1
|
Lintunen J, Taipale H, Tanskanen A, Mittendorfer-Rutz E, Tiihonen J, Lähteenvuo M. Long-Term Real-World Effectiveness of Pharmacotherapies for Schizoaffective Disorder. Schizophr Bull 2021; 47:1099-1107. [PMID: 33533399 PMCID: PMC8266596 DOI: 10.1093/schbul/sbab004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the long-term real-world effectiveness of antipsychotics and other psychopharmacotherapies in the treatment of schizoaffective disorder (SCHAFF). METHOD Two nationwide cohorts of SCHAFF patients were identified from Finnish and Swedish registers. Within-individual design was used with stratified Cox regression. The main exposure was use of antipsychotics. Adjunctive pharmacotherapies included mood stabilizers, antidepressants, and benzodiazepines and benzodiazepine-related drugs. The main outcome was hospitalization due to psychosis. RESULTS The Finnish cohort included 7655 and the Swedish cohort 7525 patients. Median follow-up time was 11.2 years (IQR 5.6-11.5) in the Finnish and 7.6 years (IQR 3.8-10.3) in the Swedish cohort. Clozapine and long-acting injectable (LAI) antipsychotics were consistently associated with a decreased risk of psychosis hospitalization and treatment failure (psychiatric hospitalization, any change in medication, death) in both cohorts. Quetiapine was not associated with a decreased risk of psychosis hospitalization. Mood stabilizers used in combination with antipsychotics were associated with a decreased risk of psychosis hospitalization (Finnish cohort HR 0.76, 95% CI 0.71-0.81; Swedish cohort HR 0.84, 0.78-0.90) when compared with antipsychotic monotherapy. Combination of antidepressants and antipsychotics was associated with a decreased risk of psychosis hospitalization in the Swedish cohort (HR 0.90, 0.83-0.97) but not in the Finnish cohort (1.00, 0.94-1.07), and benzodiazepine use was associated with an increased risk (Finnish cohort HR 1.07, 1.01-1.14; Swedish cohort 1.21, 1.13-1.30). CONCLUSIONS Clozapine, LAIs, and combination therapy with mood stabilizers were associated with the best outcome and use of quetiapine and benzodiazepines with the worst outcome in the treatment of SCHAFF.
Collapse
Affiliation(s)
- Jonne Lintunen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,To whom correspondence should be addressed; Niuvanniemi Hospital, Niuvankuja 65, 70240 Kuopio, Finland; tel: +358-295-242-111, fax: +358-17-368-2419, e-mail:
| | - Heidi Taipale
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
2
|
Miller M, Barbe N, Poulsen RJ, Coffey BJ. Overcoming Complications in Management of a Difficult-to-Treat Adolescent with Schizoaffective Disorder. J Child Adolesc Psychopharmacol 2020; 30:526-530. [PMID: 32931309 DOI: 10.1089/cap.2020.29190.bjc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Michelle Miller
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Jackson Behavioral Health Hospital, Miami, Florida, USA
| | - Nadege Barbe
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Jackson Behavioral Health Hospital, Miami, Florida, USA
| | - Raul J Poulsen
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Jackson Behavioral Health Hospital, Miami, Florida, USA
| | - Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Jackson Behavioral Health Hospital, Miami, Florida, USA
| |
Collapse
|
3
|
Du Y, Liu J, Sui J, He H, Pearlson GD, Calhoun VD. Exploring difference and overlap between schizophrenia, schizoaffective and bipolar disorders using resting-state brain functional networks. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:1517-20. [PMID: 25570258 DOI: 10.1109/embc.2014.6943890] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Schizophrenia, schizoaffective and bipolar disorders share some common symptoms. However, the biomarkers underlying those disorders remain unclear. In fact, there is still controversy about the schizoaffective disorder with respect to its validity of independent category and its relationship with schizophrenia and bipolar disorders. In this paper, based on brain functional networks extracted from resting-state fMRI using a recently proposed group information guided ICA (GIG-ICA) method, we explore the biomarkers for discriminating healthy controls, schizophrenia patients, bipolar patients, and patients with two symptom defined subsets of schizoaffective disorder, and then investigate the relationship between different groups. The results demonstrate that the discriminating regions mainly including frontal, parietal, precuneus, cingulate, supplementary motor, cerebellar, insular and supramarginal cortices perform well in distinguishing the different diagnostic groups. The results also suggest that schizoaffective disorder may be an independent disorder, although its subtype characterized by depressive episodes shares more similarity with schizophrenia.
Collapse
|
4
|
Du Y, Pearlson GD, Liu J, Sui J, Yu Q, He H, Castro E, Calhoun VD. A group ICA based framework for evaluating resting fMRI markers when disease categories are unclear: application to schizophrenia, bipolar, and schizoaffective disorders. Neuroimage 2015. [PMID: 26216278 DOI: 10.1016/j.neuroimage.2015.07.054] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Schizophrenia (SZ), bipolar disorder (BP) and schizoaffective disorder (SAD) share some common symptoms, and there is still a debate about whether SAD is an independent category. To the best of our knowledge, no study has been done to differentiate these three disorders or to investigate the distinction of SAD as an independent category using fMRI data. This study is aimed to explore biomarkers from resting-state fMRI networks for differentiating these disorders and investigate the relationship among these disorders based on fMRI networks with an emphasis on SAD. Firstly, a novel group ICA method, group information guided independent component analysis (GIG-ICA), was applied to extract subject-specific brain networks from fMRI data of 20 healthy controls (HC), 20 SZ patients, 20 BP patients, 20 patients suffering from SAD with manic episodes (SADM), and 13 patients suffering from SAD with depressive episodes exclusively (SADD). Then, five-level one-way analysis of covariance and multiclass support vector machine recursive feature elimination were employed to identify discriminative regions from the networks. Subsequently, the t-distributed stochastic neighbor embedding (t-SNE) projection and the hierarchical clustering were implemented to investigate the relationship among those groups. Finally, to evaluate the generalization ability, 16 new subjects were classified based on the found regions and the trained model using original 93 subjects. Results show that the discriminative regions mainly included frontal, parietal, precuneus, cingulate, supplementary motor, cerebellar, insula and supramarginal cortices, which performed well in distinguishing different groups. SADM and SADD were the most similar to each other, although SADD had greater similarity to SZ compared to other groups, which indicates that SAD may be an independent category. BP was closer to HC compared with other psychotic disorders. In summary, resting-state fMRI brain networks extracted via GIG-ICA provide a promising potential to differentiate SZ, BP, and SAD.
Collapse
Affiliation(s)
- Yuhui Du
- The Mind Research Network & LBERI, Albuquerque, NM, USA; School of Information and Communication Engineering, North University of China, Taiyuan, China.
| | - Godfrey D Pearlson
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Neurobiology, Yale University, New Haven, CT, USA; Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT, USA
| | - Jingyu Liu
- The Mind Research Network & LBERI, Albuquerque, NM, USA; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Jing Sui
- The Mind Research Network & LBERI, Albuquerque, NM, USA; Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Qingbao Yu
- The Mind Research Network & LBERI, Albuquerque, NM, USA
| | - Hao He
- The Mind Research Network & LBERI, Albuquerque, NM, USA; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
| | | | - Vince D Calhoun
- The Mind Research Network & LBERI, Albuquerque, NM, USA; Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
| |
Collapse
|
5
|
Murru A, Pacchiarotti I, Nivoli AMA, Grande I, Colom F, Vieta E. What we know and what we don't know about the treatment of schizoaffective disorder. Eur Neuropsychopharmacol 2011; 21:680-90. [PMID: 21565468 DOI: 10.1016/j.euroneuro.2011.03.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 02/24/2011] [Accepted: 03/02/2011] [Indexed: 11/17/2022]
Abstract
Schizoaffective disorder (SAD) is a chronic, severe and disabling illness consisting on the concurrent presentation of symptoms of schizophrenia and affective disorders (depression and/or mania). Evidence for the treatment of SAD mostly derives from studies based on mixed samples (i.e. schizophrenic and schizoaffective patients) or on extrapolations from studies on schizophrenia or bipolar disorder. The objective of the present review is to systematically consider and summarize the best evidence-based approaches to the treatment of SAD and extensively point out the gap between treatment research and clinical practice of this disorder. The complex problem of controlling the pleomorphic presentation of SAD's syndromic construct is reflected in the lack of evidence on key topics, including: diagnostic consistency, pharmacological approaches (mood stabilizers, antidepressants, both in acute and maintenance treatment as well as their possible combination), and the adjunctive role of psychosocial and biophysical interventions. Finally, treatment strategies for SAD, both unipolar and bipolar type, are proposed.
Collapse
Affiliation(s)
- A Murru
- Bipolar Disorders Programme, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | | | | | | | | |
Collapse
|
6
|
Minirth FB, Neal V. Assessment of patient preference and side effects in patients switched from divalproex sodium delayed release to divalproex sodium extended release. J Clin Psychopharmacol 2005; 25:99-101. [PMID: 15643111 DOI: 10.1097/01.jcp.0000150233.91995.6b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Stoner SC, Dubisar BM, Lea JW, Marken PA, Ramlatchman LV, Reynolds JB. Extended-Release Divalproex Sodium for Mood Stabilization. Pharmacotherapy 2004; 24:1147-53. [PMID: 15460175 DOI: 10.1592/phco.24.13.1147.38088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To evaluate the efficacy, safety, and tolerability of extended-release divalproex sodium. DESIGN Prospective, open-label, 4-week study SETTING Long-term care facility of the Missouri Department of Mental Health. PATIENTS Ten hospitalized patients (mean age 39.4 yrs) with mood or thought disorders who were experiencing adverse effects from delayed-release divalproex sodium. INTERVENTION All participants were switched from delayed-release to extended-release divalproex sodium. MEASUREMENTS AND MAIN RESULTS Efficacy was monitored with the Brief Psychiatric Rating Scale (BPRS), and safety and tolerability were monitored with the Systematic Assessment for Treatment Emergent Events (SAFTEE). Frequently reported adverse effects before conversion were sedation, stomach upset, and tremor. At study conclusion, no differences were seen in total BPRS scores or individual BPRS items, although a trend pointed to decreased somatic complaints (p=0.057). The mean serum concentration of valproic acid among participants did not change significantly in the transition from the delayed-release formulation to an equivalent dose-adjusted extended-release formulation (90.5 mg/L vs 95.5 mg/L, p=0.493). At study conclusion, significant decreases in low-density lipoprotein cholesterol (p=0.010) and potassium (p=0.043) levels were identified. Three categories of adverse effects decreased significantly after patients switched to the extended-release form of divalproex sodium: sedation (p=0.022), stomach or abdominal discomfort (p=0.045), and tremor (p=0.004). CONCLUSION This preliminary investigation suggests that patients receiving delayed-release divalproex sodium for mood lability can be converted successfully to extended-release divalproex sodium. Moreover, these findings imply that this transition is associated with a reduction in some of the adverse effects associated with divalproex sodium.
Collapse
Affiliation(s)
- Steven C Stoner
- University of Missouri-Kansas City Schools of Pharmacy and Medicine, Kansas City, MO 64506, USA.
| | | | | | | | | | | |
Collapse
|