Prevalence and management practice of first generation antipsychotics induced side effects among schizophrenic patients at Amanuel Mental Specialized Hospital, central Ethiopia: cross-sectional study

Risk factors for abnormal glucose metabolism during antipsychotic treatment: A prospective cohort study

Antipsychotic medications increase the risk of abnormal glucose metabolism. However, in clinical practice, it is difficult to predict this risk because it is affected by medication-related and background factors. This study aimed to identify the risk factors for abnormal glucose metabolism during antipsychotic treatment. We conducted a multicenter, prospective, cohort study in patients with schizophrenia, schizoaffective disorder, or bipolar disorder. Of these patients, those with prediabetes or possible diabetes were excluded. Finally, 706 patients were included in the analysis. The hazard ratio (HR) for each factor was calculated for events of progression to hyperglycemia using time-dependent Cox regression analysis stratified according to facility type and adjusted for available background and drug-related factors. Treatments with olanzapine (HR = 2.06, 95% confidence interval [CI] = 1.05-4.05), clozapine (HR = 4.25, 95% CI = 1.56-11.60), and chlorpromazine (HR = 4.48, 95% CI = 1.21-16.57), overweight and obesity (HR = 1.57, 95% CI = 1.02-2.41), and hypertriglyceridemia (HR = 1.72, 95% CI = 1.02-2.88) were associated with a significantly higher occurrence of hyperglycemic progression. The number and daily dose of antipsychotics were not associated with their occurrence. Our study demonstrated that more careful monitoring is necessary during olanzapine, clozapine, and chlorpromazine treatment because of the higher occurrence of abnormalities in glucose metabolism. Furthermore, patients with obesity or hypertriglyceridemia warrant monitoring for the occurrence of abnormal glucose metabolism, regardless of the type of antipsychotic medication.

Oculogyric crisis symptoms related to risperidone treatment: a case report

BACKGROUND

Oculogyric crisis (OGC) is a rare focal dystonia of the ocular muscles that not only interferes with patients' medication adherence but also negatively affects the course and prognosis of the primary disease. Early detection and treatment of OGC can improve patients' medication adherence and quality of life.

CASE PRESENTATION

This paper reports a case of a 19-year-old Asian female with a diagnosis of schizophrenia who was treated intermittently with atypical antipsychotics aripiprazole or risperidone for 2 years, with improvement of psychotic symptoms during the course of medication, and then developed double eye rolling and staring with irritability when treated with risperidone 4 mg/d or 6 mg/d. Then, we changed the medication to clozapine, and the patient's psychotic symptoms were controlled and stable. The symptoms of double eye rolling and gaze disappeared.

CONCLUSION

Oculogyric crisis (OGC) is a rare focal dystonia of the oculogyric muscle. This case provides clinicians with a basis for the early recognition and management of oculogyric crisis during the use of atypical antipsychotics (risperidone).

Drug-Induced Movement Disorders

Drug-induced movement disorders (DIMDs) are most commonly associated with typical and atypical antipsychotics. However, other drugs such as antidepressants, antihistamines, antiepileptics, antiarrhythmics, and gastrointestinal drugs can also cause abnormal involuntary movements. Different types of movement disorders can also occur because of adverse drug reactions. Therefore, the important key to diagnosing DIMDs is a causal relationship between potential offending drugs and the occurrence of abnormal movements. The pathophysiology of DIMDs is not clearly understood; however, many cases of DIMDs are thought to exert adverse mechanisms of action in the basal ganglia. The treatment of some DIMDs is quite challenging, and removing the offending drugs may not be possible in some conditions such as withdrawing antipsychotics in the patient with partially or uncontrollable neuropsychiatric conditions. Future research is needed to understand the mechanism of DIMDs and the development of drugs with better side-effect profiles. This article reviews the phenomenology, diagnostic criteria, pathophysiology, and management of DIMDs.

Severity in schizophrenia patients receiving atypical antipsychotic medications

Atypical antipsychotic drugs are nowadays the mainstay of treatment of schizophrenia due to their lesser extrapyramidal symptoms (EPS) as adverse effects. However, these drugs have different profiles of adverse drug reactions (ADRs). Here, the objective of this study was to analyze the probability, occurrences, and more significant involvement of various risk factors. A prospective observational study was carried out on a patient with schizophrenia who has prescribed atypical antipsychotic drugs for their treatment. The probability of the ADR was analyzed by using the Naranjo causality assessment scale. While Glasgow antipsychotic Side effect Scale (GASS) was used to estimate the severity of side effects. Statistical software for social science (SPSS) ver 25; was used for different descriptive statistics and chi-square analysis. A total of 140 patients were included in the study of which the majority (58.57 %) was male. However, atypical antipsychotic drugs were primarily prescribed to the patient as mono therapy (81.43 %). Interestingly, COVID-19 infections were reported as positive in 39.29 % of total patients. Probability assessment of ADRs revealed that most (55 %) were "Probable". Subsequently, the GASS score was evaluated for severity, the majority (55.71 %) were reported as "Mild". The statistically significant association between gender and severity of side effects & duration of illness and severity of side effects were found (P>0.5).The Present study aids in knowing the risk factors and improving the management practices of ADR, thereby improving the guidelines in terms of safe clinical approaches for psychiatric patients.

The type rather than the daily dose or number of antipsychotics affects the incidence of hyperglycemic progression

There have been concerns that antipsychotics increase the incidence of hyperglycemic progression. Many factors have been suggested to contribute to the risk of antipsychotic-induced hyperglycemic progression, including the type, daily dose, and number of antipsychotics; however, few studies have examined these relationships. This study aimed to examine the affect of antipsychotic treatment-associated factors on hyperglycemic progression, after adjustment for the affect of background factors suggested to be associated with hyperglycemic progression. This was a nationwide, multicenter, prospective cohort study examining the incidence of hyperglycemic progression during a 12 mo period following the initiation of newly prescribed antipsychotic medication. Demographic data, medication history, and blood test values were collected from 631 study participants with normal blood glucose levels at baseline for 12 mo. The primary endpoint (incidence of hyperglycemic progression) was defined as progression from normal to prediabetic or probable diabetic status, and was evaluated based on the Japanese monitoring guidance in patients with schizophrenia. To further examine the affect of antipsychotics on glucose metabolism over time, we examined changes in HbA1c levels 3, 6, and 12 mo after the initiation of treatment with each antipsychotic. We found that treatment with zotepine and clozapine was associated with a significantly high incidence of hyperglycemic progression. Furthermore, changes in HbA1c levels 6 mo after the initiation of zotepine treatment were significantly higher than those following blonanserin and haloperidol treatments. In contrast, there was no significant difference in the change in total cholesterol, triglycerides, HDL cholesterol, and BMI during the same period. Moreover, the "daily dose" and "number" of antipsychotics did not show an association with the incidence of hyperglycemic progression. However, in a post hoc analysis in which the antipsychotics were divided into two groups according to the strength of blockade of H₁, M₁, M₃, and 5-HT_2C receptors, the incidence of hyperglycemic progression was higher in the medium- and high-daily dose groups than in the low-daily dose group in the antipsychotic group with strong blockade of these receptors. Our study indicated that the type of antipsychotic had a greater affect on the incidence of hyperglycemic progression than the daily dose of antipsychotics or their number. Among these, zotepine was most likely to increase the incidence of hyperglycemic progression, suggesting the need for caution when these antipsychotics are prescribed.

Quality of individual and group level interventions for first-episode psychosis at the tertiary psychiatric hospital in Uganda

Background

Individual and group level interventions have the largest effect on outcomes in patients with the first episode of psychosis. The quality of these individual and group level interventions provided to first-episode psychosis patients in Uganda is unclear.

Aim

To determine the quality of the individual and group level interventions provided to first episode psychosis patients in Uganda

Setting

The study was performed at the only tertiary psychiatric hospital in Uganda.

Methods

A retrospective chart review of recently discharged adult in-patients with the first episode of psychosis was performed. The proportion of participants who received different essential components for individual and group level interventions were calculated. From the different proportions, the quality of the services across the individual and group interventions was determined using the first-episode psychosis services fidelity scale (FEPS-FS). The FEPS-FS assigns a grade of 1–5 on a Likert scale depending on the proportion of patients who received the different components of the intervention. Twelve essential components across the individual and group interventions were assessed and their quality quantified.

Results

The final sample included 156 first-episode psychosis patients. The median age was 27 years (inter-quartile range [IQR] [24–36]) and 55% of the participants were female. All 12 essential components had poor quality with the range of scores on the FEPS-FS between one and three. Only one essential component assessed (use of single antipsychotics) had moderate quality.

Conclusion

Amongst current services at the Butabika National Referral Mental Hospital in Uganda, the essential components for individual and group level interventions for psychotic disorders are of poor quality. Further studies are required on how the quality of these interventions can be improved.

Adverse Drug Reaction and Its Predictors Among Psychiatric Patients Taking Psychotropic Medications at the Mizan-Tepi University Teaching Hospital

INTRODUCTION

Psychotropic medications are crucial in the treatment of a variety of psychiatric disorders. Use of second-generation antipsychotics (SGA) has been associated with many adverse events. Assessment and monitoring of ADRs is required to develop appropriate interventional strategies to manage, prevent and minimize the risks of undesirable effects and thus improve quality of life and adherence, avoid relapse, and reduce treatment costs.

OBJECTIVE

The objectives of this study were to assess adverse drug reactions and its predictors in psychiatric patients taking psychotropic medications from the outpatient pharmacy of MTUTH.

METHODS

A cross-sectional study design was conducted using a structured questionnaire interviewing a psychiatric patient. One way ANOVA and bivariate logistic regression was computed for all independent variables to identify variables that fit for multivariate logistic regression. A p-value less than 0.05 was considered significant.

RESULTS AND DISCUSSIONS

A total of 101 patients (91.8%) experienced one or more types of ADR in the current study. There was a statistically significant relationship between ADRs management and age, marital status, educational status, occupation, and monthly income of the study participants. The odds of having experienced autonomic adverse drug reactions experience among respondents aged 30 years and older higher than those under 30 years. Participants taking multiple medications were more likely to face psychiatric adverse drug reactions compared to those taking a single medication. Patients taking multiple psychotropic medications were ten times more likely to develop autonomic adverse drug reactions compared to those taking a single drug.

CONCLUSION

The study revealed a moderate incidence of ADR in patients attending the psychiatric OPD. Age and number of antipsychotics were predictors of ADR (autonomic and psychiatric). This study revealed that there is a gap in the role of clinicians in the monitoring and reporting of ADRs.

Magnitude, Nature, and Risk Factors of Adverse Drug Reactions Associated with First Generation Antipsychotics in Outpatients with Schizophrenia: A Cross-Sectional Study

Background

ADRs to antipsychotics are amongst the major challenges in the treatment of patients with psychotic disorders. The extent of patient-reported ADRs assessed in many studies using standardized scales is found to be inconsistent. However, there is a paucity of such research in Eritrea. The aim of the study is therefore to determine the magnitude, nature, and the possible risk factors associated with ADRs of the first generation antipsychotics in outpatients with schizophrenia at Saint Mary Neuro-Psychiatric National Referral Hospital in Asmara, Eritrea, using the LUNSERS self-rating scale.

Methods

A cross-sectional, descriptive and analytical study design utilizing a quantitative approach was employed. Data were collected from patients' self-administered questionnaires, interviews, and medical records. The collected variables were analyzed using SPSS 22.0 with descriptive statistics, correlation, t-tests, ANOVA, and multiple regression. Statistical significance was tested at P-value<0.05.

Results

In this study, 93.8% of the research participants experienced at least one ADR. LUNSERS total mean score of the relevant items was 28.01 (SD=18.46) with 24.7% of the study participants scoring medium-to-high. The prevalence of the categories of ADRs was psychic (91.3%), autonomic (78.1%), extra-pyramidal (76.9%), miscellaneous (66.5%), hormonal (58.3%), anti-cholinergic (44.2%), and allergic reactions (44.2%). At multivariate level, factors significantly and positively associated with total ADR score were smoking (P=0.028) and being at secondary educational level (P=0.015).

Conclusion

There was high prevalence of ADRs with moderate-to-high overall ADR scores in a significant number of patients. The most frequently reported ADRs were psychic, autonomic, extra-pyramidal, hormonal, and miscellaneous. Smoking and secondary level of education were found to be the main determinants of ADRs.

Schizophrenia in the context of mental health services in Palestine: a literature review

BACKGROUND

Mental health conditions remain a significant cause of disability in the Arab World. Palestinians are predominantly at a higher risk for mental health problems due to their chronic exposure to political violence, prolonged displacement, and others as limited professional, educational, financial opportunities and mental health services. Schizophrenia is an overwhelming mental illness that affects nearly one percent of the various populations throughout the world. Studies have shown patients with schizophrenia die prematurely and have lower life expectancy compared to the general population. Moreover, antipsychotic medications and client's lifestyle play a significant role in increased morbidity and mortality in these patients. The present study willingly undertakes a literature review on schizophrenia in the context of mental health services in Palestine.

METHODS

Studies were identified through PubMed, Science Direct, Google Scholar, CINAHL, Semantic Scholar and Elsevier.

RESULTS

Twenty-four studies were included in this review; 11 articles related to schizophrenia and thirteen articles related to mental health services in Westbank and Gaza. Results revealed the life of patients with schizophrenia in Palestine is complicated. Barriers as lacking awareness about mental illness, stigma, inconsistent availability of medications, absence of multidisciplinary teamwork, insufficient specialists, fragmented mental health system, occupation, and other obstacles stand in the face of improving the quality of life among these patients.

LIMITATIONS

Palestine is a state that is seeking independence with a scarcity of resources. It has been described as "uncharted territories'' due to a lack of data, resources and records. As a result, there is insufficient data regarding schizophrenia in Palestine. Therefore, a thesis study that estimated 10 years' risk of coronary heart diseases in patients with schizophrenia was included.

CONCLUSIONS

Recommendations include ending the occupation as the leading cause of mental illness for Palestinians and implementing efficient and effective mental health nursing care through the multidisciplinary work and raising awareness regarding mental illness to fight the stigma.

Adverse drug reactions experienced by out-patients taking chlorpromazine or haloperidol at Zomba Mental Hospital, Malawi

Objective

Drugs for managing mental disorders can cause adverse drug reactions (ADRs) that have negative impacts on patients yet, in Malawi, epidemiological data on the drug-related problems are limited. This study assessed the prevalence and severity of ADRs in out-patients at Zomba Mental Hospital.

Results

Twenty-six of forty patients (65.0%) were taking haloperidol and 14 (35.0%) chlorpromazine. The commonest diagnosis was schizophrenia (n = 23, 57.5%) followed by epileptic psychosis (n = 4, 10.0%) and general psychosis (n = 4, 10.0%) with one of psychotic depression and one psychosis secondary to general medical condition. Comorbidities were also found with epilepsy being the commonest (n = 4, 10.0%). All patients reported at least one ADR of varying severity (mild, moderate and severe). Polydipsia was the most prevalent (24, 60.0%) followed by weight gain (20, 50.0%), spasm (15, 37.5%) and xerostomia (15, 37.5%). Some ADRs were gender specific and these included impotence (6/27, 29.6%) for males and menstrual changes (3/14, 21.4%) for females. Severe ADRs were more common in the older aged group (> 35 years 8.3% vs 7.1%), in males (11.1% vs 0.0%) and on chlorpromazine (14.3% vs 3.8%). Patients taking chlorpromazine and haloperidol are at risk of experiencing a wide range of ADRs with varying degrees of severity.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4398-6) contains supplementary material, which is available to authorized users.