1
|
Vessels T, Strayer N, Lee H, Choi KW, Zhang S, Han L, Morley TJ, Smoller JW, Xu Y, Ruderfer DM. Integrating Electronic Health Records and Polygenic Risk to Identify Genetically Unrelated Comorbidities of Schizophrenia That May Be Modifiable. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:100297. [PMID: 38645405 PMCID: PMC11033077 DOI: 10.1016/j.bpsgos.2024.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 04/23/2024] Open
Abstract
Background Patients with schizophrenia have substantial comorbidity that contributes to reduced life expectancy of 10 to 20 years. Identifying modifiable comorbidities could improve rates of premature mortality. Conditions that frequently co-occur but lack shared genetic risk with schizophrenia are more likely to be products of treatment, behavior, or environmental factors and therefore are enriched for potentially modifiable associations. Methods Phenome-wide comorbidity was calculated from electronic health records of 250,000 patients across 2 independent health care institutions (Vanderbilt University Medical Center and Mass General Brigham); associations with schizophrenia polygenic risk scores were calculated across the same phenotypes in linked biobanks. Results Schizophrenia comorbidity was significantly correlated across institutions (r = 0.85), and the 77 identified comorbidities were consistent with prior literature. Overall, comorbidity and polygenic risk score associations were significantly correlated (r = 0.55, p = 1.29 × 10-118). However, directly testing for the absence of genetic effects identified 36 comorbidities that had significantly equivalent schizophrenia polygenic risk score distributions between cases and controls. This set included phenotypes known to be consequences of antipsychotic medications (e.g., movement disorders) or of the disease such as reduced hygiene (e.g., diseases of the nail), thereby validating the approach. It also highlighted phenotypes with less clear causal relationships and minimal genetic effects such as tobacco use disorder and diabetes. Conclusions This work demonstrates the consistency and robustness of electronic health record-based schizophrenia comorbidities across independent institutions and with the existing literature. It identifies known and novel comorbidities with an absence of shared genetic risk, indicating other causes that may be modifiable and where further study of causal pathways could improve outcomes for patients.
Collapse
Affiliation(s)
- Tess Vessels
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Digital Genomic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicholas Strayer
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hyunjoon Lee
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Karmel W. Choi
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Siwei Zhang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lide Han
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Digital Genomic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Theodore J. Morley
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Digital Genomic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jordan W. Smoller
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas M. Ruderfer
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Digital Genomic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
2
|
Ying J, Chew QH, Wang Y, Sim K. Global Neuropsychopharmacological Prescription Trends in Adults with Schizophrenia, Clinical Correlates and Implications for Practice: A Scoping Review. Brain Sci 2023; 14:6. [PMID: 38275511 PMCID: PMC10813099 DOI: 10.3390/brainsci14010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
It is important to examine the psychotropic prescription practices in schizophrenia, as it can inform regarding changing treatment choices and related patient profiles. No recent reviews have evaluated the global neuropsychopharmacological prescription patterns in adults with schizophrenia. A systematic search of the literature published from 2002 to 2023 found 88 empirical papers pertinent to the utilization of psychotropic agents. Globally, there were wide inter-country and inter-regional variations in the prescription of psychotropic agents. Overall, over time there was an absolute increase in the prescription rate of second-generation antipsychotics (up to 50%), mood stabilizers (up to 15%), and antidepressants (up to 17%), with an observed absolute decrease in the rate of antipsychotic polypharmacy (up to 15%), use of high dose antipsychotic (up to 12% in Asia), clozapine (up to 9%) and antipsychotic long-acting injectables (up to 10%). Prescription patterns were mainly associated with specific socio-demographic (such as age), illness (such as illness duration), and treatment factors (such as adherence). Further work, including more evidence in adjunctive neuropsychopharmacological treatments, pharmaco-economic considerations, and examination of cohorts in prospective studies, can proffer insights into changing prescription trends relevant to different treatment settings and predictors of such trends for enhancement of clinical management in schizophrenia.
Collapse
Affiliation(s)
- Jiangbo Ying
- East Region, Institute of Mental Health, Singapore 539747, Singapore
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | - Yuxi Wang
- East Region, Institute of Mental Health, Singapore 539747, Singapore
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore 539747, Singapore
| |
Collapse
|
3
|
Vessels T, Strayer N, Choi KW, Lee H, Zhang S, Han L, Morley TJ, Smoller JW, Xu Y, Ruderfer DM. Identifying modifiable comorbidities of schizophrenia by integrating electronic health records and polygenic risk. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.01.23290057. [PMID: 37333378 PMCID: PMC10274978 DOI: 10.1101/2023.06.01.23290057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Patients with schizophrenia have substantial comorbidity contributing to reduced life expectancy of 10-20 years. Identifying which comorbidities might be modifiable could improve rates of premature mortality in this population. We hypothesize that conditions that frequently co-occur but lack shared genetic risk with schizophrenia are more likely to be products of treatment, behavior, or environmental factors and therefore potentially modifiable. To test this hypothesis, we calculated phenome-wide comorbidity from electronic health records (EHR) in 250,000 patients in each of two independent health care institutions (Vanderbilt University Medical Center and Mass General Brigham) and association with schizophrenia polygenic risk scores (PRS) across the same phenotypes (phecodes) in linked biobanks. Comorbidity with schizophrenia was significantly correlated across institutions (r = 0.85) and consistent with prior literature. After multiple test correction, there were 77 significant phecodes comorbid with schizophrenia. Overall, comorbidity and PRS association were highly correlated (r = 0.55, p = 1.29×10-118), however, 36 of the EHR identified comorbidities had significantly equivalent schizophrenia PRS distributions between cases and controls. Fifteen of these lacked any PRS association and were enriched for phenotypes known to be side effects of antipsychotic medications (e.g., "movement disorders", "convulsions", "tachycardia") or other schizophrenia related factors such as from smoking ("bronchitis") or reduced hygiene (e.g., "diseases of the nail") highlighting the validity of this approach. Other phenotypes implicated by this approach where the contribution from shared common genetic risk with schizophrenia was minimal included tobacco use disorder, diabetes, and dementia. This work demonstrates the consistency and robustness of EHR-based schizophrenia comorbidities across independent institutions and with the existing literature. It identifies comorbidities with an absence of shared genetic risk indicating other causes that might be more modifiable and where further study of causal pathways could improve outcomes for patients.
Collapse
Affiliation(s)
- Tess Vessels
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville TN
| | - Nicholas Strayer
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville TN
| | - Karmel W. Choi
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston MA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston MA
| | - Hyunjoon Lee
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston MA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston MA
| | - Siwei Zhang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville TN
| | - Lide Han
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville TN
| | - Theodore J. Morley
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville TN
| | - Jordan W. Smoller
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston MA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston MA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville TN
| | - Douglas M. Ruderfer
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville TN
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
4
|
Geng Y, Zhang G, Chen Y, Peng Y, Wang X, Wang Z. Si-Rhodamine Derivatives for Brain Fluorescence Imaging and Monitoring of H2S in the Brain of Schizophrenic Mice before and after Treatment. Anal Chem 2022; 94:1813-1822. [DOI: 10.1021/acs.analchem.1c04611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Yujie Geng
- State Key Laboratory of Chemical Resource Engineering, College of Chemistry, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, China
| | - Guoyang Zhang
- State Key Laboratory of Chemical Resource Engineering, College of Chemistry, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, China
| | - Yuzhi Chen
- Institute of Health Service and Transfusion Medicine, Academy of Military Medical Sciences, Beijing 100039, P.R.China
| | - Yanghan Peng
- State Key Laboratory of Chemical Resource Engineering, College of Chemistry, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, China
| | - Xuefei Wang
- School of Chemistry and Chemical Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhuo Wang
- State Key Laboratory of Chemical Resource Engineering, College of Chemistry, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, China
| |
Collapse
|
5
|
Zhou Z, Wang Y, Feng P, Li T, Tebes JK, Luan R, Yu Y. Associations of Caregiving Knowledge and Skills With Caregiver Burden, Psychological Well-Being, and Coping Styles Among Primary Family Caregivers of People Living With Schizophrenia in China. Front Psychiatry 2021; 12:631420. [PMID: 34122169 PMCID: PMC8187614 DOI: 10.3389/fpsyt.2021.631420] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/15/2021] [Indexed: 02/03/2023] Open
Abstract
Background: There is a lack of clarity regarding the correlation of caregiving knowledge and skills with caregiving experiences of people living with schizophrenia (PLSs). To address this gap, this comprehensive study examines the relationships of caregiving knowledge and skills to the primary family caregiver's experiences of burden, psychological well-being (stress, anxiety, depression, caregiving rewarding feelings), and coping styles in China. Methods: A total of 395 primary family caregivers of PLSs were enrolled in a cross-sectional study between May 2019 and September 2019. Each family caregiver was independently assessed on caregiving knowledge and skills, caregiver burden, and psychological well-being, as well as coping styles. Results: A higher level of caregiving knowledge and skills was positively correlated with less stress (b = -0.48, P < 0.001), anxiety (b = -0.23, P = 0.029), depression (b = -0.29, P = 0.013), and more caregiving rewarding feelings (b = 0.54, P < 0.001). Also, caregivers with more knowledge and skills were more inclined to adopt positive coping strategies (b = 0.44, P < 0.001). Despite these differences, caregivers with different levels of caregiving knowledge and skills reported comparable caregiver burden (b = 0.11, P = 0.705) and the use of a passive coping style (b = 0.10, P = 0.169). Conclusion: Caregiving knowledge and skills are a reliable predictor of psychological well-being and active coping among the primary family caregivers of PLSs. These findings inform the development of psychoeducational interventions to support family caregivers of PLSs.
Collapse
Affiliation(s)
- Zonglei Zhou
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yao Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Ping Feng
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Tongxin Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jacob Kraemer Tebes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Rongsheng Luan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
6
|
Nicotra EF, Lecca D, Casu G, Palomba M, Sil A, Marchese G. Lights and shadows of schizophrenia therapy research: Lessons from oral risperidone and olanzapine. J Psychopharmacol 2020; 34:574-579. [PMID: 31961244 DOI: 10.1177/0269881119900980] [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: 11/15/2022]
Abstract
BACKGROUND Recently, patents of several atypical antipsychotics have reached their expiration date. AIMS The purpose of the study was to highlight whether modifications of economic/scientific factors may be associated with possible changes in ongoing clinical research on antipsychotic drugs. METHODS A large systematic analysis was used to depict the time-dependent distribution of published research articles addressing the clinical properties of oral risperidone and olanzapine conventional tablets, two largely prescribed atypical antipsychotics for which the patents have already expired in most of the countries. RESULTS The systematic analysis indicated that the time-dependent distribution of the selected research articles followed a wave-shape pattern. A dramatic decline of primary and secondary analyses investigating the clinical effects of oral risperidone and olanzapine has occurred in the last decade, complemented by an expected strong reduction in the numbers of industrial-supported clinical studies and a smaller, but significant, decline in the amount of independent research articles. CONCLUSIONS To date, greater involvement of independent research seems to be the only realistic chance to properly continue the investigation on the clinical properties of oral risperidone and olanzapine conventional tablets, as well as those of other off-patent antipsychotic drugs. However, the limits and potentialities of independent research in accomplishing such a demanding and enduring scientific effort should be addressed.
Collapse
Affiliation(s)
- Eraldo F Nicotra
- Department of Pedagogy, Psychology and Philosophy, University of Cagliari, Cagliari, Italy
| | - Daniele Lecca
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Gianluca Casu
- Institute of Translational Pharmacology, Secondary location of Cagliari, Pula, Italy
| | - Mario Palomba
- Institute of Translational Pharmacology, Secondary location of Cagliari, Pula, Italy
| | - Annesha Sil
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Giorgio Marchese
- Institute of Translational Pharmacology, Secondary location of Cagliari, Pula, Italy
| |
Collapse
|
7
|
Filipcic I, Simunovic Filipcic I, Ivezic E, Matic K, Tunjic Vukadinovic N, Vuk Pisk S, Bodor D, Bajic Z, Jakovljevic M, Sartorius N. Chronic physical illnesses in patients with schizophrenia spectrum disorders are independently associated with higher rates of psychiatric rehospitalization; a cross-sectional study in Croatia. Eur Psychiatry 2020; 43:73-80. [DOI: 10.1016/j.eurpsy.2017.02.484] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/29/2017] [Accepted: 02/22/2017] [Indexed: 01/10/2023] Open
Abstract
AbstractBackground:Increased physical morbidity in patients with schizophrenia spectrum disorders (SSDs) is well documented. However, much less is known about the association between somatic comorbidities and psychosis treatment outcomes.Subjects and methods:This cross-sectional study, nested within the larger frame of a prospective cohort study, was done in 2016 at Psychiatric Hospital Sveti Ivan, Zagreb, Croatia. Data were collected on a consecutive sample of 301 patients diagnosed with schizophrenia spectrum disorders who achieved a stable therapeutic dosage. Key outcome was the number of psychiatric rehospitalizations since diagnosis of the primary psychiatric illness. Predictors were number of physical and psychiatric comorbidities. By robust regression, we controlled different clinical, sociodemographic, and lifestyle confounding factors.Results:The number of chronic somatic comorbidities was statistically significantly associated with a larger number of psychiatric rehospitalizations, even after the adjustment for number of psychiatric comorbidities and large number of other clinical, sociodemographic, and lifestyle variables.Conclusions:Chronic somatic comorbidities are associated with higher rates of psychiatric rehospitalization independently of psychiatric comorbidities and other clinical, sociodemographic, and lifestyle factors. Therefore, to treat psychosis effectively, it may be necessary to treat chronic somatic comorbidities promptly and adequately. Chronic somatic comorbidities should be considered equally important as the SSD, and should be brought to the forefront of psychiatric treatment and research with the SSD as one entity. The integrative approach should be the imperative in clinical practice.
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Llorca PM, Bobes J, Fleischhacker WW, Heres S, Moore N, Bent-Ennakhil N, Sapin C, Loze JY, Nylander AG, Patel MX. Baseline results from the European non-interventional Antipsychotic Long acTing injection in schizOphrenia (ALTO) study. Eur Psychiatry 2018; 52:85-94. [PMID: 29734130 DOI: 10.1016/j.eurpsy.2018.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/06/2018] [Accepted: 04/07/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Antipsychotic Long-acTing injection in schizOphrenia (ALTO) study was a non-interventional study across several European countries examining prescription of long-acting injectable (LAI) antipsychotics to identify sociodemographic and clinical characteristics of patients receiving and physicians prescribing LAIs. ALTO was also the first large-scale study in Europe to report on the use of both first- or second-generation antipsychotic (FGA- or SGA-) LAIs. METHODS Patients with schizophrenia receiving a FGA- or SGA-LAI were enrolled between June 2013 and July 2014 and categorized as incident or prevalent users. Assessments included measures of disease severity, functioning, insight, well-being, attitudes towards antipsychotics, and quality of life. RESULTS For the 572 patients, disease severity was generally mild-to-moderate and the majority were unemployed and/or socially withdrawn. 331/572 were prevalent LAI antipsychotic users; of whom 209 were prescribed FGA-LAI. Paliperidone was the most commonly prescribed SGA-LAI (56% of incident users, 21% of prevalent users). 337/572 (58.9%) were considered at risk of non-adherence. Prevalent LAI users had a tendency towards better insight levels (PANSS G12 item). Incident FGA-LAI users had more severe disease, poorer global functioning, lower quality of life, higher rates of non-adherence, and were more likely to have physician-reported lack of insight. CONCLUSIONS These results indicate a lower pattern of FGA-LAI usage, reserved by prescribers for seemingly more difficult-to-treat patients and those least likely to adhere to oral medication.
Collapse
Affiliation(s)
- Pierre-Michel Llorca
- University Hospital Center, EA 7280 University Clermont Auvergne, Clermont-Ferrand, France
| | - Julio Bobes
- Department of Psychiatry - CIBERSAM, University of Oviedo, Oviedo, Spain
| | - W Wolfgang Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry, Medical University Innsbruck, Innsbruck, Austria
| | - Stephan Heres
- Department of Psychiatry and Psychotherapy, Munich Technical University, Munich, Germany
| | - Nicholas Moore
- Department of Pharmacology, University of Bordeaux, Bordeaux, France
| | | | | | - Jean-Yves Loze
- Otsuka Pharmaceutical Europe Ltd., Wexham, United Kingdom
| | | | - Maxine X Patel
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
10
|
Blanchard JJ, Bradshaw KR, Garcia CP, Nasrallah HA, Harvey PD, Casey D, Csoboth CT, Hudson JI, Julian L, Lentz E, Nuechterlein KH, Perkins DO, Skale TG, Snowden LR, Tandon R, Tek C, Velligan D, Vinogradov S, O'Gorman C. Examining the reliability and validity of the Clinical Assessment Interview for Negative Symptoms within the Management of Schizophrenia in Clinical Practice (MOSAIC) multisite national study. Schizophr Res 2017; 185:137-143. [PMID: 28087270 DOI: 10.1016/j.schres.2017.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 11/28/2022]
Abstract
The current study sought to expand on prior reports of the validity and reliability of the CAINS (CAINS) by examining its performance across diverse non-academic clinical settings as employed by raters not affiliated with the scale's developers and across a longer test-retest follow-up period. The properties of the CAINS were examined within the Management of Schizophrenia in Clinical Practice (MOSAIC) schizophrenia registry. A total of 501 participants with a schizophrenia spectrum diagnosis who were receiving usual care were recruited across 15 national Patient Assessment Centers and evaluated with the CAINS, other negative symptom measures, and assessments of functioning, quality of life and cognition. Temporal stability of negative symptoms was assessed across a 3-month follow-up. Results replicated the two-factor structure of the CAINS reflecting Motivation and Pleasure and expression symptoms. The CAINS scales exhibited high internal consistency and temporal stability. Convergent validity was supported by significant correlations between the CAINS subscales with other negative symptom measures. Additionally, the CAINS was significantly correlated with functioning and quality of life. Discriminant validity was demonstrated by small to moderate associations between the CAINS and positive symptoms, depression, and cognition (and these associations were comparable to those found with other negative symptom scales). Findings suggest that the CAINS is a reliable and valid tool for measuring negative symptoms in schizophrenia across diverse clinical samples and settings.
Collapse
Affiliation(s)
| | | | | | - Henry A Nasrallah
- Saint Louis University, 1438 S. Grand Boulevard, Saint Louis, MO 63104 3, USA
| | - Philip D Harvey
- University of Miami, Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, USA
| | - Daniel Casey
- Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | | | - James I Hudson
- Harvard Medical School/McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Laura Julian
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Ellen Lentz
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Keith H Nuechterlein
- University of California, Los Angeles, 300 UCLA Medical Plaza, Los Angeles, CA 90095-6968, USA
| | | | - Tracey G Skale
- Greater Cincinnati Behavioral Health Services, 1501 Madison Road, Walnut Hills, OH 45206, USA
| | | | - Rajiv Tandon
- University of Florida, Gainesville, FL 32611, USA
| | - Cenk Tek
- Yale University/Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519, USA
| | - Dawn Velligan
- University of Texas Health Science Center, 7703 Floyd Curl Dr. San Antonio, San Antonio, TX 78240, USA
| | - Sophia Vinogradov
- University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA; San Francisco Veterans Administration Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Cedric O'Gorman
- Formerly of Genentech. Currently at Intra-Cellular Therapies, Inc., 430 East 29th Street, New York City, NY 10016, USA
| |
Collapse
|
11
|
Nordstroem AL, Talbot D, Bernasconi C, Berardo CG, Lalonde J. Burden of illness of people with persistent symptoms of schizophrenia: A multinational cross-sectional study. Int J Soc Psychiatry 2017; 63:139-150. [PMID: 28134026 DOI: 10.1177/0020764016688040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few studies have examined the impact of persistent symptoms of schizophrenia, especially with respect to patient-reported outcomes (PROs), carer burden and health economic impact. AIMS Analyse data relating to burden and severity of illness, functional impairment and quality of life for patients with persistent symptoms of schizophrenia. METHODS A cohort of stable outpatients with persistent symptoms of schizophrenia across seven countries were assessed in a multicentre, non-interventional, cross-sectional survey and retrospective medical record review using PRO questionnaires, clinical rating scales and carer questionnaires. RESULTS Overall, 1,421 patients and 687 carers were enrolled. Approximately two-thirds of patients had moderate/mild schizophrenia with more severe negative symptoms predominating. Patients showed impaired personal/social functioning and unsuitability for work correlated with various patient factors, most notably symptom-related assessments. Quality-of-life assessments showed 25% to ⩾30% of patients had problems with mobility, washing or dressing. Carer burden was also considerable, with carers having to devote an average of 20.5 hours per week and notable negative impact on quality-of-life measures. Healthcare resource utilisation for in-hospital, outpatient and other care provider visits was significant. CONCLUSION These results demonstrate the significant burden of schizophrenia for patients, carers and society and highlight the need for improved treatment approaches.
Collapse
|
12
|
Lee EE, Hong S, Martin AS, Eyler LT, Jeste DV. Inflammation in Schizophrenia: Cytokine Levels and Their Relationships to Demographic and Clinical Variables. Am J Geriatr Psychiatry 2017; 25:50-61. [PMID: 27840055 PMCID: PMC5164855 DOI: 10.1016/j.jagp.2016.09.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Inflammation may play a role in the accelerated physical aging reported in schizophrenia, though biomarker findings and associations with demographic and clinical factors are inconsistent. METHODS In a cross-sectional, case-control design, 95 outpatients with schizophrenia (mean age ± SD: 48.1 ± 10.2 years) and 95 demographically comparable healthy comparison subjects (HCs) (mean age ± SD: 48.1 ± 12.1 years) were studied. Sociodemographic and clinical data were collected, and plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interferon-γ (IFN-γ) were assayed. The authors compared cytokine levels, examined demographic and clinical associations, and adjusted for relevant variables with linear models. RESULTS Individuals with schizophrenia had higher levels of TNF-α and IL-6 but not IFN-γ than HCs. Age was not related to cytokine levels, and age relationships did not differ between diagnostic groups. Women had higher levels of IL-6. TNF-α and IL-6 levels were significantly correlated with depressive symptoms, and adjustment for depression reduced the group effect for both. Within the HCs, TNF-α levels were associated with physical comorbidity and body mass index. IL-6 levels were significantly correlated with body mass index and within schizophrenia patients, with worse mental and physical well-being. Accounting for physical morbidity and mental well-being reduced group differences in TNF-α and IL-6 levels, respectively. Worse positive symptoms were associated with higher IL-6 levels. CONCLUSION Higher TNF-α and IL-6 levels in schizophrenia patients were associated with depression, physical comorbidity, and mental well-being. Further longitudinal studies are warranted to assess inflammation as a potential treatment target for a subgroup of schizophrenia.
Collapse
Affiliation(s)
- Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Suzi Hong
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Department of Family Medicine and Public Health, University of California, San Diego
| | - Averria Sirkin Martin
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Lisa T. Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States,Center for Healthy Aging, University of California San Diego, La Jolla, CA, United States,Department of Neurosciences, University of California, San Diego
| |
Collapse
|
13
|
Quintero J, Oyagüez I, González B, Cuervo-Arango I, García I, Casado MA. Cost-Minimisation Analysis of Paliperidone Palmitate Long-Acting Treatment versus Risperidone Long-Acting Treatment for Schizophrenia in Spain. Clin Drug Investig 2016; 36:479-90. [PMID: 27000061 DOI: 10.1007/s40261-016-0393-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Long-acting formulations for paliperidone (PPLAT) and risperidone (RLAT) are effective second-generation antipsychotics. This study aimed to compare treatment costs between PPLAT and RLAT in schizophrenia patients. METHODS A cost-minimization analysis was performed from the perspective of the Spanish National Healthcare System (NHS), in line with the approach accepted by the Scottish Medicine Consortium evaluation. Only direct health costs (€, 2015) were included, i.e. medication (including oral antipsychotic drug supplementation), hospitalization and cost of administration in the community. Two time horizons were used: 1 year (to compare initiation treatment) and 2 years (to compare maintenance treatment). Base-case considered the following assumptions: setting for treatment initiation (50 % hospital and 50 % community); 50 % of patients initiating from a long-acting treatment and 50 % from an oral antipsychotic; no reduction in the length of stay. One-way sensitivity analyses (SA) were performed. RESULTS The estimated costs/patient were €7698 (PPLAT) and €8168 (RLAT) for the first year, and €4314 (PPLAT) and €5003 (RLAT) for the second year. Cost savings related to PPLAT therapy were €470 and €689 for first and second year, respectively. SA results confirmed the robustness of the model results, even in the most conservative scenarios: (1) if 100 % of patients initiate treatment in hospital, the savings could be €454 per patient; (2) if 100 % of patients initiate treatment from an oral antipsychotic, the savings could be €277 per patient/year; and (3) if PPLAT could not reduce the length of stay by approximately one-third, as some studies indicate, the savings could be €470 per patient/year. CONCLUSIONS The use of PPLAT instead of RLAT could be a cost-saving strategy for the Spanish NHS.
Collapse
Affiliation(s)
| | - Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia, Pº Joaquín Rodrigo 4I, Pozuelo de Alarcón, 28224, Madrid, Spain.
| | | | | | | | - Miguel Angel Casado
- Pharmacoeconomics & Outcomes Research Iberia, Pº Joaquín Rodrigo 4I, Pozuelo de Alarcón, 28224, Madrid, Spain
| |
Collapse
|
14
|
Lee EE, Eyler LT, Wolkowitz OM, Martin AS, Reuter C, Kraemer H, Jeste DV. Elevated plasma F2-isoprostane levels in schizophrenia. Schizophr Res 2016; 176:320-326. [PMID: 27318521 PMCID: PMC5026902 DOI: 10.1016/j.schres.2016.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Schizophrenia is one of the most disabling psychiatric disorders with increased morbidity and mortality. Both schizophrenia and oxidative stress have been associated with accelerated aging. Previous studies found increased oxidative stress in individuals with schizophrenia, though only one study measured F2-isoprostanes and did so in urine. To our knowledge, the present study is the first to assess plasma F2-isoprostane levels, the putative gold standard measure of systemic oxidative stress in vivo, in schizophrenia. METHODS We compared plasma F2-isoprostane levels in 134 stable outpatients with schizophrenia and 120 age- and gender-matched healthy comparison (HC) subjects. Sociodemographic and clinical data were collected in both groups. RESULTS Plasma F2-isoprostane levels were significantly higher in the schizophrenia group than in the HC group. Women had higher F2-isoprostane levels compared to men, and those with higher body mass index (BMI) had higher levels, within each group. F2-isoprostane levels correlated with BMI, physical functioning, and medical comorbidity but not with severity of psychopathology or executive function. Linear models showed significant effects of diagnosis, gender, and BMI on F2-isoprostane levels, but no interactions. DISCUSSION Our finding of increased oxidative stress in schizophrenia is consistent with reports of increased morbidity and mortality as well as accelerated aging in schizophrenia. The significant associations between F2-isoprostane levels and both gender and BMI warrant further study.
Collapse
Affiliation(s)
- Ellen E. Lee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Lisa T. Eyler
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego
| | | | - Averria Sirkin Martin
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Chase Reuter
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Helena Kraemer
- Department of Psychiatry, Stanford University, Palo Alto
| | - Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States,Center for Healthy Aging, University of California, San Diego, La Jolla, CA, United States,Department of Neurosciences, University of California, San Diego
| |
Collapse
|
15
|
Carreño SP, Sánchez-Herrera B, Carrillo GM, Chaparro-Díaz L, Gómez OJ. Carga de la enfermedad crónica para los sujetos implicados en el cuidado. REVISTA FACULTAD NACIONAL DE SALUD PÚBLICA 2016. [DOI: 10.17533/udea.rfnsp.v34n3a08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
16
|
Paulzen M, Haen E, Gründer G, Lammertz SE, Stegmann B, Schruers KR, Walther S, Schoretsanitis G. Pharmacokinetic considerations in the treatment of hypertension in risperidone-medicated patients - thinking of clinically relevant CYP2D6 interactions. J Psychopharmacol 2016; 30:803-9. [PMID: 27251417 DOI: 10.1177/0269881116650390] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Treatment of arterial hypertension in patients with severe mental illnesses often results in polypharmacy, potentially leading to drug-drug interactions. The objective of the study was to analyse the in vivo inhibitory potential of two antihypertensive drugs, amlodipine and metoprolol on CYP2D6 catalysed 9-hydroxylation of risperidone (RIS). METHODS A therapeutic drug monitoring database with plasma concentrations of RIS and 9-hydroxyrisperidone (9-OH-RIS) of 1584 patients was analysed. Three groups were considered; a group of patients receiving RIS without a potentially cytochrome influencing co-medication (control group, R0, n=852), a group co-medicated with amlodipine (RA, n=27) and a group, co-medicated with metoprolol (RM, n=41). Plasma concentrations, concentration-to-dose ratios (C/Ds) of RIS, 9-OH-RIS and the active moiety (AM), as well as the metabolic ratios were computed and compared using the Kruskal-Wallis test, the Mann-Whitney U test and the Jonckheere-Terpstra test to determine the means and different patterns of distribution of plasma concentrations as well as the concentration-to-dose ratios. RESULTS The median daily dosage of RIS did not differ between the groups (p=0.708). No differences were found in median plasma concentrations of RIS, 9-OH-RIS and AM. However, concentration-to-dose ratios for RIS, 9-OH-RIS and AM were significantly higher in the amlodipine group (p=0.025, p=0.048 and p=0.005). In the metoprolol group, the concentration-to-dose ratio for RIS was significantly higher than in the control group (p=0.017), while the C/D for 9-OH-RIS and AM was not. CONCLUSIONS AND LIMITATIONS Our data show a potential pharmacokinetic interaction, most likely via CYP3A4 between amlodipine and RIS, reflected in significantly different C/Ds for RIS, 9-OH-RIS and AM. Although the interaction did not result in significantly higher plasma levels, changes in C/Ds and their distribution with regard to the median concentrations were observed.
Collapse
Affiliation(s)
- Michael Paulzen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany Jülich Aachen Research Alliance, Translational Brain Medicine, Jülich/Aachen, Germany
| | - Ekkehard Haen
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Gerhard Gründer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany Jülich Aachen Research Alliance, Translational Brain Medicine, Jülich/Aachen, Germany
| | - Sarah E Lammertz
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany Jülich Aachen Research Alliance, Translational Brain Medicine, Jülich/Aachen, Germany
| | - Benedikt Stegmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany Department of Pharmacology and Toxicology, University of Regensburg, Regensburg, Germany
| | - Koen Rj Schruers
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | | | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany Jülich Aachen Research Alliance, Translational Brain Medicine, Jülich/Aachen, Germany University Hospital of Psychiatry, Bern, Switzerland
| |
Collapse
|
17
|
Citrome L, McEvoy JP, Saklad SR. A Guide to the Management of Clozapine-Related Tolerability and Safety Concerns. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2016:CSRP.SACI.070816. [PMID: 27454214 DOI: 10.3371/csrp.saci.070816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Clozapine is a highly effective antipsychotic medication, which provides a range of significant benefits for patients with schizophrenia, and is the standard of care for treatment-resistant schizophrenia as well as for reducing the risk of suicidal behaviors in schizophrenia and schizoaffective disorder. However, clozapine is widely underutilized, largely because prescribing clinicians lack experience in prescribing it and managing its adverse events (AEs). Clozapine is associated with 3 uncommon but immediately dangerous AEs, agranulocytosis, myocarditis/cardiomyopathy, and seizures, as well as AEs that may become dangerous if neglected, including weight gain, metabolic syndrome and constipation, and others that are annoying or distressing such as sedation, nighttime enuresis and hypersalivation. Because of the risk of agranulocytosis, clozapine formulations are available only through restricted distribution via a patient registry, with mandatory, systematized monitoring for absolute neutrophil count using a specific algorithm. We identified articles on managing clozapine-associated AEs by searching PubMed using appropriate keywords and search techniques for each topic. A review of the prevalence and clinical characteristics of clozapine-associated AEs shows that these risks can be managed efficiently and effectively. The absolute risks for both agranulocytosis and myocarditis/cardiomyopathy are low, diminish after the first 6 months, and are further reduced with appropriate monitoring. Weight gain/metabolic disorders and constipation, which develop more gradually, can be mitigated with regular monitoring and timely interventions. Sedation, hypersalivation, and enuresis are common but manageable with ameliorative measures and/or medications.
Collapse
Affiliation(s)
| | | | - Stephen R Saklad
- 3 College of Pharmacy, University of Texas at Austin, Austin, TX, USA
- 4 Pharmacotherapy Education and Research Center, UT Health Science Center San Antonio, San Antonio, TX, USA
| |
Collapse
|
18
|
Metabolic syndrome and obesity among users of second generation antipsychotics: A global challenge for modern psychopharmacology. Pharmacol Res 2015. [PMID: 26218604 DOI: 10.1016/j.phrs.2015.07.022] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Second generation antipsychotics (SGAs), such as clozapine, olanzapine, risperidone and quetiapine, are among the most effective therapies to stabilize symptoms schizophrenia (SZ) spectrum disorders. In fact, clozapine, olanzapine and risperidone have improved the quality of life of billions SZ patients worldwide. Based on the broad spectrum of efficacy and low risk of extrapyramidal symptoms displayed by SGAs, some regulatory agencies approved the use of SGAs in non-schizophrenic adults, children and adolescents suffering from a range of neuropsychiatric disorders. However, increasing number of reports have shown that SGAs are strongly associated with accelerated weight gain, insulin resistance, diabetes, dyslipidemia, and increased cardiovascular risk. These metabolic alterations can develop in as short as six months after the initiation of pharmacotherapy, which is now a controversial fact in public disclosure. Although the percentage of schizophrenic patients, the main target group of SGAs, is estimated in only 1% of the population, during the past ten years there was an exponential increase in the number of SGAs users, including millions of non-SZ patients. The scientific bases of SGAs metabolic side effects are not yet elucidated, but the evidence shows that the activation of transcriptional factor SRBP1c, the D1/D2 dopamine, GABA2 and 5HT neurotransmitions are implicated in the SGAs cardiovascular toxicity. Polypharmacological interventions are either non- or modestly effective in maintaining low cardiovascular risk in SGAs users. In this review we critically discuss the clinical and molecular evidence on metabolic alterations induced by SGAs, the evidence on the efficacy of classical antidiabetic drugs and the emerging concept of antidiabetic polyphenols as potential coadjutants in SGA-induced metabolic disorders.
Collapse
|