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Mutwalli H, Keeler JL, Bektas S, Dhopatkar N, Treasure J, Himmerich H. Eating cognitions, emotions and behaviour under treatment with second generation antipsychotics: A systematic review and meta-analysis. J Psychiatr Res 2023; 160:137-162. [PMID: 36804110 PMCID: PMC10682412 DOI: 10.1016/j.jpsychires.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
Weight gain and metabolic disturbances are frequent in people treated with second generation antipsychotics (SGA). We aimed to investigate the effect of SGAs on eating behaviors, cognitions and emotions, as a possible contributor to this adverse effect. A systematic review and a meta-analysis were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Original articles measuring outcomes relating to eating cognitions, behaviours and emotions, during treatment with SGAs were included in this review. A total of 92 papers with 11,274 participants were included from three scientific databases (PubMed, Web of Science and PsycInfo). Results were synthesized descriptively except for the continuous data where meta-analyses were performed and for the binary data where odds ratios were calculated. Hunger was increased in participants treated with SGAs with an odds ratio for appetite increase of 1.51 (95% CI [1.04, 1.97]; z = 6.40; p < 0.001). Compared to controls, our results showed that craving for fat and carbohydrates are the highest among other craving subscales. There was a small increase in dietary disinhibition (SMD = 0.40) and restrained eating (SMD = 0.43) in participants treated with SGAs compared to controls and substantial heterogeneity across studies reporting these eating traits. There were few studies examining other eating-related outcomes such as food addiction, satiety, fullness, caloric intake and dietary quality and habits. Understanding the mechanisms associated with appetite and eating-related psychopathology changes in patients treated with antipsychotics is needed to reliably inform the development of effective preventative strategies.
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Affiliation(s)
- Hiba Mutwalli
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Clinical Nutrition, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sevgi Bektas
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychology, Hacettepe University, Ankara, Turkey
| | - Namrata Dhopatkar
- Eating Disorders Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust (SLaM), London, UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Eating Disorders Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust (SLaM), London, UK
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Eating Disorders Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust (SLaM), London, UK
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Besag FM, Vasey MJ, Lao KS, Chowdhury U, Stern JS. Pharmacological treatment for Tourette syndrome in children and adults: What is the quality of the evidence? A systematic review. J Psychopharmacol 2021; 35:1037-1061. [PMID: 34286606 DOI: 10.1177/02698811211032445] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tourette syndrome (TS) is a neurodevelopmental disorder characterised by involuntary muscle movements manifesting as motor and vocal tics. In the majority, tics are manageable without medication. Where tics cause discomfort or impair function, behavioural or pharmaceutical treatments may be considered. AIMS To provide a meticulous examination of the quality of evidence for the current pharmacological treatments for TS. METHODS PubMed and Google Scholar were searched to identify randomised, placebo-controlled trials (RCTs) of aripiprazole, risperidone, clonidine, guanfacine, haloperidol, pimozide, tiapride and sulpiride for the treatment of tics in children and adults with TS. Quality of reporting and risk of bias were assessed against the CONSORT checklist and Cochrane risk of bias criteria, respectively. RESULTS Seventeen RCTs were identified. Response rates reached 88.6% for aripiprazole, 68.9% for clonidine, 62.5% for risperidone and 19% for guanfacine. Statistically significant improvements were reported for all medications compared to placebo in at least one study and for at least one measure of tic severity. Most studies predated the CONSORT and Cochrane criteria and did not score highly when assessed on these measures. CONCLUSIONS There are relatively few placebo-controlled trials of commonly prescribed medications. Studies are often of poor quality and short duration. There is evidence for the efficacy of each medication, but no drug is clearly superior. Clonidine and guanfacine are better tolerated than antipsychotics, but less effective. There is too little evidence to determine whether adults respond differently from children.
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Affiliation(s)
- Frank Mc Besag
- East London NHS Foundation Trust, Bedford, UK.,University College London, London, UK.,King's College London, UK
| | | | - Kim Sj Lao
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Uttom Chowdhury
- Child and Adolescent Mental Health Services, East London NHS Foundation Trust, Dunstable, Bedfordshire, UK
| | - Jeremy S Stern
- St George's Hospital Neurology, London, UK.,Tourettes Action, Farnborough, Hampshire, UK
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The clinical intervention choice for pediatric tic disorder patients from a tertiary children's hospital in China: a large-scale retrospective study based on electronic medical records. Int Clin Psychopharmacol 2021; 36:208-213. [PMID: 34030167 DOI: 10.1097/yic.0000000000000362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pharmacological intervention played an important role in the management of tic disorder. Large-scale prescription data for pediatric tic disorder patients in the real-world setting were scarce. The demographic and prescription data of tic disorder were extracted from the electronic medical records database of Beijing Children's Hospital from 2018 to 2020. The intervention choice for outpatient pediatric tic disorder patients was analyzed. A total of 20 417 patients were included, 28.1% (n = 5028) of them did not receive any pharmacological treatment. Over 70% were prescribed with anti-tic medication. For children less than 6 years of age, clonidine adhesive patches (CAPs) and traditional Chinese medicine (TCM) were the common choice. With the age growing, the use of antipsychotics was on the rise; 22% (n = 3389) were prescribed for at least two anti-tic medication, and the most common medication combination group was tiapride and TCM (33.7%), followed by CAP and TCM (22.1%). The clinical intervention choice for tic disorder is highly individualized. The pharmacological choice was influenced by severity, duration of symptom, age, the acceptance of parents and other factors.
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Abstract
Introduction: Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple tics which often persisting in forms of different severity throughout adult life. The prevalence of neuropsychiatric co-morbidity in patients with TS is high. Treatment of TS can involve pharmacological, behavioral, or, in rare cases, surgical therapies. Over the last two decades there has been growing interest in the use of aripiprazole, a novel partial dopamine receptor agonist, as a promising anti-tic agent.Areas covered: The authors reviewed the available literature evaluating the role of aripiprazole in the treatment of TS and other tic disorders in both children and adults. This includes data from five randomized controlled trials (RCTs) and eleven open-label studies.Expert opinion: There is moderate quality evidence supporting the use of aripiprazole in reducing tic severity in children and adolescents, however there is a lack of robust evidence evaluating its use in adults, despite expert consensus. Overall, it appears that aripiprazole is a safe and effective treatment for tics. Further large scale RCTs assessing the long-term efficacy and safety of aripiprazole in the treatment of tics are warranted, especially in adult populations with TS.
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Affiliation(s)
- Joanna H Cox
- Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, UK.,School of Life and Health Sciences, Aston University, Birmingham, UK.,University College London and Institute of Neurology, London, UK
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Iasevoli F, Barone A, Buonaguro EF, Vellucci L, de Bartolomeis A. Safety and tolerability of antipsychotic agents in neurodevelopmental disorders: a systematic review. Expert Opin Drug Saf 2020; 19:1419-1444. [DOI: 10.1080/14740338.2020.1820985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Felice Iasevoli
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Annarita Barone
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Elisabetta Filomena Buonaguro
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Licia Vellucci
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
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Zelnik N. Drug and Non-drug Treatment of Tourette Syndrome. CURRENT DRUG THERAPY 2020. [DOI: 10.2174/1574885514666191121141923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by multiple repetitive motor and vocal tics. In most patients, its clinical course has a waxing and waning nature and most patients, usually children, will benefit from tolerant environmental and psychoeducation. Patients with more complicated tics, in particular, those with significant comorbidities will require drug therapy.Objective:The present paper is a mini-review of the current therapeutic arsenal for TS with reference to drug and non-drug management approach.Methods:A systematic survey of medical literature regarding the treatment decision making and the reported clinical trials or accumulating experience with different medications or other therapeutic modalities which were proven beneficial over the years.Results:Reviewing the literature indicates that dopamine antagonists, such as haloperidol and pimozoide, are the most reliable agents in terms of treatment response. Due to numerous adverse effects, newer atypical anti-psychotic drugs have been shown effective. Other widely accepted medications include alpha-2 adrenergic agonists, benzamides, dopamine depleting agents, benzodiazepines and dopamine depleting agents. In more selective and intractable cases botulinum toxin, dopamine agonists and cannabinoids should be also considered. Non-pharmacologic therapies reported beneficial effects, which include on the one hand, non-invasive behavioral techniques, such as comprehensive behavior therapy for tics. While on the other hand, in cases with particular protracted pharmaco-resistant tics electric stimulation techniques, such as deep brain stimulation, have been shown to be successful.Conclusion:Currently, there are numerous multifarious options for treatment of tics and other comorbid symptoms of TS. Nevertheless, treatment options and decision-making algorithms are still a clinical challenge.Area Covered:A step by step decision-making and various drugs and non-pharmacologic modalities appropriate for the management of TS.
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Affiliation(s)
- Nathanel Zelnik
- Child Neurology and Development, Carmel Medical Center & Clalit Health Services, Haifa District, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Liu ZS, Cui YH, Sun D, Lu Q, Jiang YW, Jiang L, Wang JQ, Luo R, Fang F, Zhou SZ, Wang Y, Cai FC, Lin Q, Xiong L, Zheng Y, Qin J. Current Status, Diagnosis, and Treatment Recommendation for Tic Disorders in China. Front Psychiatry 2020; 11:774. [PMID: 32903695 PMCID: PMC7438753 DOI: 10.3389/fpsyt.2020.00774] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/21/2020] [Indexed: 12/19/2022] Open
Abstract
Tic disorders (TD) are a group neuropsychiatric disorders with childhood onset characterized by tics, i.e. repetitive, sudden, and involuntary movements or vocalizations; and Tourette syndrome (TS) is the most severe form of TD. Their clinical manifestations are diverse; and are often associated with various psychopathological and/or behavioral comorbidities, including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, depression, and sleep disorders. Individual severity and response to treatment are highly variable, and there are some refractory cases, which are less responsive to conventional TD treatment. TD/TS are also common in the Chinese pediatric population. To help improve the understanding of TD for pediatricians and other health professionals, and to improve its diagnosis and treatment in China, the Chinese Child Neurology Society (CCNS) has developed an Expert Consensus on Diagnosis and Treatment of TD in China, which is based on our clinical experience and the availability therapeutic avenues. It is focused on clinical diagnosis and evaluation of TD and its comorbidities, psychological and educational intervention, nonpharmacological therapy, pharmacological treatment, including traditional Chinese medicine and acupuncture, as well as prognosis in children with TD in China. A summary of the current status of TD and up-to-date diagnosis and treatment recommendations for TD in China is presented here.
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Affiliation(s)
- Zhi-Sheng Liu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong-Hua Cui
- Department of Neurology and Psychiatry, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Dan Sun
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Lu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Wu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jia-Qin Wang
- Department of Pediatrics, Third Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Rong Luo
- Department of Pediatrics, Huaxi Second Hospital of Sichuan University, Chengdu, China
| | - Fang Fang
- Department of Neurology and Psychiatry, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Shui-Zhen Zhou
- Department of Neurology, Pediatric Hospital Affiliated to Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, Pediatric Hospital Affiliated to Fudan University, Shanghai, China
| | - Fang-Cheng Cai
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Lin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Lan Xiong
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Yi Zheng
- Department of Pediatrics, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
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Yang C, Yi Q, Zhang L, Cui H, Mao J. Safety of aripiprazole for tics in children and adolescents: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15816. [PMID: 31145316 PMCID: PMC6709053 DOI: 10.1097/md.0000000000015816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Aripiprazole is widely used in the management of tic disorders (TDs), we aimed to assess the safety of aripiprazole for TDs in children and adolescents. METHODS A systematic literature review was performed in the databases of MEDLINE, Embase, the Cochrane Library and 4 Chinese databases, from inception to February 2019. All types of studies evaluating the safety of aripiprazole for TDs were included. The quality of studies was assessed using the Cochrane Risk of Bias tool, the Newcastle-Ottawa Scale tool, the National Institute of Clinical Excellence, the CARE (Case Report) guidelines according to types of studies. Risk ratio (RR) and incidence rate with a 95% confidence interval (CI) were used to summarize the results. RESULTS A total 50 studies involving 2604 children met the inclusion criteria. The result of meta-analysis of randomized controlled trials showed that there was a significant difference between aripiprazole and haloperidol with respect to rate of somnolence (RR = 0.596, 95% CI: 0.394, 0.901), extrapyramidal symptoms (RR = 0.236, 95% CI: 0.111, 0.505), tremor (RR = 0.255, 95% CI: 0.114, 0.571), constipation (RR = 0.148, 95% CI: 0.040, 0.553), and dry mouth (RR = 0.141, 95% CI: 0.046, 0.425). There was a significant difference between aripiprazole and placebo in the incidence rate of adverse events (AEs) for somnolence (RR = 6.565, 95% CI: 1.270, 33.945). The meta-analysis of incidence of AEs related to aripiprazole for case series studies revealed that the incidence of sedation was 26.9% (95% CI: 16.3%, 44.4%), irritability 25% (95% CI: 9.4%, 66.6%), restlessness 31.3% (95% CI: 13%, 75.1%), nausea and vomiting 28.9% (95% CI: 21.1%, 39.5%), and weight gain 31.3% (95% CI: 10.7%, 91.3%). CONCLUSION Aripiprazole was generally well tolerated in children and adolescents. Common AEs were somnolence, headache, sedation, nausea, and vomiting. Further high-quality studies are needed to confirm the safety of aripiprazole for children and adolescents with TDs.
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Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Qiusha Yi
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- West China School of Medicine
| | - Lingli Zhang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Hao Cui
- Department of Pediatric Neurology, West China Hospital, Sichuan University, Chengdu
- Department of Health, Zhuhai Maternity and Child Health Hospital, Zhuhai, Guangdong, China
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Mogwitz S, Buse J, Wolff N, Roessner V. Update on the Pharmacological Treatment of Tics with Dopamine-Modulating Agents. ACS Chem Neurosci 2018; 9:651-672. [PMID: 29498507 DOI: 10.1021/acschemneuro.7b00460] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
More than 40 years of research and clinical practice have proven the effectiveness of dopamine receptor antagonists in the pharmacological treatment of tics. A blockade of the striatal dopamine-D2 receptors is mainly responsible for their tic-reducing effect. A broad spectrum of dopamine-modulating agents, such as typical and atypical antipsychotics, but also dopamine receptor agonists are used with an immanent discord between experts about which of them should be considered as first choice. The present Review outlines the state of the art on pharmacological treatment of tics with dopamine-modulating agents by giving an systematic overview of studies on their effectiveness and a critical discussion of their specific adverse effects. It is considered as an update of a previous review of our research group published in 2013. The Review closes with a description of the current resulting treatment recommendations including the results of a first published revised survey on European expert's prescription preferences. Based on the enormously growing evidence on its effectiveness and safety, aripiprazole currently seems to be the most promising agent in the pharmacological treatment of tics. Furthermore, benzamides (especially tiapride), which are commonly used in Europe, have proven their excellent effectiveness-tolerability profile over decades in clinical practice and are therefore also highly recommended for the treatment of tics. Nevertheless, pharmacological treatment of tics remains an indiviual choice depending on each patient's own specific needs.
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Affiliation(s)
- Sabine Mogwitz
- Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, 01307 Dresden, Germany
| | - Judith Buse
- Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, 01307 Dresden, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, 01307 Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, 01307 Dresden, Germany
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Abstract
Tics are the most common movement disorder in childhood and are a frequent reason for referral to child neurology clinics. The purpose of this review is to examine the phenomenology of tics, discuss what is known regarding their genetic and pathophysiological causes and to evaluate current treatment options. The evidence for the evaluation and treatment of the controversial diagnosis of pediatric autoimmune neuropsychiatric disorders associated with group A streptococci (PANDAS) will also be reviewed. With improved understanding of tic disorders, their etiology and response to current treatment options, we may be able to more effectively diagnose them and identify novel treatment strategies.
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Affiliation(s)
- Joanna S Blackburn
- Division of Child Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL.
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Ganos C, Martino D, Pringsheim T. Tics in the Pediatric Population: Pragmatic Management. Mov Disord Clin Pract 2017; 4:160-172. [PMID: 28451624 PMCID: PMC5396140 DOI: 10.1002/mdc3.12428] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/23/2016] [Accepted: 07/27/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary tic disorders, notably Tourette syndrome, are very common movement disorders in childhood. However, the management of such patients still poses great therapeutic challenges to medical professionals. METHODS Based on a synthesis of the available guidelines published in Europe, Canada, and the United States, coupled with more recent therapeutic developments, the authors provide a pragmatic guide to aid clinicians in deciding when and how to treat patients who have primary tic disorders. RESULTS After a systematic assessment of tics and common neuropsychiatric comorbidities (primarily attention-deficit hyperactivity disorder [ADHD] and obsessive-compulsive disorder [OCD]), the first step in treatment is a comprehensive psychoeducation of patients and families that addresses the protean phenomenology of tics and associated behaviors, coping mechanisms, prognosis, and treatment options. When more active intervention beyond watchful monitoring is indicated, hierarchical evaluation of treatment targets (i.e., tics vs. comorbid behavioral symptoms) is crucial. Behavioral treatments for tics are restricted to older children and are not readily available to all centers, mainly due to the paucity of well-trained therapists. Pharmacological treatments, such as antipsychotics for tics, stimulants and atomoxetine for ADHD, and α2A-agonists for children with tics plus ADHD, represent widely available and effective treatment options, but safety monitoring must be provided. Combined polypharmacological and behavioral/pharmacological approaches, as well as neuromodulation strategies, remain under-investigated in this population of patients. CONCLUSIONS The treatment of children with tics and Tourette syndrome is multifaceted. Multidisciplinary teams with expertise in neurology, psychiatry, psychology, and pediatrics may be helpful to address the complex needs of these children.
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Affiliation(s)
- Christos Ganos
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | - Davide Martino
- International Parkinson's Centre of ExcellenceKing's College and King's College HospitalDenmark Hill CampusLondonUnited Kingdom
- Queen Elizabeth Hospital, WoolwichLewisham and Greenwich National Health Service TrustLondonUnited Kingdom
| | - Tamara Pringsheim
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
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Gerasch S, Kanaan AS, Jakubovski E, Müller-Vahl KR. Aripiprazole Improves Associated Comorbid Conditions in Addition to Tics in Adult Patients with Gilles de la Tourette Syndrome. Front Neurosci 2016; 10:416. [PMID: 27672358 PMCID: PMC5018494 DOI: 10.3389/fnins.2016.00416] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022] Open
Abstract
Gilles de la Tourette Syndrome (GTS) is characterized by motor and vocal tics, as well as associated comorbid conditions including obsessive-compulsive disorder (OCD), attention deficit/hyperactivity disorder (ADHD), depression, and anxiety which are present in a substantial number of patients. Although randomized controlled trials including a large number of patients are still missing, aripiprazole is currently considered as a first choice drug for the treatment of tics. The aim of this study was to further investigate efficacy and safety of aripiprazole in a group of drug-free, adult patients. Specifically, we investigated the influence of aripiprazole on tic severity, comorbidities, premonitory urge (PU), and quality of life (QoL). Moreover, we were interested in the factors that influence a patient's decision in electing for-or against- pharmacological treatment. In this prospective uncontrolled open-label study, we included 44 patients and used a number of rating scales to assess tic severity, PU, comorbidities, and QoL at baseline and during treatment with aripiprazole. Eighteen out of fortyfour patients decided for undergoing treatment for their tics with aripiprazole and completed follow-up assessments after 4–6 weeks. Our major findings were (1) aripiprazole resulted in significant reduction of tics, but did not affect PU; (2) aripiprazole significantly improved OCD and showed a trend toward improvement of other comorbidities including depression, anxiety, and ADHD; (3) neither severity of tics, nor PU or QoL influenced patients' decisions for or against treatment of tics with aripiprazole; instead patients with comorbid OCD tended to decide in favor of, while patients with comorbid ADHD tended to decide against tic treatment; (4) most frequently reported adverse effects were sleeping problems; (5) patients' QoL was mostly impaired by comorbid depression. Our results suggest that aripiprazole may improve associated comorbid conditions in addition to tics in patients with GTS. It can be hypothesized that these beneficial effects are related to aripiprazole's adaptive pharmacological profile, which exhibits an influence on the dopaminergic as well as a number of other neurotransmitter systems. For the first time, our data provide evidence that patients' decision making process for or against medical treatment is influenced by other factors than tic severity and QoL.
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Affiliation(s)
- Sarah Gerasch
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Ahmad Seif Kanaan
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical SchoolHannover, Germany; Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
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Bernagie C, Danckaerts M, Wampers M, De Hert M. Aripiprazole and Acute Extrapyramidal Symptoms in Children and Adolescents: A Meta-Analysis. CNS Drugs 2016; 30:807-18. [PMID: 27395403 PMCID: PMC4996892 DOI: 10.1007/s40263-016-0367-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Both the US FDA and the European Medicines Agency (EMA) have approved aripiprazole for use in adolescents for specific indications. Given the assumed favorable side-effect profile of aripiprazole, its use in children and adolescents has increased for both official and off-label indications (anxiety disorders, eating disorders, personality disorders). However, several cases of children and adolescents with new-onset extrapyramidal symptoms (EPS) after commencing treatment with aripiprazole have been reported, and a more systematic appraisal of this possible risk is lacking. OBJECTIVE We conducted a systematic review and a meta-analysis to assess the evidence for acute EPS (acute dystonia, akathisia, Parkinsonism) associated with the use of aripiprazole in children and adolescents. METHOD We searched the MEDLINE and Embase databases (2003-10 April 2016) for clinical trials in pediatric patients (aged 0-18 years) using the keywords 'aripiprazole' (regardless of the formulation) and 'extrapyramidal symptoms'. We evaluated the abstracts of papers using the following exclusion criteria: (1) study design: case report, letter to the editor, editorial, or poster presentation data; (2) unrelated PICOS (population, intervention, comparators, outcomes, study) structure. We performed a meta-analysis, in which we used effect sizes with 95 % confidence intervals (CIs). To examine the homogeneity of the effect size distribution, we used a Q-statistic. When we observed heterogeneity in effect sizes, we assessed the possible influence of moderator variables (age and sex, mean dose, study duration, and method of measuring EPS incidence) and evaluated the suitability of either a fixed or a random model. Finally, we assessed the incidence of EPS in children and adolescents treated with aripiprazole compared with placebo. RESULTS An initial search via PubMed and Embase yielded 328 hits. A manual search of the reference lists of review papers revealed seven additional relevant articles. We included 41 studies, with 2114 pediatric patients, in the meta-analysis. For the analysis of the mean incidence of EPS, data were provided by 24 studies, with a total of 1446 pediatric patients. Meta-analysis revealed a mean EPS incidence of 17.1 % (95 % CI 0.128-0.223). In terms of the incidence of various extrapyramidal side effects, overall, no significant effects of age, sex, mean dose, study duration, or measuring method could be demonstrated. The side effects 'EPS', 'parkinsonism', and 'tremor' were significantly more common in children and adolescents treated with aripiprazole than in those treated with placebo. CONCLUSION Our meta-analysis provides evidence for a non-negligible incidence of acute EPS in children and adolescents treated with aripiprazole. Although the study has several limitations and further investigation is needed, these findings may help clinicians make more balanced treatment choices and more closely monitor the use of this drug in youth.
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Affiliation(s)
- Chiara Bernagie
- Department of Child and Adolescent Psychiatry, UPC KU Leuven-Z.org KU Leuven, UPC KU Leuven campus Leuven, UZ Leuven campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, UPC KU Leuven-Z.org KU Leuven, UPC KU Leuven campus Leuven, UZ Leuven campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Martien Wampers
- Department of Psychiatry, UPC KU Leuven-Z.org KU Leuven, Leuven, Belgium
| | - Marc De Hert
- Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Psychiatry, UPC KU Leuven-Z.org KU Leuven, Leuven, Belgium
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14
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Cox JH, Seri S, Cavanna AE. Safety and efficacy of aripiprazole for the treatment of pediatric Tourette syndrome and other chronic tic disorders. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2016; 7:57-64. [PMID: 29388585 PMCID: PMC5683285 DOI: 10.2147/phmt.s87121] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Tourette syndrome is a childhood-onset chronic tic disorder characterized by multiple motor and vocal tics and often accompanied by specific behavioral symptoms ranging from obsessionality to impulsivity. A considerable proportion of patients report significant impairment in health-related quality of life caused by the severity of their tics and behavioral symptoms and require medical intervention. The most commonly used medications are antidopaminergic agents, which have been consistently shown to be effective for tic control, but are also associated with poor tolerability because of their adverse effects. The newer antipsychotic medication aripiprazole is characterized by a unique mechanism of action (D2 partial agonism), and over the last decade has increasingly been used for the treatment of tics. We conducted a systematic literature review to assess the available evidence on the efficacy and safety of aripiprazole in pediatric patients with Tourette syndrome and other chronic tic disorders (age range: 4–18 years). Our search identified two randomized controlled trials (involving 60 and 61 participants) and ten open-label studies (involving between six and 81 participants). The majority of these studies used two validated clinician-rated instruments (Yale Global Tic Severity Scale and Clinical Global Impression scale) as primary outcome measures. The combined results from randomized controlled trials and open-label studies showed that aripiprazole is an effective, safe, and well-tolerated medication for the treatment of tics. Aripiprazole-related adverse effects (nausea, sedation, and weight gain) were less frequent compared to other antidopaminergic medications used for tic management and, when present, were mostly transient and mild. The reviewed studies were conducted on small samples and had relatively short follow-up periods, thus highlighting a need for further trials to assess the long-term use of aripiprazole in pediatric patients with Tourette syndrome and other chronic tic disorders with measurement of its efficacy using both clinician-rated and self-report scales.
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Affiliation(s)
| | - Stefano Seri
- School of Life and Health Sciences, Aston Brain Centre, Aston University.,Children's Epilepsy Surgery Programme, The Birmingham Children's Hospital NHS Foundation Trust
| | - Andrea E Cavanna
- School of Life and Health Sciences, Aston Brain Centre, Aston University.,Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and UCL, London, UK
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15
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Wang LJ, Chou WJ, Chou MC, Gau SSF. The Effectiveness of Aripiprazole for Tics, Social Adjustment, and Parental Stress in Children and Adolescents with Tourette's Disorder. J Child Adolesc Psychopharmacol 2016; 26:442-8. [PMID: 27028456 DOI: 10.1089/cap.2015.0104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Tourette's syndrome (TS) frequently results in a negative impact on multiple functional domains. This prospective open-label study investigated the potential effectiveness of aripiprazole for tics, social adjustment, and parental stress in children and adolescents with TS. METHODS Study participants consisted of 26 patients (mean age 10.4 ± 3.0 years; 22 boys and 4 girls) who were prescribed aripiprazole, with each dose ranging from 2.5 to 15 mg/day. At baseline and 2, 4, and 8 weeks from baseline, tic symptoms, social adjustment, and parenting stress were assessed using the Yale Global Tic Severity Scale (YGTSS), the Social Adjustment Inventory for Children and Adolescents (SAICA), and the Parenting Stress Index (PSI). Aripiprazole could be optionally titrated from 2.5 to 30 mg/day at each visit. RESULTS Of the 26 patients at the initial visit, 22 (84.6%) completed the study. The mean dose of aripiprazole at the endpoint was 8.0 ± 4.0 mg/day. During the 8-week aripiprazole treatment period, motor tics, phonic tics, and impairment on the YGTSS all showed significant improvement. Home behaviors on the SAICA and child domain on the PSI also showed significant improvement. Patients' phonic tics, but not motor tics, showed a positive correlation with their school function and peer relationships. The child domain on the PSI was positively correlated with motor tics, phonic tics, and impairment, as measured by the YGTSS. CONCLUSIONS An 8-week aripiprazole treatment program for children and adolescents with TS was beneficial to their tic symptoms, behaviors at home, and caregivers' stress with regard to fulfilling parenting roles. A long-term placebo-controlled trial with larger samples is warranted to confirm the effectiveness of aripiprazole for social adjustment and parental stress.
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Affiliation(s)
- Liang-Jen Wang
- 1 Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
| | - Wen-Jiun Chou
- 1 Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
| | - Miao-Chun Chou
- 1 Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
| | - Susan Shur-Fen Gau
- 2 Department of Psychiatry, National Taiwan University Hospital and College of Medicine , Taipei, Taiwan
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16
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Liu Y, Ni H, Wang C, Li L, Cheng Z, Weng Z. Effectiveness and Tolerability of Aripiprazole in Children and Adolescents with Tourette's Disorder: A Meta-Analysis. J Child Adolesc Psychopharmacol 2016; 26:436-41. [PMID: 26914764 DOI: 10.1089/cap.2015.0125] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Aripiprazole, an atypical antipsychotic drug, has shown potential as a promising candidate for the treatment of Tourette's disorder (TD). However, the effectiveness and the tolerability profile of aripiprazole in the reduction of tics in children and adolescents with TD have not been systematically analyzed. This meta-analysis aimed to evaluate the effectiveness and tolerability of aripiprazole in children and adolescents with TD. METHODS We searched for clinical trials that investigated the effect of aripiprazole in children and adolescents with TD in PubMed and Web of Science. The outcomes of interest comprised the Yale Global Tic Severity Score (YGTSS) total tic scores and the Clinical Global Impressions Scale for Tic Severity (CGI-S) scores. The pooled effect size (ES) and 95% confidence interval (CI) were calculated to assess the effectiveness of aripiprazole in children and adolescents with TD. RESULTS Ten studies were retrieved from 122 citations for the analysis, and in total, 302 patients (mean age, 11.6 years; median follow-up, 9 weeks) were included in the analysis. After synthesis of the data, the meta-analysis showed significantly greater improvement in the mean change in the YGTSS total tic scores (ES = -1.99, 95% CI = [-2.26]-[-1.72]; p = 0.001) and the mean CGI-S scores (ES = -2.34, 95% CI = [-2.96]-[-1.73]; p = 0.001) from pretreatment to posttreatment. Adverse events were reported in nine trials. Drowsiness (28.5%), nausea (20.2%), and headache (13.8%) were common adverse events. CONCLUSIONS The use of aripiprazole is safe, and shows therapeutic effectiveness in children and adolescents with TD.
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Affiliation(s)
- Yueying Liu
- 1 Department of Pediatrics, Affiliated Hospital, Jiangnan University , Wuxi, Jiangsu, China
| | - Hong Ni
- 2 Neurology Laboratory, Soochow University Affiliated Children's Hospital , Suzhou, Jiangsu, China
| | - Chunhong Wang
- 1 Department of Pediatrics, Affiliated Hospital, Jiangnan University , Wuxi, Jiangsu, China
| | - Lili Li
- 2 Neurology Laboratory, Soochow University Affiliated Children's Hospital , Suzhou, Jiangsu, China
| | - Zaohuo Cheng
- 3 Department of Clinical Psychology, Wuxi Mental Health Center affiliated to Nanjing Medical University , Wuxi, Jiangsu, China
| | - Zhen Weng
- 4 Key Laboratory of Nano-Bio Interface, Division of Nanobiomedicine and i-Lab, Suzhou Institute of Nano-Tech and Nano-Bionics , Chinese Academy of Sciences, Suzhou, Jiangsu, China
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17
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Abstract
Pisa syndrome (PS) is characterized by an abnormally sustained posture with flexion of the body and head to one side and slight axial rotation of the trunk. PS has been related to the use of neuroleptics and is clinically classified as either an acute or a tardive dystonia. This is the first report describing a case of late-onset PS, occurring in a young patient treated with aripiprazole for 2 years. To establish optimal treatment management, we reviewed the literature on aripiprazole-induced PS and tardive dystonia. In light of current knowledge, we proposed a multistep algorithm to aid in the clinical management of this condition.
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18
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Zheng W, Li XB, Xiang YQ, Zhong BL, Chiu HFK, Ungvari GS, Ng CH, Lok GKI, Xiang YT. Aripiprazole for Tourette's syndrome: a systematic review and meta-analysis. Hum Psychopharmacol 2016; 31:11-8. [PMID: 26310194 DOI: 10.1002/hup.2498] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/23/2015] [Accepted: 07/02/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review the efficacy and safety of aripiprazole (ARI) for Tourette's syndrome (TS). METHODS This review included randomized controlled trials (RCTs) of children and adolescents (6-18 years) with TS comparing ARI monotherapy with another monotherapies in relation to clinical improvement and adverse events. RESULTS Six RCTs with a total of 528 subjects (ARI treatment group: n = 253; control group: n = 275) met the inclusion criteria. These included two RCTs (n = 255) that compared ARI monotherapy with tiapride (TIA). Tic symptoms control assessed by Yale Global Tic Severity Scale (Standard Mean Difference (SMD) = -0.38 (Confidence Interval (CI) = -1.32 to 0.56); I(2) = 90%, P = 0.42) revealed no significant differences between the two groups. Extrapyramidal symptoms were significantly different when ARI (1.5%) was compared with haloperidol (HAL) (43.5%). No significant group differences were found in the rates of nausea/vomiting, dizziness, and dry mouth between ARI and TIA (RR = 0.57 to 1.00 (95%CI = 0.14-4.20); I(2) = 0% to 69%, P = 0.35 to 1.00). CONCLUSION This review found that ARI has similar efficacy to TIA and HAL for TS, while extrapyramidal symptoms were significantly less with ARI than with HAL. ARI can be considered as an alternative treatment option for TS.
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Affiliation(s)
- Wei Zheng
- Beijing Anding Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Psychiatric Disorders, China
| | - Xian-Bin Li
- Beijing Anding Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Psychiatric Disorders, China
| | - Ying-Qiang Xiang
- Beijing Anding Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Psychiatric Disorders, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia.,School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Grace K I Lok
- Kiang Wu Nursing College of Macau, Macao, SRA, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao, SAR, China
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19
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Budman CL. The role of atypical antipsychotics for treatment of Tourette's syndrome: an overview. Drugs 2015; 74:1177-93. [PMID: 25034359 DOI: 10.1007/s40265-014-0254-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Tourette's syndrome (TS) is a neuropsychiatric disorder of childhood onset characterized by multiple motor and phonic tics that fluctuate over time. Tic symptoms often improve by late adolescence, but some children and adults with TS may experience significant tic-related morbidity, including social and family problems, academic difficulties, and pain. When more conservative interventions are not successful, and when certain psychiatric co-morbidities further complicate the clinical profile, treating TS with an atypical antipsychotic medication may be a reasonable second-tier approach. However, the evidence supporting efficacy and safety of the atypical antipsychotics for treatment of tics is still very limited. The objective of this paper is to provide an updated overview of the role of atypical antipsychotics for treatment of TS, with evidence-based guidance on their use. Evidence for efficacy of different typical and atypical antipsychotics for treatment of tics was examined by conducting a systematic, keyword-related search of 'atypical antipsychotics' and 'Tourette's syndrome' in PubMed (National Library of Medicine, Washington, DC, USA). Four recent treatment consensus publications were also reviewed. This review focused on literature published from 2000 to 2013 and on available randomized controlled trials in TS. Evidence supporting the use of atypical antipsychotics for treatment of TS is limited. There are few randomized medication treatment trials in TS (i.e. risperidone, aripiprazole, ziprasidone), which employed varying methodologies, thereby restricting meaningful comparisons among studies. Future collaborations among clinical sites with TS expertise employing high-quality study design may better elucidate the role of atypical antipsychotics for treatment of TS.
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Affiliation(s)
- Cathy L Budman
- Department of Psychiatry, North Shore-LIJ Health System, Hofstra University School of Medicine, 400 Community Drive, Manhasset, NY, 11030, USA,
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20
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Bunai Y, Ishii A, Akaza K, Nagai A, Nishida N, Yamaguchi S. A case of sudden death after Japanese encephalitis vaccination. Leg Med (Tokyo) 2015; 17:279-82. [PMID: 25819538 DOI: 10.1016/j.legalmed.2015.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 03/04/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
Japanese encephalitis (JE) virus is estimated to result in 3500-50,000 clinical cases every year, with mortality rates of up to 20-50% and a high percentage of neurological sequelae in survivors. Vaccination is the single most important measure in preventing this disease. Inactivated Vero cell culture-derived JE vaccines have not been linked to any fatalities, and few serious adverse events after vaccination have been reported. Here, we report a case of sudden death in which a 10-year-old boy experienced cardiopulmonary arrest 5 min after receiving a Japanese encephalitis vaccination. He had been receiving psychotropic drugs for the treatment of pervasive developmental disorders. Postmortem examinations were nonspecific, and no signs of dermatologic or mucosal lesions or an elevation of the serum tryptase level, which are characteristic of anaphylaxis, were observed. A toxicological examination revealed that the blood concentrations of the orally administered psychotropic drugs were within the therapeutic ranges. The patient was considered to have died of an arrhythmia that was not directly associated with the vaccination.
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Affiliation(s)
- Yasuo Bunai
- Department of Legal Medicine, Gifu University, Graduate School of Medicine, Gifu 501-1194, Japan.
| | - Akira Ishii
- Department of Legal Medicine and Bioethics, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Kayoko Akaza
- Department of Legal Medicine, Gifu University, Graduate School of Medicine, Gifu 501-1194, Japan
| | - Atsushi Nagai
- Department of Legal Medicine, Gifu University, Graduate School of Medicine, Gifu 501-1194, Japan
| | - Naoki Nishida
- Department of Legal Medicine, University of Toyama, School of Medicine, Toyama 930-0194, Japan
| | - Seiji Yamaguchi
- Department of Pediatrics, Shimane University, School of Medicine, Izumo 693-8501, Japan
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21
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Jensen KG, Juul K, Fink-Jensen A, Correll CU, Pagsberg AK. Corrected QT changes during antipsychotic treatment of children and adolescents: a systematic review and meta-analysis of clinical trials. J Am Acad Child Adolesc Psychiatry 2015; 54:25-36. [PMID: 25524787 DOI: 10.1016/j.jaac.2014.10.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 08/26/2014] [Accepted: 10/13/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effect of antipsychotics on the corrected QT (QTc) interval in youth. METHOD We searched PubMed (http://www.ncbi.nlm.nih.gov/pubmed) for randomized or open clinical trials of antipsychotics in youth <18 years with QTc data, meta-analyzing the results. Meta-regression analyses evaluated the effect of age, sex, dose, and study duration on QTc. Incidences of study-defined QTc prolongation (>440-470 milliseconds), QTc >500 milliseconds, and QTc change >60 milliseconds were also evaluated. RESULTS A total of 55 studies were meta-analyzed, evaluating 108 treatment arms covering 9 antipsychotics and including 5,423 patients with QTc data (mean age = 12.8 ± 3.6 years, female = 32.1%). Treatments included aripiprazole: studies = 14; n = 814; haloperidol: studies = 1; n = 15; molindone: studies = 3; n = 125; olanzapine: studies = 5; n = 212; paliperidone: studies = 3; n = 177; pimozide: studies = 1; n = 25; quetiapine: studies = 5; n = 336; risperidone: studies = 23; n = 2,234; ziprasidone: studies = 10, n = 523; and placebo: studies = 19, n = 962. Within group, from baseline to endpoint, aripiprazole significantly decreased the QTc interval (-1.44 milliseconds, CI = -2.63 to -0.26, p = .017), whereas risperidone (+1.68, CI = +0.67 to +2.70, p = .001) and especially ziprasidone (+8.74, CI = +5.19 to +12.30, p < .001) significantly increased QTc. Compared to pooled placebo arms, aripiprazole decreased QTc (p = .007), whereas ziprasidone increased QTc (p < .001). Compared to placebo, none of the investigated antipsychotics caused a significant increase in the incidence of the 3 studied QTc prolongation measures, but there was significant reporting bias. CONCLUSION Based on these data, the risk of pathological QTc prolongation seems low during treatment with the 9 studied antipsychotics in otherwise healthy youth. Nevertheless, because individual risk factors interact with medication-related QTc effects, both medication and patient factors need to be considered when choosing antipsychotic treatment.
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Affiliation(s)
- Karsten Gjessing Jensen
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region and Faculty of Health Science, University of Copenhagen, Denmark.
| | - Klaus Juul
- Rigshospitalet University Hospital, Copenhagen
| | - Anders Fink-Jensen
- Laboratory of Neuropsychiatry, University of Copenhagen and Psychiatric Centre Copenhagen, University Hospital Copenhagen
| | - Christoph U Correll
- Hofstra North Shore Long Island Jewish School of Medicine and the Recognition and Prevention Program, Zucker Hillside Hospital, Glen Oaks, NY
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region and Faculty of Health Science, University of Copenhagen, Denmark
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22
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Ghanizadeh A, Haghighi A. Aripiprazole versus risperidone for treating children and adolescents with tic disorder: a randomized double blind clinical trial. Child Psychiatry Hum Dev 2014; 45:596-603. [PMID: 24343476 DOI: 10.1007/s10578-013-0427-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
There are some uncontrolled studies about the efficacy and safety of both aripiprazole and risperidone for treating tic disorder. Moreover, the efficacy of these medications has never been compared. This is the first double blind randomized clinical trial comparing the safety and efficacy of aripiprazole and risperidone for treating patients with tic disorder. Sixty children and adolescents with tic disorder were randomly allocated into one of the two groups to receive either aripiprazole or risperidone for 2 months. The primary outcome measure was the score of Yale Global Tic Severity Scale. In addition, health related quality of life and adverse events were assessed. Both aripiprazole and risperidone decreased the Yale Global Tic Severity Scale score during this trial. Moreover, both medications increased the health related quality of life score. Both aripiprazole and risperidone were tolerated well. Aripiprazole [3.22 (1.9) mg/day] decreased tic score as much as risperidone [0.6 (0.2) mg/day]. Their adverse effects and their effects on health related quality of life were comparable. However, risperidone increased the patients' social functioning more than aripiprazole in short term.
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Affiliation(s)
- Ahmad Ghanizadeh
- Department of Psychiatry, Research Center for Psychiatry and Behavioral Sciences, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,
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23
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Abstract
Tourette syndrome is a childhood onset neurodevelopmental disorder characterized by multiple motor and vocal tics. Although many youth experience attenuation or even remission of tics in adolescence and young adulthood, some individuals experience persistent tics, which can be debilitating or disabling. Most patients also have 1 or more psychiatric comorbid disorders, such as attention-deficit/hyperactivity disorder or obsessive-compulsive disorder. Treatment is multimodal, including both pharmacotherapy and cognitive-behavioral treatment, and requires disentanglement of tics and the comorbid symptoms.
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Affiliation(s)
- Zoey A Shaw
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA
| | - Barbara J Coffey
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA.
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24
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Ho CS, Chiu NC, Tseng CF, Huang YL. Clinical effectiveness of aripiprazole in short-term treatment of tic disorder in children and adolescents: a naturalistic study. Pediatr Neonatol 2014; 55:48-52. [PMID: 23920131 DOI: 10.1016/j.pedneo.2013.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 05/01/2013] [Accepted: 05/22/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE The purpose of this study was to evaluate the effectiveness and tolerability of aripiprazole in short-term treatment of children and adolescents with tic disorder (TD). METHODS This was a 14-week, prospective, open-label flexible dose trial of aripiprazole. We enrolled patients with TD aged between 4 years and 18 years. They received aripiprazole (dose: 2.5 mg/day) initially, which was then adjusted according to clinical response. The severity was assessed by the Yale Global Tic Severity Score (YGTSS) at 0, 2, 6, 10, and 14 weeks. The linear mixed models were used for evaluation of the YGTSSs at each follow-up, which were compared with baseline scores. RESULTS Eighty-one patients were enrolled in this study. Nine patients withdrew from the study with complaints of adverse side effects. Of the remaining 72 patients, 15 patients discontinued medications prematurely due to being free of symptoms for over 2 weeks. Two patients discontinued medications due to no significant improvement. The mean scores had significantly decreased since the 2nd week (p < 0.01). The mean reduction was 51.0% in the motor tic scores, 67.1% in the vocal tic scores, and 70.0% in the total YGTSSs. The common adverse effects were sedation (32.1%) and increased appetite (22.2%). A slight increase in average body weight was noted, from 32.7 to 33.7 kg (+1.0 kg, p < 0.05). CONCLUSION Aripiprazole is effective for short-term treatment of TD, especially vocal tics, in children and adolescents with mild adverse effects. However, further double-blind trials against placebo or other medications are needed to verify the efficacy of aripiprazole in the pharmacotherapy of TD.
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Affiliation(s)
- Che-Sheng Ho
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Chih-Fan Tseng
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yuan-Ling Huang
- Department of Pediatrics, Mackay Memorial Hospital, Taitung, Taiwan.
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25
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Yamamuro K, Makinodan M, Ota T, Iida J, Kishimoto T. Paliperidone extended release for the treatment of pediatric and adolescent patients with Tourette's disorder. Ann Gen Psychiatry 2014; 13:13. [PMID: 24829608 PMCID: PMC4020572 DOI: 10.1186/1744-859x-13-13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/16/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE A subgroup of patients with Tourette's disorder (TD) has symptoms refractory to haloperidol, a standard therapeutic drug for TD. METHODS We report on three cases of pediatric and adolescent patients who were treated with paliperidone extended release. RESULTS In two cases, TD symptoms were remarkably improved by switching from haloperidol to paliperidone extended release, and in another case, paliperidone extended release showed significant efficacy in treating TD symptoms as the first-line drug. In all cases, no significant adverse side effects were detected. CONCLUSION Paliperidone extended release may be a strong candidate for the treatment of pediatric and adolescent patients with TD.
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Affiliation(s)
- Kazuhiko Yamamuro
- Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Toyosaku Ota
- Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Junzo Iida
- Faculty of Nursing, Nara Medical University School of Medicine, Kashihara 634-8522, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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Practice parameter for the assessment and treatment of children and adolescents with tic disorders. J Am Acad Child Adolesc Psychiatry 2013; 52:1341-59. [PMID: 24290467 DOI: 10.1016/j.jaac.2013.09.015] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/03/2013] [Indexed: 02/07/2023]
Abstract
Tic disorders, including Tourette's disorder, present with a wide range of symptom severity and associated comorbidity. This Practice Parameter reviews the evidence from research and clinical experience in the evaluation and treatment of pediatric tic disorders. Recommendations are provided for a comprehensive evaluation to include common comorbid disorders and for a hierarchical approach to multimodal interventions.
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Safer DJ, Calarge CA, Safer AM. Prolactin serum concentrations during aripiprazole treatment in youth. J Child Adolesc Psychopharmacol 2013; 23:282-9. [PMID: 23647135 PMCID: PMC3657283 DOI: 10.1089/cap.2012.0062] [Citation(s) in RCA: 21] [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: 01/09/2023]
Abstract
OBJECTIVE This study aimed to: document the extent of the reduction of serum prolactin (PRL) levels induced by aripiprazole (ARI) treatment in children and adolescents, compare this effect by age group, and shed light on this phenomenon. METHODS PRL serum levels in unmedicated subjects were compared to those in subjects treated with aripiprazole to calculate the rate of subnormal PRL levels during aripiprazole treatment. Next, a literature search was performed to better understand the effects of dopaminergic drugs on PRL levels by age group. RESULTS Sixty percent of those treated with aripiprazole exhibited subnormal PRL serum levels versus 8% of unmedicated subjects. The rate of PRL subnormality in response to aripiprazole was half as frequent in adolescents and was minimal in adults. The drug-induced reduction of PRL serum levels became more prominent with increasing doses of aripiprazole and with an increased treatment duration. CONCLUSIONS With the increasing use of aripiprazole in the United States population, it is important that future research be conducted to explore the potential sequelae of subnormal PRL serum levels in children and adolescents.
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Affiliation(s)
- Daniel J Safer
- Departments of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Mogwitz S, Buse J, Ehrlich S, Roessner V. Clinical pharmacology of dopamine-modulating agents in Tourette's syndrome. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 112:281-349. [PMID: 24295625 DOI: 10.1016/b978-0-12-411546-0.00010-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Forty years of research and clinical practice have proved dopamine (DA) receptor antagonists to be effective agents in the treatment of Tourette's syndrome (TS), allowing a significant tic reduction of about 70%. Their main effect seems to be mediated by the blockade of the striatal DA-D2 receptors. Various typical and atypical agents are available and there is still discord between experts about which of them should be considered as first choice. In addition, there are suggestions to use DA receptor agonists such as pergolide or non-DA-modulating agents. The present chapter is focusing on the clinical pharmacology of DA-modulating agents in the treatment of TS. The introduction outlines their clinical relevance and touches on the hypotheses of the role of DA in the pathophysiology of TS. Subsequently, general information about the mechanisms of action and adverse effects are provided. The central part of the chapter forms a systematic review of all DA-modulating agents used in the treatment of TS, including an overview of studies on their effectiveness, and a critical discussion of their specific adverse effects. The present chapter closes with a summary of the body of evidence and a description of the resulting recommendations for the pharmacological treatment of TS.
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Affiliation(s)
- Sabine Mogwitz
- Department of Child and Adolescent Psychiatry, University Medical Center, Technische Univerität Dresden, Dresden, Germany
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Rizzo R, Eddy CM, Calí P, Gulisano M, Cavanna AE. Metabolic effects of aripiprazole and pimozide in children with Tourette syndrome. Pediatr Neurol 2012; 47:419-22. [PMID: 23127261 DOI: 10.1016/j.pediatrneurol.2012.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 08/27/2012] [Indexed: 11/17/2022]
Abstract
This study assessed the metabolic effects of aripiprazole and pimozide in pediatric Tourette syndrome, a neurodevelopmental condition characterized by multiple motor and phonic tics. Patients receiving aripiprazole (n = 25) or pimozide (n = 25) were compared with medication-free patients (n = 25). Body mass index, glycemia, triglyceridemia, and cholesterolemia were monitored at baseline and 12 and 24 months after commencing treatment. The aripiprazole group demonstrated significant increases in cholesterolemia. The pimozide group demonstrated significant increases in glycemia. Both groups demonstrated elevations in triglyceridemia not significantly different from those in unmedicated control subjects. The effect of aripiprazole on cholesterol was apparent after 12 months, but leveled off during year 2 of treatment. Longitudinal studies are required to evaluate the full extent of glycemic alterations with pimozide. Both agents appear relatively safe for use in pediatric Tourette syndrome. These findings will help guide medication selection in patients with specific medical vulnerabilities.
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Affiliation(s)
- Renata Rizzo
- Section of Child Neurology and Psychiatry, Department of Pediatrics, University of Catania, Catania, Italy
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Hartmann A, Worbe Y. Pharmacological treatment of Gilles de la Tourette syndrome. Neurosci Biobehav Rev 2012; 37:1157-61. [PMID: 23137552 DOI: 10.1016/j.neubiorev.2012.10.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/10/2012] [Accepted: 10/28/2012] [Indexed: 11/25/2022]
Abstract
Pharmacological treatment is usually indicated in moderate to severe tics in psychosocial and/or functional impairment. Neuroleptics with D2 antagonistic activity remain the cornerstone of anti-tic therapy. Lack of randomized controlled clinical trials base therapeutic decisions mainly on clinical expertise and common sense. Recently, aripiprazole has emerged as the neuroleptic with the most advantageous efficacy/side effect ratio for treating tics. Yet, in non-responders to aripiprazole, many neuroleptic and non-neuroleptic drugs, including botulinum toxin injections, are available and often successful. Apart from conducting methodologically sound trials (which includes sufficiently long observation periods), future efforts in the field should test the combination of cognitive-behavioral therapy with drugs or of multi-drug therapy as well as the development of biomarkers (endophenotypes) to monitor and even predict treatment response.
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Affiliation(s)
- Andreas Hartmann
- Centre de Référence National Maladie Rare: Syndrome Gilles de la Tourette, Département de Neurologie, Pôle des Maladies du Système Nerveux, France.
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Abstract
OBJECTIVE Aripiprazole is an atypical neuroleptic with agonistic and antagonistic dopaminergic and serotonergic effects. Because preliminary data obtained from uncontrolled studies suggest that aripiprazole may be effective in the treatment of tics, we performed a retrospective study with a large group of patients with Tourette syndrome. METHODS One hundred patients (78 men and 22 women; mean ± SD age, 27.1 years (± 11.5) years) who had been treated with daily doses of 5 to 45 mg (mean, 17.0 ± 9.6 mg) aripiprazole at our specialized Tourette syndrome outpatient clinic were included. Ninety-five patients with insufficient pretreatment (one or more neuroleptics) were switched to aripiprazole. RESULTS Eighty-two patients exhibited a considerable reduction in tic severity. In 48 patients, effective treatment lasted for more than 12 months. Five patients reported additional beneficial effects on behavioral comorbidities such as depression, anxiety, and autoaggression. Altogether, 31 patients (31%) dropped out of the treatment owing to inefficacy (n = 7), adverse effects (n = 15: drowsiness, agitation, weight gain, and sleep disturbances), both (n = 4) or other reasons (n = 5). CONCLUSION This is the largest case series on the treatment of tics with aripiprazole so far. Overall, our results corroborate previous data suggesting that aripiprazole is effective and safe in most patients. In particular, our data confirm effectiveness in adult patients and clarify that beneficial effects sustain. However, in contrast to previous data, in 1 of 3 of our highly selected patients, aripiprazole was ineffective or not well tolerated. Optimal dose seems to be individually different and may range from 5 to 45 mg.
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Roessner V, Schoenefeld K, Buse J, Wanderer S, Rothenberger A. Therapie der Tic-Störungen. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2012; 40:217-36; quiz 236-7. [DOI: 10.1024/1422-4917/a000176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Seit dem Erscheinen unserer letzten Übersichtsarbeit zur «Therapie der Tic-Störungen» in der Zeitschrift für Kinder- und Jugendpsychiatrie wurden große Fortschritte auf diesem Gebiet erzielt. So wurden einzelne Bausteine auf dem Weg zur optimalen Behandlung konkretisiert, z. B. Veröffentlichung einheitlicher Kriterien zur Behandlungsindikation oder Entwicklung und Evaluierung eines detaillierten verhaltenstherapeutischen Manuals zum Habit-Reversal-Training. Daneben sind neue Therapiemöglichkeiten, wie das Medikament Aripiprazol oder die Tiefenhirnstimulation, erfolgreich implementiert worden. Auch wurde das Augenmerk viel stärker auf begleitende Störungen, wie ADHS und Zwangsstörungen, gerichtet, da diese in der Regel eine besonders starke Beeinträchtigung für die weitere Entwicklung des Kindes oder Jugendlichen darstellen. Dennoch bestehen weiterhin große Wissenslücken über die Effektivität der einzelnen Behandlungsmethoden, möglicher Kombinationsbehandlungen sowie deren direkter Vergleich untereinander. Daneben erschwert das Fehlen jeglicher Parameter zur Vorhersage der individuell sehr unterschiedlichen Entwicklung der Tics über die nächsten Monate und Jahre eine evidenzbasierte Therapieempfehlung und damit das Erlernen der Feinheiten bei der Behandlung von Tic-Störungen. Zusammengefasst ist noch immer eine große klinische Erfahrung für die Therapieentscheidungen beim einzelnen Patienten von großem Vorteil angesichts der enormen Bandbreite an individueller Tic-Symptomatik und Komorbidität gepaart mit den unvorhersehbaren Schwankungen im zeitlichen Verlauf.
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Affiliation(s)
- Veit Roessner
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Dresden
| | - Katia Schoenefeld
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Dresden
| | - Judith Buse
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Dresden
| | - Sina Wanderer
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Dresden
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Neuner I, Nordt C, Schneider F, Kawohl W. Effectiveness of aripiprazole in the treatment of adult Tourette patients up to 56 months. Hum Psychopharmacol 2012; 27:364-9. [PMID: 22700477 DOI: 10.1002/hup.2235] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 03/16/2012] [Accepted: 05/02/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Tourette Syndrome (TS) is characterized by motor and vocal tics. Its pharmacological treatment is often a challenge because of the so-called tachyphylactic effects. Aripiprazole has been reported to be effective in small case series with short follow-up periods. METHODS In a retrospective analysis, we assessed the effect of off-label treatments with aripiprazole in 20 adult patients (mean age 27.4) divided in a group of severely [67 Yale Global Tourette Severity Scale (YGTTS)-total] and moderately (43.3 YGTTS-total) affected patients. TS patients were treated with aripiprazole (mean 11.8 mg daily) and followed for up to 56 months. RESULTS Applying a random coefficient model, we found a significant benefit resulting from treatment with aripiprazole. This effect was larger in the severely affected patient group in comparison with the moderately affected patient group. The effect was stable over a time period up to 56 months. CONCLUSION Aripiprazole, a neuroleptic drug of the third generation with a partial D(2) -agonism is effective in moderately and severely affected adult Tourette patients. We add to the current knowledge through our data extending the follow-up interval up to a maximum of 56 months. All available clinical data strongly support the initiation of a double-blind placebo or other neuroleptic substance controlled trial.
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Affiliation(s)
- Irene Neuner
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany.
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Cavanna AE, Selvini C, Termine C, Luoni C, Eddy CM, Rickards H. Tolerability profile of aripiprazole in patients with Tourette syndrome. J Psychopharmacol 2012; 26:891-5. [PMID: 21824981 DOI: 10.1177/0269881111408462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Over the last few years, aripiprazole has been proposed as a potentially useful medication for tics in patients with Tourette syndrome (TS). Aripiprazole has been associated with fewer adverse effects compared with other atypicals; however, little is known about its tolerability profile in the TS population. This study assessed the prevalence and characteristics of adverse effects resulting from the use of aripiprazole in a retrospective chart review of 29 patients with TS. Six patients (20.7%) discontinued aripiprazole because of the severity of specific adverse effects. The most commonly reported adverse effects were sedation (n = 9, 30%) and sleep problems (n = 5, 17%). In the majority of cases, adverse effects were not severe. There were no differences in demographic or clinical variables between the patients who did or did not experience adverse effects. The discontinuation rate of 20.7% suggests that aripiprazole is safe and reasonably well tolerated for use in TS. The prevalence of adverse effects appears to increase with treatment duration.
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Affiliation(s)
- Andrea E Cavanna
- Michael Trimble Neuropsychiatry Research Group, BSMHFT and University of Birmingham, Birmingham, UK.
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Masi G, Gagliano A, Siracusano R, Berloffa S, Calarese T, Ilardo G, Pfanner C, Magazù A, Cedro C. Aripiprazole in children with Tourette's disorder and co-morbid attention-deficit/hyperactivity disorder: a 12-week, open-label, preliminary study. J Child Adolesc Psychopharmacol 2012; 22:120-5. [PMID: 22375853 DOI: 10.1089/cap.2011.0081] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tourette's disorder (TD) in children and adolescents is frequently co-morbid with attention-deficit/hyperactivity disorder (ADHD). Dopamine-blockers are the first line treatment for TD, whereas dopamine-agonists, such as stimulants, are the gold-standard in the treatment of ADHD. These contrasting effects supported concerns about the risk that stimulants for treating ADHD may trigger or worsen co-morbid tics. Aripiprazole, a partial dopamine agonist, acts as an antagonist at dopamine D2 receptors in hyperdopaminergic conditions and displays agonist properties under hypodopaminergic conditions. The present study describes the use of aripiprazole (10.0 ± 4.8 mg/day) in a consecutive group of 28 patients with a primary diagnosis of TD and co-morbid ADHD, combined subtype. The Yale Global Tic Severity Scale (YGTSS) and the ADHD-Rating Scale (ADHD-RS-IV) were used as primary outcome measures and both significantly improved (p<0.001) after the treatment. Global measures of severity (Clinical Global Impressions-Severity) and of functional impairment (Children's Global Assessment Scale) also significantly improved during the treatment (p<0.001). At the YGTSS there was a reduction of 42.5%, in motor tics, of 47.9% in phonic tics (44.7% for the combined scores), and of 32.3% in tic impairment. Nineteen patients (67.9%) had a reduction of at least 50% of the YGTSS score (motor+phonic tics). The improvement at the ADHD-RS-IV score was 22.5%, 12 patients (42.8%) presented an improvement of 30%, but only 2 (7.1%) an improvement greater than 50%. Using a logistic regression model, a reduction of at least 30% in ADHD-RS-IV score was more likely to occur in the obsessive-compulsive disorder co-morbid group. Aripiprazole was well tolerated and none of the patients discontinued medication because of side effects. In summary, aripiprazole resulted in an effective treatment for TD, but it was only moderately effective on co-occurring ADHD symptomatology. Our preliminary data suggest that aripiprazole may represent a possible therapeutic option, among other possible monotherapies addressing both tics and ADHD.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
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Pringsheim T, Doja A, Gorman D, McKinlay D, Day L, Billinghurst L, Carroll A, Dion Y, Luscombe S, Steeves T, Sandor P. Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:133-43. [PMID: 22397999 DOI: 10.1177/070674371205700302] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This article seeks to provide the practising clinician with guidance on the pharmacological management of tic disorders in children and adults. We performed a systematic review of the literature on the treatment of tic disorders. A multi-institutional group of 14 experts in psychiatry, child psychiatry, neurology, pediatrics, and psychology engaged in a consensus meeting. The evidence was presented and discussed, and nominal group techniques were employed to arrive at consensus on recommendations. A strong recommendation is made when the benefits of treatment clearly outweigh the risks and burdens, and can apply to most patients in most circumstances without reservation. With a weak recommendation, the benefits, risks, and burdens are more closely balanced, and the best action may differ depending on the circumstances. Based on these principles, weak recommendations were made for the use of pimozide, haloperidol, fluphenazine, metoclopramide (children only), risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone, topiramate, baclofen (children only), botulinum toxin injections, tetrabenazine, and cannabinoids (adults only). Strong recommendations were made for the use of clonidine and guanfacine (children only). While the evidence supports the efficacy of many of the antipsychotics for the treatment of tics, the high rates of side effects associated with these medications resulted in only weak recommendations for these drugs. In situations where tics are not severe or disabling, the use of a medication with only a weak recommendation is not warranted. However, when tics are more distressing and interfering, the need for tic suppression to improve quality of life is stronger, and patients and clinicians may be more willing to accept the risks of pharmacotherapy.
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Affiliation(s)
- Tamara Pringsheim
- Department of Clinical Neurosciences and Pediatrics, University of Calgary, Calgary, Alberta.
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Huys D, Hardenacke K, Poppe P, Bartsch C, Baskin B, Kuhn J. Update on the role of antipsychotics in the treatment of Tourette syndrome. Neuropsychiatr Dis Treat 2012; 8:95-104. [PMID: 22442630 PMCID: PMC3307661 DOI: 10.2147/ndt.s12990] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Tourette syndrome (TS) is a neuropsychiatric disorder with typical onset in childhood and characterized by chronic occurrence of motor and vocal tics. The disorder can lead to serious impairments of both quality of life and psychosocial functioning, particularly for those individuals displaying complex tics. In such patients, drug treatment is recommended. The pathophysiology of TS is thought to involve a dysfunction of basal ganglia-related circuits and hyperactive dopaminergic innervations. Congruently, dopamine receptor antagonism of neuroleptics appears to be the most efficacious approach for pharmacological intervention. To assess the efficacy of the different neuroleptics available, a systematic, keyword-related search in PubMed (National Library of Medicine, Washington, DC) was undertaken. Much information on the use of antipsychotics in the treatment of TS is based on older data. Our objective was to give an update and therefore we focused on papers published in the last decade (between 2001 and 2011). Accordingly, the present review aims to summarize the current and evidence-based knowledge on the risk-benefit ratio of both first and second generation neuroleptics in TS.
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Affiliation(s)
- Daniel Huys
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany Head: Prof. Dr. Joachim Klosterkötter
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Chevreuil C, Polard E, Lemonnier E, Guillemot P, Bentué-Ferrer D. [Aripiprazole use in children and adolescent psychiatric patients]. Therapie 2011; 66:123-30. [PMID: 21635859 DOI: 10.2515/therapie/2011012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 10/12/2010] [Indexed: 02/04/2023]
Abstract
Aripiprazole inaugurates a new generation of antipsychotics called dopamine-serotonin system stabilizers. Its mechanism of action is different as aripiprazole is a partial dopamine D(2) and serotonin 5-HT(1A) receptor agonist and 5-HT(2A) receptor antagonist. Therefore, aripiprazole is thought to have an antagonistic action in the mesolimbic pathway but an agonistic action in the mesocortical pathway, tending to normalize the dopaminergic transmission regardless of the type of imbalance. Clinical trials involving children and adolescents have demonstrated the efficacy of aripiprazole in bipolar disorders, schizophrenia, mood disorders associated with pervasive developmental disorders, in tics and Tourette's. The most frequent side effects are extrapyramidal symptoms and sleepiness and are dose-dependent. Nevertheless, contrary to other second-generation antipsychotics available in France, it induces little weight gain, does not modify lipid and glucidic profiles, does not increase prolactin levels, or induce QTc lengthening. The main advantage of aripiprazole is its good safety profile, with different toxicity targets to other second-generation antipsychotics available in France. Aripiprazole appears to be an alternative for children and adolescents who are vulnerable to these side effects and are having trouble coping with them.
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Affiliation(s)
- Claire Chevreuil
- Service de Psychiatrie Infanto-Juvénile, CH Guillaume Régnier, Rennes, France
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Roessner V, Plessen KJ, Rothenberger A, Ludolph AG, Rizzo R, Skov L, Strand G, Stern JS, Termine C, Hoekstra PJ. European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. Eur Child Adolesc Psychiatry 2011; 20:173-96. [PMID: 21445724 PMCID: PMC3065650 DOI: 10.1007/s00787-011-0163-7] [Citation(s) in RCA: 275] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce.
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Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University of Dresden Medical School, Fetscherstrasse 74, 01307 Dresden, Germany.
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Gilles de la Tourette syndrome: the complexities of phenotype and treatment – further information. Br J Hosp Med (Lond) 2011. [DOI: 10.12968/hmed.2011.72.2.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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41
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Robertson MM. Gilles de la Tourette syndrome: the complexities of phenotype and treatment. Br J Hosp Med (Lond) 2011; 72:100-7. [DOI: 10.12968/hmed.2011.72.2.100] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Mary M Robertson
- Professor Mary M Robertson is Emeritus Professor of Neuropsychiatry, University College London and Visiting Professor and Honorary Consultant, Department of Neurology, St Georges Hospital and Medical School, London SW17 0QT
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Open-label study comparing the efficacy and tolerability of aripiprazole and haloperidol in the treatment of pediatric tic disorders. Eur Child Adolesc Psychiatry 2011; 20:127-35. [PMID: 21188439 PMCID: PMC3046348 DOI: 10.1007/s00787-010-0154-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 12/15/2010] [Indexed: 12/04/2022]
Abstract
Due to its unique pharmacodynamic properties of dopamine partial agonist activity, and its association with few and mild side effects, aripiprazole is a candidate atypical antipsychotic for patients with tic disorders. This open-label study compared the efficacy and tolerability of aripiprazole with haloperidol, a typical antipsychotic widely used to treat patients with tic disorders. Forty-eight children and adolescents with tic disorders were recruited from the outpatient clinic at South Korea and treated with aripiprazole (initial dose, 5.0 mg/d; maximum dose 20 mg/d) or haloperidol (initial dose, 0.75 mg/d; maximum dose, 4.5 mg/d) for 8 weeks. Treatment efficacy was measured using the yale global tic severity scale (YGTSS), and tolerability was measured using the extrapyramidal symptom rating scale (ESRS) and an adverse effects checklist. Total tic scores as measured by the YGTSS decreased over time in both groups (p < 0.001) without any significant differences between groups. ESRS scores were significantly higher in the haloperidol group during the 4 weeks after commencement of medication (p < 0.05). These results indicate that aripiprazole may be a promising drug in the treatment of children and adolescents with tic disorders. Further controlled studies are needed to determine the efficacy and tolerability of aripiprazole in these patients.
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Abstract
Tics are intermittent, repetitive, patterned but usually nonrhythmic motor movements or sounds performed in response to urges or involuntarily. They are the cardinal symptom required for a DSM-IV-TR diagnosis of Tourette's disorder (TD). Many children with TD present with mild tics that cause no significant impairment. However, when tics cause pain or interference, medical treatment is reasonable. This article reviews current evidence for treatment of tics in TD with medications as well as deep brain stimulation and transcranial magnetic stimulation. It concludes with some context for understanding this literature, relevant to treatment decisions and future treatment research in TD.
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Affiliation(s)
- Steve W Wu
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Cui YH, Zheng Y, Yang YP, Liu J, Li J. Effectiveness and tolerability of aripiprazole in children and adolescents with Tourette's disorder: a pilot study in China. J Child Adolesc Psychopharmacol 2010; 20:291-8. [PMID: 20807067 DOI: 10.1089/cap.2009.0125] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The primary aim of the study was to evaluate the effectiveness and tolerability of aripiprazole on motor and vocal tics in children and adolescents with Tourette's disorder (TD). The secondary aim was to assess the response of TD-associated behaviors to aripiprazole exposure. METHODS This was an 8-week, open-label trial with flexible dosing strategy of aripiprazole in children and adolescents with TD. A total of 72 patients, aged 6-18 years, participated in the 8-week trial. The Yale Global Tic Severity Scale (YGTSS), the Clinical Global Impressions-Tics (CGI-Tics), and the Child Behavior Checklist (CBCL) were compared at the baseline, weeks 2 and 4, and end point. The side effects of aripiprazole, electrocardiogram (ECG), and body mass index (BMI) were evaluated. RESULTS Over the 8-week trial, aripiprazole administration was associated with a significant decrease in total tic severity as measured by the YGTSS (50.3% reduction by week 8). The mean scores of motor tic in the YGTSS were 17.42 +/- 4.83, 12.93 +/- 3.76, 8.39 +/- 3.70, and 6.75 +/- 3.95 at baseline, weeks 2 and 4, and end point. A significant decrease in the scores was observed in week 2 compared to the baseline, and the scores continued to decrease for the remainder of the study period (degrees of freedom [df ] = 3, F = 96.02, p = 0.000). The mean phonic tic scores were 12.71 +/- 4.60, 8.53 +/- 3.26, 6.10 +/- 2.50, and 3.63 +/- 2.20 at baseline, weeks 2 and 4, and end point, respectively. A significant change was observed during week 2 compared to the baseline, and this change continued for the rest of the study period (df = 3, F = 95.16, p = 0.000). Significant improvement was also observed according to the CGI-Tics severity. The mean CGI-Tics severity score was 4.77 +/- 1.69 at baseline and decreased to 2.20 +/- 1.39 at end point (t = 10.70, p = 0.000). A significant reduction of behavior symptoms was noticed according to the CBCL and its subscales between baseline and end point. The majority of subjects tolerated aripiprazole well. The extrapyramidal symptoms (EPS) during this study were negligible. In all 21 (29.2%) of the 72 participants complained of nausea and 19 (26.4%) of them reported sedation. There was no significant difference of BMI between the two phases (df = 64, t = -0.94, p = 0.352). There were no significant changes in laboratory results. ECG monitoring revealed no significant impact on cardiac conduction by aripiprazol. CONCLUSION In this preliminary open-label trial, aripiprazole showed effectiveness in treating tic symptoms without causing significant weight gain or other serious side effects. Aripiprazole could be an option for TD cases that do not respond to conventional therapies. Further controlled, double-blind studies are warranted.
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Affiliation(s)
- Yong-hua Cui
- Beijing Anding Hospital, Capital Medical University, Beijing, China
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bestha DP, Jeevarakshagan S, Madaan V. Management of tics and Tourette's disorder: an update. Expert Opin Pharmacother 2010; 11:1813-22. [DOI: 10.1517/14656566.2010.486402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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