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Sancho-Echeverria R, Aymerich C, Rodríguez-Sánchez JM, Gil P, Pedruzo B, González-Torres MÁ, Fusar-Poli P, Arango C, Catalan A. Effect of long-acting antipsychotic treatment on psychiatric hospitalization rate in early psychosis patients: a naturalistic study. Ther Adv Psychopharmacol 2024; 14:20451253241243273. [PMID: 38644940 PMCID: PMC11032064 DOI: 10.1177/20451253241243273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/28/2024] [Indexed: 04/23/2024] Open
Abstract
Background The effectiveness of long-acting injectable (LAI) antipsychotics in preventing relapses of first-episode psychosis is currently debated. Objectives The study aimed to investigate the number of psychiatric hospitalizations comparing the LAI cohort versus the oral cohort during different phases of the illness, pre-LAI treatment, during LAI treatment, and after LAI treatment. Design A naturalistic study was conducted on two independent cohorts of early psychosis patients receiving treatment from a specific early intervention service. The first cohort comprised 228 patients who received LAIs, while the second cohort comprised 667 patients who had never received LAIs. Methods This study was designed as a longitudinal observational study conducted within a naturalistic clinical setting in two cohorts of early psychosis patients. Repeated series ANCOVA (ANCOVA-r) was used to study the number of hospitalizations in the different study periods (T1 = from the date of the first psychiatric record to the beginning of the mirror period; T2 = the mirror period; T3 = from the LAI implementation to the LAI discontinuation; and T4 = from the LAI discontinuation to the end). In all cases, discontinuation of LAI involved the return to oral treatment. In all, 35 patients had not T4 as they were still on LAI treatment at the time of database closing (September 2020), and their data were not included in the analysis of the effect of the LAI discontinuation. Results The patients in the LAI cohort were younger, more frequently males, presented more schizophrenia diagnoses, and had a higher number of hospitalizations (2.50 ± 2.61 versus 1.19 ± 1.69; p < 0.001) than the oral cohort. The number of hospitalizations at the end of the follow-up was higher in the LAI cohort [0.20 (standard deviation (SD)) = 0.79] versus 0.45 [SD = 0.45 (SD = 1.13); F(23.90), p < 0.001]. However, after the introduction of LAIs, the differences in hospitalization rates between the two cohorts became less pronounced. Once LAI treatment was ceased, the hospitalization rate increased again. Conclusion In our study, early psychosis patients receiving LAIs experienced a greater decrease in hospitalizations after introducing the LAI treatment than those treated solely with oral medication. These findings support using LAIs as a viable strategy for preventing rehospitalization and improving the overall course of treatment for individuals with early psychosis.
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Affiliation(s)
- Raúl Sancho-Echeverria
- Red de Salud Mental, Biocruces Bizkaia Health Research Institute, c/Ronda, Bilbao, Bizkaia, Spain
| | - Claudia Aymerich
- Biobizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Basurto University Hospital, OSI Bilbao-Basurto, Bilbao, Bizkaia, Spain
- Centro de Investigación en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Patxi Gil
- Red de Salud Mental, Biocruces Bizkaia Health Research Institute, c/Ronda, Bilbao, Bizkaia, Spain
| | - Borja Pedruzo
- Basurto University Hospital, OSI Bilbao-Basurto, Bilbao, Bizkaia, Spain
| | - Miguel Ángel González-Torres
- Biobizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Basurto University Hospital, OSI Bilbao-Basurto, Bizkaia, Spain
- University of the Basque Country (UPV/EHU), Barrio Sarriena, Leioa, Bizkaia, Spain
- Centro de Investigación en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- OASIS Service, South London and Maudsley National Health Service Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, UK
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación en Red de Salud Mental, Madrid, Spain
| | - Ana Catalan
- Basurto University Hospital, OSI Bilbao-Basurto, Av, Montevideo 18, 48013 Bilbao, Bizkaia, Spain
- Biobizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- University of the Basque Country (UPV/EHU), Barrio Sarriena, Leioa, Bizkaia, Spain
- Centro de Investigación en Red de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
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Fernández-Miranda JJ, Díaz-Fernández S, Cepeda-Piorno FJ, López-Muñoz F. Long-Acting Injectable Second-Generation Antipsychotics in Seriously Ill Patients with Schizophrenia: Doses, Plasma Levels, and Treatment Outcomes. Biomedicines 2024; 12:165. [PMID: 38255270 PMCID: PMC10813024 DOI: 10.3390/biomedicines12010165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
This research studies the dose-plasma level (PL) relationship of second-generation antipsychotics, together with the treatment outcomes achieved, in seriously ill people with schizophrenia. An observational, prospective, one-year follow-up study was carried out with patients (N = 68) with severe schizophrenia treated with paliperidone three-month (PP3M) or aripiprazole one-month (ARIM). Participants were divided into standard-dose or high-dose groups. PLs were divided into "standard PL" and "high PL" (above the therapeutic reference range, TRR) groups. The dose/PL relationship, and severity, hospitalizations, tolerability, compliance, and their relationship with doses and PLs were evaluated. There was no clear linear relationship between ARIM or PP3M doses and the PLs achieved. In half of the subjects, standard doses reached PLs above the TRR. The improvements in clinical outcomes (decrease in clinical severity and relapses) were related to high PLs, without worse treatment tolerability or adherence. All participants remained in the study, regardless of dose or PL. Clinical severity and hospitalizations decreased significantly more in those patients with high PLs. Considering the non-linear dose-PL relationship of ARIM and PP3M in people with severe schizophrenia, PLs above the TRR are linked to better treatment outcomes, without worse tolerability. The need in a notable number of cases for high doses to reach those effective PLs is highlighted.
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Affiliation(s)
- Juan José Fernández-Miranda
- Cabueñes Universitary Hospital, Asturian Health Service (SESPA), 33394 Gijón, Spain; (S.D.-F.); (F.J.C.-P.)
- Asturian Health Research Institute (ISPA), 33011 Oviedo, Spain
| | - Silvia Díaz-Fernández
- Cabueñes Universitary Hospital, Asturian Health Service (SESPA), 33394 Gijón, Spain; (S.D.-F.); (F.J.C.-P.)
- Asturian Health Research Institute (ISPA), 33011 Oviedo, Spain
| | - Francisco Javier Cepeda-Piorno
- Cabueñes Universitary Hospital, Asturian Health Service (SESPA), 33394 Gijón, Spain; (S.D.-F.); (F.J.C.-P.)
- Asturian Health Research Institute (ISPA), 33011 Oviedo, Spain
| | - Francisco López-Muñoz
- Health Sciences Faculty, Camilo José Cela University, 28692 Madrid, Spain;
- Neuropsychopharmacology Unit, 12 de Octubre Hospital Research Institute, 28041 Madrid, Spain
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Wei X, Shi ZM, Lan XJ, Qin ZJ, Mo Y, Wu HW, Huang XB, Zeng QB, Luo LX, Yang XH, Zheng W. Transcranial alternating current stimulation for schizophrenia: a systematic review of randomized controlled studies. Front Psychiatry 2024; 14:1308437. [PMID: 38274423 PMCID: PMC10808327 DOI: 10.3389/fpsyt.2023.1308437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Background In randomized clinical trials (RCTs) investigating the application of transcranial alternating current stimulation (tACS) in schizophrenia, inconsistent results have been reported. The purpose of this exploratory systematic review of RCTs was to evaluate tACS as an adjunct treatment for patients with schizophrenia based on its therapeutic effects, tolerability, and safety. Methods Our analysis included RCTs that evaluated adjunctive tACS' effectiveness, tolerability, and safety in schizophrenia patients. Three independent authors extracted data and synthesized it using RevMan 5.3 software. Results Three RCTs involving 76 patients with schizophrenia were encompassed in the analysis, with 40 participants receiving active tACS and 36 receiving sham tACS. Our study revealed a significant superiority of active tACS over sham tACS in improving total psychopathology (standardized mean difference [SMD] = -0.61, 95% confidence interval [CI]: -1.12, -0.10; I2 = 16%, p = 0.02) and negative psychopathology (SMD = -0.65, 95% CI: -1.11, -0.18; I2 = 0%, p = 0.007) in schizophrenia. The two groups, however, showed no significant differences in positive psychopathology, general psychopathology, or auditory hallucinations (all p > 0.05). Two RCTs examined the neurocognitive effects of tACS, yielding varied findings. Both groups demonstrated similar rates of discontinuation due to any reason and adverse events (all p > 0.05). Conclusion Adjunctive tACS is promising as a viable approach for mitigating total and negative psychopathology in individuals diagnosed with schizophrenia. However, to gain a more comprehensive understanding of tACS's therapeutic effects in schizophrenia, it is imperative to conduct extensive, meticulously planned, and well-documented RCTs.
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Affiliation(s)
- Xin Wei
- The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Zhan-Ming Shi
- Chongqing Jiangbei Mental Health Center, Chongqing, China
| | - Xian-Jun Lan
- The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Zhen-Juan Qin
- The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Yu Mo
- The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Hua-Wang Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xing-Bing Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qing-Bin Zeng
- The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Li-Xia Luo
- Chongqing Mental Health Center, Chongqing, China
| | - Xin-Hu Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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García-Carmona JA, Pappa S. Cumulative Clinical Experience of the Use of Paliperidone Palmitate 3-Monthly Long-Acting Injection in the Treatment of Schizophrenia: A Critical Appraisal. Drug Healthc Patient Saf 2023; 15:113-123. [PMID: 37720806 PMCID: PMC10504906 DOI: 10.2147/dhps.s339170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
Paliperidone palmitate 3-monthly (PP3M), an approved maintenance treatment for patients with schizophrenia, was the first long-acting antipsychotic injectable (LAI) to require only four administrations per year. Here, we aimed to review the available evidence about its use in the management of schizophrenia to date and highlight key study findings in order to provide a balanced overview of current experience in clinical practice. For that purpose, an extensive search of available literature from PubMed, Embase, and Web of Science was conducted in March 2023. Emerging data from real-world studies appear to signal that the benefits of the use of PP3M may well extent beyond the obvious convenience for patients and resource efficiency for services and may be actually associated with improved effectiveness and patient satisfaction. Large naturalistic studies from Australia, Europe and the US comparing treatment continuation between newer LAIs and/or oral antipsychotics showed that patients treated with PP3M had higher compliance rates and a longer period of continuous use. The risk of relapse, re-hospitalization and number of bed days was also lower with PP3M compared to PP1M and other LAIs as demonstrated by several cohort studies. Furthermore, patients treated with PP3M were using lower doses of benzodiazepines and concomitant oral antipsychotics compared with other LAIs. What is more, PP3M appears to positively impact patients' satisfaction and quality of life, facilitating long-term goals. In fact, recent studies recorded better quality-adjusted life years and decreased stigma, with improved social acceptability and promotion of rehabilitation for patients transitioning to PP3M. The rates of general satisfaction rates with PP3M were also higher among psychiatrists and caregivers who reported overall less concerns. In conclusion, clinical exposure and a growing body of evidence thus far, reinforce the use of PP3M in an effort to enhance patient outcomes alongside individual experience and treatment persistence.
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Affiliation(s)
- Juan Antonio García-Carmona
- Department of Neurology, Santa Lucia University Hospital, Cartagena, Murcia, Spain
- Unit of Acute Psychiatry, Reina Sofía University Hospital, Murcia, Spain
- Group of Clinical and Experimental Pharmacology, Institute for Biomedical Research of Murcia (IMIB), Murcia, Spain
| | - Sofia Pappa
- West London NHS Trust, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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5
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Milz R, Benson C, Knight K, Antunes J, Najarian D, Lopez Rengel PM, Wang S, Richarz U, Gopal S, Kane JM. The Effect of Longer Dosing Intervals for Long-Acting Injectable Antipsychotics on Outcomes in Schizophrenia. Neuropsychiatr Dis Treat 2023; 19:531-545. [PMID: 36915909 PMCID: PMC10008005 DOI: 10.2147/ndt.s395383] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/12/2023] [Indexed: 03/16/2023] Open
Abstract
Medication nonadherence in schizophrenia can have serious implications including relapses and hospitalization. Long-acting injectable (LAI) antipsychotics require fewer administrations, while ensuring sustained medication coverage. In this review, we summarize the expected real-world benefits of longer dosing intervals in the management of schizophrenia. LAIs are associated with improved clinical outcomes of less frequent relapses and reduced functional impairment, encouraging patients to regain control of their lives. Aripiprazole lauroxil and paliperidone palmitate three-monthly (PP3M) LAIs have longer dosing intervals of 2-3 months and provide improved outcomes in patients with schizophrenia. Paliperidone palmitate six-monthly (PP6M) LAI provides the longest dosing interval, twice-yearly dosing, among existing LAIs. Decreasing the frequency of LAI administrations has the potential to reduce occurrence of serious outcomes associated with poor medication adherence. By eliminating the need for daily oral antipsychotic dosing, LAIs could increase the likelihood of patient acceptance, decrease stigma, and promote self-esteem. Longer intervals of medication coverage may be desirable for patients with higher risk of relapse including adults with recent-onset schizophrenia, those living in circumstances that may deprive them of regular access (eg, homeless), those that are in transitions between care settings or to reduce interpersonal contact during public health emergencies (eg, COVID-19 pandemic).
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Affiliation(s)
- Ruth Milz
- Janssen Research & Development LLC, Titusville, NJ, USA
| | | | - Karl Knight
- Janssen Research & Development LLC, Titusville, NJ, USA
| | | | | | | | - Steven Wang
- Janssen Research & Development LLC, Titusville, NJ, USA
| | - Ute Richarz
- Janssen Global Medical Affairs, Cilag, Zug, Switzerland
| | - Srihari Gopal
- Janssen Research & Development LLC, Titusville, NJ, USA
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Queens, NY, USA.,Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
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Shan J, Tian H, Zhou C, Wang H, Ma X, Li R, Yu H, Chen G, Zhu J, Cai Z, Lin C, Cheng L, Xu Y, Liu S, Zhang C, Luo Q, Zhang Y, Jin S, Liu C, Zhang Q, Lv L, Yang L, Chen J, Li Q, Liu W, Yue W, Song X, Zhuo C. Prevalence of Heavy Menstrual Bleeding and Its Associated Cognitive Risks and Predictive Factors in Women With Severe Mental Disorders. Front Pharmacol 2022; 13:904908. [PMID: 35910343 PMCID: PMC9326357 DOI: 10.3389/fphar.2022.904908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
There has been limited studies examining treatment-induced heavy menstrual bleeding (HMB) in women with severe mental illnesses. The aim of this study was to examine HMB prevalence and HMB-associated factors in young women (18–34 years old) diagnosed with bipolar disorder (BP), major depressive disorder (MDD), or schizophrenia (SCZ) who have full insight and normal intelligence. Eighteen-month menstruation histories were recorded with pictorial blood loss assessment chart assessments of HMB. Multivariate analyses were conducted to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Drug effects on cognition were assessed with the MATRICS Consensus Cognitive Battery (MCCB). HMB prevalence were: BP, 25.85%; MDD, 18.78%; and SCH, 13.7%. High glycosylated hemoglobin (HbA1c) level was a strong risk factor for HMB [BP OR, 19.39 (16.60–23.01); MDD OR, 2.69 (4.59–13.78); and SCZ OR, 9.59 (6.14–12.43)]. Additional risk factors included fasting blood sugar, 2-h postprandial blood glucose, and use of the medication valproate [BP: OR, 16.00 (95%CI 12.74–20.22); MDD: OR, 13.88 (95%CI 11.24–17.03); and SCZ OR, 11.35 (95%CI 8.84–19.20)]. Antipsychotic, antidepressant, and electroconvulsive therapy use were minor risk factors. Pharmacotherapy-induced visual learning impairment was associated with HMB [BP: OR, 9.01 (95%CI 3.15–13.44); MDD: OR, 5.99 (95%CI 3.11–9.00); and SCZ: OR, 7.09 (95%CI 2.99–9.20)]. Lithium emerged as a protective factor against HMB [BP: OR, 0.22 (95%CI 0.14–0.40); MDD: OR, 0.30 (95%CI 0.20–0.62); and SCZ: OR, 0.65 (95%CI 0.33–0.90)]. In SCZ patients, hyperlipidemia and high total cholesterol were HMB-associated factors (ORs, 1.87–2.22). Psychiatrist awareness of HMB risk is concerningly low (12/257, 2.28%). In conclusion, prescription of VPA should be cautioned for women with mental illness, especially BP, and lithium may be protective against HMB.
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Affiliation(s)
- Jianmin Shan
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Hongjun Tian
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Chunhua Zhou
- Department of Pharmacology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Xiaoyan Ma
- MECT Center, Sleep Disorder Center, Tianjin Anding Hospital, Tianjin, China
| | - Ranli Li
- MECT Center, Sleep Disorder Center, Tianjin Anding Hospital, Tianjin, China
| | - Haiping Yu
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Guangdong Chen
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Jingjing Zhu
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Ziyao Cai
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Chongguang Lin
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Langlang Cheng
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Congpei Zhang
- Inpatient Department of Harbin First Psychiatry Hospital, Harbin, China
| | - Qinghua Luo
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunshu Zhang
- Inpatient Department of Hebei Mental Health Center, Baoding, China
| | - Shili Jin
- Inpatient Department, Shandong Daizhuang Hospital, Jining, China
| | - Chuanxin Liu
- Institute of Psychiatry, Jining Medical University, Jinning, China
| | - Qiuyu Zhang
- Institute of Psychiatry, Jining Medical University, Jinning, China
| | - Luxian Lv
- Department of Psychiatry, Henan Psychiatry Hospital, Xinxiang, China
| | - Lei Yang
- Key Laboratory of Mental Health, Ministry of Health (Peking University) and National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jiayue Chen
- Department of Psychiatry, The First Hospital Affiliated to Harbin Medical University, Harbin, China
| | - Qianchen Li
- Department of Pharmacology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Liu
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Wei Liu, ; Weihua Yue, ; Xueqin Song, ; Chuanjun Zhuo,
| | - Weihua Yue
- Department of Psychiatry, The First Hospital Affiliated to Harbin Medical University, Harbin, China
- *Correspondence: Wei Liu, ; Weihua Yue, ; Xueqin Song, ; Chuanjun Zhuo,
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Wei Liu, ; Weihua Yue, ; Xueqin Song, ; Chuanjun Zhuo,
| | - Chuanjun Zhuo
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Laboratory of Psychiatric-Neuroimaging-Genetic and Cor-morbidity, Tianjin Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
- *Correspondence: Wei Liu, ; Weihua Yue, ; Xueqin Song, ; Chuanjun Zhuo,
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Blokland A. Cholinergic models of memory impairment in animals and man: scopolamine vs. biperiden. Behav Pharmacol 2022; 33:231-237. [PMID: 35621168 DOI: 10.1097/fbp.0000000000000670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Scopolamine has been used as a pharmacologic model for cognitive impairments in dementia and Alzheimer's disease. The validity of this model seems to be limited because findings in animals do not readily translate to novel treatments in humans. Biperiden is also a cholinergic deficit model for cognitive impairments but specifically blocks muscarinic M1 receptors. The effects of scopolamine and biperiden (and pirenzepine) are compared in animal studies and related to findings in humans. It is concluded that the effects on cognitive functions are different for scopolamine and biperiden, and they should be considered as different cognitive deficit models. Scopolamine may model more advanced stages of Alzheimer's disease whereas biperiden may model the early deficits in declarative memory in aging and mild cognitive impairment.
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Affiliation(s)
- Arjan Blokland
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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8
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Garcia-Portilla MP, Benito Ruiz A, Gómez Robina F, García Dorado M, López Rengel PM. Impact on functionality of the paliperidone palmitate three-month formulation in patients with a recent diagnosis of schizophrenia: a real-world observational prospective study. Expert Opin Pharmacother 2022; 23:629-638. [PMID: 34986711 DOI: 10.1080/14656566.2021.2023496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Information on the effect of the paliperidone palmitate three-month (PP3M) formulation on functionality in patients in the early stages of psychosis is lacking. The primary aim of this study was to evaluate the impact of PP3M on functionality in patients recently diagnosed with schizophrenia. RESEARCH DESIGN AND METHODS This was an observational, multicenter, and prospective study in patients with a recent diagnosis of schizophrenia undergoing treatment with PP3M. Evaluations included the Personal and Social Performance (PSP) scale, the Clinical Global Impression-Schizophrenia (CGI-Sch), the Medication Satisfaction Questionnaire and the Involvement Evaluation Questionnaire. RESULTS A total of 101/110 evaluable patients (91.8%) completed the study and were included in the efficacy analyses. The total PSP score increased from a mean of 68.5 (15.3) at baseline to a mean of 72.1 (15.4) at month 6 and 74.8 (16.7) at month 12 with a before-and-after difference of 3.6 (95% CI, 1.6 to 5.5, p < 0.001) at month 6 and 6.2 (95% CI, 4.2 to 8.3, p < 0.001) at month 12. CGI-Sch severity significantly decreased from a mean score of 2.8 (1.1) at baseline to a score of 2.2 (1.1) at month 12 with a before-and-after difference of -0.6 (95% CI, 0.8 to -0.4, p < 0.001). CONCLUSIONS Early introduction of PP3M in the course of schizophrenia is associated with a meaningful benefit in social functioning and at least maintains clinical stability.
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Affiliation(s)
| | - Adolfo Benito Ruiz
- Psychiatry Service, University Hospital Complex of Toledo, Toledo, Spain
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9
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Gutiérrez-Rojas L, Sánchez-Alonso S, García Dorado M, López Rengel PM. Impact of 3-Monthly Long-Acting Injectable Paliperidone Palmitate in Schizophrenia: A Retrospective, Real-World Analysis of Population-Based Health Records in Spain. CNS Drugs 2022; 36:517-527. [PMID: 35460508 PMCID: PMC9095535 DOI: 10.1007/s40263-022-00917-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treatment of schizophrenia requires long-term medication to prevent relapse. Treatment nonadherence may increase the risk of relapse, leading to increased hospitalizations and emergency room (ER) visits. Long-acting injectables (LAIs) such as paliperidone palmitate have improved treatment adherence and therefore symptoms. However, real-world studies comparing 3-monthly LAI formulations with other LAIs and oral antipsychotics (OAs) are scarce. OBJECTIVE The objective of this study was to investigate and evaluate the clinical effectiveness of paliperidone palmitate LAI monthly (PP1M; Xeplion®) and 3-monthly (PP3M; Trevicta®) formulations compared with the monthly LAI aripiprazole (AM; Abilify Maintena®) and OAs in Spain. METHODS This was a retrospective, observational study including 2275 adult patients with schizophrenia in a Spanish population. Data from hospital, primary care, and pharmacy dispensation electronic medical records were obtained between January 2017 and February 2018. The main outcomes included psychiatric hospitalizations and ER visit rates, days on treatment, and treatment persistence. RESULTS Patients receiving PP3M had a significantly lower mean hospitalization rate (0.00046 ± standard deviation [SD] 0.00181; p < 0.0001) than other treatment groups. Kaplan-Meier curves revealed that 92.0 and 88.4% of patients receiving PP3M remained hospitalization free by 12 and 18 months, respectively. All treatment groups had at least a twofold significantly higher risk of psychiatric hospitalizations compared with those receiving PP3M or OAs, and the hospitalization risk among the PP3M group was significantly lower (hazard ratio [HR] 0.46; 95% confidence interval [CI] 0.31-0.67). The risk of ER visits was significantly lower with both PP3M and PP1M than with OAs, and lowest with PP3M (HR 0.462 [95% CI 0.29-0.62] and HR 0.833 [95% CI 0.59-0.97], respectively). Time until treatment switch with PP3M was high, with more than 86.5% of patients remaining on treatment at 18 months. CONCLUSIONS PP3M was more effective than OAs and monthly LAIs in improving clinical outcomes for patients with schizophrenia in a real-world setting in Spain.
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Affiliation(s)
| | - Sergio Sánchez-Alonso
- Department of Psychiatry, Jimenez Diaz Foundation University Hospital, Madrid, Spain
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10
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Zhuo C, Liu W, Jiang R, Li R, Yu H, Chen G, Shan J, Zhu J, Cai Z, Lin C, Cheng L, Xu Y, Liu S, Luo Q, Jin S, Liu C, Chen J, Wang L, Yang L, Zhang Q, Li Q, Tian H, Song X. Metabolic risk factors of cognitive impairment in young women with major psychiatric disorder. Front Psychiatry 2022; 13:880031. [PMID: 35966480 PMCID: PMC9373724 DOI: 10.3389/fpsyt.2022.880031] [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: 02/20/2022] [Accepted: 06/29/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cognitive performance improves clinical outcomes of patients with major psychiatric disorder (MPD), but is impaired by hyperglycemia. Psychotropic agents often induce metabolism syndrome (MetS). The identification of modifiable metabolic risk factors of cognitive impairment may enable targeted improvements of patient care. OBJECTIVE To investigate the relationship between MetS and cognitive impairment in young women with MPD, and to explore risk factors. METHODS We retrospectively studied women of 18-34 years of age receiving psychotropic medications for first-onset schizophrenia (SCH), bipolar disorder (BP), or major depressive disorder (MDD). Data were obtained at four time points: presentation but before psychotropic medication; 4-8 and 8-12 weeks of psychotropic therapy; and enrollment. MATRICS Consensus Cognitive Battery, (MCCB)-based Global Deficit Scores were used to assess cognitive impairment. Multiple logistic analysis was used to calculate risk factors. Multivariate models were used to investigate factors associated with cognitive impairment. RESULTS We evaluated 2,864 participants. Cognitive impairment was observed in 61.94% of study participants, and was most prevalent among patients with BP (69.38%). HbA1c within the 8-12 week-treatment interval was the most significant risk factor and highest in BP. Factors in SCH included pre-treatment waist circumference and elevated triglycerides during the 8-12 weeks treatment interval. Cumulative dosages of antipsychotics, antidepressants, and valproate were associated with cognitive impairment in all MPD subgroups, although lithium demonstrated a protect effect (all P < 0.001). CONCLUSIONS Cognitive impairment was associated with elevated HbA1c and cumulative medication dosages. Pre-treatment waist circumference and triglyceride level at 8-12 weeks were risk factors in SCH. Monitoring these indices may inform treatment revisions to improve clinical outcomes.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China.,Department of Psychiatry, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Psychiatric Transformational Research Key Laboratory, Zhengzhou University, Zhengzhou, China.,Multiple Organs Damage in the Mental Disorder (MODMD) Center of Wenzhou Seventh Hospital, Wenzhou, China.,Department of Psychiatry, Tianjin Anding Hospital, Tianjin, China
| | - Wei Liu
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ronghuan Jiang
- Department of Psychiatry, General Hospital of PLA, Beijing, China
| | - Ranli Li
- Key Laboratory of Psychiatric-Neuroimaging-Genetic and Cor-morbidity, Tianjin Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
| | - Haiping Yu
- Inpatient Department of Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Guangdong Chen
- Inpatient Department of Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Jianmin Shan
- Inpatient Department of Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Jingjing Zhu
- Inpatient Department of Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Ziyao Cai
- Inpatient Department of Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Chongguang Lin
- Inpatient Department of Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Langlang Cheng
- Inpatient Department of Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Qinghua Luo
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shili Jin
- Inpatient Department, Shandong Daizhuang Hospital, Jining, China
| | - Chuanxin Liu
- Inpatient Department, Shandong Daizhuang Hospital, Jining, China
| | - Jiayue Chen
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Lina Wang
- Department of Psychiatry, Tianjin Anding Hospital, Tianjin, China
| | - Lei Yang
- Department of Psychiatry, Yanan Fifth Hospital, Yan'An, China
| | - Qiuyu Zhang
- Department of Psychiatry, Tianjin Anning Hospital, Tianjin, China
| | - Qianchen Li
- Department of Psychiatry, Hebei Fifth Peoples Hospital, Shijiazhuang, China
| | - Hongjun Tian
- Key Laboratory of Multiple Organ Damage in Patients With Mental Disorder, Tianjin Fourth Center Hospital of Tianjin Medical University, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Psychiatric Transformational Research Key Laboratory, Zhengzhou University, Zhengzhou, China
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11
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Montemagni C, Del Favero E, Cocuzza E, Vischia F, Rocca P. Effect of long-acting injectable antipsychotics on hospitalizations and global functioning in schizophrenia: a naturalistic mirror-image study. Ther Adv Psychopharmacol 2022; 12:20451253221122526. [PMID: 36226272 PMCID: PMC9549097 DOI: 10.1177/20451253221122526] [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: 03/15/2022] [Accepted: 07/31/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Partial adherence to antipsychotics is the most common cause of relapses and rehospitalization in patients with schizophrenia (SZ), leading to higher health care costs and psychosocial disability. The use of long-acting injectable (LAI) antipsychotics may improve therapeutic continuity and adherence to treatment. OBJECTIVE To assess the effectiveness of switching from oral antipsychotics (OAs) to long-acting antipsychotics. METHODS This 1-year mirror-image study evaluated the effect of switching from OAs to LAIs on the reduction of psychiatric hospitalizations and the improvement of global functioning in patients with schizophrenia. Differences in outcomes between second-generation (SGA) LAIs and first-generation (FGA) LAIs were also analyzed. RESULTS In all, 166 patients were included: 32.5% treated by FGA-LAIs and 67.5% by SGA-LAIs. There was an overall reduction of 71% in the average number of hospital admissions and an overall improvement of 29.3% in the Global Assessment of Functioning (GAF) score between the previous 12 months and the 12 months following the switching to LAIs. Patients who switched to SGA-LAIs had no significant differences in hospitalization occurrences but a significant improvement in GAF scores when compared with patients who switched to FGA-LAIs. CONCLUSION Our results suggest that using LAIs could be the most adequate treatment choice for SZ patients with a high risk of relapse and low adherence rate. Patients with poorer social functioning may be ideal candidates for SGA-LAIs treatment. Our findings may be of particular interest from a clinical and health care management perspective.
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Affiliation(s)
- Cristiana Montemagni
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, AOU Città della Salute e della Scienza, Via Cherasco N. 15, 10126 Turin, Italy
| | - Elisa Del Favero
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Elena Cocuzza
- Department of Mental Health, Azienda Sanitaria Locale (ASL) Città di Torino, Turin, Italy
| | - Flavio Vischia
- Department of Mental Health, Azienda Sanitaria Locale (ASL) Città di Torino, Turin, Italy
| | - Paola Rocca
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
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12
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Zhuo C, Chen G, Lin C, Ping J, Zhu J, Wang L, Jin S, Liu C, Zhang Q, Yang L, Li Q, Zhou C, Cheng L, Tian H, Song X. Risk-to-befit ratios of consecutive antidepressants for heavy menstrual bleeding in young women with bipolar disorder or major depressive disorder. Front Psychiatry 2022; 13:1012644. [PMID: 36386987 PMCID: PMC9650378 DOI: 10.3389/fpsyt.2022.1012644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022] Open
Abstract
The occurrence of heavy menstrual bleeding (HMB) induced by pharmacological agents has been reported in young adult women. This study aimed to investigate a possible association between the occurrence rates of HMB and different treatment methods such as antidepressant agents alone and in combination with other pharmacological agents. The examined cohort included young women (age 18-35 years, n = 1,949) with bipolar disorder (BP) or major depressive disorder (MDD). Menstruation history for 24 months was recorded and evaluated according to pictorial blood loss assessment charts of HMB. Multivariate analyses were conducted to determine odds ratios (ORs) and 95% confidence intervals. The examined antidepressant agents had varying ORs for patients with BP vs. those with MDD. For example, the ORs of venlafaxine-induced HMB were 5.27 and 4.58 for patients with BP and MDD, respectively; duloxetine-induced HMB, 4.72 and 3.98; mirtazapine-induced HMB, 3.26 and 2.39; fluvoxamine-induced HMB, 3.11 and 2.08; fluoxetine-induced HMB, 2.45 and 1.13; citalopram-induced HMB, 2.03 and 1.25; escitalopram-induced HMB, 1.85 and 1.99; agomelatine-induced HMB, 1.45 and 2.97; paroxetine-induced HMB, 1.19 and 1.75; sertraline-induced HMB, 0.88 and 1.13; reboxetine-induced HMB, 0.45 and 0.45; and bupropion-induced HMB, 0.33 and 0.37, in each case. However, when antidepressant agents were combined with valproate, the OR of HMB greatly increased, with distinct profiles observed for patients with BP vs. those with MDD. For example, the ORs of HMB induced by venlafaxine combined with valproate were 8.48 and 6.70 for patients with BP and MDD, respectively; for duloxetine, 5.40 and 4.40; mirtazapine, 5.67 and 3.73; fluvoxamine, 5.27 and 3.37; fluoxetine, 3.69 and 4.30; citalopram, 5.88 and 3.46; escitalopram, 6.00 and 7.55; agomelatine, 4.26 and 5.65; paroxetine, 5.24 and 3.25; sertraline, 4.97 and 5.11; reboxetine, 3.54 and 2.19; and bupropion, 4.85 and 3.46, in each case. In conclusion, some antidepressant agents exhibited potential risks of inducing HMB. Therefore, a combined prescription of antidepressant agents and valproate should be carefully considered for young women with HMB.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China.,Key Laboratory of Multiple Organs Damage in Patients With Metal Disorder, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China.,Department of Psychiatry, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China.,Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Laboratory of Psychiatric-Neuroimaging-Genetic and Comorbidity, Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Guangdong Chen
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Chongguang Lin
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Jing Ping
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Jingjing Zhu
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Lina Wang
- Laboratory of Psychiatric-Neuroimaging-Genetic and Comorbidity, Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Shili Jin
- Inpatient Department, Shandong Daizhuang Hospital, Jining, China
| | - Chuanxin Liu
- College of Mental Disorder, Jining Medical University, Jining, China
| | - Qiuyu Zhang
- Key Laboratory of Multiple Organs Damage in Patients With Metal Disorder, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Lei Yang
- Key Laboratory of Multiple Organs Damage in Patients With Metal Disorder, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Qianchen Li
- Key Laboratory of Multiple Organs Damage in Patients With Metal Disorder, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Chunhua Zhou
- Department of Pharmacology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Langlang Cheng
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Hongjun Tian
- Key Laboratory of Multiple Organs Damage in Patients With Metal Disorder, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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13
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Switch to 3-Month Long-Acting Injectable Paliperidone May Decrease Plasma Levels: A Case Series. J Clin Psychopharmacol 2021; 41:694-696. [PMID: 34735103 DOI: 10.1097/jcp.0000000000001461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Simal-Aguado J, Campos-Navarro MP, Valdivia-Muñoz F, Galindo-Tovar A, García-Carmona JA. Evaluation of Risk Factors Associated to Prescription of Benzodiazepines and its Patterns in a Cohort of Patients from Mental Health: A Real World Study in Spain. PSYCHOPHARMACOLOGY BULLETIN 2021; 51:81-93. [PMID: 33897065 PMCID: PMC8063129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE we aimed 1) to evaluate the risk factors associated to the benzodiazepines intake; 2) to assess the impact about the use of long acting injectables antipsychotics (LAIs); 3) to assess the risk in severe and affective disorders and 4) to identify the prescription patterns of use in mental health in a cohort of patients from Spain. METHODS 735 outpatients from Mental Health were included. Demographic and clinical data were collected. In order to compare the use of benzodiazepines we calculated the daily dose equivalents (mg/day) to diazepam as standard. RESULTS The most commonly prescribed benzodiazepine was clonazepam (33%) and the mean daily dose of diazepam equivalents was 24.9 mg. It was higher in affective disorders (40.35 ± 3.36) and lower in patients using LAIs antipsychotics (17.50 ± 1.39; p = 0.001). Multivariate analysis showed that to be women (OR = 1.559, 95% CI = 1.059-2.295, p = 0.024), the use of drugs (OR = 1.671, 95% CI = 1.127-2.477, p = 0.011) and suffering any affective disorder (OR = 1.542, 95% CI = 1.355-1.826, p = 0.040) increased the risk of benzodiazepine intake. In contrast, the use of LAIs antipsychotics significantly reduced it versus oral antipsychotics (OR = 5.226, 95% CI = 3.185-8.575, p = 0.001). CONCLUSIONS benzodiazepines are widely prescribed, mainly clonazepam followed by lorazepam and diazepam. Most of patients used at least one benzodiazepine and the mean daily intake was 25 mg diazepam equivalents. Therefore, benzodiazepines are extensively prescribed and used at higher doses than desirable. These, findings could be useful for clinicians and their practice.
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Affiliation(s)
- Jorge Simal-Aguado
- Simal-Aguado, Galindo-Tovar, Department of Pharmacy, Health Sciences Faculty, San Antonio Catholic University of Murcia, UCAM, Murcia; Spain. Campos-Navarro, Unit of Acute Psychiatry, Santa Lucia University Hospital, Cartagena; Spain. Valdivia-Muñoz, Center of Mental Health Infante, Murcia; Spain, Center of Mental Health Cartagena, Cartagena, Murcia; Spain. Garcia-Carmona, Department of Neurology, Santa Lucia University Hospital, Cartagena; Spain, Unit of Acute Psychiatry, Reina Sofia University Hospital, Murcia; Spain
| | - María-Pilar Campos-Navarro
- Simal-Aguado, Galindo-Tovar, Department of Pharmacy, Health Sciences Faculty, San Antonio Catholic University of Murcia, UCAM, Murcia; Spain. Campos-Navarro, Unit of Acute Psychiatry, Santa Lucia University Hospital, Cartagena; Spain. Valdivia-Muñoz, Center of Mental Health Infante, Murcia; Spain, Center of Mental Health Cartagena, Cartagena, Murcia; Spain. Garcia-Carmona, Department of Neurology, Santa Lucia University Hospital, Cartagena; Spain, Unit of Acute Psychiatry, Reina Sofia University Hospital, Murcia; Spain
| | - Francisco Valdivia-Muñoz
- Simal-Aguado, Galindo-Tovar, Department of Pharmacy, Health Sciences Faculty, San Antonio Catholic University of Murcia, UCAM, Murcia; Spain. Campos-Navarro, Unit of Acute Psychiatry, Santa Lucia University Hospital, Cartagena; Spain. Valdivia-Muñoz, Center of Mental Health Infante, Murcia; Spain, Center of Mental Health Cartagena, Cartagena, Murcia; Spain. Garcia-Carmona, Department of Neurology, Santa Lucia University Hospital, Cartagena; Spain, Unit of Acute Psychiatry, Reina Sofia University Hospital, Murcia; Spain
| | - Alejandro Galindo-Tovar
- Simal-Aguado, Galindo-Tovar, Department of Pharmacy, Health Sciences Faculty, San Antonio Catholic University of Murcia, UCAM, Murcia; Spain. Campos-Navarro, Unit of Acute Psychiatry, Santa Lucia University Hospital, Cartagena; Spain. Valdivia-Muñoz, Center of Mental Health Infante, Murcia; Spain, Center of Mental Health Cartagena, Cartagena, Murcia; Spain. Garcia-Carmona, Department of Neurology, Santa Lucia University Hospital, Cartagena; Spain, Unit of Acute Psychiatry, Reina Sofia University Hospital, Murcia; Spain
| | - Juan Antonio García-Carmona
- Simal-Aguado, Galindo-Tovar, Department of Pharmacy, Health Sciences Faculty, San Antonio Catholic University of Murcia, UCAM, Murcia; Spain. Campos-Navarro, Unit of Acute Psychiatry, Santa Lucia University Hospital, Cartagena; Spain. Valdivia-Muñoz, Center of Mental Health Infante, Murcia; Spain, Center of Mental Health Cartagena, Cartagena, Murcia; Spain. Garcia-Carmona, Department of Neurology, Santa Lucia University Hospital, Cartagena; Spain, Unit of Acute Psychiatry, Reina Sofia University Hospital, Murcia; Spain
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