, McMaster University Hamilton, ON, Canada
| | - Pierre-Louis Bazin
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Christine L Tardif
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Manpreet Sehmbi
- MiNDS Neuroscience Graduate Program, McMaster University Hamilton, ON, Canada ; Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton, ON, Canada
| | - Eyesha Hashim
- Department of Psychology, Neuroscience and Behaviour, McMaster University Hamilton, ON, Canada
| | - Nadejda Zaharieva
- Department of Psychology, Neuroscience and Behaviour, McMaster University Hamilton, ON, Canada ; MiNDS Neuroscience Graduate Program, McMaster University Hamilton, ON, Canada
| | - Luciano Minuzzi
- MiNDS Neuroscience Graduate Program, McMaster University Hamilton, ON, Canada ; Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton, ON, Canada
| | - Benicio N Frey
- MiNDS Neuroscience Graduate Program, McMaster University Hamilton, ON, Canada ; Department of Psychiatry and Behavioural Neurosciences, McMaster University Hamilton, ON, Canada
| | - Nicholas A Bock
- Department of Psychology, Neuroscience and Behaviour, McMaster University Hamilton, ON, Canada ; MiNDS Neuroscience Graduate Program, McMaster University Hamilton, ON, Canada
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46
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De Hert M, Sermon J, Geerts P, Vansteelandt K, Peuskens J, Detraux J. The Use of Continuous Treatment Versus Placebo or Intermittent Treatment Strategies in Stabilized Patients with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with First- and Second-Generation Antipsychotics. CNS Drugs 2015; 29:637-58. [PMID: 26293744 DOI: 10.1007/s40263-015-0269-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although continuous treatment with antipsychotics is still recommended as the gold standard treatment paradigm for all patients with schizophrenia, some clinicians question whether continuous antipsychotic treatment is necessary, or even justified, for every patient with schizophrenia who has been stabilized on antipsychotics. OBJECTIVE The primary objectives of this systematic review and meta-analysis were (i) to compare relapse/hospitalization risks of stabilized patients with schizophrenia under active versus intermittent or placebo treatment conditions; (ii) to examine the role of several study characteristics, possibly intervening in the relationship between relapse risk and treatment condition; and (iii) to examine whether time to relapse is associated with antipsychotic treatment duration. METHODS A systematic literature search, using the MEDLINE database (1950 until November 2014), was conducted for English-language published randomized controlled trials, covering a follow-up time period of at least 6 months, and investigating relapse/rehospitalization and/or time-to-relapse rates with placebo or intermittent treatment strategies versus continuous treatment with oral and long-acting injectable first- or second-generation antipsychotics (FGAs/SGAs) in stabilized patients with schizophrenia. Additional studies were identified through searches of reference lists of other identified systematic reviews and Cochrane reports. Two meta-analyses (placebo versus continuous and intermittent versus continuous treatment) were performed to obtain an optimal estimation of the relapse/hospitalization risks of stabilized patients with schizophrenia under these treatment conditions and to assess the role of study characteristics. For time-to-relapse data, a descriptive analysis was performed. RESULTS Forty-eight reports were selected as potentially eligible for our meta-analysis. Of these, 21 met the inclusion criteria. Twenty-five records, identified through Cochrane and other systematic reviews and fulfilling the inclusion criteria, were added, resulting in a total of 46 records. Stabilized patients with schizophrenia who have been exposed for at least 6 months to intermittent or placebo strategies, respectively, have a 3 (odds ratio [OR] 3.36; 95% CI 2.36-5.45; p < 0.0001) to 6 (OR 5.64; 95% CI 4.47-7.11; p < 0.0001) times increased risk of relapse, compared with patients on continuous treatment. The availability of rescue medication (p = 0.0102) was the only study characteristic explaining systematic differences in the OR for relapse between placebo versus continuous treatment across studies. Studies reporting time-to-relapse data show that the time to (impending) relapse is always significantly delayed with continuous treatment, compared with placebo or intermittent treatment strategies. Although the interval between treatment discontinuation and symptom recurrence can be highly variable, mean time-to-relapse data seem to indicate a failure of clinical stability before 7-14 months with intermittent and before 5 months with placebo treatment strategies. For all reports included in this systematic review, median time-to-relapse rates in the continuous treatment group were not estimable as <50% of the patients in this treatment condition relapsed before the end of the study. CONCLUSIONS With continuous treatment, patients have a lower risk of relapse and remain relapse free for a longer period of time compared with placebo and intermittent treatment strategies. Moreover, 'success rates' in the intermittent treatment conditions are expected to be an overestimate of actual outcome rates. Therefore, continuous treatment remains the 'gold standard' for good clinical practice, particularly as, until now, only a few and rather general valid predictors for relapse in schizophrenia are known and subsequent relapses may contribute to functional deterioration as well as treatment resistance in patients with schizophrenia.
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Affiliation(s)
- Marc De Hert
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium.
| | - Jan Sermon
- Janssen-Cilag NV, Health Economics, Market Access and Reimbursement-Neuroscience, 2340, Beerse, Belgium
| | - Paul Geerts
- Janssen-Cilag NV, Medical Affairs-Psychiatry, 2340, Beerse, Belgium
| | - Kristof Vansteelandt
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Joseph Peuskens
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium
| | - Johan Detraux
- Department of Neurosciences, Z.org KU Leuven-University Psychiatric Centre, UPC KUL Campus Kortenberg, Leuvensesteenweg 517, 3070, Kortenberg, Belgium
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Subotnik KL, Casaus LR, Ventura J, Luo JS, Hellemann GS, Gretchen-Doorly D, Marder S, Nuechterlein KH. Long-Acting Injectable Risperidone for Relapse Prevention and Control of Breakthrough Symptoms After a Recent First Episode of Schizophrenia. A Randomized Clinical Trial. JAMA Psychiatry 2015; 72:822-9. [PMID: 26107752 PMCID: PMC5065351 DOI: 10.1001/jamapsychiatry.2015.0270] [Citation(s) in RCA: 174] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Long-acting, injectable, second-generation antipsychotic medication has tremendous potential to bring clinical stability to persons with schizophrenia. However, long-acting medications are rarely used following a first episode of schizophrenia. OBJECTIVE To compare the clinical efficacy of the long-acting injectable formulation of risperidone with the oral formulation in the early course of schizophrenia. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial performed at a university-based research clinic, between 2005 and 2012. Eighty-six patients with recent onset of schizophrenia were randomized to receive long-acting injectable risperidone or oral risperidone. Half of each group was simultaneously randomized to receive cognitive remediation to improve cognitive functioning or healthy-behaviors training to improve lifestyle habits and well-being. An intent-to-treat analysis was performed between October 4, 2012, and November 12, 2014. INTERVENTIONS A 12-month trial comparing the long-acting injectable vs oral risperidone and cognitive remediation vs healthy-behaviors training. MAIN OUTCOMES AND MEASURES Psychotic relapse and control of breakthrough psychotic symptoms. RESULTS Of the 86 patients randomized, 3 refused treatment in the long-acting injectable risperidone group. The psychotic exacerbation and/or relapse rate was lower for the long-acting risperidone group compared with the oral group (5% vs 33%; χ21 = 11.1; P < .001; relative risk reduction, 84.7%). Long-acting injectable risperidone better controlled mean levels of hallucinations and delusions throughout follow-up (β = -0.30; t68 = -2.6, P = .01). The cognitive remediation and healthy-behaviors training groups did not differ significantly regarding psychotic relapse, psychotic symptom control, or hospitalization rates, and there were no significant interactions between the 2 medications and the 2 psychosocial treatments. Discontinuations owing to inadequate clinical response were more common in the oral group than in the long-acting risperidone group (χ21 = 6.1; P = .01). Adherence to oral risperidone did not appear to differ before randomization but was better for the long-acting risperidone group compared with the oral group (t80 = 5.3; P < .001). Medication adherence was associated with prevention of exacerbation and/or relapse (χ21 =11.1; P = .003) and control of breakthrough psychotic symptoms (β = 0.2; t79 = 2.1; P = .04). CONCLUSIONS AND RELEVANCE The use of long-acting injectable risperidone after a first episode of schizophrenia has notable advantages for clinical outcomes. The key clinical advantages are apparently owing to the more consistent administration of the long-acting injectable. Such formulations should be offered earlier in the course of illness. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00333177.
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Affiliation(s)
- Kenneth L. Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Laurie R. Casaus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - John S. Luo
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Gerhard S. Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Denise Gretchen-Doorly
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Stephen Marder
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)2Department of Psychiatry, Veterans Affairs Greater Los Angeles Health
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA (University of California, Los Angeles)3Department of Psychology, UCLA
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48
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Simić-Medojević I, Burgić-Radmanović M. Quality of life of schizophrenic patients with or without depot neuroleptics. SCRIPTA MEDICA 2015. [DOI: 10.5937/scrimed1501060s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Heres S, Lambert M, Vauth R. Treatment of early episode in patients with schizophrenia: the role of long acting antipsychotics. Eur Psychiatry 2014; 29 Suppl 2:1409-13. [PMID: 25455704 DOI: 10.1016/s0924-9338(14)70001-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/10/2014] [Accepted: 10/17/2014] [Indexed: 11/26/2022] Open
Abstract
The use of long-acting injectable antipsychotics (LAIs) in schizophrenia is usually restricted to patients in long-term treatment, who prefer them to oral antipsychotics, and to patients with multiple relapses who have a history of non-adherence. However, preliminary evidence from patients in the early phases of the disease suggest that second generation LAIs may be superior to second generation oral medications with regard to the control of negative symptoms and psychosocial functioning. Moreover, several studies have found that psychiatrists are generally reluctant to prescribe LAI antipsychotics and under-estimate their acceptability by patients. Key elements to take into account when offering a LAI in the early course of schizophrenia should include their potential superiority in allowing early detection of non-adherence and in reducing the number of rehospitalisations and relapses.
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Affiliation(s)
- S Heres
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Ismaningerstraße 22, 81675 München, Germany.
| | - M Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - R Vauth
- Psychiatric University Clinics University of Basel, Centre for Mental Health, Kornhausgasse 7, 4051 Basel, Switzerland
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Brissos S, Veguilla MR, Taylor D, Balanzá-Martinez V. The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal. Ther Adv Psychopharmacol 2014; 4:198-219. [PMID: 25360245 PMCID: PMC4212490 DOI: 10.1177/2045125314540297] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite their widespread use, long-acting injectable (LAI) antipsychotics (APs) are often regarded with some negativity because of the assumption of punishment, control and insufficient evolution towards psychosocial development of patients. However, LAI APs have proved effective in schizophrenia and other severe psychotic disorders because they assure stable blood levels, leading to a reduction of the risk of relapse. Therapeutic opportunities have also arisen after introduction of newer, second-generation LAI APs in recent years. Newer LAI APs are more readily dosed optimally, may be better tolerated and are better suited to integrated rehabilitation programmes. This review outlines the older and newer LAI APs available for the treatment of schizophrenia, with considerations of past and present pharmacological and therapeutic issues. Traditional, evidence-based approaches to systematic reviews and randomized clinical trials are of limited utility in this area so this paper's blending of experimental trials with observational research is particularly appropriate and effective.
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Affiliation(s)
- Sofia Brissos
- Psychiatrist, Lisbon's Psychiatric Hospitalar Centre, Rua Conde de Redondo, nº 8 3º dt., Lisbon, 1150, Portugal
| | - Miguel Ruiz Veguilla
- Grupo Psicosis y Neurodesarrollo, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio /CSIC/Universidad de Sevilla, Unidad de Hospitalizacion de Salud Mental, Sevilla, Spain
| | - David Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, Denmark Hill, London, UK
| | - Vicent Balanzá-Martinez
- Catarroja Mental Health Unit, University Hospital Doctor Peset, FISABIO, Valencia; and Section of Psychiatry, University of Valencia, CIBERSAM, Valencia, Spain
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