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Sampogna G, Di Vincenzo M, Giuliani L, Menculini G, Mancuso E, Arsenio E, Cipolla S, Della Rocca B, Martiadis V, Signorelli MS, Fiorillo A. A Systematic Review on the Effectiveness of Antipsychotic Drugs on the Quality of Life of Patients with Schizophrenia. Brain Sci 2023; 13:1577. [PMID: 38002537 PMCID: PMC10669728 DOI: 10.3390/brainsci13111577] [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: 10/14/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Pharmacological antipsychotic drug interventions represent the cornerstone of the management of patients with schizophrenia and other psychotic spectrum disorders. The choice of the "best" treatment should be made on the basis of several clinical domains. However, despite available treatments, the quality of life reported by patients with schizophrenia taking antipsychotics is still very poor, and this outcome is rarely taken into account in trials assessing the efficacy and effectiveness of antipsychotic treatments. Therefore, we performed a systematic review in order to assess the impact of antipsychotic treatment on patients' quality of life. In particular, we aimed to identify any differences in the improvement in quality of life according to the (a) type of formulation of antipsychotic drugs (i.e., oral vs. depot vs. long-acting injectable); (b) type of the drug (first vs. second vs. third generation); and (c) patients' clinical characteristics. One hundred and eleven papers were included in the review. The main findings were as follows: (1) quality of life is usually considered a secondary outcome in trials on the efficacy and effectiveness of drugs; (2) second-generation antipsychotics have a more positive effect on quality of life; and (3) long-acting injectable antipsychotics are associated with a more stable improvement in quality of life and with a good safety and tolerability profile. Our systematic review confirms that quality of life represents a central element for selecting the appropriate treatment for people with schizophrenia. In particular, the availability of new treatments with a better tolerability profile, a proven effectiveness on patients' cognitive and social functioning, and with a more stable blood concentration might represent the appropriate strategy for improving the quality of life of people with schizophrenia.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Giulia Menculini
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy
| | - Emiliana Mancuso
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Eleonora Arsenio
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Salvatore Cipolla
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Bianca Della Rocca
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | | | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
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Iyo M, Akiyoshi H, Sekine D, Shibasaki Y, Mamiya N. An exploratory database study of factors influencing the continuation of brexpiprazole treatment (prescription) in patients with schizophrenia using information from psychiatric electronic medical records processed with natural language processing. Schizophr Res 2023; 255:122-131. [PMID: 36989669 DOI: 10.1016/j.schres.2023.03.008] [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: 07/28/2022] [Revised: 01/13/2023] [Accepted: 03/03/2023] [Indexed: 03/31/2023]
Abstract
Using natural language processing (NLP) technology to analyze and organize textual information in psychiatric electronic medical records can identify undiscovered factors associated with treatment discontinuation. This study aimed to evaluate brexpiprazole treatment continuation rate and factors affecting brexpiprazole discontinuation using a database that employs the MENTAT® system with NLP technology. This retrospective observational study evaluated patients with schizophrenia who were newly initiated on brexpiprazole (April 18, 2018-May 15, 2020). The first prescriptions of brexpiprazole were followed up for 180 days. Factors associated with brexpiprazole discontinuation were assessed using structured and unstructured patient data (April 18, 2017-December 31, 2020). The analysis population comprised 515 patients; mean (standard deviation) age of patients was 48.0 (15.3) years, and 47.8 % were male. Using Kaplan-Meier analysis, the cumulative brexpiprazole continuation rate at 180 days was 29 % (estimate: 0.29; 95 % confidence interval, 0.25-0.33). Univariate Cox proportional hazards analysis identified 16 variables independently associated with brexpiprazole discontinuation. Multivariate analysis identified eight variables associated with treatment discontinuation: variables with hazard ratio <1 were the presence of physical complications, longer hospitalization duration, and maximum chlorpromazine-equivalent dose of antipsychotics of >200 to ≤400 mg/day vs ≤200 mg/day in the past year; variables with hazard ratio >1 were previous electroconvulsive therapy, availability of key contact person information, a history of crime committed/reported, increase in brexpiprazole dose to 2 mg in >28 days, and appearance/worsening of symptoms other than positive symptoms. In conclusion, we identified potential new factors that may be associated with brexpiprazole discontinuation, which may improve the treatment strategy and continuation rate in patients with schizophrenia.
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Affiliation(s)
- Masaomi Iyo
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Japan
| | - Hisashi Akiyoshi
- Medical Affairs Department, Otsuka Pharmaceutical Co., Ltd., Japan.
| | - Daisuke Sekine
- Medical Affairs Department, Otsuka Pharmaceutical Co., Ltd., Japan
| | | | - Noriyuki Mamiya
- Medical Affairs Department, Otsuka Pharmaceutical Co., Ltd. (contractor), Japan
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Ishigooka J, Nakagome K, Ohmori T, Iwata N, Inada K, Iga JI, Kishi T, Fujita K, Kikuchi Y, Shichijo T, Tabuse H, Koretsune S, Terada H, Terada H, Kishimoto T, Tsutsumi Y, Kanda Y, Ohi K, Sekiyama K. Discontinuation and remission rates and social functioning in patients with schizophrenia receiving second-generation antipsychotics: 52-week evaluation of JUMPs, a randomized, open-label study. Psychiatry Clin Neurosci 2022; 76:22-31. [PMID: 34626144 PMCID: PMC9299006 DOI: 10.1111/pcn.13304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
AIM Globally, evidence from short-term studies is insufficient for the guidelines to uniformly recommend a particular antipsychotic(s) for the maintenance treatment of schizophrenia. Therefore, long-term comprehensive evaluation of antipsychotics is required from a social rehabilitation perspective, especially for drugs that have not yet been studied. The Japan Useful Medication Program for Schizophrenia (JUMPs) is a large-scale, long-term naturalistic study to present pivotal 52-week data on the continuity of second-generation antipsychotics (SGA: aripiprazole, blonanserin, and paliperidone). METHODS JUMPs was an open-label, three-arm, randomized, parallel-group, 52-week study. Enrolled patients had schizophrenia, were ≥20 years old, and required antipsychotic treatment or switched from previous therapy. The primary endpoint was treatment discontinuation rate over 52 weeks. Secondary outcomes included remission rate, social functioning, and quality-of-life scores [Personal and Social Performance Scale (PSP) and EuroQol-5 dimensions], and safety. RESULTS In total, 251 patients received aripiprazole (n = 82), blonanserin (n = 85), or paliperidone (n = 84). The discontinuation rate (P = 0.9771) and remission rates (P > 0.05) over 52 weeks did not differ significantly between the three treatment groups. The discontinuation rates were 68.3%, 68.2%, and 65.5% in the aripiprazole, blonanserin, and paliperidone groups, respectively. Significant improvements (all P < 0.05) from baseline in PSP scores were observed at start of monotherapy, week 26, and week 52 in the overall cohort and blonanserin group and at week 26 in the aripiprazole group. The adverse event profile favored blonanserin. CONCLUSION All three SGAs evaluated in this study showed similar treatment discontinuation rates in patients with chronic schizophrenia in Japan.
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Affiliation(s)
- Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan
| | - Kazuyuki Nakagome
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake-shi, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan
| | - Jun-Ichi Iga
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake-shi, Japan
| | - Kiyoshi Fujita
- Okehazama Hospital Fujita Kokoro Care Center, Toyoake-shi, Japan
| | - Yuka Kikuchi
- Department of Psychiatry, Akita University Hospital, Akita, Japan
| | | | - Hideaki Tabuse
- Department of Psychiatry, Holy Cross Hospital, Toki-shi, Japan
| | | | | | | | | | | | - Yoshiki Kanda
- Musashikoganei Minamiguchi Shinryou Clinic, Koganei-shi, Japan
| | - Kazutaka Ohi
- Department of Neuropsychiatry, Kokubu Hospital, Osaka, Japan
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Antipsychotic discontinuation: mind the patient and the real-world evidence. Lancet Psychiatry 2021; 8:555-557. [PMID: 33930316 DOI: 10.1016/s2215-0366(21)00159-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 01/09/2023]
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Jongen PJ, Lemmens WA, Hoogervorst EL, Donders R. Glatiramer acetate treatment persistence - but not adherence - in multiple sclerosis patients is predicted by health-related quality of life and self-efficacy: a prospective web-based patient-centred study (CAIR study). Health Qual Life Outcomes 2017; 15:50. [PMID: 28292329 PMCID: PMC5351176 DOI: 10.1186/s12955-017-0622-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 03/03/2017] [Indexed: 12/03/2022] Open
Abstract
Background In patients with relapsing remitting multiple sclerosis (RRMS) the persistence of and adherence to disease modifying drug (DMD) treatment is inadequate. To take individualised measures there is a need to identify patients with a high risk of non-persistence or non-adherence. As patient-related factors have a major influence on persistence and adherence, we investigated whether health-related quality of life (HRQoL) and self-efficacy could predict persistence or adherence. Methods In a prospective web-based patient-centred study in 203 RRMS patients, starting treatment with glatiramer acatete (GA) 20 mg subcutaneously daily, we measured physical and mental HRQoL (Multiple Sclerosis Quality of Life-54 questionnaire), functional and control self-efficacy (Multiple Sclerosis Self-Efficacy Scale), the 12-month persistence rate and, in persistent patients, the percentage of missed doses. HRQoL and self-efficacy were compared between persistent and non-persistent patients, and between adherent and non-adherent patients. Logistic regression analysis was used to assess whether persistence and adherence were explained by HRQoL and self-efficacy. Results Persistent patients had higher baseline physical (mean 58.1 [standard deviation, SD] 16.9) and mental HRQoL (63.8 [16.8]) than non-persistent patients (49.5 [17.6]; 55.9 [20.4]) (P = 0.001; P = 0.003) with no differences between adherent and non-adherent patients (P = 0.46; P = 0.54). Likewise, in persistent patients function (752 [156]) and control self-efficacy (568 [178]) were higher than in non-persistent patients (689 [173]; 491 [192]) (P = 0.009; P = 0.004), but not in adherent vs. non-adherent patients (P = 0.26; P = 0.82). Logistic regression modelling identified physical HRQoL and control self-efficacy as factors that explained persistence. Based on predicted scores from the model, patients were classified into quartiles and the percentage of non-persistent patients per quartile was calculated: non-persistence in the highest quartile was 23.4 vs. 53.2% in the lowest quartile. Risk differentiation with respect to adherence was not possible. Based on these findings we propose a practical work-up scheme to identify patients with a high risk of non-persistence and to identify persistence-related factors. Conclusions Findings suggest that pre-treatment physical HRQoL and control self-efficacy may identify RRMS patients with a high risk of early discontinuation of injectable DMD treatment. Targeting of high-risk patients may enable the efficient use of persistence-promoting measures. Trial Registration Nederlands Trial Register code: NTR2432. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0622-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Joseph Jongen
- University Medical Centre Groningen, Department of Community and Occupational Medicine, University Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands. .,MS4 Research Institute, Ubbergseweg 34, 6522, KJ, Nijmegen, The Netherlands.
| | - Wim A Lemmens
- Department for Health Evidence, Radboud University Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | | | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
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Nonadherence to antipsychotics: the role of positive attitudes towards positive symptoms. Eur Neuropsychopharmacol 2014; 24:1745-52. [PMID: 25444234 DOI: 10.1016/j.euroneuro.2014.09.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/07/2014] [Indexed: 11/23/2022]
Abstract
Approximately 50-75% of all patients do not take their antipsychotic medication as prescribed. The current study examined reasons why patients continue versus discontinue antipsychotic medication. We were particularly interested to which extent positive attitudes towards psychotic symptoms foster medication nonadherence. An anonymous online questionnaire was set up to decrease response biases. After a strict selection process, 91 participants with schizophrenia spectrum disorders were retained for the final analyses. On average, 6.2 different reasons for nonadherence were reported. Side-effects (71.4%), sudden subjective symptom improvement (52.4%) and forgetfulness (33.3%) emerged as the most frequent reasons for drug discontinuation. Approximately one fourth of all participants (27.3%) reported at least one positive aspect of psychosis as a reason for nonadherence. In contrast, patients reported on average 3.5 different reasons for adherence (e.g., want to live a normal life (74.6%) and fear of psychotic symptoms (49.3%)). The belief that paranoia represents a survival strategy (subscale derived from the Beliefs about Paranoia Scale) was significantly associated with nonadherence. Patients' attitudes toward medication and the individual illness model need to be carefully considered when prescribing medication. In particular for patients who are likely to discontinue psychopharmacological treatment complementary or alternative psychological treatment should be sought because of a largely increased risk of relapse in the case of sudden drug discontinuation.
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