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Houix M, Humbert I, D'Acremont F, Sauvaget A, Huon JF, Bulteau S. What about the relevance of PIP of psychotropics in older psychiatric inpatients? L'ENCEPHALE 2024:S0013-7006(24)00114-3. [PMID: 38981810 DOI: 10.1016/j.encep.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/15/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE In 2019, a regional survey of potentially inappropriate prescriptions (PIP) of psychotropic drugs in elderly psychiatric inpatients was carried out highlighting their inappropriate use in this population. The aim of this study was to assess the clinical relevance - defined as the provision of an appropriate and necessary treatment, chosen from other alternatives as being the most likely to produce the expected results for a given patient - of these prescriptions considered inappropriate according to current established criteria. MATERIAL AND METHOD Patients aged over 75, or 64 to 75 and polypathological with at least one PIP of psychotropic drugs or drugs with a high anticholinergic burden, identified by an audit grid established on the basis of STOPP/STARTv2 criteria and the Laroche list on the prescription at 48h of hospitalization, were included. The weighing of the inappropriateness nature of the prescription (resistance to treatment, period of crisis, comorbidities…) was established by a pharmacist-psychiatrist pair on the entire computerized record of the current episode. The clinical relevance of the PIP and the overall prescription was rated as 0 (irrelevant), 1 (partially relevant) or 2 (relevant). RESULTS Thirty-four patients were included. One hundred and twenty-five PIP of psychotropic drugs were noted: 50.4% concerned benzodiazepines and non-benzodiazepines anxiolytics (BZD/Z), 25.6% neuroleptics (NL), 12% antidepressants (ATD) and 12% drugs with a high anticholinergic burden. On one hand, 49.2% of PIP of BZD/Z, 50% of PIP of NL and 20% of PIP of ATD were considered irrelevant. On the other hand, 49.2% of PIP of BZD/Z, 31.3% of PIP of NL and 13.3% of PIP of ATD were considered partially relevant. Furthermore, 1.6% of PIP of BZD/Z, 18.8% of PIP of NL and 66.7% of PIP of ATD were considered relevant. For PIPs of drugs with a high anticholinergic burden, 80% were deemed irrelevant, 13.3% partially relevant and 6.7% relevant. In all, of the 34 drug prescriptions studied, three (8.8%) were considered irrelevant, 11 (32.4%) partially relevant and 20 (58.8%) clinically relevant. CONCLUSION This study highlighted the clinical relevance of more than half the prescriptions considered inappropriate according to current PPI criteria in the elderly. It underlines the interest of a new PPI detection tool for elderly patients with psychiatric disorders.
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Affiliation(s)
- Morgane Houix
- Service pharmacie, centre hospitalier universitaire de Nantes, 44000 Nantes, France.
| | - Ilia Humbert
- Unité PPANs, centre hospitalier universitaire de Strasbourg, 67091 Strasbourg, France
| | - Fanny D'Acremont
- Service pharmacie, centre hospitalier universitaire de Nantes, 44000 Nantes, France; OMEDIT Pays de la Loire, 44000 Nantes, France
| | - Anne Sauvaget
- Département de psychiatrie et addictologie, centre hospitalier universitaire de Nantes, 44000 Nantes, France
| | - Jean-François Huon
- Service pharmacie, centre hospitalier universitaire de Nantes, 44000 Nantes, France
| | - Samuel Bulteau
- Département de psychiatrie et addictologie, centre hospitalier universitaire de Nantes, 44000 Nantes, France
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Stamoula E, Stamatellos VP, Vavilis T, Dardalas I, Papazisis G. Weight gain, gender, and antipsychotics: a disproportionality analysis of the FDA Adverse Event Reporting System database (FAERS). Expert Opin Drug Saf 2024; 23:239-245. [PMID: 37589503 DOI: 10.1080/14740338.2023.2248873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Side effects are a very important aspect of antipsychotic treatments. Weight gain is an important side effect that jeopardizes the uninterrupted therapy administration, especially in patients with psychiatric conditions. This case-non-case pharmacovigilance study aims at investigating in a real-world adverse event reporting system whether several antipsychotics increase the risk of weight gain reporting, and the differences among men and women as far as weight gain as a reported adverse event is concerned. AREAS COVERED Adverse event reports submitted to the FDA Adverse Event Reporting System of the Food and Drug Administration of the United States (FAERS) of 24 major antipsychotics were extracted, cleaned, and analyzed to determine which of these drugs were correlated with weight gain. The Reported Odds Ratio (ROR) and the adjusted Reported Odds Ratio (aROR) were calculated for each antipsychotic using logistic regression models. Demographics like age, gender, and concomitant insulin use were taken into consideration for each drug. EXPERT OPINION Women had a statistically significant increase in weight gain reporting compared to men, while the men's group was associated with a reduced weight gain reporting in every antipsychotics in the logistic regression analyses. Out of the 24 antipsychotics included in our analysis, Aripiprazole, Brexpiprazole, Olanzapine, and Haloperidol had statistically significantly more weight increase reporting compared to the others.
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Affiliation(s)
- Eleni Stamoula
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Biotechnology, Centre of Systems Biology, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | | | - Theofanis Vavilis
- Department of Dentistry, School of Medicine, European University of Cyprus, Nicosia, Cyprus
- Laboratory of Medical Biology and Genetics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Dardalas
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Clinical Trials Unit, Special Unit for Biomedical Research and Education, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Two-Injection Start Regimen of Long-Acting Aripiprazole in 133 Patients With Schizophrenia. J Clin Psychopharmacol 2023; 43:35-38. [PMID: 36584247 DOI: 10.1097/jcp.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE/BACKGROUND Based on a population-pharmacokinetic model, the European Medicines Agency has recently approved a simplified starting strategy of aripiprazole once a month (AOM), injectable and long-acting antipsychotic, with two 400 mg injections and a single oral 20 mg dose of aripiprazole, administered on the same day, instead of 1 injection and 14 daily administrations of concurrent oral aripiprazole. However, to our knowledge, no previous study has reported the safety and tolerability of this regimen in real-world patients. METHODS/PROCEDURES We retrospectively reviewed medical records of 133 patients who received the newly approved 2-injection start regimen as part of their standard care in 10 Italian clinical centers. FINDINGS/RESULTS Adverse effects were mild or moderate, with no clinically evident difference from the adverse effects observed in previous trials where AOM was started with a single injection followed by 14 days of orally administered aripiprazole. None of the patients who started AOM after the 2-injection start regimen experienced severe adverse effects or severe adverse effects. IMPLICATIONS/CONCLUSIONS The coadministration of 2 injections of 400 mg aripiprazole and 20 mg oral aripiprazole was not associated with safety concerns beyond those reported after a single injection followed by 14 days of orally administered aripiprazole. Our results should be interpreted with caution, due to the limited sample size and to the retrospective design of the study.
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Al-Wandi A, Holmberg C, Landén M, Nordenskjöld A. A systematic review and meta-analysis of maintenance treatment for psychotic depression. Nord J Psychiatry 2022; 76:442-450. [PMID: 34665684 DOI: 10.1080/08039488.2021.1990997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To perform a systematic review on the use of maintenance treatment to prevent relapse and recurrence in patients with psychotic unipolar or bipolar depression. METHODS We conducted an electronic search in December 2019 (and an updated search in July 2021) of four databases (PubMed, Embase, PsycINFO, and Cochrane) to identify controlled studies comparing the relapse rates of patients receiving maintenance treatment for psychotic unipolar depression and psychotic bipolar depression. A meta-analysis was made that included three studies comparing antidepressant (AD) and antipsychotic (AP) combination therapy with AD monotherapy. We used the GRADE tool to assess the quality of evidence. RESULTS We included five randomized controlled trials fulfilling the inclusion criteria, making three comparisons: (a) AD + AP versus AD monotherapy; (b) AD + AP versus AP monotherapy; (c) AD + electroconvulsive therapy versus AD monotherapy. The included studies only examined patients with psychotic unipolar depression. The largest included study reported a statistically significant advantage of AD + AP compared with AD monotherapy. We made a meta-analysis of the three studies comparing AD + AP combination therapy with AD monotherapy, which included 195 patients and 56 events. The meta-analysis did not show a statistically significant difference between these treatments. CONCLUSIONS Contrary to the finding of the largest study, we did not find a statistically significant difference between AD + AP combination therapy and AD monotherapy in the meta-analysis. There is insufficient evidence to support the superiority of any treatment modality as maintenance treatment for psychotic depression. Further studies are required.
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Affiliation(s)
- Ahmed Al-Wandi
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Mikael Landén
- Institute of Neuroscience and Physiology, the Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Axel Nordenskjöld
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Mayer J, Vasic N, Wolf V, Steiner I, Klein V, Fritz M, Rothe P, Streb J, Dudeck M. Gender Differences in the Psychopharmacological Treatment of Forensic In-Patients With Schizophrenia. Front Psychiatry 2022; 13:907123. [PMID: 35911248 PMCID: PMC9334521 DOI: 10.3389/fpsyt.2022.907123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background In forensic psychiatry, psychopharmacological treatment plays a crucial role for patients with schizophrenia in improving their medical as well as legal prognosis. However, an increase in the number of females entering forensic treatment has yet to yield empirical research on the outcome of psychopharmacological treatment of female patients with schizophrenia in terms of efficacy and tolerability. Aims The aim of the present study is to elucidate pharmacological treatment strategies of women with schizophrenia in forensic psychiatry in comparison with men. Methods This study compares psychopharmacological treatment strategies, psychopathological features, as well as neurological and metabolic side effects of treatment between 29 female and 29 male in-patients with schizophrenia in three forensic facilities in Bavaria, Germany. Results Results show significant differences between genders. Poorer psychopathological and neurological features were found in the female sample, while men registered worse metabolic parameters. In terms of psychopharmacological treatment strategies, female in-patients were more often prescribed second-generation depot antipsychotics. Surprisingly, the potency of the dosages did not differ between genders. The results suggest that female forensic patients with schizophrenia have more severe and refractory diseases than their male counterparts. Conclusion Recommendations for gender-specific treatment strategies are derived.
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Affiliation(s)
- Juliane Mayer
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen, Germany
| | - Nenad Vasic
- Clinic for Psychiatry and Psychotherapy, Clinic Centre Christophsbad, Göppingen, Germany
| | - Viviane Wolf
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Clinic Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ivonne Steiner
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen, Germany
| | - Verena Klein
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen, Germany
| | - Michael Fritz
- Department of Forensic Psychiatry and Psychotherapy, District Hospital Günzburg, Ulm University, Günzburg, Germany
- School of Health and Social Sciences, AKAD University of Applied Sciences, Stuttgart, Germany
| | - Philipp Rothe
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen, Germany
- kbo-Lech-Mangfall-Clinic Agatharied, Hausham, Germany
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, District Hospital Günzburg, Ulm University, Günzburg, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, District Hospital Günzburg, Ulm University, Günzburg, Germany
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An observational study of antipsychotic medication discontinuation in first-episode psychosis: clinical and functional outcomes. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1329-1340. [PMID: 35041015 DOI: 10.1007/s00127-022-02230-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To study the impact of supervised antipsychotic medication discontinuation on clinical and functional outcomes in first-episode psychosis (FEP) in two different cultural environments. METHOD FEP patients(N = 253), treated in two early intervention services (Montreal, Canada and Chennai, India) for 2 years, were assessed for medication use, positive and negative symptom remission and social-occupational functioning at regular intervals. RESULTS Between months 4 and 24 of treatment, 107 patients discontinued medication ('Off'group) as compared to 146 who stayed on medication ('On'group). Medication discontinuation was higher in Chennai as compared to Montreal (n = 80, 49.07% vs n = 27, 16.87%; χ2 37.80, p < 0.001), with no difference in time to discontinuation [Means(SDs) = 10.64(6.82) and 10.04(5.43), respectively, p = 0.71). At month 24 (N = 235), there were no differences in the rate of positive symptom remission between the on and Off groups (81.5 vs 88.0%, respectively) at both sites. The rate of negative symptom remission was lower among patients in the On compared to the Off group (63.2 vs 87.9%, respectively, χ2 = 17.91, p < 0.001), but only in Montreal (55.4% vs 80.0%, respectively, χ2 = 4.12, p < 0.05). Social and Occupational Functioning Assessment Scale scores were equally high in both Off and On medication groups in Chennai [Means (SDs) = 79.43(12.95) and 73.59(17.63), respectively] but higher in the Off compared to the On group in Montreal Means (SDs) = 77.47(14.97) and 64.94(19.02), respectively; Time × site interaction F = 3.96(1,217), p < 0.05]. Medication status (On-Off) had no impact on the outcomes, independent of other variables known to influence outcomes. CONCLUSION Certain cultural environments and patient characteristics may facilitate supervised discontinuation of antipsychotic medication following treatment of an FEP without negative consequences.
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Read J. The experiences of 585 people when they tried to withdraw from antipsychotic drugs. Addict Behav Rep 2022; 15:100421. [PMID: 35434245 PMCID: PMC9006667 DOI: 10.1016/j.abrep.2022.100421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Many recipients of antipsychotic drugs try to stop taking them, primarily because of distressing adverse effects. Little research has been undertaken into the withdrawal symptoms that ensue. Methods In an online survey 585 antipsychotic users, from 29 countries, who had tried to stop taking the drugs, were asked specific questions about the process and the open question: 'What were the effects of withdrawing from the medication?' 44% had a diagnosis in the 'schizophrenia' spectrum. Results Responding to specific questions, 72% reported classical withdrawal effects of the kind associated with other central nervous system medications, including nausea, tremors, anxiety, agitation and headaches. 52% of these categorized those effects as 'severe'. 26% had tried four or more times to discontinue, and 23% took at least one year to successfully withdraw completely. In response to the open question, 73% reported one or more withdrawal effects, most frequently, insomnia, nervousness and extreme feelings; 26% reported one or more positive outcomes, most frequently more energy/alive and clearer thinking; and 18% reported psychosis. Conclusion These findings are consistent with a small but growing body of literature on this topic. Prescribers need to inform themselves about the nature, frequency and intensity of withdrawal effects from APs, and about withdrawal psychosis. National guidelines, professional bodies' statements, and drug company information urgently need to be updated to prevent the suffering that can occur when withdrawal is minimised, misunderstood or unsupported.
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Affiliation(s)
- John Read
- School of Psychology University of East London London E15 4LZ, UK
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Read J. How important are informed consent, informed choice, and patient-doctor relationships, when prescribing antipsychotic medication? J Ment Health 2022:1-9. [PMID: 35536145 DOI: 10.1080/09638237.2022.2069708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 02/25/2022] [Accepted: 03/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Antipsychotic medications (APs) are used for people with psychosis diagnoses and, increasingly for other problems and groups. AIMS This study examines how APs are prescribed, from the perspective of recipients. METHODS 757 people, from 30 countries, responded to questions about their experiences with APs, in an online survey. RESULTS Most (70%) were told nothing about adverse effects. Fewer than 2% recalled being told about the risks of diabetes, suicidality, sexual dysfunction, or reduced life span. None recalled being told about reduced brain volume or withdrawal effects. Only 28% recalled being offered other treatments; with only 14% offered talking therapies. 46% were not told how long to take the APs; and, of those who were told something, 48% were told to take them forever. Most respondents (76%) were not told how APs work. Only 19% were satisfied with the prescribing process, and only 25% reported a good, or very good, relationship with the prescriber. Information, satisfaction with the process, and the prescriber relationship were all positively related to three self-reported outcomes: reduction of problems the drugs were prescribed for, general helpfulness, and quality of life. CONCLUSIONS Steps need to be taken to ensure people prescribed antipsychotics are fully informed, especially about adverse effects and alternatives.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
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9
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Kølbæk P, Thorgaard MV, Grooss AS, Selvanathan T, Larsen SF, Speed M, Dines D, Østergaard SD. Clinical validation of the Aarhus Side effect Assessment Questionnaire(ASAQ). J Psychopharmacol 2022; 36:507-515. [PMID: 35234056 DOI: 10.1177/02698811221077196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychotropic medications are essential in the treatment of mental illness. Unfortunately, these medications are associated with side effects that may reduce adherence to treatment and quality of life. Therefore, systematic screening for side effects is fundamental to optimize treatment with psychotropic medications. Self-report of side effects is a practical alternative to time-consuming clinical assessments. We developed the Aarhus Side effect Assessment Questionnaire (ASAQ) in an attempt to strike the balance between extensive coverage of side effects and reasonable application time. AIM The aim of the study was to validate the ASAQ using the clinician-rated Udvalg for Kliniske Undersøgelser (UKU) Side Effect Scale as gold standard reference. METHODS A total of 122 inpatients and outpatients-mainly with psychotic (39%) and affective disorders (43%)-receiving treatment with psychotropic medication completed the ASAQ and the World Health Organization-Five Well-Being Index (WHO-5) and were subsequently rated on the UKU by trained raters. RESULTS Using the UKU as the gold standard reference, the ASAQ demonstrated sensitivity values >75% for 77% of its 30 items (ranging from 37% for cutaneous disturbances to 98% for increased sweating) and specificity values >75% for 47% of its 30 items (ranging from 28% for reduced sleep to 98% for micturition disturbances). While 17% of the participants considered discontinuing their medication, 24% had recently refrained from taking their medication as prescribed. A negative correlation was found between the ASAQ and the WHO-5 and total scores (Pearson's correlation coefficient = -0.44). CONCLUSIONS The self-reported ASAQ seems to be a sensitive tool for detecting side effects of psychotropic medications.
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Affiliation(s)
- Pernille Kølbæk
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Mette Viller Thorgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | | | - Thusitha Selvanathan
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Sofie Fly Larsen
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Maria Speed
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - David Dines
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Søren Dinesen Østergaard
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
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Pietrini F, Tatini L, Santarelli G, Brugnolo D, Squillace M, Bozza B, Ballerini A, Ricca V, D'Anna G. Self- and caregiver-perceived disability, subjective well-being, quality of life and psychopathology improvement in long-acting antipsychotic treatments: a 2-year follow-up study. Int J Psychiatry Clin Pract 2021; 25:307-315. [PMID: 34057873 DOI: 10.1080/13651501.2021.1912358] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Switching to long-acting injectable (LAI) antipsychotic maintenance treatment (AMT) represents a valuable strategy for schizophrenia. In a recovery-oriented approach, patient-reported outcomes (PROs) such as perceived disability, subjective well-being, and quality of life cannot be neglected. METHODS Forty clinically stable outpatients with schizophrenia treated with oral second-generation antipsychotics were enrolled at the time of switching to the equivalent dose of LAI. 35 subjects completed this 2-year longitudinal, prospective, open-label, observational study. Patients were assessed at baseline, after 1 year, and after 2 years of LAI-AMT, using psychometric scales (Positive And Negative Syndrome Scale, PANSS; Young Mania Rating Scale, YMRS; Montgomery-Åsberg Depression Rating Scale, MADRS), PROs (Subjective Well-Being under Neuroleptics short form, SWN-K; Short Form-36 health survey, SF-36; 12-item World Health Organisation Disability Assessment Schedule, WHODAS 2.0), and caregiver-reported outcomes (12-item WHODAS 2.0). RESULTS No psychotic relapses were observed. Psychopathology measures (PANSS total and subscales - excluding negative symptoms), mood symptoms (YMRS, MADRS), perceived disability (patient- and caregiver-administered WHODAS 2.0), subjective well-being (SWN-K), and quality of life (SF-36) showed a concomitant amelioration after 1 year, without further significant variations. DISCUSSION Switching to LAI-AMT may decrease perceived impairment, and increase subjective well-being and quality of life in clinically stable outpatients with schizophrenia.HighlightsLAI treatment may improve outcomes by reducing psychopathology levels and relapses.In a recovery-oriented approach, patient-reported outcomes cannot be neglected.LAI antipsychotics may optimise the subjective experience of treatment.Switching to LAI therapy may result in a reduction in perceived disability.There is a significant correlation between proxy- and patient-reported disability.
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Affiliation(s)
- Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Lorenzo Tatini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Santarelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Dario Brugnolo
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marco Squillace
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Bernardo Bozza
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Ballerini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulio D'Anna
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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Longden E, Branitsky A, Moskowitz A, Berry K, Bucci S, Varese F. The Relationship Between Dissociation and Symptoms of Psychosis: A Meta-analysis. Schizophr Bull 2020; 46:1104-1113. [PMID: 32251520 PMCID: PMC7505175 DOI: 10.1093/schbul/sbaa037] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Evidence suggests that dissociation is associated with psychotic experiences, particularly hallucinations, but also other symptoms. However, until now, symptom-specific relationships with dissociation have not been comprehensively synthesized. This is the first prospectively registered (CRD42017058214) meta-analysis to quantify the magnitude of association between dissociative experiences and all symptoms of psychosis. MEDLINE, PsycINFO, PubMed, and Scopus databases were searched using exhaustive terms denoting dissociation and psychotic symptoms. We included both nonclinical (58 studies; 16 557 participants) and clinical (46 studies; 3879 patient participants) samples and evaluated study quality. Ninety-three eligible articles considering 20 436 participants were retained for analysis. There was a robust association between dissociation and clinical and nonclinical positive psychotic symptoms (r = .437; 95%CI: .386 -.486), with the observed effect larger in nonclinical studies. Symptom-specific associations were also evident across clinical and nonclinical studies, and included significant summary effects for hallucinations (r = .461; 95%CI: .386 -.531), delusions (r = .418; 95%CI: .370 -.464), paranoia (r = .447; 95%CI: .393 -.499), and disorganization (r = .346; 95%CI: .249 -.436). Associations with negative symptoms were small and, in some cases, not significant. Overall, these findings confirm that dissociative phenomena are not only robustly related to hallucinations but also to multiple positive symptoms, and less robustly related to negative symptoms. Our findings are consistent with proposals that suggest certain psychotic symptoms might be better conceptualized as dissociative in nature and support the development of interventions targeting dissociation in formulating and treating psychotic experiences.
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Affiliation(s)
- Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison Branitsky
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Abstract
Studies of antipsychotic medication, which are increasingly prescribed for a broad range of problems and circumstances, rarely ask the people who take them to describe their experiences with the drugs. In this study, 650 people, from 29 countries, responded, in an online survey, to "Overall in my life antipsychotic medications have been _____?" and "Is there anything else you would like to say, or emphasise, about your experiences with antipsychotic drugs?" Of the total participants, 14.3% were categorized as reporting purely positive experiences, 27.9% had mixed experiences, and 57.7% reported only negative ones. Negative experiences were positively correlated with age. Thematic analysis identified 749 negative, 180 positive, and 53 mixed statements. The 2 positive themes were "symptom reduction" (14) and "sleep" (14), with the majority (153) unspecified. The 4 negative themes (besides "unspecified"-191) were: "adverse effects" (316), "interactions with prescriber" (169), "withdrawal/difficult to get off them" (62), and "ineffective" (11). The adverse effects included: weight gain, emotional numbing, cognitive dysfunction, sedation, akathisia, effects on relationships, and suicidality. "Interactions with prescriber" included lack of information about withdrawal effects, support, or discussion of alternatives. The only mixed theme was "short-term good, long-term bad" (28). Open questions can add to findings from methodologies focused on symptom reduction. Clinicians should pay more attention to the need for respectful and collaborative patient-prescriber relationships. At the point of prescription, this must include providing the full range of information about antipsychotics, including potential benefits and harms, difficulties withdrawing, and information on alternatives treatments such as psychological therapies.
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Affiliation(s)
- John Read
- Department of Psychology, University of East London – Stratford Campus, London, UK,To whom correspondence should be addressed; University of East London – Stratford Campus, Water Lane, London E15 4LZ; tel: +44 (0)208 223 4943, e-mail:
| | - Ann Sacia
- Department of Psychology, University of East London – Stratford Campus, London, UK
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13
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Read J, Williams J. Positive and Negative Effects of Antipsychotic Medication: An International Online Survey of 832 Recipients. Curr Drug Saf 2020; 14:173-181. [PMID: 30827259 PMCID: PMC6864560 DOI: 10.2174/1574886314666190301152734] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/16/2019] [Accepted: 02/22/2019] [Indexed: 12/22/2022]
Abstract
Background: Antipsychotic medication is currently the treatment of choice for psychosis, but few studies directly survey the first-hand experience of recipients. Objective: To ascertain the experiences and opinions of an international sample of users of antipsychotic drugs, regarding positive and negative effects. Methods: An online direct-to-consumer questionnaire was completed by 832 users of antipsychotics, from 30 countries – predominantly USA, UK and Australia. This is the largest such sample to date. Results: Over half (56%) thought, the drugs reduced the problems they were prescribed for, but 27% thought they made them worse. Slightly less people found the drugs generally ‘helpful’ (41%) than found them ‘unhelpful’ (43%). While 35% reported that their ‘quality of life’ was ‘improved’, 54% reported that it was made ‘worse’. The average number of adverse effects reported was 11, with an average of five at the ‘severe’ level. Fourteen effects were reported by 57% or more participants, most commonly: ‘Drowsiness, feeling tired, sedation’ (92%), ‘Loss of motivation’ (86%), ‘Slowed thoughts’ (86%), and ‘Emotional numbing’ (85%). Suicidality was reported to be a side effect by 58%. Older people reported particularly poor outcomes and high levels of adverse effects. Duration of treatment was unrelated to positive outcomes but significantly related to negative outcomes. Most respondents (70%) had tried to stop taking the drugs. The most common reasons people wanted to stop were the side effects (64%) and worries about long-term physical health (52%). Most (70%) did not recall being told anything at all about side effects. Conclusion: Clinical implications are discussed, with a particular focus on the principles of informed consent, and involving patients in decision making about their own lives.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, United Kingdom
| | - James Williams
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
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14
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Begemann MJH, Thompson IA, Veling W, Gangadin SS, Geraets CNW, van 't Hag E, Müller-Kuperus SJ, Oomen PP, Voppel AE, van der Gaag M, Kikkert MJ, Van Os J, Smit HFE, Knegtering RH, Wiersma S, Stouten LH, Gijsman HJ, Wunderink L, Staring ABP, Veerman SRT, Mahabir AGS, Kurkamp J, Pijnenborg GHM, Veen ND, Marcelis M, Grootens KP, Faber G, van Beveren NJ, Been A, van den Brink T, Bak M, van Amelsvoort TAMJ, Ruissen A, Blanke C, Groen K, de Haan L, Sommer IEC. To continue or not to continue? Antipsychotic medication maintenance versus dose-reduction/discontinuation in first episode psychosis: HAMLETT, a pragmatic multicenter single-blind randomized controlled trial. Trials 2020; 21:147. [PMID: 32033579 PMCID: PMC7006112 DOI: 10.1186/s13063-019-3822-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/22/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Antipsychotic medication is effective for symptomatic treatment in schizophrenia-spectrum disorders. After symptom remission, continuation of antipsychotic treatment is associated with lower relapse rates and lower symptom severity compared to dose reduction/discontinuation. Therefore, most guidelines recommend continuation of treatment with antipsychotic medication for at least 1 year. Recently, however, these guidelines have been questioned as one study has shown that more patients achieved long-term functional remission in an early discontinuation condition-a finding that was not replicated in another recently published long-term study. METHODS/DESIGN The HAMLETT (Handling Antipsychotic Medication Long-term Evaluation of Targeted Treatment) study is a multicenter pragmatic single-blind randomized controlled trial in two parallel conditions (1:1) investigating the effects of continuation versus dose-reduction/discontinuation of antipsychotic medication after remission of a first episode of psychosis (FEP) on personal and social functioning, psychotic symptom severity, and health-related quality of life. In total 512 participants will be included, aged between 16 and 60 years, in symptomatic remission from a FEP for 3-6 months, and for whom psychosis was not associated with severe or life-threatening self-harm or violence. Recruitment will take place at 24 Dutch sites. Patients are randomized (1:1) to: continuation of antipsychotic medication until at least 1 year after remission (original dose allowing a maximum reduction of 25%, or another antipsychotic drug in similar dose range); or gradual dose reduction till eventual discontinuation of antipsychotics according to a tapering schedule. If signs of relapse occur in this arm, medication dose can be increased again. Measurements are conducted at baseline, at 3, and 6 months post-baseline, and yearly during a follow-up period of 4 years. DISCUSSION The HAMLETT study will offer evidence to guide patients and clinicians regarding questions concerning optimal treatment duration and when to taper off medication after remission of a FEP. Moreover, it may provide patient characteristics associated with safe dose reduction with a minimal risk of relapse. TRIAL STATUS Protocol version 1.3, October 2018. The study is active and currently recruiting patients (since September 2017), with the first 200 participants by the end of 2019. We anticipate completing recruitment in 2022 and final assessments (including follow-up 3.5 years after phase one) in 2026. TRIAL REGISTRATION European Clinical Trials Database, EudraCT number 2017-002406-12. Registered 7 June 2017.
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Affiliation(s)
- Marieke J H Begemann
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
| | - Ilse A Thompson
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Shiral S Gangadin
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris N W Geraets
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erna van 't Hag
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne J Müller-Kuperus
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Priscilla P Oomen
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Alban E Voppel
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Mark van der Gaag
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Martijn J Kikkert
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Jim Van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - H Filip E Smit
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, The Netherlands
| | - Rikus H Knegtering
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sybren Wiersma
- Early Intervention Psychosis Team, GGZ inGeest Specialized Mental Health Care, Hoofddorp, The Netherlands
| | - Luyken H Stouten
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Harm J Gijsman
- Program for Psychosis & Severe Mental Illness, Pro Persona Mental Health, Wolfheze, The Netherlands
| | - Lex Wunderink
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, The Netherlands
| | - Anton B P Staring
- Department ABC, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - Selene R T Veerman
- Community Mental Health, Mental Health Service Noord-Holland Noord, Alkmaar, The Netherlands
| | | | - Jörg Kurkamp
- Center for Youth with Psychosis, Mediant ABC Twente, Enschede, The Netherlands
| | | | - Natalie D Veen
- GGZ Delfland, Delfland Institute for Mental Health Care, Delft, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Koen P Grootens
- Reinier van Arkel Institute for Mental Health Care, 's Hertogenbosch, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gunnar Faber
- Yulius, Mental Health Institute, Dordrecht, The Netherlands
| | - Nico J van Beveren
- Antes Center for Mental Health Care, Rotterdam, The Netherlands
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Agaath Been
- Center for Developmental Disorders, Dimence Institute for Mental Health, Deventer, The Netherlands
| | | | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | - Therese A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | | | - Christine Blanke
- Anoiksis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karin Groen
- MIND Ypsilon, Organization of Relatives and Carers of People with a Vulnerability to Psychosis, The Hague, The Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Iris E C Sommer
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
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Abstract
Introduction Lurasidone is an atypical antipsychotic that was approved in Europe in 2014 for the treatment of schizophrenia in adults aged ≥ 18 years. Clinical experience with lurasidone in Europe is currently limited, and there is therefore a need to provide practical guidance on using lurasidone for the treatment of adults with schizophrenia. Methods A panel of European psychiatrists with extensive experience of prescribing lurasidone was convened to provide recommendations on using lurasidone to treat adults with schizophrenia. Results Extensive evidence from clinical trials and the panel’s clinical experience suggest that lurasidone is as effective as other atypical agents, with the possible exception of clozapine. Lurasidone is associated with a lower propensity for metabolic side effects (in particular, weight gain) and hyperprolactinaemia than most other atypical antipsychotics and has a relatively benign neurocognitive side effect profile. Patients switching to lurasidone from another antipsychotic may experience weight reduction and/or improvements in the ability to focus/concentrate. Most side effects with lurasidone (such as somnolence) are transitory, easily managed and/or ameliorated by dose adjustment. Akathisia and extrapyramidal symptoms may occur in a minority of patients, but these can be managed effectively with dose adjustment, adjunctive therapy and/or psychosocial intervention. Conclusions Given the crucial importance of addressing the physical as well as mental healthcare needs of patients, lurasidone is a rational therapeutic choice for adults with schizophrenia, both in the acute setting and over the long term. Funding Sunovion Pharmaceuticals Europe Ltd. Electronic supplementary material The online version of this article (10.1007/s40120-019-0138-z) contains supplementary material, which is available to authorized users.
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Pietrini F, D’Anna G, Tatini L, Talamba GA, Andrisano C, Calderani E, Manetti M, Rossi Prodi P, Ricca V, Ballerini A. Changes in attitude towards LAI antipsychotic maintenance treatment: A two-year follow-up study. Eur Psychiatry 2018; 53:58-65. [DOI: 10.1016/j.eurpsy.2018.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/31/2018] [Accepted: 06/11/2018] [Indexed: 12/31/2022] Open
Abstract
AbstractBackground:To present real-world evidence on the effects of switching from oral to long-acting injectable (LAI) antipsychotic maintenance treatment (AMT) in a sample of clinically stable patients with schizophrenia, with regard to subjective experience of treatment, attitude towards drug and quality of life.Methods:50 clinically stable adult schizophrenic outpatients were recruited. At the time of enrolment (T0), all patients were under a stabilized therapy with a single oral second-generation antipsychotic (SGA) and were switched to the equivalent maintenance regimen with the long-acting formulation of the same antipsychotic. 43 patients completed the 24-month prospective, longitudinal, open-label, observational study. Participants were assessed at baseline (T0), after 12 (T1) and 24 months (T2), using psychometric scales (PANSS, YMRS and MDRS) and patient-reported outcome measures (SWN-K, DAI-10 and SF-36).Results:The switch to LAI-AMT was associated with a significant clinical improvement at T1 and T2 compared to baseline (T0). All of the psychometric indexes, as well as patients’ subjective experience of treatment (SWN-K), and quality of life (SF-36) showed a significant improvement after one year of LAI-AMT, with stable results after two years. Patients’ attitude towards drug (DAI-10) increased throughout the follow-up period, with a further improvement during the second year.Conclusions:The switch to LAI-AMT may help to address the subjective core of an optimal recovery in stabilized schizophrenic patients. A sustained improvement in patients’ attitude towards drug may help to achieve patient’s compliance. The size of this study needs to be expanded to produce more solid and generalizable results.
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The Influence of Metabolic Syndrome and Sex on the DNA Methylome in Schizophrenia. Int J Genomics 2018; 2018:8076397. [PMID: 29850476 PMCID: PMC5903198 DOI: 10.1155/2018/8076397] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/25/2018] [Indexed: 02/06/2023] Open
Abstract
Introduction The mechanism by which metabolic syndrome occurs in schizophrenia is not completely known; however, previous work suggests that changes in DNA methylation may be involved which is further influenced by sex. Within this study, the DNA methylome was profiled to identify altered methylation associated with metabolic syndrome in a schizophrenia population on atypical antipsychotics. Methods Peripheral blood from schizophrenia subjects was utilized for DNA methylation analyses. Discovery analyses (n = 96) were performed using an epigenome-wide analysis on the Illumina HumanMethylation450K BeadChip based on metabolic syndrome diagnosis. A secondary discovery analysis was conducted based on sex. The top hits from the discovery analyses were assessed in an additional validation set (n = 166) using site-specific methylation pyrosequencing. Results A significant increase in CDH22 gene methylation in subjects with metabolic syndrome was identified in the overall sample. Additionally, differential methylation was found within the MAP3K13 gene in females and the CCDC8 gene within males. Significant differences in methylation were again observed for the CDH22 and MAP3K13 genes, but not CCDC8, in the validation sample set. Conclusions This study provides preliminary evidence that DNA methylation may be associated with metabolic syndrome and sex in schizophrenia.
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18
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Iversen TSJ, Steen NE, Dieset I, Hope S, Mørch R, Gardsjord ES, Jørgensen KN, Melle I, Andreassen OA, Molden E, Jönsson EG. Side effect burden of antipsychotic drugs in real life - Impact of gender and polypharmacy. Prog Neuropsychopharmacol Biol Psychiatry 2018; 82:263-271. [PMID: 29122637 DOI: 10.1016/j.pnpbp.2017.11.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/01/2017] [Accepted: 11/06/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Antipsychotic-associated side effects are well known and represent a significant treatment challenge. Still, few large studies have investigated the overall side effect burden of antipsychotics in real-life settings. OBJECTIVE To describe the occurrence of side effects and perceived burden of antipsychotics in a large naturalistic sample, taking polypharmacy and patient characteristics into account. METHOD Patients (n=1087) with psychotic disorders were assessed for side effects using the Udvalg for Kliniske Undersøgelser (UKU) side effect rating scale in addition to assessment of clinical and pharmacological data. Statistical analyses were performed controlling for possible confounding factors. RESULTS Use of antipsychotics showed significant associations to neurologic and sexual symptoms, sedation and weight gain, and >75% of antipsychotics-users reported side effects. More side effects were observed in patients using several antipsychotics (p=0.002), with increasing total dose (p=0.021) and with antipsychotics in combinations with other psychotropic drugs. Patients and investigators evaluated the side effect burden differently, particularly related to severity, gender and antipsychotics dose. Twice as many females described side effect burden as severe (p=0.004). CONCLUSION Patients with psychotic disorders have a high occurrence of symptoms associated with use of antipsychotics, and polypharmacy and female gender are seemingly risk factors for reporting a severe side effect burden. Due to the cross-sectional design evaluation of causality is tentative, and these findings should be further investigated in prospective studies.
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Affiliation(s)
- Trude Seselie Jahr Iversen
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway.
| | - Nils Eiel Steen
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ingrid Dieset
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Sigrun Hope
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; Department of Neurohabilitation, Oslo University Hospital, Oslo, Norway
| | - Ragni Mørch
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Erlend Strand Gardsjord
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Kjetil Nordbø Jørgensen
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
| | - Erik G Jönsson
- NORMENT K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway; Department of Clinical Neuroscience, Center for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
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Holmes EA, Ghaderi A, Harmer CJ, Ramchandani PG, Cuijpers P, Morrison AP, Roiser JP, Bockting CLH, O'Connor RC, Shafran R, Moulds ML, Craske MG. The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science. Lancet Psychiatry 2018; 5:237-286. [PMID: 29482764 DOI: 10.1016/s2215-0366(17)30513-8] [Citation(s) in RCA: 323] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Trust Foundation, Warneford Hospital, Oxford, UK
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Heath Trust, Manchester, UK; School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Claudi L H Bockting
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - Rory C O'Connor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Roz Shafran
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW, Sydney, NSW, Australia
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Sellers R, Wells A, Parker S, Morrison AP. Do people with psychosis engage in unhelpful metacognitive coping strategies? A test of the validity of the Cognitive Attentional Syndrome (CAS) in a clinical sample. Psychiatry Res 2018; 259:243-250. [PMID: 29091823 DOI: 10.1016/j.psychres.2017.10.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 10/14/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
Abstract
The Self-Regulatory Executive Function (S-REF) model assumes that unhelpful metacognitive coping strategies characterised by worry, rumination, threat monitoring and attempts to control thoughts, have a central role in psychological disorders and prolonged negative affect. Collectively, these strategies constitute the Cognitive Attentional Syndrome (CAS). This research aims to test whether a questionnaire designed to capture these responses (the CAS-1: Wells, 2009, p. 268) is a valid assessment tool in clinical psychosis, and to test whether activation of the CAS is associated with positive and negative outcomes. A sample of 60 people with psychosis completed a semi-structured interview about psychotic symptoms, the CAS-1 self-report measure and validated self-report measures of metacognitive beliefs, negative affect, quality of life and recovery. The CAS-1 demonstrated good internal consistency, concurrent validity and predictive validity. Hierarchical multiple regression analyses revealed that negative metacognitive beliefs predict negative affect, perceptions of recovery and quality of life in people with psychosis over and above psychotic symptoms. CAS-1 scores did not contribute additional variance in the final regression models. Implications for theory and clinical practice are discussed.
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Affiliation(s)
- Rachel Sellers
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom.
| | - Adrian Wells
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Sophie Parker
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom
| | - Anthony P Morrison
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom
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Hulvershorn L, Parkhurst S, Jones S, Dauss K, Adams C. Improved Metabolic and Psychiatric Outcomes with Discontinuation of Atypical Antipsychotics in Youth Hospitalized in a State Psychiatric Facility. J Child Adolesc Psychopharmacol 2017; 27:897-907. [PMID: 28880609 DOI: 10.1089/cap.2017.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the impact of antipsychotic tapering and discontinuation on measures of metabolic functioning and psychiatric symptom severity in severely impaired youth hospitalized in a psychiatric state hospital. METHODS The study examined psychiatric and metabolic measures in 67 hospitalized children and adolescents (mean age 11.9; 56 with discontinued use of antipsychotics, 10 with continued use of antipsychotics, and 1 started on an antipsychotic) from admission to discharge. RESULTS Upon admission, 56 youth were tapered off of antipsychotic medications, started on other forms of pharmacotherapy (92.9% were started on medications used to treat attention-deficit/hyperactivity disorder), and received evidence-based behavioral programming and were ultimately discharged from the hospital. The mean duration of treatment was 228 days for the discontinuation group and 204 days for the continuation group. Significant decreases in body mass index [BMI; t(53) = 7.12, p = 0.0001] and BMI percentile [t(53) = 6.73, p = 0.0001] were found from admission to discharge in the antipsychotic discontinuation group. Changes in BMI, BMI percentile, or systolic blood pressure were not found in the group (n = 10) who were maintained on antipsychotics. Both groups experienced a significant increase in their Global Assessment of Functioning score [t(52) = 19.98, p = 0.0001 for discontinued; t(8) = 5.092, p = 0.001 for maintained]. Psychiatric symptom severity scores significantly improved in many subscales relevant to disruptive behaviors and mood disorders for those who were removed from the medications. For those maintained on the antipsychotics, there were fewer changes in psychiatric symptom scores. CONCLUSION Discontinuation of atypical antipsychotic medications in conjunction with tailoring treatment to presenting diagnoses resulted in metabolic and psychiatric symptom improvement among severely impaired state hospital inpatient youth. These results serve as a feasibility demonstration that discontinuation of antipsychotics does not provoke psychiatric destabilization, particularly among disruptive behavior disordered youth.
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Affiliation(s)
- Leslie Hulvershorn
- 1 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Samantha Parkhurst
- 1 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Shannon Jones
- 2 Evansville Psychiatric Children's Center , Indiana Family and Social Services Agency, Evansville, Indiana
| | - Kristin Dauss
- 1 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Caitlin Adams
- 1 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
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Wykes T, Evans J, Paton C, Barnes TRE, Taylor D, Bentall R, Dalton B, Ruffell T, Rose D, Vitoratou S. What side effects are problematic for patients prescribed antipsychotic medication? The Maudsley Side Effects (MSE) measure for antipsychotic medication. Psychol Med 2017; 47:2369-2378. [PMID: 28420450 PMCID: PMC5820531 DOI: 10.1017/s0033291717000903] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Capturing service users' perspectives can highlight additional and different concerns to those of clinicians, but there are no up to date, self-report psychometrically sound measures of side effects of antipsychotic medications. Aim To develop a psychometrically sound measure to identify antipsychotic side effects important to service users, the Maudsley Side Effects (MSE) measure. METHOD An initial item bank was subjected to a Delphi exercise (n = 9) with psychiatrists and pharmacists, followed by service user focus groups and expert panels (n = 15) to determine item relevance and language. Feasibility and comprehensive psychometric properties were established in two samples (N43 and N50). We investigated whether we could predict the three most important side effects for individuals from their frequency, severity and life impact. RESULTS MSE is a 53-item measure with good reliability and validity. Poorer mental and physical health, but not psychotic symptoms, was related to side-effect burden. Seventy-nine percent of items were chosen as one of the three most important effects. Severity, impact and distress only predicted 'putting on weight' which was more distressing, more severe and had more life impact in those for whom it was most important. CONCLUSIONS MSE is a self-report questionnaire that identifies reliably the side-effect burden as experienced by patients. Identifying key side effects important to patients can act as a starting point for joint decision making on the type and the dose of medication.
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Affiliation(s)
- T. Wykes
- Psychology Department,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
- South London and Maudsley NHS Foundation
Trust, London UK
| | - J. Evans
- NIHR Biomedical Research Centre, South London and
Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology, and Neuroscience,
King's College London, London, UK
| | - C. Paton
- Chief Pharmacist, Oxleas NHS
Foundation Trust, Dartford, UK
| | | | - D. Taylor
- Pharmacy and Pathology, South
London and Maudsley NHS Foundation Trust, London,
UK
- Institute of Pharmaceutical Science, King's
College London, London, UK
| | - R. Bentall
- Department of Psychological Sciences,
University of Liverpool, UK
| | - B. Dalton
- Department for Psychological Medicine,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - T. Ruffell
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - D. Rose
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - S. Vitoratou
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
- Psychometrics and Measurement Lab,
Biostatistics and Health Informatics, Institute of
Psychiatry, Psychology, and Neuroscience, King's College London,
London, UK
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23
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Verrotti A, Iapadre G, Pisano S, Coppola G. Ketogenic diet and childhood neurological disorders other than epilepsy: an overview. Expert Rev Neurother 2016; 17:461-473. [PMID: 27841033 DOI: 10.1080/14737175.2017.1260004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In the last years, ketogenic diet (KD) has been experimentally utilized in various childhood neurologic disorders such as mitochondriopathies, alternating hemiplegia of childhood (AHC), brain tumors, migraine, and autism spectrum disorder (ASD). The aim of this review is to analyze how KD can target these different medical conditions, highlighting possible mechanisms involved. Areas covered: We have conducted an analysis on literature concerning KD use in mitochondriopathies, AHC, brain tumors, migraine, and ASD. Expert commentary: The role of KD in reducing seizure activity in some mitochondriopathies and its efficacy in pyruvate dehydrogenase deficiency is known. Recently, few cases suggest the potentiality of KD in decreasing paroxysmal activity in children affected by AHC. A few data support its potential use as co-adjuvant and alternative therapeutic option for brain cancer, while any beneficial effect of KD on migraine remains unclear. KD could improve cognitive and social skills in a subset of children with ASD.
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Affiliation(s)
- Alberto Verrotti
- a Department of Pediatrics , University of L'Aquila, San Salvatore Hospital , L'Aquila , Italy
| | - Giulia Iapadre
- a Department of Pediatrics , University of L'Aquila, San Salvatore Hospital , L'Aquila , Italy
| | - Simone Pisano
- b Department of Child and Adolescent Neuropsychiatry , University of Salerno , Salerno , Italy
| | - Giangennaro Coppola
- c Department of Child Neuropsychiatry , University of Salerno , Salerno , Italy
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