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Nielsen MØ, Kristensen TD, Borup Bojesen K, Glenthøj BY, Lemvigh CK, Ebdrup BH. Differential Effects of Aripiprazole and Amisulpride on Negative and Cognitive Symptoms in Patients With First-Episode Psychoses. Front Psychiatry 2022; 13:834333. [PMID: 35370857 PMCID: PMC8969108 DOI: 10.3389/fpsyt.2022.834333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Aripiprazole is hypothesized to have an effect on negative and cognitive symptoms in schizophrenia. Likewise, amisulpride is one of the only second-generation antipsychotics with which an effect on negative symptoms is reported. In the present study, we compare the effect of aripiprazole and amisulpride in initially antipsychotic-naïve patients with first-episode psychoses. METHODS Psychopathology and cognitive measures from two consecutive cohorts of antipsychotic-naïve first episode psychotic patients were obtained before and after 6 weeks of antipsychotic monotherapy with either aripiprazole or amisulpride. Matched healthy controls were included to account for retest effects on the cognitive measures. Analyses of variance (repeated-measures ANOVA) were performed to detect effect of time and possible cohort*time interactions. RESULTS Longitudinal data was obtained from 47 and 48 patients treated for 6 weeks with amisulpride or aripiprazole, respectively. For the Wallwork negative symptom dimension, there was a cohort*time interaction [F (1, 93) = 4.29, p = 0.041] and a significant effect of time [F (1, 93) = 6.03, p = 0.016], which was driven by an improvement in patients treated with aripiprazole [t (47) = 4.1, p < 0.001] and not observed in patients treated with amisulpride (p > 0.5). For the eight cognitive measures, no cohort*time interaction was found and neither was cognitive improvement in any of the cohorts when accounting for retest effect. CONCLUSION Patients treated with aripiprazole improved on negative symptoms, which was not the case for patients treated with amisulpride. This may point to a general effect of a partial D2 receptor agonist on negative symptoms in patients with first-episode psychoses. There was, however, no improvement in cognitive functions.
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Affiliation(s)
- Mette Ødegaard Nielsen
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Tina Dam Kristensen
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark
| | - Kirsten Borup Bojesen
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark
| | - Birte Y Glenthøj
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie K Lemvigh
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Mental Health Center, Glostrup, Copenhagen University Hospital - Mental Health Services Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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2
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Neurocognitive Benefits of Second-Generation Antipsychotics Versus Placebo: Insufficient Evidence Based on a Systematic Review. J Clin Psychopharmacol 2017; 37:274-276. [PMID: 28129314 DOI: 10.1097/jcp.0000000000000662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Goozee R, O'Daly O, Handley R, Reis Marques T, Taylor H, McQueen G, Hubbard K, Pariante C, Mondelli V, Reinders AATS, Dazzan P. Effects of aripiprazole and haloperidol on neural activation during a simple motor task in healthy individuals: A functional MRI study. Hum Brain Mapp 2016; 38:1833-1845. [PMID: 28009070 DOI: 10.1002/hbm.23485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 11/08/2022] Open
Abstract
The dopaminergic system plays a key role in motor function and motor abnormalities have been shown to be a specific feature of psychosis. Due to their dopaminergic action, antipsychotic drugs may be expected to modulate motor function, but the precise effects of these drugs on motor function remain unclear. We carried out a within-subject, double-blind, randomized study of the effects of aripiprazole, haloperidol and placebo on motor function in 20 healthy men. For each condition, motor performance on an auditory-paced task was investigated. We entered maps of neural activation into a random effects general linear regression model to investigate motor function main effects. Whole-brain imaging revealed a significant treatment effect in a distributed network encompassing posterior orbitofrontal/anterior insula cortices, and the inferior temporal and postcentral gyri. Post-hoc comparison of treatments showed neural activation after aripiprazole did not differ significantly from placebo in either voxel-wise or region of interest analyses, with the results above driven primarily by haloperidol. We also observed a simple main effect of haloperidol compared with placebo, with increased task-related recruitment of posterior cingulate and precentral gyri. Furthermore, region of interest analyses revealed greater activation following haloperidol compared with placebo in the precentral and post-central gyri, and the putamen. These diverse modifications in cortical motor activation may relate to the different pharmacological profiles of haloperidol and aripiprazole, although the specific mechanisms underlying these differences remain unclear. Evaluating healthy individuals can allow investigation of the effects of different antipsychotics on cortical activation, independently of either disease-related pathology or previous treatment. Hum Brain Mapp 38:1833-1845, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Rhianna Goozee
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Owen O'Daly
- Centre for Neuroimaging Sciences (CNS), King's College London, London, United Kingdom
| | | | - Tiago Reis Marques
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Heather Taylor
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Grant McQueen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Kathryn Hubbard
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Carmine Pariante
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Antje A T S Reinders
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Kings College London, London, United Kingdom
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Hwang SSH, Ahn YM, Kim YS. Neurocognitive functioning as an intermediary variable between psychopathology and insight in schizophrenia. Psychiatry Res 2015; 230:792-9. [PMID: 26602231 DOI: 10.1016/j.psychres.2015.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 07/30/2015] [Accepted: 11/02/2015] [Indexed: 02/05/2023]
Abstract
Based on the neuropsychological deficit model of insight in schizophrenia, we constructed exploratory prediction models for insight, designating neurocognitive measures as the intermediary variables between psychopathology and insight into patients with schizophrenia. The models included the positive, negative, and autistic preoccupation symptoms as primary predictors, and activation symptoms as an intermediary variable for insight. Fifty-six Korean patients, in the acute stage of schizophrenia, completed the Positive and Negative Syndrome Scale, as well as a comprehensive neurocognitive battery of tests at the baseline, 8-weeks, and 1-year follow-ups. Among the neurocognitive measures, the Korean Wechsler Adult Intelligence Scale (K-WAIS) picture arrangement, Controlled Oral Word Association Test (COWAT) perseverative response, and the Continuous Performance Test (CPT) standard error of reaction time showed significant correlations with the symptoms and the insight. When these measures were fitted into the model as intermediaries between the symptoms and the insight, only the perseverative response was found to have a partial mediating effect - both cross-sectionally, and in the 8-week longitudinal change. Overall, the relationship between insight and neurocognitive functioning measures was found to be selective and weak.
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Affiliation(s)
- Samuel Suk-Hyun Hwang
- Department Psychology, Chonnam National University, 77 Yongbong-ro, Buk-gu, Gwangju, 500-757, Korea.
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, Korea.
| | - Yong Sik Kim
- Department of Neuropsychiatry, Dongguk University International Hospital, Dongguk University Medical School, 27 Dongguk-Ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-773, Korea.
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Huang M, Kwon S, Oyamada Y, Rajagopal L, Miyauchi M, Meltzer HY. Dopamine D3 receptor antagonism contributes to blonanserin-induced cortical dopamine and acetylcholine efflux and cognitive improvement. Pharmacol Biochem Behav 2015; 138:49-57. [DOI: 10.1016/j.pbb.2015.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/09/2015] [Accepted: 09/11/2015] [Indexed: 12/01/2022]
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Cognitive effects of a single dose of atypical antipsychotics in healthy volunteers compared with placebo or haloperidol. J Clin Psychopharmacol 2012; 32:778-86. [PMID: 23131890 DOI: 10.1097/jcp.0b013e318272d10c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cognitive dysfunction in patients with schizophrenia is a strong correlate of poor outcome than any other symptom domain. To have greater knowledge about the effects of antipsychotics on cognitive function, subjects of this study were healthy volunteers who had no confounding variables typically found in patients with schizophrenia. The cognitive function of healthy volunteers in response to single doses of haloperidol, risperidone, aripiprazole, and amisulpride in a double-blind placebo-controlled trial was investigated. Assessments for the computerized neurocognitive test, mental and physical sedation, and extrapyramidal symptoms were performed within 1 week before (baseline) and approximately 4 hours after drug administration. Compared to the placebo, single administration of amisulpride at 400 mg in healthy volunteers enhanced word fluency test performance and remained intact after controlling for sedation and extrapyramidal symptoms. Significant improvement in some measurements of the computerized neurocognitive test was also observed in each antipsychotic-treated group but may have been related to practice effect. These findings suggest that amisulpride may have cognitive-enhancing effects in healthy volunteers.
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Ahn YM, Lee KY, Kim CE, Kang DY, Seok JH, Shin YM, Chung IW, Jun TY, Chang JS, Kim YS. The acute and long-term effectiveness of amisulpride in patients with schizophrenia: results of a 12-month open-label prospective follow-up study. Hum Psychopharmacol 2011; 26:568-77. [PMID: 22139601 DOI: 10.1002/hup.1246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 07/20/2011] [Accepted: 10/11/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the effectiveness of amisulpride in acute (up to 8 weeks) and maintenance (week 8 to 12 months) phases of a 12-month course of treatment in a heterogeneous group of patients with schizophrenia. METHODS We conducted a 12-month, open-label clinical trial with flexible doses of amisulpride among 129 Korean patients with schizophrenia. The Positive and Negative Symptom Scale (PANSS) and several other scales measuring efficacy and tolerability were analyzed during the acute and maintenance phases. RESULTS The completion rates were 78.3% by week 8 and 55.8% by month 12. Total PANSS scores and scores on the negative-symptom and general-symptom subscales improved significantly during both acute and maintenance periods, but scores on the positive-symptom subscale improved only during the acute phase. Improvement during both treatment phases was significant in all other scales except for the Drug Attitude Inventory. The negative-symptom and mixed-symptom groups showed significant improvement in the PANSS negative subscale, the Clinical Global Impression scale, and the Global Assessment of Functioning during the maintenance period. Hyperprolactinemia and related events were commonly reported. CONCLUSIONS This study demonstrated the significant effectiveness and a good safety profile of amisulpride for treating acute and 12-month phases of schizophrenia under natural conditions.
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Affiliation(s)
- Yong Min Ahn
- Department of Psychiatry and Behavioral Science and Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Horiguchi M, Huang M, Meltzer HY. The Role of 5-Hydroxytryptamine 7 Receptors in the Phencyclidine-Induced Novel Object Recognition Deficit in Rats. J Pharmacol Exp Ther 2011; 338:605-14. [DOI: 10.1124/jpet.111.180638] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Goldberg TE, Keefe RSE, Goldman RS, Robinson DG, Harvey PD. Circumstances under which practice does not make perfect: a review of the practice effect literature in schizophrenia and its relevance to clinical treatment studies. Neuropsychopharmacology 2010; 35:1053-62. [PMID: 20090669 PMCID: PMC3055399 DOI: 10.1038/npp.2009.211] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this article, we review the literature on practice effects in schizophrenia, an underappreciated confound in interpreting cognitive improvement in clinical trials. We first examine claims regarding first- and second-generation antipsychotic medications as cognitive enhancers, and follow it with a discussion of recent studies demonstrating how practice or placebo effects may drive 'positive' findings. Thus, this review suggests that many previous findings can be reinterpreted in this light. Critically, we also make several suggestions about test construction, study design, and statistical analyses that the field might use to overcome this potential confound. Our suggestions may also have implications for drug discovery and regulatory approval of cognitive-enhancing adjunctive agents, in terms of study design and/or test psychometric characteristics, including the development of tests that are relatively insensitive to practice-related changes. Such advances might be important for improving the methodology involved in the assessment of cognitive change in treatment studies.
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Affiliation(s)
- Terry E Goldberg
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY 11004, USA.
| | | | | | - Delbert G Robinson
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
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The effects of psychopathology on subjective experience of side effects of antipsychotics in patients with schizophrenia. Int Clin Psychopharmacol 2010; 25:83-90. [PMID: 20065855 DOI: 10.1097/yic.0b013e328334e5a8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study was conducted to delineate the relationship between self-reported side effects and psychopathology in schizophrenia patients. Patients with schizophrenia completed the Liverpool University Neuroleptic Side Effects Rating Scale for subjective side effects and were evaluated with the Positive and Negative Syndrome Scale for their psychopathology. Based on a series of multiple linear regression analyses, we derived a model accounting for the relationships among the specific domains of psychopathology and red herring (RH) items of the Liverpool University Neuroleptic Side Effects Rating Scale in predicting subjective side effects. The model with anxiety/depressive symptoms and RH serving as mediators between positive symptoms and side effects was found to show good fit. Positive symptoms caused mostly anxiety symptoms and tendency to report RH items, whereby resulting in over-generalized reporting of subjective side effects. However, a large proportion of variance of side effects was explained by RH, which was only partially explained by positive symptoms alone. Therefore, patients with severe levels of positive and anxiety/depressive symptoms may be prone to nocebo-like effects of antipsychotics. Studies that include acute stage patients presenting severe levels of these symptoms should not rely only on the subjective report of side effects but also apply objective measures.
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Causal model of insight and psychopathology based on the PANSS factors: 1-year cross-sectional and longitudinal revalidation. Int Clin Psychopharmacol 2009; 24:189-98. [PMID: 19521247 DOI: 10.1097/yic.0b013e32832d6bca] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study presents results of a 1-year follow-up investigation of the causal model of insight in schizophrenia using a subsample of acute patients starting or switching to amisulpride included in an earlier study. Our causal model of insight based on the Positive and Negative Syndrome Scale factors, with the positive, negative, and autistic preoccupation factors designated as the primary predictors, and the activation factor as a mediating variable of insight, was examined for fitness at the stabilized stage (8 week) and at the chronic stage (1 year) using the structural equation modeling method. Results showed that the intercorrelations among the factors and regression coefficients toward insight changed in their magnitudes, but the validity of our hypothesized model of insight was still confirmed for both the stages with nearly perfect goodness-of-fitness indices. The fitness of the model was also confirmed for the longitudinal changes in the scores of insight and psychopathology. An alternative model, which included the anxiety/depressive factor as a second mediating variable between insight and the positive and negative factors, was also found to be valid for both the stages. A post-hoc causal model with anxiety/depressive factor showed tentative evidence favoring anxiety/depressive variable predicting insight than the other way around.
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