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Alachkar A, Lee J, Asthana K, Vakil Monfared R, Chen J, Alhassen S, Samad M, Wood M, Mayer EA, Baldi P. The hidden link between circadian entropy and mental health disorders. Transl Psychiatry 2022; 12:281. [PMID: 35835742 PMCID: PMC9283542 DOI: 10.1038/s41398-022-02028-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 12/22/2022] Open
Abstract
The high overlapping nature of various features across multiple mental health disorders suggests the existence of common psychopathology factor(s) (p-factors) that mediate similar phenotypic presentations across distinct but relatable disorders. In this perspective, we argue that circadian rhythm disruption (CRD) is a common underlying p-factor that bridges across mental health disorders within their age and sex contexts. We present and analyze evidence from the literature for the critical roles circadian rhythmicity plays in regulating mental, emotional, and behavioral functions throughout the lifespan. A review of the literature shows that coarse CRD, such as sleep disruption, is prevalent in all mental health disorders at the level of etiological and pathophysiological mechanisms and clinical phenotypical manifestations. Finally, we discuss the subtle interplay of CRD with sex in relation to these disorders across different stages of life. Our perspective highlights the need to shift investigations towards molecular levels, for instance, by using spatiotemporal circadian "omic" studies in animal models to identify the complex and causal relationships between CRD and mental health disorders.
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Affiliation(s)
- Amal Alachkar
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA, USA. .,Institute for Genomics and Bioinformatics, University of California, Irvine, CA, USA. .,Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA.
| | - Justine Lee
- grid.266093.80000 0001 0668 7243Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA USA
| | - Kalyani Asthana
- grid.266093.80000 0001 0668 7243Department of Computer Science, School of Information and Computer Sciences, University of California, Irvine, CA USA
| | - Roudabeh Vakil Monfared
- grid.266093.80000 0001 0668 7243Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA USA
| | - Jiaqi Chen
- grid.266093.80000 0001 0668 7243Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA USA
| | - Sammy Alhassen
- grid.266093.80000 0001 0668 7243Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA USA
| | - Muntaha Samad
- grid.266093.80000 0001 0668 7243Institute for Genomics and Bioinformatics, University of California, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Computer Science, School of Information and Computer Sciences, University of California, Irvine, CA USA
| | - Marcelo Wood
- grid.266093.80000 0001 0668 7243Institute for Genomics and Bioinformatics, University of California, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA USA ,grid.266093.80000 0001 0668 7243Department of Neurobiology and Behavior, School of Biological Sciences, University of California, Irvine, CA USA
| | - Emeran A. Mayer
- grid.266093.80000 0001 0668 7243Institute for Genomics and Bioinformatics, University of California, Irvine, CA USA ,grid.19006.3e0000 0000 9632 6718G. Oppenheimer Center of Neurobiology of Stress & Resilience and Goldman Luskin Microbiome Center, Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles, CA USA
| | - Pierre Baldi
- Institute for Genomics and Bioinformatics, University of California, Irvine, CA, USA. .,Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA. .,Department of Computer Science, School of Information and Computer Sciences, University of California, Irvine, CA, USA.
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Capuzzi E, Caldiroli A, Ciscato V, Russo S, Buoli M. Experimental Serotonergic Agents for the Treatment of Schizophrenia. J Exp Pharmacol 2021; 13:49-67. [PMID: 33574716 PMCID: PMC7872893 DOI: 10.2147/jep.s259317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/16/2021] [Indexed: 12/19/2022] Open
Abstract
Schizophrenia remains one of the most chronic and highly disabling mental disorder. To date, the pathomechanism of schizophrenia is not fully understood and current treatments are characterized by some limitations. First- and second-generation antipsychotics have shown clinical efficacy in treating positive symptoms, while are poorly effective on both negative symptoms and cognitive deficits. Moreover, they can involve many metabolic and neurological side effects, leading to low therapeutic compliance. Many evidence suggested that serotonin may play a complex role in the neurobiology of schizophrenia. Therefore, new drugs targeting 5-HT receptors (5-HTRs) have become an important area of research in schizophrenia in the hope that treatment efficacy may be improved without inducing side effects observed with currently available antipsychotics. Research using the main database sources was conducted to obtain an overview of preclinical and clinical pharmacological 5-HTR-targeted therapies in patients with schizophrenia. We identified 17 experimental serotonergic agents, under study for their potential use in schizophrenia treatment. Particularly, AVN-211, LuAF-35700 and Brilaroxazine are currently under clinical development. Moreover, some compounds showed some pro-cognitive and antipsychotic-like properties in animal models, while other agents showed contradictory effects in improving symptoms and were removed from the development program. Although some serotonergic drugs seem promising for improving the treatment of schizophrenia, further studies regarding the pathophysiological mechanisms of schizophrenia and novel compounds as well as high-quality trials are necessary in order to improve schizophrenia outcomes.
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Affiliation(s)
- Enrico Capuzzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Alice Caldiroli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Veronica Ciscato
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, MB, 20900, Italy
| | - Stefania Russo
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, MB, 20900, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Buoli M, Serati M, Ciappolino V, Altamura AC. May selective serotonin reuptake inhibitors (SSRIs) provide some benefit for the treatment of schizophrenia? Expert Opin Pharmacother 2016; 17:1375-85. [DOI: 10.1080/14656566.2016.1186646] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Canada KE, Markway G, Albright D. Psychiatric symptoms and mental health court engagement. PSYCHOLOGY, CRIME & LAW : PC & L 2016; 22:513-529. [PMID: 28090168 PMCID: PMC5224529 DOI: 10.1080/1068316x.2016.1168422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
People with mental illnesses are overrepresented in the criminal justice system. Many interventions have been implemented to treat the underlying causes of criminal justice involvement and prevent people with mental illnesses from recidivating. Mental health courts (MHC) are one of these programs. This analysis examines the relationship between psychiatric symptoms and MHC engagement. Eighty MHC participants from two Midwestern MHCs were interviewed. Symptom severity was assessed at baseline using the Brief Psychiatric Rating Scale. MHC engagement was estimated by treatment adherence, substance use, days spent in jail, probation violations, and MHC retention during a six month follow-up period. Using nonparametric statistical tests and logistic regression, results indicate symptoms of depression, anxiety, and guilt are more severe at baseline for those people who are incarcerated during the follow-up period. Symptoms of anxiety are more severe for people who are terminated or went missing during the follow-up period. Further research is needed to determine the directionality and causality of these relationships. MHCs professionals should be aware of the relationship between symptom severity and MHC engagement and attempt to connect participants with treatment and services as early as possible and individualize treatment plans based on current symptoms and need.
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Affiliation(s)
- Kelli E Canada
- University of Missouri, School of Social Work, 706 Clark Hall, Columbia, 65211 United States
| | - Greg Markway
- Missouri Department of Mental Health, Jefferson City, United States
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Abstract
We focused on the application of antidepressants in schizophrenia treatment in this review. Augmentation of antidepressants with antipsychotics is a common clinical practice to treat resistant symptoms in schizophrenia, including depressive symptoms, negative symptoms, comorbid obsessive-compulsive symptoms, and other psychotic manifestations. However, recent systematic review of the clinical effects of antidepressants is lacking. In this review, we have selected and summarized current literature on the use of antidepressants in patients with schizophrenia; the patterns of use and effectiveness, as well as risks and drug-drug interactions of this clinical practice are discussed in detail, with particular emphasis on the treatment of depressive symptoms in schizophrenia.
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Affiliation(s)
- Ye-Meng Mao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, World Health Organization Collaborating Center for Research and Training in Mental Health, Shanghai, People’s Republic of China
| | - Ming-Dao Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, World Health Organization Collaborating Center for Research and Training in Mental Health, Shanghai, People’s Republic of China
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Talaslahti T, Alanen HM, Hakko H, Isohanni M, Häkkinen U, Leinonen E. Change in antipsychotic usage pattern and risk of relapse in older patients with schizophrenia. Int J Geriatr Psychiatry 2013; 28:1305-11. [PMID: 23558986 DOI: 10.1002/gps.3962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 02/06/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to explore the use of first (FGAs) and second generation antipsychotics (SGAs) in older outpatients with schizophrenia and schizoaffective disorder. Factors associated with schizophrenic relapses were also studied. METHODS The study sample consisting of 8792 patients aged 64 years or more was collected from Finnish nationwide registers. The register data on the use of FGAs and SGAs were followed up between 1998 and 2003. Factors associated with psychiatric hospitalization in 1999 indicating relapse were studied using logistic regression analysis. RESULTS The use of SGAs increased from 2.8% to 12.4%, and the use of FGAs decreased from 57.5% to 39.4%. The use of a combination of SGAs and FGAs increased from 4.0% to 8.5%. The proportion of those who did not buy any antipsychotics varied between 35.8% and 39.7%. The number of patients hospitalized on psychiatric wards within a year (1999; relapsed) was 8.8%. Factors independently associated with relapse were use of combined FGAs and SGAs [odds ratio (OR) 1.70, p = 0.001] and use of antidepressants (OR 1.27, p = 0.019). Diagnosis of cardiovascular disease was negatively associated with risk of schizophrenic relapse (OR 0.84, p = 0.040). CONCLUSION The use of SGAs increased while the use of FGAs decreased in older outpatients with schizophrenia. Almost 40% of the study sample did not use any antipsychotic medication. The 1-year relapse rate was 8.8%. Several factors, such as combined use of FGAs and SGAs, or antidepressants, were associated with schizophrenic relapse, whereas cardiovascular disease showed a negative association with the relapse.
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Affiliation(s)
- Tiina Talaslahti
- Department of Psychiatry, Helsinki University Central Hospital, Finland
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McRenolds D, Mehta P, Nasrallah HA. Evaluation and Treatment Strategies in Patients with Schizophrenia and Comorbid Depression. Psychiatr Ann 2013. [DOI: 10.3928/00485713-20131003-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Vahia IV, Lanouette NM, Golshan S, Fellows I, Mohamed S, Kasckow JW, Zisook S. Adding antidepressants to antipsychotics for treatment of subsyndromal depressive symptoms in schizophrenia: Impact on positive and negative symptoms. Indian J Psychiatry 2013; 55:144-8. [PMID: 23825848 PMCID: PMC3696237 DOI: 10.4103/0019-5545.111452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It remains unclear how augmenting anti-psychotic medications with anti-depressants impacts primary positive and negative symptoms of schizophrenia. In this study, we used data collected from a randomized trial comparing citalopram to placebo for management of subsyndromal depression (SSD) in schizophrenia and schizoaffective disorder, to assess the effects of antidepressant augmentation on positive and negative symptoms. MATERIALS AND METHODS Participants in this study conducted at the University of California, San Diego and the University of Cincinnati, were persons with schizophrenia or schizoaffective disorder aged 40 or older and who met study criteria for SSD. Patients were randomly assigned to flexible-dose treatment with citalopram or placebo augmentation of their current anti-psychotic medication. Analysis of covariance was used to compare changes in positive and negative syndrome scale (PANSS) scores between treatment groups. We also assessed mediating effects of improvement in depression and moderating effects of multiple factors on positive and negative symptoms. RESULTS There was significant improvement in PANSS negative symptoms scores in the citalopram group, which was partially mediated by improvement in depressive symptoms. There was no effect on PANSS positive scores. CONCLUSIONS In patients with schizophrenia/schizoaffective disorder, treating depressive symptoms with citalopram appears to carry the added benefit of improving negative symptoms.
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Affiliation(s)
- Ipsit V Vahia
- Department of Psychiatry, University of California San Diego, California, USA ; Stein Institute for Research on Aging, University of California San Diego, California, USA
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Abstract
This paper considers the issue of the measurement of depression with those who have a primary diagnosis of schizophrenia. Originally the concept of depression as a core aspect of schizophrenia was raised by Bleuler and that affective disorders are associated with psychosis raised by Kraepelin. The construct of depression within the context of schizophrenia as a distinct condition that constitutes an apparent shift from the individual's usual cognitive style, affect and functioning, is an observation that has been relatively recently highlighted. In individuals with a primary diagnosis of schizophrenia comorbid depression can be a factor in risk of suicide, impaired level of functioning, and higher rates of relapse or rehospitalization. The assessment of depression in this population creates many challenges in relation to the differentiation of this condition within the complex presentation of schizophrenia. The depression literature may refer to: (i) depressed affect; (ii) depression as a symptom isolated from the wider signs of depressive illness; and (iii) depression as a syndrome with all the facets required for a formal diagnosis. This review considers the literature in relation to the measurement of depression in people with a primary diagnosis of schizophrenia and assesses the psychometric properties of those measures with this population.
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Affiliation(s)
- B Scholes
- Lecturer in Mental Health Chair in Mental Health, School of Health, Nursing and Midwifery, University of the West of Scotland, Ayr, UK
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Britton PC, Ilgen MA, Rudd MD, Conner KR. Warning signs for suicide within a week of healthcare contact in Veteran decedents. Psychiatry Res 2012; 200:395-9. [PMID: 22796102 PMCID: PMC5064427 DOI: 10.1016/j.psychres.2012.06.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 05/16/2012] [Accepted: 06/23/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study examined warning signs for suicide observed in the final day(s) of life in Veteran decedents who received healthcare from Veterans Health Administration (VHA) (N=381), using data obtained from detailed chart reviews. METHODS Veterans who died within a week (7 days) of healthcare contact (18%) were compared to those who died later (82%). Multivariate logistic regression was used to examine differences in suicidal thoughts, psychiatric symptoms, and somatic symptoms as documented at the last visit, after controlling for demographic variables. A second multivariate regression examined whether the identified warning signs were also risk factors for suicide within a month (30 days) of contact. RESULTS Documented suicidal ideation, OR (95% CI)=3.46 (1.15-10.38), and psychotic symptoms, OR (95% CI)=2.67 (1.11-6.42), at the last visit increased the likelihood of suicide within a week of healthcare contact. Both variables also increased the odds of suicide within a month of contact. CONCLUSIONS The assessment of suicidal ideation is critical to identify Veterans at immediate risk. However, recognition of psychotic symptoms may also improve identification. In addition to indicating immediate risk, some warning signs may also suggest on-going risk.
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Affiliation(s)
- Peter C. Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, Peter C. Britton, Ph.D. is the corresponding author located at the VISN 2 Center of Excellence for Suicide Prevention at the Department of Veteran Affairs Medical Center, Canandaigua, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA ()
| | - Mark A. Ilgen
- VISN 11 Serious Mental Illness Treatment Resource and Evaluation (SMITREC), Department of Veteran Affairs Medical Center, Ann Arbor, MI, U.S.A., Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - M. David Rudd
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Kenneth R. Conner
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs Medical Center, Canandaigua, NY, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Álamo C, López-Muñoz F. Eficacia de quetiapina de liberación prolongada en la sintomatología afectiva. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2012; 5 Suppl 1:3-19. [DOI: 10.1016/s1888-9891(12)70012-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Babinkostova Z, Stefanovski B. Forms of antipsychotic therapy: improved individual outcomes under personalised treatment of schizophrenia focused on depression. EPMA J 2011; 2:391-402. [PMID: 23199176 PMCID: PMC3405399 DOI: 10.1007/s13167-011-0103-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 07/19/2011] [Indexed: 11/09/2022]
Abstract
Depressive symptoms are common in schizophrenia and they can occur during any phase of the disorder. Early diagnosis, adequate differential diagnosis and promptly initiated interventions have been shown to reduce further deterioration of illness and to improve patients' quality of life. Common psychiatric rating scales for early detection of depressive symptoms in schizophrenia are Calgary Depression Scale for Schizophrenia and Hamilton Depression Rating Scale, but the most appropriate assessment instrument today regarding this topic is Calgary Depression Scale for Schizophrenia. Treatment of depression in schizophrenia consists of a combination of pharmacologic and psychosocial approach. Atypical antipsychotics have advantages over typical in reducing depressive symptoms in the context of schizophrenia. Most of the studies referred that clozapine, olanzapine, quetiapine and risperidone have an antidepressant spectrum of activity in patients with schizophrenia. Antidepressant augmentation of antipsychotic treatment in schizophrenic patients with depressive symptoms improves depressive symptomatology, particularly SSRI and SNRI augmentation.
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Affiliation(s)
- Zoja Babinkostova
- University Clinic of Psychiatry, Belgradska bb, 1000 Skopje, Macedonia
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Vares M, Saetre P, Strålin P, Levander S, Lindström E, Jönsson EG. Concomitant medication of psychoses in a lifetime perspective. Hum Psychopharmacol 2011; 26:322-31. [PMID: 21695733 PMCID: PMC3505368 DOI: 10.1002/hup.1209] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 04/17/2011] [Accepted: 04/25/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Patients treated with antipsychotic drugs often receive concomitant psychotropic compounds. Few studies address this issue from a lifetime perspective. Here, an analysis is presented of the prescription pattern of such concomitant medication from the first contact with psychiatry until the last written note in the case history documents, in patients with a diagnosis of psychotic illness. METHODS A retrospective descriptive analysis of all case history data of 66 patients diagnosed with schizophrenia or schizophrenia-like psychotic disorders. RESULTS Benzodiazepines and benzodiazepine-related anxiolytic drugs had been prescribed to 95% of the patients, other anxiolytics, sedatives or hypnotic drugs to 61%, anti-parkinsonism drugs to 86%, and antidepressants to 56% of the patients. However, lifetime doses were small and most of the time patients had no concomitant medication. The prescribed lifetime dose of anti-parkinsonism drugs was associated with that of prescribed first-generation but not second-generation antipsychotics. CONCLUSIONS Most psychosis patients are sometimes treated with concomitant drugs but mainly over short periods. Lifetime concomitant add-on medication at the individual patient level is variable and complex but not extensive.
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Affiliation(s)
- Maria Vares
- Department of Clinical Neuroscience, Karolinska Institutet and HospitalStockholm, Sweden
| | - Peter Saetre
- Department of Clinical Neuroscience, Karolinska Institutet and HospitalStockholm, Sweden
| | - Pontus Strålin
- Department of Clinical Neuroscience, Karolinska Institutet and HospitalStockholm, Sweden
| | - Sten Levander
- Department of Health and Society, Malmö UniversityMalmö, Sweden
| | - Eva Lindström
- Department of Forensic Psychiatry, Malmö University HospitalMalmö, Sweden
| | - Erik G Jönsson
- Department of Clinical Neuroscience, Karolinska Institutet and HospitalStockholm, Sweden,*Correspondence to: E. G. Jönsson, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Hospital Solna R5:00, SE-17176 Stockholm, Sweden. Tel: +46 8 51772626; Fax: +46 8 346563. E-mail:
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Kasckow J, Montross L, Prunty L, Fox L, Zisook S. Suicidal behavior in the older patient with schizophrenia. AGING HEALTH 2011; 7:379-393. [PMID: 22028735 PMCID: PMC3198783 DOI: 10.2217/ahe.11.23] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Little is known about treating elderly suicidal patients with schizophrenia. The purpose of this article is to review the literature dealing with this population and to discuss what is required to advance this field. Most available studies from middle-aged and older individuals suggest that risk factors include hopelessness, lower quality of life, past traumatic events, depressive symptoms, lifetime suicidal ideation and past attempts; it is not clear whether these findings are generalizable to geriatric populations. Although little treatment research has been performed in older suicidal patients with schizophrenia, an integrated psychosocial and pharmacologic approach is recommended. In addition, one recent study augmented antipsychotic treatment with an SSRI (i.e., citalopram) in a sample of middle-aged and older individuals with schizophrenia with subsyndromal depression; in that study, serotonin selective reuptake inhibitor augmentation reduced depressive symptoms and suicidal ideation. More research is required to better understand suicidal behavior in older patients with schizophrenia.
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Affiliation(s)
- John Kasckow
- Veterans Affairs Pittsburgh Health Care System MIRECC & Behavioral Health Service, 7180 Highland Dr., Pittsburgh, PA 15206, USA
- Western Psychiatric Institute & Clinics, University of Pittsburgh Medical Center, 3811 O’Hara St Pittsburgh, PA 15213, USA
| | - Lori Montross
- The Institute for Palliative Medicine at The San Diego Hospice, 4311 Third Avenue, San Diego, CA 921034, USA
| | - Laurie Prunty
- Veterans Affairs Pittsburgh Health Care System MIRECC & Behavioral Health Service, 7180 Highland Dr., Pittsburgh, PA 15206, USA
| | - Lauren Fox
- Veterans Affairs Pittsburgh Health Care System MIRECC & Behavioral Health Service, 7180 Highland Dr., Pittsburgh, PA 15206, USA
| | - Sidney Zisook
- Veterans Affairs San Diego Health Care System, San Diego, Department of Psychiatry, University of California, San Diego, CA 92161, USA
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Barnes TRE. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2011; 25:567-620. [PMID: 21292923 DOI: 10.1177/0269881110391123] [Citation(s) in RCA: 239] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
These guidelines from the British Association for Psychopharmacology address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting, involving experts in schizophrenia and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from the participants and interested parties, and cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. The practice recommendations presented are based on the available evidence to date, and seek to clarify which interventions are of proven benefit. It is hoped that the recommendations will help to inform clinical decision making for practitioners, and perhaps also serve as a source of information for patients and carers. They are accompanied by a more detailed qualitative review of the available evidence. The strength of supporting evidence for each recommendation is rated.
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Affiliation(s)
- Thomas R E Barnes
- Centre for Mental Health, Imperial College, Charing Cross Campus, London, UK.
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Abstract
The management of suicide risk in patients with schizophrenia poses many challenges for clinicians. Compared with the general population, these patients have an 8.5-fold greater risk of suicide. This article reviews the literature dealing with the treatment of at-risk patients with schizophrenia. An integrated psychosocial and pharmacological approach to managing this population of patients is recommended. Although there is at least modest evidence suggesting that antipsychotic medications protect against suicidal risk, the evidence appears to be most favourable for second-generation antipsychotics, particularly clozapine, which is the only medication approved by the US FDA for preventing suicide in patients with schizophrenia. In addition, treating depressive symptoms in patients with schizophrenia is an important component of suicide risk reduction. While selective serotonin receptor inhibitors (SSRIs) ameliorate depressive symptoms in patients with schizophrenia, they also appear to attenuate suicidal thoughts. Further research is needed to more effectively personalize the treatment of suicidal thoughts and behaviours and the prevention of suicide in patients with schizophrenia.
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Affiliation(s)
- John Kasckow
- MIRECC and Behavioral Health Service, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania 15206, USA.
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Felmet K, Zisook S, Kasckow JW. Elderly patients with schizophrenia and depression: diagnosis and treatment. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2011; 4:239-50. [PMID: 21177241 PMCID: PMC3062362 DOI: 10.3371/csrp.4.4.4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The treatment of older patients with schizophrenia and depressive symptoms poses many challenges for clinicians. Current classifications of depressive symptoms in patients with schizophrenia include: Major Depressive Episodes that occur in patients with schizophrenia and are not classified as schizoaffective disorder, Schizoaffective Disorder, and Schizophrenia with subsyndromal depression in which depressive symptoms do not meet criteria for Major Depression. Research indicates that the presence of any of these depressive symptoms negatively impacts the lives of patients suffering from schizophrenia-spectrum disorders. PURPOSE The purpose of this paper is to review the literature related to older patients with schizophrenia-spectrum disorders and co-occurring depressive symptoms, and to guide mental health professionals to better understand the diagnosis and treatment of depressive symptoms in patients with schizophrenia. CONCLUSIONS The treatment of elderly patients with schizophrenia and depressive symptoms includes first reassessing the diagnosis to make sure symptoms are not due to a comorbid condition, metabolic problems or medications. If these are ruled out, pharmacological agents in combination with psychosocial interventions are important treatments for older patients with schizophrenia and depressive symptoms. A careful assessment of each patient is needed in order to determine which antipsychotic would be optimal for their care; second-generation antipsychotics are the most commonly used antipsychotics. Augmentation with an antidepressant medication can be helpful for the elderly patient with schizophrenia and depressive symptoms. More research with pharmacologic and psychosocial interventions is needed, however, to better understand how to treat this population of elderly patients.
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Affiliation(s)
- Kandi Felmet
- VA Pittsburgh Health Care System MIRECC and Behavioral Health, Pittsburgh, PA
| | - Sidney Zisook
- San Diego VAMC and University of California, San Diego, Department of Psychiatry, San Diego, CA
| | - John W. Kasckow
- VA Pittsburgh Health Care System MIRECC and Behavioral Health, Pittsburgh, PA
- Western Psychiatric Institute and Clinics, University of Pittsburgh Medical Center, Pittsburgh, PA
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Tempier R, Hepp SL, Duncan CR, Rohr B, Hachey K, Mosier K. Patient-centered care in affective, non-affective, and schizoaffective groups: patients' opinions and attitudes. Community Ment Health J 2010; 46:452-60. [PMID: 20480394 DOI: 10.1007/s10597-010-9316-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 04/28/2010] [Indexed: 01/17/2023]
Abstract
An outcome evaluation was conducted to obtain psychiatric inpatients' perspectives on acute care mental health treatment and services. The applicability of diagnostic categories based on affective, non-affective, and schizoaffective disorder were considered in the predictability of responses to treatment regimens and the related services provided in an inpatient psychiatric unit. A multidimensional approach was used to survey patients, which included the DAI-30, the BMQ, the SERVQUAL, and the CSQ-8. Overall, findings indicate that inpatient satisfaction could be improved with tailoring treatment to suit their respective symptoms. Furthermore, this exploratory study demonstrates some preliminary support for the inclusion of patients with a diagnosis of schizoaffective disorder as a separate group toward improving acute mental health care while hospitalized.
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Affiliation(s)
- Raymond Tempier
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada.
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Treatment of subsyndromal depressive symptoms in middle-age and older patients with schizophrenia: effect of age on response. Am J Geriatr Psychiatry 2010; 18:853-7. [PMID: 20808103 PMCID: PMC3079763 DOI: 10.1097/jgp.0b013e3181dba12f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The authors hypothesized that age would moderate the response of patients with schizophrenia and subsyndromal depression (SSD) treated citalopram with depressive symptoms and other outcomes. Also, older patients would exhibit more side effects with citalopram. METHODS Participants of 40 years or older had schizophrenia or schizoaffective disorder with SSD. Patients randomly received flexible dosing of citalopram or placebo augmentation of their antipsychotic medication. Linear regression determined whether age had any moderating effect on depressive symptoms, global psychopathology, negative symptoms, mental functioning, and quality of life. Age-related side effects were examined. RESULTS There were no significant drug group by age interaction in depressive or psychotic symptoms, mental Short Form-12, or quality of life scores. Similarly, there were few age-related side effect differences. CONCLUSION Symptoms in younger and older patients with schizophrenia and SSD treated with citalopram seem to respond similarly. Adverse events do not seem to differ with age.
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Kasckow J, Lanouette N, Patterson T, Fellows I, Golshan S, Solorzano E, Zisook S. Treatment of subsyndromal depressive symptoms in middle-aged and older adults with schizophrenia: effect on functioning. Int J Geriatr Psychiatry 2010; 25:183-90. [PMID: 19711335 PMCID: PMC3073368 DOI: 10.1002/gps.2318] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Subsyndromal symptoms of depression (SSD) in patients with schizophrenia are common and clinically important. SSRI's appear to be helpful in alleviating depressive symptoms in patients with schizophrenia who have SSD in patients age 40 and greater. It is not known whether SSRI's help improve functioning in this population. We hypothesized that treating this population with the SSRI citalopram would lead to improvements in social, mental and physical functioning as well as improvements in medication management and quality of life. METHODS Participants were 198 adults > or = 40 years old with schizophrenia or schizoaffective disorder who met study criteria for subsyndromal depression based on having two or more of the nine DSM-IV symptoms of a major depressive episode, for at least 2 weeks, and a Hamilton depression rating scale (HAM-D 17) score > or = 8. Patients were randomly assigned to flexible-dose treatment with citalopram or placebo augmentation of their current antipsychotic medication(s) which was stable for 1 month. Subjects were assessed with the following functional scales at baseline and at the end of the 12-week trial: (1) social skills performance assessment (SSPA), (2) medication management ability assessment (MMAA), (3) mental and physical components of the medical outcomes study SF-12 Scale, and (4) the Heinrichs quality of life scale (QOLS). Analysis of covariance (ANCOVA) was used to compare differences between endpoint scores of the citalopram and placebo treated groups, controlling for site and baseline scores. ANCOVAs were also used to compare differences in the above endpoint scores in responders versus non-responders (responders = those with > 50% reduction in depressive symptoms). RESULTS Overall, the citalopram group had significantly higher SSPA, mental functioning SF-12, and quality of life scale (QOLS) scores compared to the placebo group. There was no effect on MMAA or physical functioning SF-12 scores. Responders had significantly better endpoint mental SF-12 and QOLS scores compared to non-responders. Response to citalopram in terms of depressive symptoms mediated the effect of citalopram on mental functioning, but not on the quality of life. CONCLUSIONS Citalopram augmentation of antipsychotic treatment in middle aged and older patients with schizophrenia and subsyndromal depression appears to improve social and mental health functioning as well as quality of life. Thus it is important for clinicians to monitor these aspects of functioning when treating this population of patients with schizophrenia with SSRI agents.
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Affiliation(s)
- John Kasckow
- VA Pittsburgh Health Care System MIRECC and Behavioral Health Service, 7180 Highland Dr., Pittsburgh, PA, USA.
| | - Nicole Lanouette
- VA San Diego Healthcare System and University of California, San Diego Department of Psychiatry, San Diego, CA, USA
| | - Thomas Patterson
- VA San Diego Healthcare System and University of California, San Diego Department of Psychiatry, San Diego, CA, USA
| | - Ian Fellows
- VA San Diego Healthcare System and University of California, San Diego Department of Psychiatry, San Diego, CA, USA
| | - Shahrokh Golshan
- VA San Diego Healthcare System and University of California, San Diego Department of Psychiatry, San Diego, CA, USA
| | - Ellen Solorzano
- VA San Diego Healthcare System and University of California, San Diego Department of Psychiatry, San Diego, CA, USA
| | - Sidney Zisook
- VA San Diego Healthcare System and University of California, San Diego Department of Psychiatry, San Diego, CA, USA
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Macedo CE, Angst MJ, Guiberteau T, Brasse D, O'Brien TJ, Sandner G. Acoustic hypersensitivity in adult rats after neonatal ventral hippocampus lesions. Behav Brain Res 2009; 207:161-8. [PMID: 19818810 DOI: 10.1016/j.bbr.2009.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 09/25/2009] [Accepted: 10/02/2009] [Indexed: 10/20/2022]
Abstract
Rats with a bilateral neonatal ventral hippocampus lesion (NVHL) are used as models of neurobiological aspects of schizophrenia. In view of their decreased number of GABAergic interneurons, we hypothesized that they would show increased reactivity to acoustic stimuli. We systematically characterized the acoustic reactivity of NVHL rats and sham operated controls. They were behaviourally observed during a loud white noise. A first cohort of 7 months' old rats was studied. Then the observations were reproduced in a second cohort of the same age after characterizing the reactivity of the same rats to dopaminergic drugs. A third cohort of rats was studied at 2, 3, 4, 5 and 6 months. In subsets of lesioned and control rats, inferior colliculus auditory evoked potentials were recorded. A significant proportion of rats (50-62%) showed aberrant audiogenic responses with explosive wild running resembling the initial phase of audiogenic seizures. This was not correlated with their well-known enhanced reactivity to dopaminergic drugs. The proportion of rats showing this strong reaction increased with rats' age. After the cessation of the noise, NVHL rats showed a long freezing period that did neither depend on the size of the lesion nor on the rats' age. The initial negative deflection of the auditory evoked potential was enhanced in the inferior colliculus of only NVHL rats that displayed wild running. Complementary anatomical investigations using X-ray scans in the living animal, and alizarin red staining of brain slices, revealed a thin layer of calcium deposit close to the medial geniculate nuclei in post-NVHL rats, raising the possibility that this may contribute to the hyper-reactivity to sounds seen in these animals. The findings of this study provide complementary information with potential relevance for the hyper-reactivity noted in patients with schizophrenia, and therefore a tool to investigate the underlying biology of this endophenotype.
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Affiliation(s)
- Carlos Eduardo Macedo
- Laboratorio de Psicobiologia, Universidade de São Paulo (USP), Ribeirão Preto, Brazil
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