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Hrovatin K, Kunej T, Dolžan V. Genetic variability of serotonin pathway associated with schizophrenia onset, progression, and treatment. Am J Med Genet B Neuropsychiatr Genet 2020; 183:113-127. [PMID: 31674148 DOI: 10.1002/ajmg.b.32766] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 09/11/2019] [Accepted: 10/07/2019] [Indexed: 12/22/2022]
Abstract
Schizophrenia (SZ) onset and treatment outcome have important genetic components, however individual genes do not have strong effects on SZ phenotype. Therefore, it is important to use the pathway-based approach and study metabolic and signaling pathways, such as dopaminergic and serotonergic. Serotonin pathway has an important role in brain signaling, nevertheless, its role in SZ is not as thoroughly examined as that of dopamine pathway. In this study, we reviewed serotonin pathway genes and genetic variations associated with SZ, including variations at DNA, RNA, and epigenetic level. We obtained 30 serotonin pathway genes from Kyoto encyclopedia of genes and genomes and used these genes for the literature review. We extracted 20 protein coding serotonin pathway genes with genetic variations associated with SZ onset, development, and treatment from 31 research papers. Genes associated with SZ are present on all levels of serotonin pathway: serotonin synthesis, transport, receptor binding, intracellular signaling, and reuptake; however, regulatory genes are poorly researched. We summarized common challenges of genetic association studies and presented some solutions. The analysis of reported serotonin pathway-SZ associations revealed lack of information about certain serotonin pathway genes potentially associated with SZ. Furthermore, it is becoming clear that interactions among serotonin pathway genes and their regulators may bring further knowledge about their involvement in SZ.
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Affiliation(s)
- Karin Hrovatin
- University of Ljubljana, Biotechnical Faculty, Department of Animal Science, Ljubljana, Slovenia
| | - Tanja Kunej
- University of Ljubljana, Biotechnical Faculty, Department of Animal Science, Ljubljana, Slovenia
| | - Vita Dolžan
- University of Ljubljana, Faculty of Medicine, Institute of Biochemistry, Pharmacogenetics Laboratory, Ljubljana, Slovenia
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2
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Iqbal MM, Aneja A, Rahman A, Megna JL, Yasmin L, Schwartz TL, Osmany S, Alam MA. Therapeutic Options in the Treatment of Clozapine-Induced Adverse Effects. J Pharm Technol 2016. [DOI: 10.1177/875512250402000303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To review the therapeutic options in the management of clozapine-induced adverse effects. Data Sources: A MEDLINE search (from 1966 to present) was conducted, and English-language studies and review articles were retrieved to review the adverse effects of clozapine and their management. Study Selection and Data Extraction: All studies evaluating clozapine's adverse effects, such as agranulocytosis, seizures, neuroleptic malignant syndrome, hypersalivation, weight gain, sedation, fatigue, orthostatic hypotension, eosinophilia, delirium, new-onset diabetes, constipation, nausea, tachycardia, myocarditis, and pancreatitis, and their management were included. Data Synthesis: Clozapine, an atypical antipsychotic that has been proven effective and comparable, as well as superior, to conventional antipsychotics in treatment-resistant schizophrenia, is also being used in the treatment of a wide variety of other psychiatric conditions, including suicidal ideation, tardive dyskinesia, and affective disorders such as depression, bipolar disorders, and schizoaffective disorder. Although clozapine exhibits a markedly low incidence of extrapyramidal symptoms compared with similar medications, it has other adverse effects, some of which are potentially life threatening, requiring careful monitoring. The adverse effects of clozapine range from benign drooling, weight gain, nausea, and constipation, to life-threatening agranulocytosis, seizures, and neuroleptic malignant syndrome (NMS). Mandatory periodic white blood cell monitoring has resulted in dramatic reduction in mortality due to clozapine-induced agranulocytosis, promoting high adherence by patients. Prompt diagnosis and treatment of adverse effects of clozapine has also been effective in reducing complications, including mortality due to other serious adverse effects such as NMS and seizure. Other adverse effects are comparatively benign and can be managed effectively. Conclusions: Clozapine has a wide variety of adverse effects, some of which are potentially life threatening. Clinicians should be aware of possible severe complications and emergency management. Differentiating between minor and major adverse effects and initiating appropriate intervention is essential for a positive therapeutic outcome when prescribing clozapine.
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Affiliation(s)
- Mohammad Masud Iqbal
- MOHAMMAD MASUD IQBAL MD MPH MSPH DTM, Clinical Assistant Instructor, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY
| | - Alka Aneja
- ALKA ANEJA MD MA, Clinical Assistant Instructor, Department of Psychiatry, SUNY Upstate Medical University
| | - Atiq Rahman
- ATIQ RAHMAN MD DrPH MPH, Postdoctoral Fellow, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - James L Megna
- JAMES L MEGNA MD PhD, Assistant Professor, SUNY Upstate Medical University
| | - Laila Yasmin
- LAILA YASMIN MD MPH, Clinical Assistant Instructor, Department of Psychiatry, Elmhurst Hospital, Elmhurst, NY
| | - Thomas L Schwartz
- THOMAS L SCHWARTZ MD, Assistant Professor, Department of Psychiatry, SUNY Upstate Medical University
| | - Saabry Osmany
- SAABRY OSMANY MD, Clinical Assistant Instructor, Department of Nuclear Medicine, University of Alabama at Birmingham
| | - Mohammed Adnan Alam
- MOHAMMED ADNAN ALAM MD, Board Certified Psychiatrist, Alabama Psychiatric Service, Birmingham
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Ames D, Carr-Lopez SM, Gutierrez MA, Pierre JM, Rosen JA, Shakib S, Yudofsky LM. Detecting and Managing Adverse Effects of Antipsychotic Medications: Current State of Play. Psychiatr Clin North Am 2016; 39:275-311. [PMID: 27216904 DOI: 10.1016/j.psc.2016.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Antipsychotics are some of the most frequently prescribed medications not only for psychotic disorders and symptoms but also for a wide range of on-label and off-label indications. Because second-generation antipsychotics have largely replaced first-generation antipsychotics as first-line options due to their substantially decreased risk of extrapyramidal side effects, attention has shifted to other clinically concerning adverse events associated with antipsychotic therapy. The focus of this article is to update the nonextrapyramidal side effects associated with second-generation antipsychotics. Issues surrounding diagnosis and monitoring as well as clinical management are addressed.
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Affiliation(s)
- Donna Ames
- Department of Psychiatry, Psychosocial Rehabilitation and Recovery Center, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA; David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
| | - Sian M Carr-Lopez
- Pharmacy Service, Veterans Affairs Northern California Health Care System, 10535 Hospital Way, Mather, CA 95655, USA; Department of Pharmacy Practice, University of the Pacific, 3601 Pacific Avenue, Stockton, CA 95211, USA
| | - Mary A Gutierrez
- Chapman University School of Pharmacy, 9401 Jeronimo Road, Irvine, CA 92618, USA
| | - Joseph M Pierre
- Schizophrenia Treatment Unit, West Los Angeles VA Medical Center, Los Angeles, CA 90073, USA; Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Jennifer A Rosen
- Department of Pharmacy, Veterans Affairs Northern California Healthcare System, 150 Muir Road, Martinez, CA 94553, USA; University of the Pacific School of Pharmacy, 3601 Pacific Avenue, Stockton, CA 95211, USA; University of Southern California School of Pharmacy, 1985 Zonal Avenue, Los Angeles, CA 90089, USA
| | - Susan Shakib
- Thomas J. Long School of Pharmacy & Health Sciences, University of the Pacific 3601 Pacific Avenue, Stockton, CA 95211, USA; Department of Pharmacy, Veterans Affairs Long Beach Healthcare System, 5901 East 7th Street, Long Beach, CA 90822, USA
| | - Lynn M Yudofsky
- Semel Institute for Neuroscience & Human Behavior, UCLA, 760 Westwood Plaza, Suite C8-193, Los Angeles, CA 90024, USA
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Schwarz E, Steiner J, Guest PC, Bogerts B, Bahn S. Investigation of molecular serum profiles associated with predisposition to antipsychotic-induced weight gain. World J Biol Psychiatry 2015; 16:22-30. [PMID: 24001020 DOI: 10.3109/15622975.2013.817685] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Metabolic disturbances are major adverse side effects in the treatment of schizophrenia patients with antipsychotics. A substantial proportion of patients discontinue treatment with second-generation antipsychotics due to weight gain. The objective of this study was to investigate molecular factors predisposing patients to the development of such metabolic disturbances. METHODS We investigated whether serum molecules measured before treatment initiation were associated with subsequent weight gain following a 6-week treatment with antipsychotics. The concentrations of 191 molecules were measured longitudinally in serum from 77 schizophrenia patients using multiplex immunoassays. RESULTS This showed that the levels of 10 serum molecules at T0 were significantly associated with ΔBMI, which included interleukin-6 receptor, epidermal growth factor and thyroid stimulating hormone. CONCLUSIONS Our results suggest that patients who experience antipsychotic-induced weight gain have specific molecular alterations already prior to treatment. Further studies are required to validate and evaluate current findings in the context of response and side-effect development. This may ultimately lead to molecular tests that can aid in the selection of antipsychotic treatments.
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Affiliation(s)
- Emanuel Schwarz
- Department of Chemical Engineering and Biotechnology, University of Cambridge , Cambridge , UK
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Schneiderhan ME, Shuster SM, Davey CS. Twelve-month prospective randomized study of pharmacists utilizing point-of-care testing for metabolic syndrome and related conditions in subjects prescribed antipsychotics. Prim Care Companion CNS Disord 2014; 16:14m01669. [PMID: 25667811 DOI: 10.4088/pcc.14m01669] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Determine the percentage of subjects taking antipsychotics who meet criteria for metabolic syndrome based on point-of-care testing analyses. Evaluate pharmacist comprehensive medication management services using point-of-care tests to reduce the mean difference in number of metabolic syndrome risk parameters at 6 and 12 months. METHOD This 12-month, prospective, multisite, randomized, controlled study included 120 subjects taking antipsychotics (mean [SD] age of 42.9 [11.3] years) recruited from 3 community mental health clinics in Minnesota. Subjects consented to receive either pharmacist (PCS; n = 60) or no pharmacist (NCS; n = 60) comprehensive medication management services. Data were collected from February 2010 to January 2012. RESULTS No statistical differences in metabolic syndrome based on point-of-care tests were observed between the 2 groups at baseline (PCS: 85.2%, n = 46 versus NCS: 71.2%, n = 42, P = .073) or at 12 months (PCS: 84.4%, n = 38 versus NCS: 70.2%, n = 33, P = .104). Subjects, overall, screened positive at baseline for dyslipidemia (85.8%, n = 106), hypertension (52.5%, n = 63), and diabetes (22.5%, n = 27) based on point-of-care testing for metabolic risk criteria. After 12 months, a nonsignificant (P = .099) higher adjusted mean number of metabolic syndrome parameters in PCS subjects compared to NCS subjects (mean difference [95% CI] = 0.41 [-0.08 to 0.90]) were found. CONCLUSIONS A relatively high proportion of subjects met criteria for metabolic syndrome, although no significant improvement was observed between the groups after 12 months. Point-of-care test analyses identified a high proportion of subjects meeting criteria for dyslipidemia, hypertension, and diabetes. Utilizing point-of-care tests in mental health settings and fostering interprofessional partnerships with comprehensive medication management pharmacists may improve identification and long-term management of metabolic risks among patients prescribed antipsychotics. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02029989.
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Affiliation(s)
- Mark E Schneiderhan
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth (Dr Schneiderhan); St Luke's Hospital, Duluth, Minnesota (Dr Shuster); and Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis (Ms Davey)
| | - Sara M Shuster
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth (Dr Schneiderhan); St Luke's Hospital, Duluth, Minnesota (Dr Shuster); and Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis (Ms Davey)
| | - Cynthia S Davey
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth (Dr Schneiderhan); St Luke's Hospital, Duluth, Minnesota (Dr Shuster); and Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis (Ms Davey)
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Zugno AI, Barcelos M, Oliveira LD, Canever L, Luca RDD, Fraga DB, Matos MP, Rezin GT, Scaini G, Búrigo M, Streck EL, Quevedo J. Energy metabolism, leptin, and biochemical parameters are altered in rats subjected to the chronic administration of olanzapine. BRAZILIAN JOURNAL OF PSYCHIATRY 2012; 34:168-75. [DOI: 10.1590/s1516-44462012000200009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 08/06/2011] [Indexed: 01/07/2023]
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Health management of older persons with chronically medicated psychotic disorders: the results of a survey in France. Int Psychogeriatr 2012; 24:496-502. [PMID: 21835072 DOI: 10.1017/s1041610211001487] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The medical care of elderly patients with psychotic disorders is a matter of major concern. The aim of the study was to investigate health conditions and treatment of elderly patients with psychotic disorders in France. METHODS The SAGE (Schizophrenia AGEd) study (observational, cross-sectional) was a survey conducted among 123 physicians in France, regarding prescriptions of antipsychotic drugs in elderly patients (≥60 years) suffering from psychotic disorders. The survey was based on a questionnaire addressing the mental and somatic health management of the patients. RESULTS Data from 930 patients (mean age: 70.4 years) were collected. Most patients (58.5%) suffered from schizophrenia, 20.8% had delusional disorder and 20.6% hallucinatory chronic psychosis (very-late-onset schizophrenia-like psychosis). 70.8% of them were outpatients, while 29.2% were inpatients. The severity of psychotic symptoms was assessed in 97.8% of patients, but cognitive function was only evaluated in 41.6%. Some 46.5% of patients were treated with atypical antipsychotics alone, 36.2% with classical antipsychotics alone and 17.3% received a combination of both, atypical and classical antipsychotics; 36.3% patients were given antiparkinsonian medication, of whom only 17.8% as preventive treatment; 51.1% of patients had somatic comorbidities, particularly cardiovascular disorders (34.0%). Evaluation of renal and/or liver function to adjust the dose of treatment was done in only 32.1% of patients. Over the previous 12 months, almost half of the patients had had no ECG, glycemia or creatininemia investigated and HDL-cholesterol and triglycerides were available for less than one-third of them. CONCLUSIONS Antipsychotic and antiparkinsonian drug prescriptions in French aged psychotic patients follow only partially the clinical guidelines and recommendations of consensus conferences. Moreover, cognitive, cardiac and metabolic aspects are not fully managed as expected.
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Motsinger C, Slack M, Weaver M, Reed M. Physician patterns of metabolic screening for patients taking atypical antipsychotics: a retrospective database study. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 8:220-3. [PMID: 16964317 PMCID: PMC1557474 DOI: 10.4088/pcc.v08n0405] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Accepted: 12/15/2005] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this retrospective database study was to determine rates of screening for metabolic side effects by physician specialty in community hospital patients prescribed atypical antipsychotics. METHOD A pharmacy database review identified patients who were prescribed atypical antipsychotics over a 6-month period from July 1, 2004, to December 31, 2004. This list of patients was then cross-referenced with the laboratory database to determine if screening laboratory tests for metabolic abnormalities had been ordered. RESULTS 13% of patients prescribed atypical antipsychotics had fasting blood glucose levels measured during the study period. 30% of patients prescribed atypical antipsychotics also had lipid panels measured during the study period. Screening rates varied by specialty of physician. Physicians trained in combined family practice and psychiatry had the highest rate of screening, followed by other nonpsychiatric specialties. Psychiatrists had the lowest rate of screening. CONCLUSIONS The rate of screening for metabolic side effects of atypical antipsychotics in this community hospital setting was low.
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Affiliation(s)
- Charles Motsinger
- National Capital Area Consortium, Combined Family Practice and Psychiatry Residency, MD, USA.
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McCloughen A, Foster K. Weight gain associated with taking psychotropic medication: an integrative review. Int J Ment Health Nurs 2011; 20:202-22. [PMID: 21492360 DOI: 10.1111/j.1447-0349.2010.00721.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
People with serious mental illness have higher morbidity and mortality rates than general populations, and overweight/obesity-related conditions are prevalent. Psychotropic medications are a primary factor in significant weight gain. Adolescents and young adults, particularly those with first-episode psychoses taking atypical antipsychotics, are susceptible to weight gain. This paper reports findings from an integrative review of research investigating the impact and treatment of psychotropic-induced weight gain. Four databases were searched, yielding 522 papers. From these and hand-searched papers, 36 research reports were systematically classified and analysed. The review revealed people experiencing psychotropic-induced weight gain perceive it as distressing. It impacts on quality of life and contributes to treatment non-adherence. Weight management and prevention strategies have primarily targeted adults with existing/chronic illness rather than those with first-episode psychoses and/or drug naiveté. Single and multimodal interventions to prevent or manage weight gain produced comparable, modest results. This review highlights that the effectiveness of weight management interventions is not fully known, and there is a lack of information regarding weight gain prevention for young people taking psychotropics. Future research directions include exploring the needs of young people regarding psychotropic-related weight gain and long-term, follow-up studies of lifestyle interventions to prevent psychotropic-related weight gain.
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Affiliation(s)
- Andrea McCloughen
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia.
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Abstract
Patients with schizophrenia have a greater incidence of being overweight or obese compared with the general population. Such individuals are often treated with second-generation (atypical) antipsychotics (SGAs), which are associated with weight gain, dyslipidemia, and other metabolic derangements. As a result, frequent monitoring of weight and other metabolic parameters is recommended. In addition, several pharmacologic strategies to help prevent or reduce SGA-induced weight gain have been proposed. Despite this, clinicians often struggle to manage obesity and metabolic issues in such patients. Metformin has attracted attention as a potential treatment option because it is thought to result in weight reduction and improved glycemic control in obese patients with and without type 2 diabetes mellitus. This article focuses on relevant pharmacologic aspects of metformin and reviews currently available evidence on the use of metformin as an augmentation agent for the treatment or prevention of SGA-induced weight gain.
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Abstract
AIM To assess the degree of compliance and adherence to treatment during the follow-up of schizophrenic outpatients after a new therapeutic strategy had been initiated. METHODS A multicenter, retrospective, prospective, observational study of 1,848 outpatients with schizophrenia or schizoaffective disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) was conducted. Patients were treated either with oral or injectable conventional or second generation antipsychotics, and were followed up for 3 months at mental health centers. Patient compliance with the pharmacological treatment was assessed by the use of questionnaires, scales, medication accountability, and the Medication Event Monitoring System. Patients were considered compliant if they reported a high compliance rate (> or = 80%). RESULTS At baseline only 29% of patients on oral medication were compliant compared with 79% of patients on injectable medication (injection counting) (OR= 9.11; 95% CI 6.02-13.77; P<.0001). At the 3 month visit, 84% of patients had changed their treatment and in these, the compliance rate of those on injectable medication was 94% versus 87% of patients taking oral medication (OR= 2.47; 95% CI 1.21-5.05; P=.022). CONCLUSION The use of long-acting injectable antipsychotics, which improves compliance rates and patient follow-up, should facilitate the management of Spanish patients with schizophrenia in mental health centers.
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Primary healthcare for people with mental health problems or learning disabilities. Health Policy 2008; 86:325-34. [DOI: 10.1016/j.healthpol.2007.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 11/19/2007] [Accepted: 11/22/2007] [Indexed: 11/15/2022]
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Buckley PF, Wirshing DA, Bhushan P, Pierre JM, Resnick SA, Wirshing WC. Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs 2007; 21:129-41. [PMID: 17284095 DOI: 10.2165/00023210-200721020-00004] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
People with schizophrenia commonly lack insight, that is, they are unaware of their illness and the consequences thereof. One of the most important consequences of lack of insight is a failure to recognise the need for treatment, leading to treatment nonadherence. With several scales that now enable objective measurement of insight, it is possible to examine correlates of insight change, including course of illness and treatment adherence. Specific interventions, both pharmacological and psychotherapeutic, have been developed to enhance illness insight and treatment adherence. The extent to which second-generation antipsychotic medications, including a recently released long-acting formulation, improve insight and/or enhance treatment adherence remains to be determined.
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Affiliation(s)
- Peter F Buckley
- Department of Psychiatry, Medical College of Georgia, 1515 Pope Avenue, Augusta, Georgia 30912, USA.
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Usher K, Foster K, Park T. The metabolic syndrome and schizophrenia: the latest evidence and nursing guidelines for management. J Psychiatr Ment Health Nurs 2006; 13:730-4. [PMID: 17087676 DOI: 10.1111/j.1365-2850.2006.01026.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The introduction of second-generation antipsychotic drugs for the treatment of schizophrenia has provided significant benefits for clients experiencing this disorder. While they have been found effective in reducing psychotic symptoms, there is evidence that these drugs are also linked with a group of side effects commonly known as the metabolic syndrome. Mental health nurses are well positioned to prevent, detect and/or manage the development of this problematic constellation of symptoms. Guidelines for practice can be useful in prevention and management of the syndrome and enhance nursing care of clients who are taking second-generation antipsychotics.
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Affiliation(s)
- K Usher
- School of Nursing Sciences, James Cook University, Townsville, Qld, Australia.
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Joukamaa M, Heliövaara M, Knekt P, Aromaa A, Raitasalo R, Lehtinen V. Schizophrenia, neuroleptic medication and mortality. Br J Psychiatry 2006; 188:122-7. [PMID: 16449697 DOI: 10.1192/bjp.188.2.122] [Citation(s) in RCA: 244] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is an excess of death from natural causes among people with schizophrenia. AIMS Schizophrenia and its treatment with neuroleptics were studied for their prediction of mortality in a representative population sample of 7217 Finns aged >/= 30 years. METHOD A comprehensive health examination was carried out at baseline. Schizophrenia was determined using the Present State Examination and previous medical records. RESULTS During a 17-year follow-up, 39 of the 99 people with schizophrenia died. Adjusted for age and gender, the relative mortality risk between those with schizophrenia and others was 2.84 (95% CI 2.06-3.90), and was 2.25 (95% CI1.61-3.15) after further adjusting for somatic diseases, bloodpressure, cholesterol, body mass index, smoking, exercise, alcohol intake and education. The number of neuroleptics used at the time of the baseline survey showed a graded relation to mortality. Adjusted for age, gender, somatic diseases and other potential risk factors for premature death, the relative risk was 2.50 (95% CI1.46-4.30) per increment of one neuroleptic. CONCLUSIONS There is an urgent need to ascertain whether the high mortality in schizophrenia is attributable to the disorder itself or the antipsychotic medication.
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Affiliation(s)
- Matti Joukamaa
- Department of Social Psychiatry, Tampere School of Public Health, University of Tampere, FIN-33014, Finland.
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Smith DA, Buckley PF. Pharmacotherapy of delusional disorders in the context of offending and the potential for compulsory treatment. BEHAVIORAL SCIENCES & THE LAW 2006; 24:351-67. [PMID: 16705664 DOI: 10.1002/bsl.683] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Delusional disorder is an uncommon mental illness with an estimated prevalence of 0.03%. Its low prevalence has likely contributed to the paucity of research interest in this area, leading to substantial gaps in knowledge concerning its treatment and management. In the absence of a robust literature, most clinicians rely on their experience and guidelines for treating schizophrenia when treating patients with delusional disorder. This article reviews the available literature that is specific to the treatment of delusional disorder. In addition, it focuses on specific forensic and medicolegal aspects of managing patients with delusional disorder.
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McDermott S, Moran R, Platt T, Isaac T, Wood H, Dasari S. Heart disease, schizophrenia, and affective psychoses: epidemiology of risk in primary care. Community Ment Health J 2005; 41:747-55. [PMID: 16328587 DOI: 10.1007/s10597-005-6431-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A retrospective cohort design was used to study risk factors and cardiovascular end points among adults, with and without psychoses, receiving primary care. Earlier onset of risk factors and heart disease was noted among individuals with schizophrenia compared to those with affective psychoses and no disabilities. Patients with schizophrenia had increased relative risk for obesity, congestive heart failure, dementia, depression and death, while patients with affective psychoses had increased risk for dementia and diabetes.
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Affiliation(s)
- Suzanne McDermott
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, USA.
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Abstract
The treatment of schizophrenia changed drastically with the discovery of antipsychotic medications in the 1950s, the release of clozapine in the US in 1989 and the subsequent development of the atypical or novel antipsychotics. These newer medications differ from their conventional counterparts, primarily based on their reduced risk of extrapyramidal symptoms (EPS). EPS can be categorised as acute (dystonia, akathisia and parkinsonism) and tardive (tardive dyskinesia and tardive dystonia) syndromes. They are thought to have a significant impact on subjective tolerability and adherence with antipsychotic therapy in addition to impacting function. Unlike conventional antipsychotic medications, atypical antipsychotics have a significantly diminished risk of inducing acute EPS at recommended dose ranges. These drugs may also have a reduced risk of causing tardive dyskinesia and in some cases may have the ability to suppress pre-existing tardive dyskinesia. This paper reviews the available evidence regarding the incidence of acute EPS and tardive syndromes with atypical antipsychotic therapy. Estimates of incidence are subject to several confounds, including differing methods for detection and diagnosis of EPS, pretreatment effects and issues surrounding the administration of antipsychotic medications. The treatment of acute EPS and tardive dyskinesia now includes atypical antipsychotic therapy itself, although other adjunctive strategies such as antioxidants have also shown promise in preliminary trials. The use of atypical antipsychotics as first line therapy for the treatment of schizophrenia is based largely on their reduced risk of EPS compared with conventional antipsychotics. Nevertheless, EPS with these drugs can occur, particularly when prescribed at high doses. The EPS advantages offered by the atypical antipsychotics must be balanced against other important adverse effects, such as weight gain and diabetes mellitus, now known to be associated with these drugs.
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Affiliation(s)
- Joseph M Pierre
- David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
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Affiliation(s)
- Prakash S Masand
- Duke University Medical Center, 110 Swift Avenue, Suite 1, Durham, NC 27705, USA.
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MacDonald ML, Eaton ME, Dudman JT, Konradi C. Antipsychotic drugs elevate mRNA levels of presynaptic proteins in the frontal cortex of the rat. Biol Psychiatry 2005; 57:1041-51. [PMID: 15860345 PMCID: PMC2734482 DOI: 10.1016/j.biopsych.2005.01.022] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Revised: 09/14/2004] [Accepted: 01/13/2005] [Indexed: 02/01/2023]
Abstract
BACKGROUND Molecular adaptations are believed to contribute to the mechanism of action of antipsychotic drugs (APDs). We attempted to establish common gene regulation patterns induced by chronic treatment with APDs. METHODS Gene expression analysis was performed with the Affymetrix U34A array in the frontal cortex (FC) and the striatum of rats chronically treated with two concentrations of either clozapine or haloperidol. Key data were verified with real-time quantitative polymerase chain reaction. RESULTS Many genes in the FC affected by APD-treatment contribute to similar functions. mRNAs coding for synaptic vesicle docking- and microtubule-associated proteins were upregulated; mRNAs for serine-threonine protein phosphatases were downregulated, whereas the serine-threonine kinases protein kinase A, protein kinase C, and calcium/calmodulin kinase II alpha and IV were upregulated, indicating increased potential for protein phosphorylation. In the striatum, altered gene expression was less focused on genes of particular function or location, and the high concentration of haloperidol had a different gene expression profile than any of the other APD treatments. CONCLUSION We found an increase in the transcription of genes coding for proteins involved in synaptic plasticity and synaptic activity in the FC. We furthermore found that the gene expression profile of APDs is different between FC and striatum.
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Affiliation(s)
| | - Molly E. Eaton
- Laboratory of Neuroplasticity, McLean Hospital, Belmont, MA02478
| | - Joshua T. Dudman
- Laboratory of Neuroplasticity, McLean Hospital, Belmont, MA02478
| | - Christine Konradi
- Laboratory of Neuroplasticity, McLean Hospital, Belmont, MA02478
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115
- to whom correspondence should be addressed at: Laboratory of Neuroplasticity, McLean Hospital, 115 Mill Street, Belmont, MA 02478, Tel: 617 855 2052, Fax: 617 855 2023, e-mail:
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Chafetz L, White MC, Collins-Bride G, Nickens J. The poor general health of the severely mentally ill: impact of schizophrenic diagnosis. Community Ment Health J 2005; 41:169-84. [PMID: 15974497 DOI: 10.1007/s10597-005-2651-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study focused on poor health among the severely mentally ill and additional risks associated with schizophrenia. Records of 781 clients in short-term residential treatment programs provided data. The schizophrenic subgroup was compared to others in bivariate analyses, with significant findings included in logistic regression. Those with schizophrenia were more likely to be male, unemployed, and insured by MediCal/Medicare. Most health problems occurred at similar rates across diagnoses, reflecting common environmental risk factors. Those with schizophrenia had less substance abuse and fewer liver conditions, but more diabetes and chronic respiratory problems. Implications for providers and for research are discussed.
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Affiliation(s)
- Linda Chafetz
- University of California, San Francisco Community Health Systems, School of Nursing, USA.
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Riedel M, Strassnig M, Müller N, Zwack P, Möller HJ. How representative of everyday clinical populations are schizophrenia patients enrolled in clinical trials? Eur Arch Psychiatry Clin Neurosci 2005; 255:143-8. [PMID: 15549345 DOI: 10.1007/s00406-004-0547-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Accepted: 09/03/2004] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There has been considerable discussion whether clinical trials accurately depict everyday practice. Restrictive inclusion/exclusion criteria, ethical considerations, differences in the severity of psychopathology between clinical and trial patients, or safety issues may bias results, which in turn may rather represent outcome for the "ideal" than for the "average"patient. Therefore, translation into psychiatric practice may be difficult. METHODS A retrospective case-control study was performed. Schizophrenia inpatients at the LMU Department of Psychiatry, Munich, Germany, who had participated in clinical trials were compared to regular patients serving as controls. Probands and controls were matched by DSM-IV diagnosis, gender and age. The AMDP module, CGI and GAF were used to compare psychopathology. In addition, charts were reviewed for medication dosages, concurrent medical and neurological illness, and clinical history such as age of onset or family history. RESULTS A total of 200 probands (100/100) were enrolled in the study. With respect to psychopathology, formally thought disordered or suicidal patients were significantly less likely to be study participants (n = 3) than controls (n = 22; p < or = 0.05). Similarly, negative schizophrenia symptoms were significantly less often present in study participants (n = 17) than in controls (n = 38; p < or = 0.05). Study participants were also medically and neurologically healthier than controls. (p = 0.05 respectively). No differences in overall illness severity as depicted by CGI and GAF were observed. CONCLUSION We found the patients included in our clinical trials representative of the patient encountered in routine clinical practice. Adherence to inclusion and exclusion criteria prevents inclusion of severely ill (e. g. suicidal) patients requiring a more intensive treatment setting. Illness severity was found to be similar in trial participants and controls, and indicates an overall comparably severe psychopathology. The more chronic, rather treatment refractory patients were also not reflected in the trial participant pool; this population may arguably not represent the average clinical patient either. A more careful administration of antipsychotic medication was found in trial participants and may effectively be considered "good clinical practice".
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Affiliation(s)
- M Riedel
- Ludwig-Maximilians-University Munich, Dept. of Psychiatry and Psychotherapy, Nussbaumstrasse 7, 80336 Munich, Germany.
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Mahoney WJ. The aggressive and impulsive child: Innovations in assessment and treatment - A commentary. Paediatr Child Health 2004; 9:537-538. [PMID: 19680479 DOI: 10.1093/pch/9.8.537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Psychotic symptoms frequently occur in patients with comorbid medical disorders and present a diagnostic and treatment challenge. They may be a part of an independent psychiatric illness associated with the underlying medical condition or induced by substance use or medications. The presence of psychotic symptoms can contribute to misdiagnosis or complicate the management of the comorbid medical illness. Psychiatrists must be familiar with the assessment and management of psychotic disorders in patients with comorbid medical disorders. Medications that may be used to treat psychosis include antipsychotic agents, benzodiazepines, or possibly certain anticonvulsants. Selecting the appropriate medication requires knowledge of the pharmacokinetics of different agents and their side effect profile. Understanding the neuropsychiatric effects of medications and drug-drug interactions may help in preventing psychotic symptoms.
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Affiliation(s)
- Ashwin A Patkar
- Section of Biological Psychiatry and Clinical Trials, Thomas Jefferson University, 33 South 9th Street, Suite 210E, Philadelphia, PA 19107, USA.
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Abstract
OBJECTIVE To selectively review the literature on obesity in people with schizophrenia. CONCLUSIONS Obesity is a common problem for people with schizophrenia, with an estimated 40-60% of this population being obese or overweight. Obesity among the mentally ill may contribute to adverse medical and psychological consequences as well as medication non-compliance and poorer quality and enjoyment of life. This review discusses the issues related to obesity in schizophrenia and the role of pharmacological and behavioural treatments in the reduction of obesity and maintenance of gains.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2003; 12:617-32. [PMID: 14558186 DOI: 10.1002/pds.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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