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Yang Y, Yuan Y, Zhang H, Fu X, Wang T, Wang J, Fang CC. Optimal exercise dose and type for improving schizophrenia symptoms in adults: A systematic review and Bayesian network meta-analysis. Neurosci Biobehav Rev 2024; 167:105896. [PMID: 39326771 DOI: 10.1016/j.neubiorev.2024.105896] [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: 07/13/2024] [Revised: 08/30/2024] [Accepted: 09/13/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Exercise has shown promise in aiding patients with schizophrenia, potentially improving symptoms, quality of life, mood, and cognition. This review evaluates the effectiveness of different physical activities in this context, aiming to guide treatment and research towards the most beneficial exercise interventions for schizophrenia management. METHODS This systematic review and network meta-analysis searched PubMed, MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, Web of Science, and CNKI up to March 30, 2024. We utilized the "gemtc," "MBNMAdose," "metafor," and "ggplot2" packages for data analysis in R. Additionally, our results were reported as standardized mean differences with 95 % confidence intervals. To assess the risk of bias in the included studies, we used ROB2 and CINeMA tools. RESULTS In the results section of our systematic review and network meta-analysis, we analyzed data from 47 studies involving 4031 participants. Our findings indicate that among the various exercise interventions examined for schizophrenia patients, yoga emerged as the most effective in improving Total symptoms, positive and negative symptoms. RT+AE (Resistance Training + Aerobic Exercise) showed the greatest improvement in general symptoms, whereas Tai Chi (TC) was the least effective. In terms of improvement of cognitive functions and depression, AE proved the most beneficial, while TC was found to be the least effective. EX+PT (Physical Exercise + Psychological Nursing) was identified as the most effective approach for improved quality of life, with TC again showing the least efficacy. The optimal total exercise dose to improve the patient's total symptoms was estimated to be 1200 METs-min/week. (SMD: -0.956, 95 %Crl: -1.376 to -0.536). CONCLUSIONS Yoga, RT+AE, EX+PT, and Baduanjin have demonstrated enhanced efficacy in alleviating clinical symptoms, quality of life, depressive states, and cognitive functions in patients with schizophrenia. We identified optimal overall exercise doses and provided exercise guidance recommendations for healthcare professionals.
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Affiliation(s)
- Yong Yang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, Hefei 238000, China
| | - Yuan Yuan
- Department of Physical Education, Kunsan National University, Daehak-ro, Gunsan-si, Jeollabuk-do 541150, South Korea
| | - HaoYang Zhang
- Institute of Physical Education, Henan University, Kaifeng 475001, China
| | - XueYing Fu
- Institute of Physical Education, Henan University, Kaifeng 475001, China
| | - Tao Wang
- College of Physical Education and Health, Southwest University of Science and Technology, Mianyang 621010, China
| | - JunYu Wang
- The School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Chu-Chun Fang
- Physical Education Office, National Taipei University of Business, Taipei 100025, Taiwan; Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan.
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Yu TH, Lee TL, Hsuan CF, Wu CC, Wang CP, Lu YC, Wei CT, Chung FM, Lee YJ, Tsai IT, Tang WH. Inter-relationships of risk factors and pathways associated with all-cause mortality in patients with chronic schizophrenia. Front Psychiatry 2024; 14:1309822. [PMID: 38831863 PMCID: PMC11144862 DOI: 10.3389/fpsyt.2023.1309822] [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: 10/17/2023] [Accepted: 12/18/2023] [Indexed: 06/05/2024] Open
Abstract
Introduction Of all psychiatric disorders, schizophrenia is associated with the highest risk of all-cause mortality. This study aimed to investigate independent risk factors for all-cause mortality in patients with chronic schizophrenia. In addition, the possible causal inter-relationships among these independent risk factors and all-cause mortality were also explored. Methods We conducted an analysis of 1,126 patients with chronic schizophrenia from our psychiatric department from April 2003 to August 2022, and retrospectively reviewed their medical records. The study endpoint was all-cause mortality. Baseline clinical characteristics including sociodemographic data, biochemical data, lifestyle factors, comorbidities and antipsychotic treatment were examined with Cox proportional hazards analysis. Results The all-cause mortality rate was 3.9% (44 patients). Multivariate Cox regression analysis revealed that several factors were independently associated with all-cause mortality, including diabetes mellitus (DM), hypertension, heart failure, gastroesophageal reflux disease (GERD), peptic ulcer disease, ileus, underweight, fasting glucose, triglycerides, albumin, and hemoglobin. Structural equation modeling (SEM) analysis revealed that several factors had statistically significant direct effects on all-cause mortality. Heart failure, hypertension, underweight, age at onset, and ileus showed positive direct effects, while albumin and hemoglobin demonstrated negative direct effects. In addition, several factors had indirect effects on all-cause mortality. GERD indirectly affected all-cause mortality through ileus, and peptic ulcer disease had indirect effects through albumin and ileus. Ileus, underweight, DM, and hypertension also exhibited indirect effects through various pathways involving albumin, hemoglobin, and heart failure. Overall, the final model, which included these factors, explained 13% of the variability in all-cause mortality. Discussion These results collectively suggest that the presence of DM, hypertension, heart failure, GERD, peptic ulcer disease, ileus, and underweight, along with lower levels of albumin or hemoglobin, were independently associated with all-cause mortality. The SEM analysis further revealed potential causal pathways and inter-relationships among these risk factors contributing to all-cause mortality in patients with chronic schizophrenia.
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Affiliation(s)
- Teng-Hung Yu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Cheng-Ching Wu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Chao-Ping Wang
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Yung-Chuan Lu
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Ching-Ting Wei
- Division of General Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- The School of Chinese Medicine for Post Baccalaureate, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | | | - I-Ting Tsai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Wei-Hua Tang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Yuli Branch, Hualien, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Saperstein AM, Meyler S, Golub JS, Medalia A. Correlates of hearing loss among adults with schizophrenia. Schizophr Res 2023; 257:1-4. [PMID: 37230041 DOI: 10.1016/j.schres.2023.05.014] [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] [Received: 02/23/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Hearing loss (HL) is associated with adverse cognitive, mental, and physical health outcomes. There is evidence that across age groups HL is more prevalent in people with schizophrenia than the general population. Given that people with schizophrenia may already be vulnerable to cognitive and psychosocial disability, we sought to examine how hearing ability relates to concurrent levels of cognitive, mental and daily functioning. METHODS Community-dwelling adults with schizophrenia (N = 84) ages 22-50 completed pure tone audiometry assessments. Hearing threshold (in decibels) was defined as the lowest detectable pure tone at 1000 Hz. Pearson correlation was used to test the hypothesis that higher hearing thresholds (worse hearing) would be significantly associated with poorer performance on the Brief Assessment of Cognition in Schizophrenia (BACS). Additional analyses explored the relationships between audiometric threshold and functional capacity measured with the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) and symptoms severity rated on the Positive and Negative Syndrome Scale (PANSS). RESULTS Hearing threshold was inversely and significantly correlated with the BACS composite score (r = -0.27, p = 0.017). This relationship was reduced but remained significant after controlling for age (r = -0.23, p = 0.04). Hearing threshold was not associated with VRFCAT or psychiatric symptom measures. CONCLUSIONS While schizophrenia and HL are independently associated with cognitive impairment, the magnitude of impairment in this sample was greater among those with poorer hearing. Findings warrant further mechanistic study of the relationship between hearing impairment and cognition and have implications for addressing modifiable health risk factors for higher morbidity and mortality in this vulnerable population.
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Affiliation(s)
- Alice M Saperstein
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, Box 100, New York, NY 10032, United States.
| | - Shanique Meyler
- The Graduate Center, City University of New York, 365 5th Avenue, New York, NY 10016, United States
| | - Justin S Golub
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 180 Fort Washington Avenue, New York, NY 10032, United States
| | - Alice Medalia
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, 1051 Riverside Drive, Box 100, New York, NY 10032, United States
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Daniel P, Rajaree KM, Rudy L, Jafor S, Prasad S, Avanthika C, Jhaveri S. Myocarditis in patients on long-term antipsychotics -mechanism, management and recent updates. Heliyon 2023; 9:e13930. [PMID: 36923851 PMCID: PMC10008991 DOI: 10.1016/j.heliyon.2023.e13930] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/17/2022] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Clozapine is the first atypical antipsychotic drug and was frequently cited as the most effective antipsychotic for treatment-resistant schizophrenia, but it is associated with a concert of significant cardiotoxic side effects. Clozapine-induced Myocarditis (CIM) is diagnosed based on the combination of clinical symptoms, laboratory investigations, radiological findings, and sometimes biopsy. The literature on CIM management and clinical consensus on the best course of action is mixed. Methodology An all-language literature search on Medline, Cochrane, Embase, and Google Scholar until April 2022. The following search strings and Medical Subject Heading (MeSH) terms were used: "CIM," "clozapine," "cardiotoxicity," and "myocarditis." We explored the literature on CIM for its pathophysiology, diagnosis, monitoring, and management. Results The clinical features of CIM may be highly variable, ranging from asymptomatic disease to fulminant heart failure, and cessation of medication was the mainstay treatment of CIM, followed by supportive therapy. Other antipsychotics have also been linked with cardiotoxic side effects. Conclusion Despite being the most effective antipsychotic, clozapine is associated with a cardiotoxic side effect. Current literature suggests that these antipsychotic-related cardiotoxic events impact the treatment selection for schizophrenia and other psychotic disorders, and they must be kept in mind while designing new treatment protocols in the future.
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Affiliation(s)
| | | | - Luna Rudy
- Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sadeque Jafor
- Al Mostaqbal Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Sakshi Prasad
- Faculty of Medicine, National Pirogov Memorial Medical University, 21018, Vinnytsya, Ukraine
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Minzenberg MJ, Yoon JH. A profile of high scores on the Peters delusion inventory and low engagement in pandemic-related health behaviors in a non-clinical sample. Schizophr Res 2022; 250:10-12. [PMID: 36242785 DOI: 10.1016/j.schres.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/19/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022]
Affiliation(s)
| | - Jong H Yoon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA 94304, United States of America
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Ringen PA, Lund-Stenvold E, Andreassen OA, Gaarden TL, Hartberg CB, Johnsen E, Myklatun S, Osnes K, Sørensen K, Sørensen K, Vaaler A, Tonstad S, Engh JA, Høye A. Quality of clinical management of cardiometabolic risk factors in patients with severe mental illness in a specialist mental health care setting. Nord J Psychiatry 2022; 76:602-609. [PMID: 35200088 DOI: 10.1080/08039488.2022.2039288] [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: 10/19/2022]
Abstract
PURPOSE Cardiometabolic disease in patients with severe mental illness is a major cause of shortened life expectancy. There is sparse evidence of real-world clinical risk prevention practice. We investigated levels of assessments of cardiometabolic risk factors and risk management interventions in patients with severe mental illness in the Norwegian mental health service according to an acknowledged international standard. METHODS We collected data from 264 patients residing in six country-wide health trusts for: (a) assessments of cardiometabolic risk and (b) assessments of levels of risk reducing interventions. Logistic regressions were employed to investigate associations between risk and interventions. RESULTS Complete assessments of all cardiometabolic risk variables were performed in 50% of the participants and 88% thereof had risk levels requiring intervention according to the standard. Smoking cessation advice was provided to 45% of daily smokers and 4% were referred to an intervention program. Obesity was identified in 62% and was associated with lifestyle interventions. Reassessment of psychotropic medication was done in 28% of the obese patients. Women with obesity were less likely to receive dietary advice, and use of clozapine or olanzapine reduced the chances for patients with obesity of getting weight reducing interventions. CONCLUSIONS Nearly nine out of the ten participants were identified as being at cardiometabolic high risk and only half of the participants were adequately screened. Women with obesity and patients using antipsychotics with higher levels of cardiometabolic side effects had fewer adequate interventions. The findings underscore the need for standardized recommendations for identification and provision of cardiometabolic risk reducing interventions in all patients with severe mental illness.
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Affiliation(s)
- Petter A Ringen
- Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elisabeth Lund-Stenvold
- Department of Clinical Medicine, UiT The Arctic University of Norway and Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | - Ole A Andreassen
- NORMENT Centre of Excellence, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torfinn L Gaarden
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway
| | - Cecilie B Hartberg
- Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Johnsen
- NORMENT Centre of Excellence, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Silje Myklatun
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway
| | - Kåre Osnes
- Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten Sørensen
- Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjetil Sørensen
- Division of Mental Health, Østmarka, St Olav's University Hospital, Trondheim, Norway
| | - Arne Vaaler
- Department of acute psychiatry, St. Olavs University Hospital and Department of Mental Health, NTNU, Trondheim, Norway
| | - Serena Tonstad
- Section for Preventive Cardiology Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - John A Engh
- Division of Mental health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne Høye
- Department of Clinical Medicine, UiT The Arctic University of Norway and Department of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
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El Hayek SA, Shatila MA, Adnan JA, Geagea LE, Kobeissy F, Talih FR. Is there a therapeutic potential in combining bupropion and naltrexone in schizophrenia? Expert Rev Neurother 2022; 22:737-749. [PMID: 36093756 DOI: 10.1080/14737175.2022.2124369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION A sustained-release tablet composed of a combination of the dopamine and norepinephrine reuptake inhibitor bupropion (BUP) and the µ-opioid receptor antagonist naltrexone (NAT) is marketed under the brand name Contrave by Orexigen Therapeutics for appetite control. Minimal literature is available regarding the use of combination bupropion and naltrexone (BUPNAT) in individuals with schizophrenia. AREAS COVERED In this review, we propose a theoretical model where BUPNAT may have a therapeutic effect in the treatment of schizophrenia. We explore the pathways targeted by the constituent drugs BUP and NAT and summarize the literature on their efficacy and possible adverse effects. We then look at the potential use of BUPNAT in schizophrenia. EXPERT OPINION Research has hinted that BUP's dopaminergic properties affect the same striatal pathways involved in schizophrenia. NAT, via opioid receptor antagonism, indirectly increases striatal dopamine release by disinhibiting nicotinic acetylcholine receptors. As such, we hypothesize that BUPNAT can have a therapeutic effect in schizophrenia, particularly on negative symptoms. We also suggest that it may ameliorate comorbidities frequently seen in this group of patients, including obesity, smoking, and substance use. Further research and clinical data are needed to elucidate the potential clinical benefits of BUPNAT in the treatment of schizophrenia.
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Affiliation(s)
- Samer A. El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Malek A. Shatila
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jana A. Adnan
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Luna E. Geagea
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Farid R. Talih
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
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Ayyagari R, Goldschmidt D, Zhou M, Ribalov R, Caroff SN, Leo S. Defining utility values for patients with tardive dyskinesia. Curr Med Res Opin 2022; 38:401-407. [PMID: 35045768 DOI: 10.1080/03007995.2021.2022918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To measure health state preferences and estimate utility values for tardive dyskinesia (TD) from the perspective of the US general population, accounting for factors affecting quality of life (QOL). METHODS Participants from the general population were recruited and asked to watch and assess videos of professional actors simulating nine health states, including psychiatric disorders with/without TD and moderate-to-severe TD without any underlying disease. Time tradeoff (TTO) methods were used to elicit utility values, which ranged from -1 (worse than death) to +1 (perfect health) and represented individual preferences for avoiding specific health states associated with TD. Lower TTO utility values indicated individuals' willingness to give up more years of life to avoid living in each health state. RESULTS Based on TTO responses (n = 157), mean ± standard deviation utility for TD alone was 0.59 ± 0.38. Mean utilities for schizophrenia with negative symptoms (without TD: 0.43; with TD: 0.29) and positive symptoms (without TD: 0.44; with TD: 0.30) were generally lower than those for bipolar disorder (without TD: 0.59; with TD: 0.46) and major depressive disorder (without TD: 0.60; with TD: 0.44). According to utility decrements associated with TD (0.13-0.16), respondents were willing to give up 1.3 to 1.6 years during a 10-year lifespan to avoid living with TD. CONCLUSIONS Utility decrements for TD in this study were slightly larger than previously reported values, potentially due to incorporation of QOL and social consequences in TD health state descriptions. An important limitation of this analysis is that participants' willingness to trade future years of healthy life may not indicate actual willingness to accept the life decrement. These findings can be leveraged to improve cost-effectiveness analyses used to assess the value of treatments for TD.
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Affiliation(s)
| | | | - Mo Zhou
- Analysis Group, Inc, Boston, MA, USA
| | | | - Stanley N Caroff
- Department of Psychiatry, Michael J. Crescenz VA Medical Center and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sam Leo
- Teva Pharmaceuticals, Parsippany, NJ, USA
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Ayyagari R, Goldschmidt D, Mu F, Caroff SN, Carroll B. An Experimental Study to Assess the Professional and Social Consequences of Tardive Dyskinesia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2022; 20:154-166. [PMID: 35078958 PMCID: PMC8813323 DOI: 10.9758/cpn.2022.20.1.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/12/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Antipsychotic medications may cause tardive dyskinesia (TD), an often-irreversible movement disorder characterized by involuntary movements that are typically stereotypic, choreiform, or dystonic and may impair quality of life. This study evaluated others' perceptions of abnormal TD movements in professional and social situations. METHODS This was an experimental, randomized, blinded, digital survey in a general population sample. Participants were randomized 1:1 into a test or control group to view a video of a professional actor simulating TD movements or no TD movements prior to completing surveys on employment, dating, and friendship domains. Assessments for mild-to-moderate and moderate-to-severe TD movements were conducted separately. Authenticity of abnormal movements and Abnormal Involuntary Movement Scale (AIMS) scores were evaluated by physician experts. RESULTS Surveys were completed by 2,400 participants each for mild-to-moderate and moderate-to-severe TD. In all domains, participants responded significantly less favorably to persons with TD movements (both mild-to-moderate and moderate-to-severe) than those without TD movements. Fewer participants in the test versus control group for mild-to-moderate and moderate-to-severe TD, respectively, considered the candidate as a potential employee (29.2% and 22.7% fewer), found him/her attractive (20.5% and 18.7% fewer), and were interested in becoming friends with him/her (12.3% and 16.5% fewer). CONCLUSION Professional actors simulating TD movements were perceived more negatively than those without TD movements in employment, dating, and friendship domains. To our knowledge, this is the first randomized study to quantify professional and social stigma associated with TD movements that may reduce opportunities for gainful employment, marital status, and an effective support system.
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Affiliation(s)
| | | | - Fan Mu
- Analysis Group, Inc., Boston, MA, USA
| | - Stanley N. Caroff
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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González Tejón S, Ibarra Jato M, Fernández San Martín MI, Prats Uribe A, Real Gatius J, Martin-Lopez LM. [Hip fractures in patients treated with antipsychotic drugs. Study of retrospective cohorts in Catalonia]. Aten Primaria 2022; 54:102171. [PMID: 34798403 PMCID: PMC8605286 DOI: 10.1016/j.aprim.2021.102171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/05/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the incidence of hip fracture in patients with antipsychotic treatment, comparing it with that of individuals who have not been treated with antipsychotics. DESIGN Retrospective cohort study of patients treated with antipsychotic drugs (TAP) and patients without known treatment (non-TAP). The observation period was 2006-2014. SITE: All primary care teams in Catalonia of the Catalan Health Institute (ICS). PARTICIPANTS Patients older than 44 years with TAP lasting at least 3 months. Control cohort: random selection of non-TAP patients matching for baseline comorbidities and other variables. A total of 22,010 are analyzed. Main measurements Incidence rate (1000× person-years: PY) of hip fracture in each group (TAP and non-TAP). Cox regression models to estimate adjusted risks (hazard ratio: HR). RESULTS The hip fracture incidence rate was higher in TAP patients (5.83 vs 3.58 fractures per 1000 PY), and is higher in all strata according to sex, age and type of diagnosis. The risk of suffering a hip fracture was 60% higher (HR: 1.60 95% CI: 1.34-1.92) in the TAP group than in the non-TAP group. The risk was higher in the group with schizophrenia (HR: 3.57 95% CI: 1.75-7.30), followed by bipolar disorder (HR: 2.61; 95% CI: 1.39-4.92) and depression (HR: 1.51; 95% CI: 1.21-1.88). CONCLUSIONS Patients with antipsychotic treatment have a higher risk of hip fracture than those who have not been treated with antipsychotics.
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Affiliation(s)
- Susana González Tejón
- Equipo Atención Primaria Raval Sud, Barcelona, España; Grup TMS IdiapJgol, Barcelona, España
| | - Montserrat Ibarra Jato
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar Hospital del Mar, Barcelona, España
| | - M Isabel Fernández San Martín
- Grup TMS IdiapJgol, Barcelona, España; Gerencia Territorial Barcelona Ciutat, Unidad Docente de Medicina Familiar y Comunitaria, Institut Català de la Salut, Barcelona, España
| | - Albert Prats Uribe
- Preventive Medicine and Public Health Training Unit, Parc de Salut Mar, Pompeu Fabra University-Public Health Agency of Barcelona, Barcelona, España; Centre for Statistics in Medicine, Botnar Research Centre, NDORMS, University of Oxford, Oxford, Reino Unido
| | - Jordi Real Gatius
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), España
| | - Luis Miguel Martin-Lopez
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar Hospital del Mar, Barcelona, España; Department of Psychiatry and Forensic Medicine (UAB), Autonomous University of Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España.
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De las Cuevas C, Sanz EJ, Rohde C, de Leon J. Association between myocarditis and antipsychotics other than clozapine: a systematic literature review and a pharmacovigilance study using VigiBase. Expert Rev Clin Pharmacol 2022; 15:65-78. [DOI: 10.1080/17512433.2022.2032659] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of La Laguna, Canary Islands, Spain
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Emilio J. Sanz
- Department of Physical Medicine and Pharmacology, School of Medicine, Universidad de La Laguna, Canary Islands, Spain
- Hospital Universitario de Canarias, Tenerife, Spain
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, US
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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12
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Kirli U, Alptekın K. Pharmacotherapy of Schizophrenia in Acute and Maintenance Phase. ACTA ACUST UNITED AC 2021; 58:S17-S23. [PMID: 34658631 PMCID: PMC8498812 DOI: 10.29399/npa.27441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
Schizophrenia is one of the leading disorders causing impairment in society. Therefore, it is crucial to review evidence-based treatment approaches which are both effective and causing minimum side effects. In this paper, treatment recommendations for first episode schizophrenia, patients in acute phase with a history of multiple episodes, and patients in the maintenance phase will be discussed in light of the Psychiatric Association of Turkey Guideline for Treatment of Schizophrenia, other recent national and international guidelines as well as expert consensus reports in the literature. Finally, practical considerations will be suggested.
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Affiliation(s)
- Umut Kirli
- Ege University, Institute on Drug Abuse, Toxicology and Pharmaceutical Science, İzmir, Turkey
| | - Köksal Alptekın
- Dokuz Eylül University, School of Medicine, Department of Psychiatry, İzmir, Turkey.,Dokuz Eylül University, Institute of Health Sciences, Department of Neuroscience, İzmir, Turkey
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13
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New D2R partial agonist candidates: an in silico approach from statistical models, molecular docking, and ADME/Tox properties. Struct Chem 2021. [DOI: 10.1007/s11224-021-01742-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Zichlin ML, Mu F, Leo S, Ayyagari R. The Impact of Antipsychotic Dose Reduction on Clinical Outcomes and Health Care Resource Use Among Medicare Patients with Schizophrenia. Clin Drug Investig 2021; 41:853-863. [PMID: 34480726 PMCID: PMC8481169 DOI: 10.1007/s40261-021-01060-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Antipsychotic medications are used to treat schizophrenia and may be associated with adverse effects, including tardive dyskinesia (TD), following prolonged use or upon changes in dosing regimen. OBJECTIVE This retrospective analysis evaluated the burden of antipsychotic dose reduction in Medicare patients with schizophrenia. METHODS This matched cohort study used Medicare claims data (2006-2017) analyzed for patients with schizophrenia and two or more claims for antipsychotics, with one or more antipsychotic monotherapy period ≥ 90 days. Cohorts were defined for patients with antipsychotic dose reductions ≥ 10% and stable doses. A separate analysis was conducted using patients with dose reductions ≥ 30%. Outcomes included all-cause emergency room (ER) visits, all-cause inpatient visits, schizophrenia relapse, other psychiatric relapse, and TD diagnosis. Covariates included age, disease duration, comorbidities, and medication use. RESULTS The analysis included 276,030 patients with ≥ 10% dose reductions and 211,575 patients with ≥ 30% dose reductions. Patient characteristics were balanced between cohorts. Patients with ≥ 10% or ≥ 30% dose reductions had a shorter time to ER visit, inpatient visit, schizophrenia relapse, other psychiatric relapse, and TD diagnosis versus those receiving stable doses (all p < 0.001). Significance was maintained when unmatched baseline characteristics were adjusted. CONCLUSIONS Patients with antipsychotic dose reductions may be at risk for increased ER visits, increased hospitalizations, and significant unfavorable mental health-related clinical outcomes, suggesting that dose reduction may increase overall health care burden in some patients with schizophrenia. This work highlights the need for alternative strategies in the management of patients with TD.
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Affiliation(s)
- Miriam L Zichlin
- Analysis Group, Inc., 111 Huntington Avenue, Fourteenth Floor, Boston, MA, 02199, USA
| | - Fan Mu
- Analysis Group, Inc., 111 Huntington Avenue, Fourteenth Floor, Boston, MA, 02199, USA
| | - Sam Leo
- Teva Pharmaceuticals, Parsippany, NJ, USA
| | - Rajeev Ayyagari
- Analysis Group, Inc., 111 Huntington Avenue, Fourteenth Floor, Boston, MA, 02199, USA.
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15
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Butala N, Williams A, Kneebusch J, Mitchell M. Impact of a pharmacist-driven tardive dyskinesia screening service. Ment Health Clin 2021; 11:248-253. [PMID: 34316421 PMCID: PMC8287863 DOI: 10.9740/mhc.2021.07.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/21/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Tardive dyskinesia (TD) is defined as involuntary movements that can develop with prolonged antipsychotic use. Regular monitoring using the Abnormal Involuntary Movement Scale (AIMS) is recommended to be conducted every 3 to 6 months for early recognition, although the AIMS is underused. Several studies have investigated risk factors that may be associated with TD, including age, sex, and long-term antipsychotic use. This study aimed to increase the monitoring and treatment of TD for those assessed to be at higher risk. Methods This was a prospective quality improvement study on the effectiveness of a psychiatric pharmacist–driven TD screening service (PPDTSS) in an inpatient psychiatric facility. Participants were composed of adult patients admitted between May and November 2018. Patients were screened daily by a clinical pharmacist and, if determined to be high risk based on studied risk factors, prioritized to receive a formal TD screening via the AIMS. The primary objective was to optimize standard of care by increasing the number of AIMS screenings conducted. The secondary objective was to increase the treatment of TD. Results A total of 402 patients were assessed prior to implementation of the PPDTSS, and 390 patients were screened following implementation. The PPDTSS increased the number of AIMS screenings attempted by 85.1% for high-risk individuals. Of the 75 patients who had an AIMS screening attempted in the postintervention group, 46 (61.3%) had an AIMS screening completed, of which 3 (6.5%) were positive. Discussion The results of this study demonstrate that psychiatric pharmacists can be used to improve the regular monitoring of patients at high risk for TD.
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Affiliation(s)
- Niyati Butala
- Senior Clinical Pharmacist, Riverside University Health System, Riverside, California.,Clinical Pharmacist, Riverside University Health System, Riverside, California.,Senior Clinical Pharmacist-Special Projects, Riverside University Health System, Riverside, California
| | - Andrew Williams
- Senior Clinical Pharmacist, Riverside University Health System, Riverside, California
| | - Jamie Kneebusch
- Clinical Pharmacist, Riverside University Health System, Riverside, California
| | - Melissa Mitchell
- Senior Clinical Pharmacist-Special Projects, Riverside University Health System, Riverside, California
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16
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Soria-Chacartegui P, Villapalos-García G, Zubiaur P, Abad-Santos F, Koller D. Genetic Polymorphisms Associated With the Pharmacokinetics, Pharmacodynamics and Adverse Effects of Olanzapine, Aripiprazole and Risperidone. Front Pharmacol 2021; 12:711940. [PMID: 34335273 PMCID: PMC8316766 DOI: 10.3389/fphar.2021.711940] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
Olanzapine, aripiprazole and risperidone are atypical antipsychotics or neuroleptics widely used for schizophrenia treatment. They induce various adverse drug reactions depending on their mechanisms of action: metabolic effects, such as weight gain and alterations of glucose and lipid metabolism; hyperprolactinemia and extrapyramidal effects, such as tremor, akathisia, dystonia, anxiety and distress. In this review, we listed polymorphisms associated with individual response variability to olanzapine, aripiprazole and risperidone. Olanzapine is mainly metabolized by cytochrome P450 enzymes, CYP1A2 and CYP2D6, whereas aripiprazole and risperidone metabolism is mainly mediated by CYP2D6 and CYP3A4. Polymorphisms in these genes and other enzymes and transporters, such as enzymes from the uridine 5'-diphospho-glucuronosyltransferase (UGT) family and ATP-binding cassette sub-family B member 1 (ABCB1), are associated to differences in pharmacokinetics. The three antipsychotics act on dopamine and serotonin receptors, among others, and several studies found associations between polymorphisms in these genes and variations in the incidence of adverse effects and in the response to the drug. Since olanzapine is metabolized by CYP1A2, a lower starting dose should be considered in patients treated with fluvoxamine or other CYP1A2 inhibitors. Regarding aripiprazole, a reduced dose should be administered in CYP2D6 poor metabolizers (PMs). Additionally, a reduction to a quarter of the normal dose is recommended if the patient is treated with concomitant CYP3A4 inhibitors. Risperidone dosage should be reduced for CYP2D6 PMs and titrated for CYPD6 ultrarapid metabolizers (UMs). Moreover, risperidone dose should be evaluated when a CYP2D6, CYP3A4 or ABCB1 inhibitor is administered concomitantly.
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Affiliation(s)
- Paula Soria-Chacartegui
- Clinical Pharmacology Department, School of Medicine, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Gonzalo Villapalos-García
- Clinical Pharmacology Department, School of Medicine, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Pablo Zubiaur
- Clinical Pharmacology Department, School of Medicine, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.,UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, School of Medicine, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.,UICEC Hospital Universitario de La Princesa, Platform SCReN (Spanish Clinical Research Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Dora Koller
- Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center, West Haven, CT, United States
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17
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Cicek M, McCall WV, Yao Z, Sackeim HA, Rosenquist P, Youssef NA. Is There Evidence That Stimulus Parameters and Electrode Placement Affect the Cognitive Side Effects of Electroconvulsive Therapy in Patients With Schizophrenia and Schizoaffective Disorder?: A Systematic Review. J ECT 2021; 37:133-139. [PMID: 33369995 DOI: 10.1097/yct.0000000000000737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Seventy percent of patients with treatment-resistant schizophrenia do not respond to clozapine. Electroconvulsive therapy (ECT) can potentially offer significant benefit in clozapine-resistant patients. However, cognitive side effects can occur with ECT and are a function of stimulus parameters and electrode placements. Thus, the objective of this article is to systematically review published clinical trials related to the effect of ECT stimulus parameters and electrode placements on cognitive side effects. We performed a systematic review of the literature up to July of 2020 for clinical studies published in English or German examining the effect of ECT stimulus parameters and/or electrode placement on cognitive side effects in patients with schizophrenia or schizoaffective disorder. The literature search generated 3 randomized, double-blind, clinical trials, 1 randomized, nonblinded trial, and 1 retrospective study. There are mixed findings regarding whether pulse width and stimulus dose impact on cognitive side effects. One study showed less cognitive side effect for right unilateral (RUL) than bitemporal (BT) electrode placement, and 2 studies showed a cognitive advantage for bifrontal (BF) compared with BT ECT. Only 1 retrospective study measured global cognition and showed post-ECT cognitive improvement with all treatment modalities using Montreal Cognitive Assessment in comparison to pre-ECT Montreal Cognitive Assessment scores. Current data are limited, but evolving. The evidence suggests that RUL or BF ECT have more favorable cognitive outcomes than BT ECT. Definitive larger clinical trials are needed to optimize parameter and electrode placement selection to minimize adverse cognitive effects.
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Affiliation(s)
| | - William V McCall
- Department of Psychiatry & Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA
| | - Zhixing Yao
- Department of Psychiatry & Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA
| | - Harold A Sackeim
- Departments of Psychiatry and Radiology, Columbia University, New York, NY
| | - Peter Rosenquist
- Department of Psychiatry & Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA
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18
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Soda T, Richards J, Gaynes BN, Cueva M, Laux J, McClain C, Frische R, Lindquist LK, Cuddeback GS, Jarskog LF. Systematic Quality Improvement and Metabolic Monitoring for Individuals Taking Antipsychotic Drugs. Psychiatr Serv 2021; 72:647-653. [PMID: 33887956 PMCID: PMC8192348 DOI: 10.1176/appi.ps.202000155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to increase the rate of cardiometabolic monitoring for patients receiving antipsychotic drugs in an academic outpatient psychiatric clinic serving people with serious mental illness. METHODS Using a prospective quasi-experimental, interrupted time-series design with data from the electronic health record (EHR), the authors determined metabolic monitoring rates before, during, and after implementation of prespecified quality improvement (QI) measures between August 2016 and July 2017. QI measures included a combination of provider, patient, and staff education; systematic barrier reduction; and an EHR-based reminder system. RESULTS After 1 year of QI implementation, the rate of metabolic monitoring had increased from 33% to 49% (p<0.01) for the primary outcome measure (hemoglobin A1C and lipid panel). This increased monitoring rate was sustained for 27 months beyond the end of the QI intervention. More than 75% of providers did not find the QI reminders burdensome. CONCLUSIONS Significant improvement in the rate of metabolic monitoring for people taking antipsychotic drugs can be achieved with little added burden on providers. Future research needs to assess the full range of patient, provider, and system barriers that prevent cardiometabolic monitoring for all individuals receiving antipsychotic drugs.
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Affiliation(s)
- Takahiro Soda
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Jennifer Richards
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Bradley N Gaynes
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Michelle Cueva
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Jeffrey Laux
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Christine McClain
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Rachel Frische
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Lisa K Lindquist
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Gary S Cuddeback
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - L Fredrik Jarskog
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
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19
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Besag FMC, Vasey MJ, Salim I. Is Adjunct Aripiprazole Effective in Treating Hyperprolactinemia Induced by Psychotropic Medication? A Narrative Review. CNS Drugs 2021; 35:507-526. [PMID: 33880739 DOI: 10.1007/s40263-021-00812-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/10/2023]
Abstract
Psychotropic medication treatment can cause elevated serum prolactin levels and hyperprolactinaemia (HPRL). Reports have suggested that aripiprazole may decrease elevated prolactin. The aim of this review was to assess evidence for the efficacy of adjunct aripiprazole in the treatment of psychotropic-induced HPRL. PubMed and Google Scholar were searched to identify randomised placebo-controlled trials (RCTs) of adjunct aripiprazole in patients with HPRL attributed to primary psychotropic medications. Data for individual patients from case studies, chart reviews and open-label studies were also identified and assessed. Six RCTs, with a total of 609 patients, met inclusion criteria. Primary psychotropics included risperidone, haloperidol, paliperidone, fluphenazine and loxapine. Reductions in prolactin from baseline, before the introduction of aripiprazole, were significantly greater for adjunct aripiprazole than for adjunct placebo in all the studies (p = 0.04 to p < 0.0001). Normalisation of serum prolactin levels was significantly more likely with adjunct aripiprazole than adjunct placebo (p = 0.028 to p < 0.001, data from three studies). Improvement or resolution of HPRL-related symptoms (galactorrhoea, oligomenorrhoea, amenorrhoea and sexual dysfunction) were reported in three studies. Prolactin levels decreased in all case reports and in both of two open-label studies; they normalised in 30/41 patients (73.2%) in case studies and 12/29 (41.4%) in the open-label studies. Adjunct aripiprazole was statistically significantly effective in treating elevated serum prolactin levels in six RCTs. Evidence from case reports and open-label studies suggests a degree of effectiveness in most patients.
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Affiliation(s)
- Frank M C Besag
- East London Foundation NHS Trust, 9 Rush Court, Bedford, MK40 3JT, UK. .,University College London, London, UK. .,King's College London, London, UK.
| | | | - Iffah Salim
- East London Foundation NHS Trust, Glen Road, Cherry Tree Way, Newham, London, E13 8SP, UK
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20
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Collins C, Finegan P, O'Shea M, Larkin J, Pericin I, Osborne B. Promoting physical health among people with enduring mental illness: a qualitative study of healthcare providers' perspectives. BMJ Open 2021; 11:e044855. [PMID: 33883151 PMCID: PMC8061849 DOI: 10.1136/bmjopen-2020-044855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND People with enduring mental illness (EMI) have higher morbidity and mortality from chronic diseases than the general population, and this results in a significantly reduced relative life expectancy-accounted for primarily by physical illness. This gap may be partly influenced by the reduced likelihood of access to and uptake of regular physical health screening. AIM To establish Irish service providers' perspectives regarding the care of the physical health of people with EMI in an effort to inform future service developments aimed at improving the physical health of people with EMI. DESIGN AND SETTING Qualitative study of healthcare providers-general practitioners (GPs) and members of the community mental health teams-in Ireland. PARTICIPANTS GPs and mental health service providers. METHODS Qualitative semi-structured interviews were conducted with 34 service providers. Thematic analysis was undertaken. RESULTS Participants considered that the physical health of people with EMI is not currently regularly addressed by the patient's GP or the mental health team. Factors associated with this include patient compliance with attendance, time constraints in consultations to adequately support patient self-management, communication difficulties with the patient and between primary and secondary care, and lack of clarity as to whose responsibility it is to ensure physical health is monitored. In participants' view, a barrier to improvement is the present funding approach. CONCLUSION The evidence from this study has the potential to form the basis for innovation and change in service delivery for people with an EMI in Ireland and internationally, specifically in countries where it is not clear who has the overall responsibility to monitor the physical health of patients with EMI. This role requires time and regular contact, and both the organisation and the funding of the health system need to support it.
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Affiliation(s)
- Claire Collins
- Research Centre, Irish College of General Practitioners, Dublin, Ireland
| | - Pearse Finegan
- Research Centre, Irish College of General Practitioners, Dublin, Ireland
| | - Marie O'Shea
- Research Centre, Irish College of General Practitioners, Dublin, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ivana Pericin
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
| | - Brian Osborne
- Research Centre, Irish College of General Practitioners, Dublin, Ireland
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21
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Isomura K, Sidorchuk A, Brander G, Jernberg T, Rück A, Song H, Valdimarsdóttir UA, Lichtenstein P, Larsson H, Rück C, Mataix-Cols D, Fernández de la Cruz L. Risk of specific cardiovascular diseases in obsessive-compulsive disorder. J Psychiatr Res 2021; 135:189-196. [PMID: 33493948 DOI: 10.1016/j.jpsychires.2020.12.066] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 02/05/2023]
Abstract
Individuals with obsessive-compulsive disorder (OCD) may have an increased risk of cardiovascular disease (CVD), but evidence for specific types of CVD is limited. This population-based, sibling-controlled cohort study investigated the risk of specific CVD in individuals with OCD. Linking data from various Swedish population-based registers, we explored the risk of a range of CVD in a cohort of individuals diagnosed with OCD between 1973 and 2013 (n = 33,561), compared to matched (1:10) unaffected individuals (n = 335,610). Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using conditional Cox proportional hazards regression models, adjusting for history of somatic diseases. To control for familial confounders, we analyzed 23,263 clusters of full siblings discordant for OCD. Individuals with psychiatric comorbidities were systematically excluded to assess the impact of these comorbidities. Over an average follow-up time of 27 years, OCD was associated with an increased risk of a broad range of CVD (adjusted HR [aHR] for any CVD = 1.25 [95% confidence interval [CI], 1.22-1.29]). These associations were strongest for the subtypes venous thrombo-embolism (aHR = 1.48 [95% CI, 1.38-1.58]) and heart failure (aHR = 1.37 [95% CI, 1.28-1.46]). When comparing OCD-exposed individuals with their non-exposed full siblings, results were largely similar. Exclusion of several groups of psychiatric comorbidities resulted in comparable results, albeit attenuated. Individuals with OCD have a moderately increased risk of CVD-related morbidity, independent from history of somatic diseases, familial confounders, and psychiatric comorbidities. The time may be ripe for the development and evaluation of lifestyle interventions to help reduce the risk of cardiovascular morbidity in OCD.
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Affiliation(s)
- Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Gustaf Brander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Department of Medical Biochemistry and Microbiology, Uppsala Universitet, Uppsala, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Huan Song
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A Valdimarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
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22
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Vancampfort D, Firth J, Correll CU, Solmi M, Siskind D, De Hert M, Carney R, Koyanagi A, Carvalho AF, Gaughran F, Stubbs B. The Impact of Pharmacological and Non-Pharmacological Interventions to Improve Physical Health Outcomes in People With Schizophrenia: A Meta-Review of Meta-Analyses of Randomized Controlled Trials. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:116-128. [PMID: 34483776 DOI: 10.1176/appi.focus.19103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from World Psychiatry 2019;18:53-66).
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23
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Noel JM, Jackson CW. ASHP Therapeutic Position Statement on the Use of Antipsychotic Medications in the Treatment of Adults with Schizophrenia and Schizoaffective Disorder. Am J Health Syst Pharm 2020; 77:2114-2132. [PMID: 32871013 PMCID: PMC7499485 DOI: 10.1093/ajhp/zxaa303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Jason M Noel
- University of Maryland School of Pharmacy, Baltimore, MD
| | - Cherry W Jackson
- Auburn University Harrison School of Pharmacy, Auburn, AL.,Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, School of Medicine, Birmingham, AL
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24
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Friend N, Hughes J, Kisely S, Kumar R, Siskind D. Appraisal of physical health guidelines for severe mental illness. AUST HEALTH REV 2020; 44:904-915. [PMID: 33250071 DOI: 10.1071/ah20080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/15/2020] [Indexed: 11/23/2022]
Abstract
Objectives The aim of this study was to identify current physical health guidelines for severe mental illness (SMI) and appraise them using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. Methods Relevant research databases and grey literature were systematically searched to identify physical health guidelines for people with SMI. The grey literature was explored by web searches and targeted searches of the English websites of relevant peak bodies and government health agencies from Organisation for Economic Co-operation and Development countries. Included guidelines were independently appraised by two authors (NF and JH) using the AGREE II Instrument. Results Of the 5352 records screened, 33 were assessed for eligibility. Fifteen practice guidelines met the inclusion criteria. The median domain scores as rated by the AGREE II Instrument ranged from 17% to 69%. The World Health Organization guideline, which demonstrated a broad range of clinical recommendations and sound methodological rigour, was rated the best. Conclusions Most guidelines scored poorly when rated by the AGREE II Instrument. However, these guidelines may still be useful in assisting evidence-based clinical practice. The methodological rigour of future guidelines can be improved by ensuring the AGREE II domains are addressed during the development phase. What is known about the topic? Compared with the general population, people with SMI experience greater chronic disease morbidity and mortality. There is limited evidence from randomised controlled trials to guide physical health care monitoring for people with SMI. Current guidelines and practice are largely based on expert consensus, clinical experience and good intentions. What does this paper add? Using the AGREE II Instrument, this paper appraises the current physical health guidelines for people with SMI. The attributes of the guidelines examined included the evidence base, clarity of presentation, applicability in the real world, the involvement of stakeholders and conflicts of interest of various parties involved in guideline development. What are the implications for practitioners? This review highlights the scarcity of high-quality and evidence-based guidelines for clinicians and researchers to address the physical health of people with SMI.
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Affiliation(s)
- Nadia Friend
- Sunshine Coast Mental Health and Addiction Services, Maroochydore, Qld 4558, Australia.; and Corresponding author.
| | - Jade Hughes
- Metro North Mental Health Service, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia.
| | - Steve Kisely
- University of Queensland, School of Medicine, Brisbane, Qld 4102, Australia. ;
| | - Ratika Kumar
- The University of Newcastle, Faculty of Medicine and Public Health, University Drive, Callaghan, NSW 2308, Australia.
| | - Dan Siskind
- University of Queensland, School of Medicine, Brisbane, Qld 4102, Australia. ;
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25
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Zito MF, Marder SR. Rethinking the risks and benefits of long-term maintenance in schizophrenia. Schizophr Res 2020; 225:77-81. [PMID: 31806525 DOI: 10.1016/j.schres.2019.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022]
Abstract
This review addresses the risks and benefits of long-term maintenance antipsychotic treatment for patients that extends beyond two years. It focuses on framing discussions with patients who are recovering from a first episode. For these patients the evidence strongly supports the benefits over the risk for the first two years. However, both the clinical side effects of antipsychotics and the possible long-term effects of dopamine blocking drugs on the brain require a more nuanced discussion beyond this initial period. In most cases, the decision will be to continue antipsychotics but to consider strategies for mitigating the risks of drugs. This review provides information about the relative risks of dose reduction and intermittent treatment.
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Affiliation(s)
- Michael F Zito
- Semel Institute for Neuroscience at UCLA and the VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
| | - Stephen R Marder
- Semel Institute for Neuroscience at UCLA and the VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA.
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26
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Gelo OCG, Lagetto G, Dinoi C, Belfiore E, Lombi E, Blasi S, Aria M, Ciavolino E. Which Methodological Practice(s) for Psychotherapy Science? A Systematic Review and a Proposal. Integr Psychol Behav Sci 2020; 54:215-248. [PMID: 31240561 DOI: 10.1007/s12124-019-09494-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Three main methodological practices have been employed in psychotherapy science: the empirical-quantitative, empirical-qualitative, and theoretical one. Some scholars have argued for a monopoly of the empirical-quantitative methodological practice, sustained by scientific monism. This systematic review aims at exploring the contribution of each methodological practice to the field. Fifteen journals were searched from 2003 to 2013. A total of 9796 publications and 9915 studies met inclusion criteria and were coded for the methodological practice employed. Empirical-quantitative studies were the most published overall, over time, and in most of the journals considered. This overwhelming prevalence increased when considering the citation rates of the publications. We argue that these results are indicative of a quantitative monopoly, which in turn is due to a lack of critical thinking sustaining scientific monism. We call for disciplinary critical thinking and the consequent scientific pluralism valuing the plurality, diversity, and multiplicity of all the existing methodological practices.
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Affiliation(s)
- Omar Carlo Gioacchino Gelo
- Department of History, Social Sciences and Human Studies, Via di Valesio - Complesso Studium 2000, Ed. 5, 73100, Lecce, Italy. .,Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Wien, Austria.
| | - Gloria Lagetto
- Department of History, Social Sciences and Human Studies, Via di Valesio - Complesso Studium 2000, Ed. 5, 73100, Lecce, Italy
| | - Chiara Dinoi
- Department of History, Social Sciences and Human Studies, Via di Valesio - Complesso Studium 2000, Ed. 5, 73100, Lecce, Italy
| | - Erika Belfiore
- Department of Humanistic Studies, University of Urbino Carlo Bo, Urbino, Italy
| | - Elisa Lombi
- Department of Humanistic Studies, University of Urbino Carlo Bo, Urbino, Italy
| | - Stefano Blasi
- Department of Humanistic Studies, University of Urbino Carlo Bo, Urbino, Italy
| | - Massimo Aria
- Department of Economics and Statistics, University of Naples Federico II, Naples, Italy
| | - Enrico Ciavolino
- Department of History, Social Sciences and Human Studies, Via di Valesio - Complesso Studium 2000, Ed. 5, 73100, Lecce, Italy
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27
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Prevalence and awareness of cardiovascular risk factors in patients with schizophrenia: A cross-sectional study in a low cardiovascular disease risk geographical area. Eur Psychiatry 2020; 24:431-41. [DOI: 10.1016/j.eurpsy.2009.07.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 06/03/2009] [Accepted: 07/21/2009] [Indexed: 11/24/2022] Open
Abstract
AbstractObjectivePrevalence of cardiovascular disease is high in schizophrenia. Our aim is to estimate the prevalence of cardiovascular risk factors (CVRF) among schizophrenia patients.MethodNational cross-sectional study in patients diagnosed with schizophrenia under treatment with second generation antipsychotics and admitted to short-stay hospitalisation units.ResultsA sample of 733 consecutively admitted patients was enrolled; the most prevalent CVRFs were smoking 71% (95% CI: 67–74%) and hypercholesterolemia 66% (61–70%) followed by hypertriglyceridemia 26% (26–32%), hypertension 18% (15–21%) and diabetes 5% (4–7%). Metabolic syndrome showed 19% (95% CI: 16–23%) prevalence or, according to updated definitions (Clin Cornerstone 7 [2005] 36–45), 24% (95% CI: 20–28%). The rate of patients within the high-risk range of a 10-year fatal cardiovascular event was 6.5%. CVRFs under routine management were diabetes (60%), hypertension (28%) and, to a lesser extent, dyslipemia (14%). Treatment for CVRFs was associated to gender, men for hypertension OR = 25.34, p < 0.03 and women for diabetes OR = 0.02, p < 0.03.ConclusionWe found that CVRFs in schizophrenia were prevalent and under-diagnosed, and thus with insufficient therapeutic management.
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28
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Möller HJ. Antipsychotic agents. Gradually improving treatment from the traditional oral neuroleptics to the first atypical depot. Eur Psychiatry 2020; 20:379-85. [PMID: 15994065 DOI: 10.1016/j.eurpsy.2005.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Accepted: 03/21/2005] [Indexed: 10/25/2022] Open
Abstract
AbstractRelapse is one of the key factors in the long-term outcome of schizophrenia. The consequences of relapse are diverse and often unpredictable, and the time to recovery and degree of recovery worsen with each successive relapse. There is now overwhelming evidence that advances in antipsychotic drug treatment have led to significant reductions in the rate of relapse. This review charts the developments that have taken place in antipsychotic therapy from the introduction of depot formulations, through atypical agents, to the development of the first long-acting atypical antipsychotic. Depot formulations of conventional antipsychotics were developed in the 1960s and led to fewer relapses and episodes of hospitalization, compared with oral equivalents. Meta-analysis has confirmed that patients receiving depot antipsychotics experience significantly greater global improvement than those receiving the respective oral agents. Conventional antipsychotics are, however, associated with a range of potentially serious adverse events. The atypical antipsychotics were introduced in the 1990s and have significant advantages over conventional agents with regard to positive and negative symptoms. There is also evidence that atypical agents can reduce the risk of relapse. Importantly, atypical antipsychotics have an improved safety profile compared with older agents, particularly with regard to extrapyramidal symptoms. One disadvantage of atypical agents has been that they are only available in an oral form. The recent development of a long-acting injectable formulation of risperidone means that a new treatment option is available to physicians.
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Affiliation(s)
- H-J Möller
- Department of Psychiatry, Ludwig-Maximilians-University, Nussbaum Strasse 7, 80336 Munich, Germany.
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29
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Hert MD, Hudyana H, Dockx L, Bernagie C, Sweers K, Tack J, Leucht S, Peuskens J. Second-generation antipsychotics and constipation: A review of the literature. Eur Psychiatry 2020; 26:34-44. [DOI: 10.1016/j.eurpsy.2010.03.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 01/27/2010] [Accepted: 03/04/2010] [Indexed: 01/01/2023] Open
Abstract
AbstractAntipsychotics are the cornerstone in the management of psychotic disorders and schizophrenia. They are effective agents but also have a wide range of side effects. In the recent literature constipation as possible side effect has received little attention. A review of the literature concerning constipation associated with antipsychotics was performed. Overall constipation is a rarely studied or reported side effect of antipsychotic medication. Nevertheless constipation is a common side effect. Antipsychotic agents differ in their liability to induce constipation. Constipation can be severe and can lead to serious consequences such as paralytic ileus, bowel occlusion and death. Active screening, monitoring and treatment are recommended. Further research on incidence, prevalence, underlying mechanisms and preventive measures is required.
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30
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Polcwiartek C, Kragholm K, Hansen SM, Atwater BD, Friedman DJ, Barcella CA, Graff C, Nielsen JB, Pietersen A, Nielsen J, Søgaard P, Torp-Pedersen C, Jensen SE. Electrocardiogram Characteristics and Their Association With Psychotropic Drugs Among Patients With Schizophrenia. Schizophr Bull 2020; 46:354-362. [PMID: 31219596 PMCID: PMC7442389 DOI: 10.1093/schbul/sbz064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND There are limited data on electrocardiogram (ECG) characteristics and their association with psychotropic drugs in schizophrenia. METHODS Using a cross-sectional design, we included Danish primary care patients with first-time digital ECGs from 2001 to 2015. Patients diagnosed with schizophrenia before ECG recording were matched 1:5 on age, sex, and ECG recording year to controls without psychiatric disease. Multivariable logistic regression was used to compute odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS We included 4486 patients with schizophrenia matched with 22 430 controls (median age, 47 years; male, 55%). Between groups, the prevalence of abnormal ECGs was similar (54%, P = .536), but patients with schizophrenia demonstrated higher median heart rate (79 vs 69 beats per minute, P < .001) and Fridericia-corrected QT (QTc) interval (416 vs 412 ms, P < .001) than controls. QTc prolongation was also more prevalent among patients with schizophrenia (3.4% vs 1.1%, P < .001), and so were pathological Q waves (5.3% vs 3.9%, P < .001). Patients with schizophrenia less frequently demonstrated left ventricular hypertrophy (6.1% vs 9.6%, P < .001) and atrial fibrillation or flutter (0.7% vs 1.4%, P < .001). Among patients with schizophrenia only, particularly antipsychotics were associated with abnormal ECGs (OR, 1.20; 95% CI, 1.04-1.39). CONCLUSIONS Patients with schizophrenia demonstrate a different cardiovascular risk profile than matched controls without psychiatric disease, with higher prevalence of elevated heart rate, QTc prolongation, and pathological Q waves, and lower prevalence of left ventricular hypertrophy and atrial fibrillation or flutter. Particularly antipsychotics were associated with abnormal ECGs. This underscores an integrated care approach when ECG abnormalities are detected in this group.
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Affiliation(s)
- Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- Division of Cardiology, Duke University Medical Center, Durham, NC
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- To whom correspondence should be addressed; Department of Cardiology, Aalborg University Hospital, Hobrovej 18–22, DK-9000 Aalborg, Denmark; e-mail:
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Steen M Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Brett D Atwater
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | | | - Carlo A Barcella
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas B Nielsen
- Laboratory for Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Adrian Pietersen
- Copenhagen General Practitioners’ Laboratory, Copenhagen, Denmark
| | - Jimmi Nielsen
- Mental Health Center Glostrup, Copenhagen University Hospital Glostrup, Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Svend E Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Gendy MNS, Ibrahim C, Sloan ME, Le Foll B. Randomized Clinical Trials Investigating Innovative Interventions for Smoking Cessation in the Last Decade. Handb Exp Pharmacol 2020; 258:395-420. [PMID: 31267165 DOI: 10.1007/164_2019_253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Every year, billions of dollars are spent treating smoking and related conditions, yet smoking-related morbidity and mortality continue to rise. There are currently only three FDA-approved medications for smoking cessation: nicotine replacement therapy, bupropion, and varenicline. Although these medications increase abstinence rates, most individuals relapse following treatment. This chapter reviews clinical trials published within the past 10 years investigating novel smoking cessation pharmacotherapies. Among these pharmacotherapies, some showed promising results, such as cytisine and endocannabinoid modulators, whereas others failed to produce significant effects. More research is needed to develop drugs that produce higher rates of long-term abstinence and to determine which subgroups of patients benefit from a given treatment.
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Affiliation(s)
- Marie N S Gendy
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Christine Ibrahim
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Matthew E Sloan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
- Addictions Division, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
- Alcohol Research and Treatment Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
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32
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Gaughran F, Stahl D, Patel A, Ismail K, Smith S, Greenwood K, Atakan Z, Gardner-Sood P, Stringer D, Hopkins D, Lally J, Forti MD, Stubbs B, Lowe P, Arbuthnott M, Heslin M, David AS, Murray RM. A health promotion intervention to improve lifestyle choices and
health outcomes in people with psychosis: a research programme including the
IMPaCT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background
People with psychotic disorders have reduced life expectancy largely because
of physical health problems, especially cardiovascular disease, that are
complicated by the use of tobacco and cannabis.
Objectives
We set out to (1) chart lifestyle and substance use choices and the emergence
of cardiometabolic risk from the earliest presentation with psychosis, (2)
develop a pragmatic health promotion intervention integrated within the
clinical teams to improve the lifestyle choices and health outcomes of
people with psychosis and (3) evaluate the clinical effectiveness and
cost-effectiveness of that health promotion intervention.
Design
We performed a longitudinal cohort study of people presenting with their
first episode of psychosis in three mental health trusts and followed up
participants for 1 year [work package 1, physical health and substance use
measures in first episode of psychosis (PUMP)]. We used an iterative Delphi
methodology to develop and refine a modular health promotion intervention,
improving physical health and reducing substance use in psychosis (IMPaCT)
therapy, which was to be delivered by the patient’s usual care
co-ordinator and used motivational interviewing techniques and
cognitive–behavioural therapy to improve health choices of people
with psychosis (work package 2). We then conducted a multicentre, two-arm,
parallel-cluster, randomised controlled trial to determine the clinical
effectiveness and cost-effectiveness of using the intervention with people
with established psychosis (work package 3: IMPaCT randomised controlled
trial) in five UK mental health trusts. The work took place between 2008 and
2014.
Participants
All people aged between 16 and 65 years within 6 months of their first
presentation with a non-organic psychosis and who were proficient in English
were eligible for inclusion in the PUMP study. Participants in the work
package 2 training development were staff selected from a range of settings,
working with psychosis. Participants in the phase 3 Delphi consensus and
manual development comprised three expert groups of (1)
therapists/researchers recruited from the local and national community, (2)
clinicians and (3) service users, each of whom took part in two iterative
review and feedback sessions. For work package 3, IMPaCT randomised
controlled trial, care co-ordinators in participating community mental
health teams who were permanently employed and had a minimum of four
eligible patients (i.e. aged between 18 and 65 years with a diagnosis of a
psychotic disorder) on their caseload were eligible to participate. In
studies 1 and 3, patient participants were ineligible if they were pregnant
or had a major illness that would have had an impact on their metabolic
status or if they had a significant learning disability. All participants
were included in the study only after giving written confirmed consent.
Main outcome measures
Cardiometabolic risk markers, including rates of obesity and central obesity,
and levels of glycated haemoglobin (HbA1c) and lipids, were the
main outcomes in work package 1 (PUMP), with descriptive data presented on
substance use. Our primary outcome measure for the IMPaCT randomised
controlled trial was the physical or mental health component Short Form
questionnaire-36 items quality-of-life scores at 12 months.
Results
Obesity rates rose from 18% at first presentation with psychosis to 24% by 1
year, but cardiometabolic risk was not associated with baseline lifestyle
and substance use choices. Patterns of increase in the levels of
HbA1c over the year following first presentation showed
variation by ethnic group. We recruited 104 care co-ordinators, of whom 52
(with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with
193 patients) were randomised to deliver treatment as usual, in keeping with
our power calculations. Of these 406 participants with established
psychosis, 318 (78%) and 301 (74%) participants, respectively, attended the
12- and 15-month follow-ups. We found no significant effect of IMPaCT
therapy compared with treatment as usual on the physical or mental health
component Short Form questionnaire-36 items scores at either time point in
an intention-to-treat analysis [physical health score (‘d’)
–0.17 at 12 months and –0.09 at 15 months; mental health score
(‘d’) 0.03 at 12 months and –0.05 at 15 months] or on
costs. Nor did we find an effect on other cardiovascular risk indicators,
including diabetes, except in the case of high-density lipoprotein
cholesterol, which showed a trend for greater benefit with IMPaCT therapy
than with treatment as usual (treatment effect 0.085, 95% confidence
interval 0.007 to 0.16; p = 0.034).
Limitations
Follow-up in work package 1 was challenging, with 127 out of 293 participants
attending; however, there was no difference in cardiometabolic measures or
demographic factors at baseline between those who attended for follow-up and
those who did not. In work package 3, the IMPaCT randomised controlled
trial, care co-ordinators struggled to provide additional time to their
patients that was devoted to the health promotion intervention on top of
their usual clinical care contact with them.
Conclusions
Cardiometabolic risk is prominent even soon after first presentation with
psychosis and increases over time. Lifestyle choices and substance use
habits at first presentation do not predict those who will be most
cardiometabolically compromised 1 year later. Training and supervising care
co-ordinators to deliver a health promotion intervention to their own
patients on top of routine care is not effective in the NHS for improving
quality of life or reducing cardiometabolic risk.
Future work
Further work is needed to develop and evaluate effective, cost-effective and
affordable ways of preventing the emergence of and reversing existing
cardiometabolic risk indicators in people with psychosis.
Trial registration
Current Controlled Trials ISRCTN58667926.
Funding
This project was funded by the National Institute for Health Research (NIHR)
Programme Grants for Applied Research programme and will be published in
full in Programme Grants for Applied Research; Vol. 8, No.
1. See the NIHR Journals Library website for further project
information.
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Affiliation(s)
- Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, London, UK
- Centre for Primary Care and Public Health, Blizard Institute,
Queen Mary University of London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College London, London, UK
- Forensic Services, South London and Maudsley NHS Foundation
Trust, London, UK
| | - Kathryn Greenwood
- Sussex Partnership NHS Foundation Trust, Worthing, UK
- School of Psychology, University of Sussex, Brighton, UK
| | - Zerrin Atakan
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King’s
Health Partners, London, UK
| | - John Lally
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland,
Beaumont Hospital, Dublin, Ireland
| | - Marta Di Forti
- Social, Genetic & Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Physiotherapy Department, South London and Maudsley NHS
Foundation Trust, London, UK
| | | | | | - Margaret Heslin
- King’s Health Economics, Health Service & Population
Research Department, Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, London, UK
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, University
College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
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Lee SM, Liao DL. Improving physical health in patients with severe mental illness. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Affiliation(s)
- Stephen R Marder
- From the Section on Psychosis, Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles, and the Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (S.R.M.); and the Departments of Psychology and Psychiatry, Yale University, New Haven, CT (T.D.C.)
| | - Tyrone D Cannon
- From the Section on Psychosis, Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles, and the Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles (S.R.M.); and the Departments of Psychology and Psychiatry, Yale University, New Haven, CT (T.D.C.)
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Fang SC, Huang CY, Liao DL, Hsu CC, Shao YHJ. Associations among antipsychotics, metabolism-related diseases, and cataracts in patients with schizophrenia: A retrospective cohort study. Schizophr Res 2019; 212:150-156. [PMID: 31395489 DOI: 10.1016/j.schres.2019.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/04/2019] [Accepted: 07/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term cataract risks associated with first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs), and their associations with metabolism-related diseases are not yet elucidated. METHODS Using Taiwan National Health Insurance data, we conducted a propensity score matched population-based cohort study consisting of 10,014 patients with newly diagnosed schizophrenia from 2005 to 2009 and followed them until the end of 2013. A Cox hazard model with metabolism-related diseases as time-dependent covariates was adapted to estimate the hazard ratio (HR) of cataracts between SGAs and FGAs groups. RESULTS During the 8-year follow-up, patients receiving SGAs were associated with a higher risk of cataract than those receiving FGAs with an adjusted HR of 1.59 (95% confidence interval [CI] = 1.06-2.36). Patients receiving high-metabolic-risk SGAs (clozapine and olanzapine) showed the highest risk of cataracts among SGAs when compared with those receiving FGAs (aHR = 2.57, 95% CI: 1.35-4.88). SGAs demonstrated a stronger contribution in the risk of cataract in patients without diabetes mellitus (DM) and hyperlipidemia than in those developed these diseases. Patients who developed DM or hyperlipidemia after receiving antipsychotics had an approximately 2.5-fold increased cataract risk over those who did not develop these diseases. CONCLUSIONS Regardless of the condition of metabolic-related diseases, SGAs were independently associated with an increased risk of cataract. DM and hyperlipidemia developed after antipsychotics contributed to the risk of cataract risk.
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Affiliation(s)
- Su-Chen Fang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Yi Huang
- Department of Community Psychiatry and Addiction Psychiatry, Bali Psychiatric Center, New Taipei City, Taiwan
| | - Ding-Lieh Liao
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan
| | - Chun-Chi Hsu
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan
| | - Yu-Hsuan Joni Shao
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA; Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Clozapine-dependent inhibition of EGF/neuregulin receptor (ErbB) kinases. Transl Psychiatry 2019; 9:181. [PMID: 31371697 PMCID: PMC6675791 DOI: 10.1038/s41398-019-0519-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/01/2019] [Indexed: 12/20/2022] Open
Abstract
Clozapine is an antipsychotic agent prescribed to psychotic patients exhibiting tolerance and/or resistance to the conventional antipsychotic medications that mainly drive monoamine antagonism. As the pharmacological fundamentals of its unique antipsychotic profile have been unrevealed, here, we attempted to obtain hints at this question. Here, we found that clozapine directly acts on ErbB kinases to downregulate epidermal growth factor (EGF)/neuregulin signaling. In cultured cell lines and cortical neurons, EGF-triggered ErbB1 phosphorylation was diminished by 30 μM clozapine, but not haloperidol, risperidone, or olanzapine. The neuregulin-1-triggered ErbB4 phosphorylation was attenuated by 10 μM clozapine and 30 μM haloperidol. We assumed that clozapine may directly interact with the ErbB tyrosine kinases and affect their enzyme activity. To test this assumption, we performed in vitro kinase assays using recombinant truncated ErbB kinases. Clozapine (3-30 μM) significantly decreased the enzyme activity of the truncated ErbB1, B2, and B4 kinases. Acute in vivo administration of clozapine (20 mg/kg) to adult rats significantly suppressed the basal phosphorylation levels of ErbB4 in the brain, although we failed to detect effects on basal ErbB1 phosphorylation. Altogether with the previous findings that quinazoline inhibitors for ErbB kinases harbor antipsychotic potential in animal models for schizophrenia, our present observations suggest the possibility that the micromolar concentrations of clozapine can attenuate the activity of ErbB receptor kinases, which might illustrate a part of its unique antipsychotic psychopharmacology.
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Kim SW, Park WY, Jhon M, Kim M, Lee JY, Kim SY, Kim JM, Shin IS, Yoon JS. Physical Health Literacy and Health-related Behaviors in Patients with Psychosis. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:279-287. [PMID: 30905128 PMCID: PMC6478081 DOI: 10.9758/cpn.2019.17.2.279] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/03/2018] [Accepted: 10/09/2018] [Indexed: 12/30/2022]
Abstract
Objective This study compared the levels of knowledge of physical illnesses and patterns of health behaviors between patients with psychosis and the general population. Methods A total of 712 participants were included in the study; 292 patients with a schizophrenia spectrum disorder and 420 healthy controls matched for age and gender. Questionnaires were administered to study participants to determine the level of knowledge of chronic physical illnesses such as cancer, hypertension, and diabetes mellitus and health-related behavior. Results from the two study groups were compared to identify differences in knowledge of physical illness and health-related behaviors. Results Compared with healthy controls, patients with psychosis were less likely to undergo regular medical check-ups and engage in exercise. Patients with psychosis had poorer knowledge of physical illnesses, and were more likely to smoke, be overweight, or have diabetes. Patients with psychosis were significantly less likely to acknowledge the importance of early detection of cancer and controlling hypertension and diabetes, independent of education and type of medical insurance. Patients who smoked were significantly less likely to agree with the statement on the relationship between smoking and physical illnesses. Patients not undergoing regular medical check-ups were significantly less likely to agree with statements concerning the need for cancer screening. Conclusion Patients with psychosis demonstrated lower levels of knowledge of physical illnesses and a lack of understanding of preventive behaviors. Low levels of knowledge were associated with poor health-related behaviors. Education of physical health should be provided to patients with psychosis.
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Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School.,Gwangju Mental Health and Welfare Commission.,MindLink, Gwangju Bukgu Community Mental Health Center
| | | | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School.,MindLink, Gwangju Bukgu Community Mental Health Center
| | - Mina Kim
- Gwangju Mental Health and Welfare Commission.,Department of Nursing, Graduate School, Chonnam National University
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School.,Gwangju Mental Health and Welfare Commission.,MindLink, Gwangju Bukgu Community Mental Health Center
| | - Seon-Young Kim
- Department of Psychiatry, Chonnam National University Medical School
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School
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Carmichael JM, Meier J, Robinson A, Taylor J, Higgins DT, Patel S. Leveraging electronic medical record data for population health management in the Veterans Health Administration: Successes and lessons learned. Am J Health Syst Pharm 2019; 74:1447-1459. [PMID: 28887346 DOI: 10.2146/ajhp161048] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The process and operational elements to establish a population health program using electronic medical record data in a Veterans Health Administration region are described. SUMMARY Pharmacists are uniquely qualified to assume important roles in population health through the use of their clinical knowledge, assisted by electronic tools that consolidate and report patient-specific data for clinical care. Veterans Integrated Services Network (VISN) 21 has developed 300 dashboards and reports to improve the quality, safety, and value of healthcare to veterans. Within a group of specialty task forces, physicians, nurses, and pharmacists assist in the design and development of evidence-based tools to leverage timely electronic health information into metrics, benchmarks, and targets to assist with goal achievement. Examples of programs designed to improve care in 3 areas were selected for further description and review of outcomes. Population health improvement using Healthcare Effectiveness Data and Information Set and hepatitis C metrics were used to describe populations that may have an indication for evidence-based care but are not receiving it. Deprescribing efforts are described, as are medication safety monitoring efforts to prevent potential adverse events known to be associated with therapy. CONCLUSION Quality, safety, and value outcomes are the measures of success for population health programs in VISN 21. Data-rich project dashboards and reports are developed by pharmacist data analysts and implemented and used by teams of clinicians who provide continuous feedback and support to improve population health. The use of task forces, metrics, benchmarks, targets, and teams is instrumental in the successful application of these tools.
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Affiliation(s)
| | - Joy Meier
- VA Sierra Pacific Network, Martinez, CA
| | | | | | | | - Shardool Patel
- Postgraduate Year 2 Pharmacy Outcomes and Healthcare Analytics, VA Sierra Pacific Network, Reno, NV
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Rødevand L, Steen NE, Elvsåshagen T, Quintana DS, Reponen EJ, Mørch RH, Lunding SH, Vedal TSJ, Dieset I, Melle I, Lagerberg TV, Andreassen OA. Cardiovascular risk remains high in schizophrenia with modest improvements in bipolar disorder during past decade. Acta Psychiatr Scand 2019; 139:348-360. [PMID: 30697685 DOI: 10.1111/acps.13008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE While CVD risk has decreased in the general population during the last decade, the situation in patients with schizophrenia (SCZ) and bipolar disorder (BD) is unknown. METHODS We compared CVD risk factors in patients with SCZ and BD recruited from 2002-2005 (2005 sample, N = 270) with patients recruited from 2006-2017 (2017 sample, N = 1011) from the same catchment area in Norway. The 2017 sample was also compared with healthy controls (N = 922) and the general population (N range = 1285-4587, Statistics Norway) from the same area and period. RESULTS Patients with SCZ and BD in the 2017 sample had significantly higher level of most CVD risk factors compared to healthy controls and the general population. There was no significant difference in the prevalence of CVD risk factors in SCZ between the 2005 and 2017 samples except a small increase in glucose in the 2017 sample. There were small-to-moderate reductions in hypertension, obesity, total cholesterol, low-density lipoprotein, systolic and diastolic blood pressure in the BD 2017 sample compared to the 2005 sample. CONCLUSION Despite major advances in health promotion during the past decade, there has been no reduction in the level of CVD risk factors in patients with SCZ and modest improvement in BD.
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Affiliation(s)
- L Rødevand
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - N E Steen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T Elvsåshagen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - D S Quintana
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - E J Reponen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - R H Mørch
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - S H Lunding
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T S J Vedal
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - I Dieset
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - I Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T V Lagerberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Estrogens and SERMS as adjunctive treatments for schizophrenia. Front Neuroendocrinol 2019; 53:100743. [PMID: 30922675 DOI: 10.1016/j.yfrne.2019.03.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 03/12/2019] [Accepted: 03/23/2019] [Indexed: 01/25/2023]
Abstract
More than thirty years have passed since sex and gender differences were noted in the age of onset, course and outcomes for schizophrenia. The 'estrogen hypothesis" was coined in the 1990's to describe neuroprotective effects of estrogen. Intervention studies in schizophrenia patients with estradiol and selective estrogen receptor modulators (SERMs) are promising but psychiatrists and other health practitioners do not generally take up this useful adjunctive treatment for their female patients with schizophrenia. The reasons for this are manifold, but overall a cultural shift in the practice of psychiatry is needed to recognise the specific needs of women with schizophrenia and tailor treatments, such as hormone adjuncts to improve the outcomes for this significant population. The two main aims of this article are to review the evidence and theory of estrogen treatments in schizophrenia and to recommend translation of adjunctive estrogen treatment into clinical practice for women with schizophrenia.
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Vancampfort D, Firth J, Correll CU, Solmi M, Siskind D, De Hert M, Carney R, Koyanagi A, Carvalho AF, Gaughran F, Stubbs B. The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry 2019; 18:53-66. [PMID: 30600626 PMCID: PMC6313230 DOI: 10.1002/wps.20614] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We summarized and compared meta-analyses of pharmacological and non-pharmacological interventions targeting physical health outcomes among people with schizophrenia spectrum disorders. Major databases were searched until June 1, 2018. Of 3,709 search engine hits, 27 meta-analyses were included, representing 128 meta-analyzed trials and 47,231 study participants. While meta-analyses were generally of adequate or high quality, meta-analyzed studies were less so. The most effective weight reduction interventions were individual lifestyle counseling (standardized mean difference, SMD=-0.98) and exercise interventions (SMD=-0.96), followed by psychoeducation (SMD=-0.77), aripiprazole augmentation (SMD=-0.73), topiramate (SMD=-0.72), d-fenfluramine (SMD=-0.54) and metformin (SMD=-0.53). Regarding waist circumference reduction, aripiprazole augmentation (SMD=-1.10) and topiramate (SMD=-0.69) demonstrated the best evidence, followed by dietary interventions (SMD=-0.39). Dietary interventions were the only to significantly improve (diastolic) blood pressure (SMD=-0.39). Switching from olanzapine to quetiapine or aripiprazole (SMD=-0.71) and metformin (SMD=-0.65) demonstrated best efficacy for reducing glucose levels, followed by glucagon-like peptide-1 receptor agonists (SMD=-0.39), dietary interventions (SMD=-0.37) and aripiprazole augmentation (SMD=-0.34), whereas insulin resistance improved the most with metformin (SMD=-0.75) and rosiglitazone (SMD=-0.44). Topiramate had the greatest efficacy for triglycerides (SMD=-0.68) and low-density lipoprotein (LDL)-cholesterol (SMD=-0.80), whereas metformin had the greatest beneficial effects on total cholesterol (SMD=-0.51) and high-density lipoprotein (HDL)-cholesterol (SMD=0.45). Lifestyle interventions yielded small effects for triglycerides, total cholesterol and LDL-cholesterol (SMD=-0.35 to -0.37). Only exercise interventions increased exercise capacity (SMD=1.81). Despite frequent physical comorbidities and premature mortality mainly due to these increased physical health risks, the current evidence for pharmacological and non-pharmacological interventions in people with schizophrenia to prevent and treat these conditions is still limited and more larger trials are urgently needed.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven Department of Rehabilitation SciencesLeuvenBelgium,University Psychiatric Centre KU LeuvenKortenbergBelgium
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney UniversityWestmeadAustralia,Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Christoph U. Correll
- Hofstra Northwell School of Medicine HempsteadNew YorkNY, USA,Department of PsychiatryZucker Hillside HospitalNew YorkNYUSA,Department of Child and Adolescent PsychiatryCharité UniversitätsmedizinBerlinGermany
| | - Marco Solmi
- Department of NeurosciencesUniversity of PaduaPaduaItaly
| | - Dan Siskind
- Metro South Addiction and Mental Health ServiceBrisbaneAustralia,School of Medicine, University of QueenslandBrisbaneAustralia
| | - Marc De Hert
- University Psychiatric Centre KU LeuvenKortenbergBelgium,KU Leuven Department of NeurosciencesLeuvenBelgium
| | - Rebekah Carney
- Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMMadridSpain
| | - André F. Carvalho
- Centre for Addiction and Mental HealthTorontoOntarioCanada,Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation TrustLondonUK,Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation TrustLondonUK,Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
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Yun JY, Lee JS, Kang SH, Nam B, Lee SJ, Lee SH, Choi J, Kim CH, Chung YC. Korean Treatment Guideline on Pharmacotherapy of Co-existing Symptoms and Antipsychotics-related Side Effects in Patients with Schizophrenia. ACTA ACUST UNITED AC 2019. [DOI: 10.16946/kjsr.2019.22.2.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Korea
- Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Suk Lee
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Shi Hyun Kang
- Adult Psychiatry, Division of Medical Services, National Center for Mental Health, Seoul, Korea
| | - Beomwoo Nam
- Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea
| | - Seung Jae Lee
- Department of Psychiatry, School of Medicine, Kyoungpook National University, Daegu, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, Korea
| | - Joonho Choi
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Korea
| | - Chan-Hyung Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
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Silva DGCD, Kanazawa LKS, Vecchia DD. Schizophrenia: effects of aripiprazole in metabolic syndrome. BRAZ J PHARM SCI 2019. [DOI: 10.1590/s2175-97902019000217840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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The past and future of novel, non-dopamine-2 receptor therapeutics for schizophrenia: A critical and comprehensive review. J Psychiatr Res 2019; 108:57-83. [PMID: 30055853 DOI: 10.1016/j.jpsychires.2018.07.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/13/2018] [Accepted: 07/12/2018] [Indexed: 01/28/2023]
Abstract
Since the discovery of chlorpromazine in the 1950's, antipsychotic drugs have been the cornerstone of treatment of schizophrenia, and all attenuate dopamine transmission at the dopamine-2 receptor. Drug development for schizophrenia since that time has led to improvements in side effects and tolerability, and limited improvements in efficacy, with the exception of clozapine. However, the reasons for clozapine's greater efficacy remain unclear, despite the great efforts and resources invested therewith. We performed a comprehensive review of the literature to determine the fate of previously tested, non-dopamine-2 receptor experimental treatments. Overall we included 250 studies in the review from the period 1970 to 2017 including treatments with glutamatergic, serotonergic, cholinergic, neuropeptidergic, hormone-based, dopaminergic, metabolic, vitamin/naturopathic, histaminergic, infection/inflammation-based, and miscellaneous mechanisms. Despite there being several promising targets, such as allosteric modulation of the NMDA and α7 nicotinic receptors, we cannot confidently state that any of the mechanistically novel experimental treatments covered in this review are definitely effective for the treatment of schizophrenia and ready for clinical use. We discuss potential reasons for the relative lack of progress in developing non-dopamine-2 receptor treatments for schizophrenia and provide recommendations for future efforts pursuing novel drug development for schizophrenia.
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Antipsychotics and cardiovascular risk: A case/non-case study. Psychiatry Res 2018; 270:341-347. [PMID: 30292087 DOI: 10.1016/j.psychres.2018.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 08/04/2018] [Accepted: 09/10/2018] [Indexed: 11/21/2022]
Abstract
Severe mental disorders have been reported to be associated with an increased cardiovascular risk. To measure the potential risk excess as compared, not with the baseline cardiovascular risk for the general population, but with the cardiovascular risk associated with drug iatrogenia. 197 reported cases of cardiovascular adverse reaction to antipsychotic drugs as compared to the reported cases of this type of adverse reactions to drugs other than antipsychotics entered in the Spanish Pharmacovigilance System database (FEDRA) (1995-2018) in an observational case/non-case study. Risk estimates of association were reporting odds ratio (ROR), and, chi-square test (χ2). Overall disproportionality for the whole drug class was found [ROR 2.3 (95% CI 2.0-2.7)], χ2 = 127.07]. When the two types of antipsychotics (typical and atypical) were analysed separately, we also found statistically significant disproportionality, and this disproportionality is similar between both groups, with disproportionality measures around 2.30, with the confidence intervals not including the 1. The disproportionality observed suggests a risk excess that might be greater than expected, which holds particularly true for torsade de pointes, sudden death and cardiac arrhythmias in patients treated with any of the two types of antipsychotics. There was no significant risk for ischaemic heart disease.
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46
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Amzand SG, Luteijn BL, van der Ven E, Bogers JP, Selten JP. Diagnostic value of a simplified screening test for metabolic syndrome in a Dutch patient cohort with schizophrenia spectrum disorders. Australas Psychiatry 2018; 26:615-618. [PMID: 29888619 DOI: 10.1177/1039856218779137] [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: 11/15/2022]
Abstract
OBJECTIVE: The aim of this study was to establish the specificity and sensitivity of a simplified screening test based on diastolic blood pressure and waist circumference for predicting metabolic syndrome. METHOD: Demographic, anthropometric (waist circumference and systolic and diastolic blood pressure) and laboratory (triglyceride, high-density lipoprotein and fasting glucose) data were collected from a large cohort of Dutch patients with a schizophrenia spectrum disorder in order to determine whether patients fulfilled the Western criteria of the International Diabetes Federation (IDF) for metabolic syndrome. The sensitivity, specificity, likelihood ratio of a positive or negative test outcome and positive and negative predictive values of the simplified test (only waist circumference and diastolic blood pressure) were calculated. RESULTS: Of 252 recruited patients, 55% met the IDF criteria for metabolic syndrome. The sensitivity and the specificity of the simplified test were 65% and 85%, respectively. The likelihood ratios of positive and negative test outcomes were 4.35 and 0.41, respectively, and the positive and negative predictive values were 87% and 67%, respectively. CONCLUSION: This simplified screening test did not have diagnostic validity for metabolic syndrome in a Dutch cohort of patients with schizophrenia spectrum disorder.
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Affiliation(s)
- Salcey G Amzand
- Psychiatrist, Mental Health Services Delfland, Delft, The Netherlands
| | - Bert L Luteijn
- Psychiatrist, Mental Health Services Rivierduinen, Gouda, The Netherlands
| | - Els van der Ven
- Psychologist and Postdoctoral Researcher, Mental Health Services Rivierduinen, Leiden, The Netherlands
| | - Jan P Bogers
- Postdoctoral Researcher and Director residency program, Mental Health Services Rivierduinen, Leiden, The Netherlands
| | - Jean-Paul Selten
- Psychiatrist, Mental Health Services Rivierduinen, Leiden, and; Professor, Maastricht University, Maastricht, The Netherlands
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Russo P, Prinzi G, Proietti S, Lamonaca P, Frustaci A, Boccia S, Amore R, Lorenzi M, Onder G, Marzetti E, Valdiglesias V, Guadagni F, Valente MG, Cascio GL, Fraietta S, Ducci G, Bonassi S. Shorter telomere length in schizophrenia: Evidence from a real-world population and meta-analysis of most recent literature. Schizophr Res 2018; 202:37-45. [PMID: 30001973 DOI: 10.1016/j.schres.2018.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/05/2018] [Accepted: 07/03/2018] [Indexed: 02/07/2023]
Abstract
Schizophrenia is a severe, chronic mental disorder. Schizophrenia is visualized as an accelerated cellular aging syndrome characterized by early onset of cardiovascular disease causing premature mortality. In human aging involves alterations in telomere length (TL). To investigate the presence of TL shortening in schizophrenia and psychiatric syndromes associated, this condition was studied in leukocytes (LTL) of a sample of patients suffering from schizophrenia and other psychotic disorders, and compared with a group of non-psychiatric controls. We explored the relationship between LTL and age, gender, and smoking habit with the aim to control whether these potential confounding factors may influence the rate of telomeres shortening. We also performed a new comprehensive meta-analysis including studies on LTL in schizophrenia patients compared to healthy subjects published in the last two years and the results of the present study. Our results suggest that a diagnosis of schizophrenia, more than gender, age, cigarette smoking or alcohol drinking, is the most important condition responsible of the LTL shortening. A strong LTL shortening was observed in patients affected by schizophrenia, Schizoaffective disorder, and Psychosis not otherwise specified when they were younger than 50 years, while in the group of older subjects no major differences were observed. Additional evidence supporting the causal link of schizophrenia with accelerated telomeres shortening came from the analysis of the updated meta-analysis. The availability of a personalized profile of mechanistic pathways, risk factors, and clinical features may pose the basis for a rehabilitative treatment addressing individual needs of the psychiatric patients.
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Affiliation(s)
- Patrizia Russo
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, RM, Italy
| | - Giulia Prinzi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, RM, Italy
| | - Stefania Proietti
- Scientific Direction, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, RM, Italy
| | - Palma Lamonaca
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, RM, Italy
| | - Alessandra Frustaci
- Specialist Services-Eating Disorders, Barnet and Enfield and Haringey Mental Health NHS Trust, St. Ann's Hospitals, St. Ann's Road, N15 3TH, London, UK
| | - Stefania Boccia
- Section of Hygiene-Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico Agostino Gemelli, Largo Agostino Gemelli, 8, 00168, RM, Italy
| | - Rosarita Amore
- Section of Hygiene-Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico Agostino Gemelli, Largo Agostino Gemelli, 8, 00168, RM, Italy
| | - Maria Lorenzi
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Agostino Gemelli, Largo Agostino Gemelli, 8, 00168, RM, Italy
| | - Graziano Onder
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Agostino Gemelli, Largo Agostino Gemelli, 8, 00168, RM, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Agostino Gemelli, Largo Agostino Gemelli, 8, 00168, RM, Italy
| | - Vanessa Valdiglesias
- DICOMOSA Group, Department of Psychology, Universidade de A Coruña, Campus Elviña, s/n -15071, A Coruña, Spain
| | - Fiorella Guadagni
- Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, RM, Italy; San Raffaele University, Via di Val Cannuta 247, 00166, RM, Italy
| | - Maria Giovanna Valente
- Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, RM, Italy
| | - Gerland Lo Cascio
- San Raffaele Montecompatri, Via San Silvestro 67, 00077 Montecompatri, RM, Italy
| | - Sara Fraietta
- Mental Health Department, ASL Roma 1, Piazza Santa Maria della Pietà 5, RM, 00135, Italy
| | - Giuseppe Ducci
- Mental Health Department, ASL Roma 1, Piazza Santa Maria della Pietà 5, RM, 00135, Italy
| | - Stefano Bonassi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, RM, Italy; San Raffaele University, Via di Val Cannuta 247, 00166, RM, Italy.
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48
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Young AS, Cohen AN, Hamilton AB, Hellemann G, Reist C, Whelan F. Implementing Patient-Reported Outcomes to Improve the Quality of Care for Weight of Patients with Schizophrenia. J Behav Health Serv Res 2018; 46:129-139. [PMID: 30465314 DOI: 10.1007/s11414-018-9641-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
"Enhancing QUality of Care In Psychosis" (EQUIP) was an eight-site clustered controlled trial of the implementation and effectiveness of patient-reported outcomes to support evidence-based practice and improve care for schizophrenia. Implementation sites chose to improve care for weight. Implementation included monitoring patient-reported outcomes using kiosks, patient and staff education, quality improvement teams, and phone care management. Qualitative and quantitative methods compared implementation and effectiveness between sites for 13 months. Eighty percent of 801 randomly selected patients were overweight. Two hundred one clinicians varied in competency. Baseline use of behavioral weight services was low. At implementation sites, patients became 2.3 times more likely to use weight services compared with control sites (95% CI, 1.5-3.6; χ2 = 14.4; p < 0.01). There was no effect on the weight gain liability of medications prescribed. Controlling for baseline, patients' final weight at control sites was 5.9 ± 2.7 kg heavier than at implementation sites (F = 4.8, p = 0.03). Patient-reported outcomes can inform implementation of evidence-based practice and improvement in outcomes.
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Affiliation(s)
- Alexander S Young
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA. .,University of California, Los Angeles, CA, USA. .,UCLA Center for Health Services, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, 90024, USA. .,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA.
| | - Amy N Cohen
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA.,University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Alison B Hamilton
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA.,University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Gerhard Hellemann
- University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Christopher Reist
- Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA.,Long Beach Veterans Healthcare System, Long Beach, CA, USA.,University of California, Irvine, CA, USA
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49
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Abstract
UNLABELLED ABSTRACTBackground:The atypical antipsychotics (AAPs) are associated with a recognized class effect of glucose and lipid dysregulation. The use of these medications is rapidly increasing in elderly patients with, and without, dementia. However, the metabolic risks specific to elderly remain poorly studied. METHODS Design: A case-control study. SETTING Psychogeriatric service in Auckland, New Zealand. PARTICIPANTS Elderly patients either receiving AAP treatment (cases) or not (controls) between 1 Jan 2008 and 1 Jan 2014. MAIN OUTCOME MEASURES metabolic data of glucose, HbA1c, lipids, and cardiovascular events and death. The data were analyzed using t-tests and linear regression models for each metabolic outcome. RESULTS There were 330 eligible cases and 301 controls from a total study population of 5,307. There was a statistically significant change in the HbA1c over time, within the cases group of -1.14 mmol/mol (p = 0.018, 95% CI -0.19 to -2.09). Also statistically significant was the reduction in total cholesterol of -0.13 mmol/L (p = 0.036, 95% CI -0.008 to -0.245). The only significant difference found between cases and controls was in the change in cholesterol ratio of 0.16 mmol/L between groups (95%CI 0.01-0.31, p = 0.036). CONCLUSIONS AAP use was not associated with any clinically significant change in metabolic outcomes in this study population.
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Lee H, Scolieri BB, Mullick PK. Learned lessons from patients who take clozapine: A case study. Perspect Psychiatr Care 2018; 54:457-461. [PMID: 28926097 DOI: 10.1111/ppc.12245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 08/08/2017] [Accepted: 09/03/2017] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this report is to provide clinical strategies to manage patients with schizophrenia taking clozapine. CONCLUSIONS Serious side effects and required blood monitoring impede the use of clozapine, despite the benefits of clozapine for managing psychiatric symptoms. Well-managed patients receiving evidence-based interventions exhibit reduced symptoms, improved functioning, and better adherence to treatment. PRACTICE IMPLICATIONS Preexisting medical conditions should be considered before prescribing clozapine. Ongoing education on medication and mental illness for patients and family members is essential to prepare them for adherence to management plans. Healthcare providers are responsible for monitoring the side effects of clozapine.
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Affiliation(s)
- Heeyoung Lee
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Britney B Scolieri
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Prabir K Mullick
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,P.K. Mullick MD & Associates PC, Pittsburgh, Pennsylvania, USA
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