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Pappa S, Caldwell-Dunn E, Kalniunas A, Kamal M. Cariprazine in the management of emotionally unstable personality disorder in female patients: a case series. Front Psychiatry 2024; 15:1421698. [PMID: 39132320 PMCID: PMC11310661 DOI: 10.3389/fpsyt.2024.1421698] [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: 04/22/2024] [Accepted: 06/17/2024] [Indexed: 08/13/2024] Open
Abstract
Background Emotionally unstable personality disorder (EUPD) is debilitating psychiatric disorder, particularly common in female and forensic populations. However, appropriate pharmacological treatment to effectively manage symptoms of EUPD remains an unmet clinical need. Dopamine receptor partial agonists (DRPAs), such as aripiprazole, have a favourable tolerability profile and have demonstrated some benefits in targeting symptoms of emotional dysregulation, although, evidence regarding the effects of novel D2/D3 DRPA cariprazine in EUPD patients has been limited. Objectives To evaluate the efficacy and tolerability of cariprazine for EUPD in a case series of female forensic inpatients where the diagnosis is more prevalent. Methods Demographic and clinical information of the patients were collected from patient electronic records during their admission in a specialized NHS forensic service. Treatment response was measured using the Positive and Negative Syndrome Scale (PANSS) at baseline, 3 and 6 months and Global Clinical Impression Scale (CGI-scores) at baseline and 6 months. Tolerability and BMI, ECG QTc interval and prolactin levels were recorded prior to initiation and at 6 months. Results Eight female patients with EUPD (mean age 29.8 years, SD 5.3) were treated with cariprazine (range 3-6mg). Total CGI-scores modestly improved from 5.6 baseline to 5.0 at 6 months. There was a reduction in mean total PANSS scores from baseline to 6 months (92.5, SD 8.1 to 72.4, SD 15.8), general psychopathology (56.1 SD 6.7 to 42.5, SD9.7), positive (21.9 SD 4.6 to 17.1, SD4.8) and negative PANSS scores (14.5 SD 6.3 to 12.8, SD4.6), corresponding to a 21%, 23%, 20% and 3% mean score reduction, respectively. Cariprazine demonstrated a favourable metabolic and hormonal side effect profile with no treatment discontinuation at 6 months follow up. Conclusion This is the first case series to evaluate the effectiveness of cariprazine in EUPD. Its efficacy in improving PANSS and CGI-S scores was overall modest and highly variable, reflective of an inherently heterogenous and comorbid patient sample but the benefits on treatment perseverance and tolerability were considerable. Cariprazine may be of particular benefit in EUPD where psychotic symptoms are co-morbid, as an augmentation strategy to clozapine, or where previous antipsychotics have caused metabolic or hormonal side effects.
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Affiliation(s)
- Sofia Pappa
- Department of Psychiatry, West London National Health Service (NHS) Trust, London, United Kingdom
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Ellice Caldwell-Dunn
- Department of Psychiatry, West London National Health Service (NHS) Trust, London, United Kingdom
| | - Arturas Kalniunas
- Department of Psychiatry, West London National Health Service (NHS) Trust, London, United Kingdom
| | - Manzar Kamal
- Department of Psychiatry, West London National Health Service (NHS) Trust, London, United Kingdom
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De Pieri M, Ferrari M, Pistis G, Gamma F, Marino F, Von Gunten A, Conus P, Cosentino M, Eap CB. Prediction of antipsychotics efficacy based on a polygenic risk score: a real-world cohort study. Front Pharmacol 2024; 15:1274442. [PMID: 38523642 PMCID: PMC10958197 DOI: 10.3389/fphar.2024.1274442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/26/2024] [Indexed: 03/26/2024] Open
Abstract
Background: Response to antipsychotics is subject to a wide interindividual variability, due to genetic and non-genetic factors. Several single nucleotide polymorphisms (SNPs) have been associated with response to antipsychotics in genome-wide association studies (GWAS). Polygenic risk scores (PRS) are a powerful tool to aggregate into a single measure the small effects of multiple risk alleles. Materials and methods: We studied the association between a PRS composed of SNPs associated with response to antipsychotics in GWAS studies (PRSresponse) in a real-world sample of patients (N = 460) with different diagnoses (schizophrenia spectrum, bipolar, depressive, neurocognitive, substance use disorders and miscellaneous). Two other PRSs composed of SNPs previously associated with risk of schizophrenia (PRSschizophrenia1 and PRSschizophrenia2) were also tested for their association with response to treatment. Results: PRSresponse was significantly associated with response to antipsychotics considering the whole cohort (OR = 1.14, CI = 1.03-1.26, p = 0.010), the subgroup of patients with schizophrenia, schizoaffective disorder or bipolar disorder (OR = 1.18, CI = 1.02-1.37, p = 0.022, N = 235), with schizophrenia or schizoaffective disorder (OR = 1.24, CI = 1.04-1.47, p = 0.01, N = 176) and with schizophrenia (OR = 1.27, CI = 1.04-1.55, p = 0.01, N = 149). Sensitivity and specificity were sub-optimal (schizophrenia 62%, 61%; schizophrenia spectrum 56%, 55%; schizophrenia spectrum plus bipolar disorder 60%, 56%; all patients 63%, 58%, respectively). PRSschizophrenia1 and PRSschizophrenia2 were not significantly associated with response to treatment. Conclusion: PRSresponse defined from GWAS studies is significantly associated with response to antipsychotics in a real-world cohort; however, the results of the sensitivity-specificity analysis preclude its use as a predictive tool in clinical practice.
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Affiliation(s)
- Marco De Pieri
- Center for Research in Medical Pharmacology, Varese, Italy
- PhD Program in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, Varese, Italy
- General Psychiatry Service, Hopitaux Universitaires de Genève, Geneva, Switzerland
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland
| | - Marco Ferrari
- Center for Research in Medical Pharmacology, Varese, Italy
| | - Giorgio Pistis
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland
| | - Franziska Gamma
- Les Toises Psychiatry and Psychotherapy Center, Lausanne, Switzerland
| | - Franca Marino
- Center for Research in Medical Pharmacology, Varese, Italy
| | - Armin Von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland
| | | | - Chin-Bin Eap
- Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, University of Lausanne, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
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Drug-Associated Liver Injury Related to Antipsychotics: Exploratory Analysis of Pharmacovigilance Data. J Clin Psychopharmacol 2022; 42:440-444. [PMID: 35730552 DOI: 10.1097/jcp.0000000000001576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Drug-associated liver injury is one of the most common causes for acute liver failure and market withdrawal of approved drugs. In addition, the potential for hepatotoxicity related to specific substances has to be considered in psychopharmacotherapy. However, systematic evaluations of hepatotoxicity related to antipsychotics are limited. METHODS We conducted an exploratory case/non-case study and evaluated pharmacovigilance data from VigiBase related to 30 antipsychotics marketed in the European Union. Reporting odds ratios were calculated for antipsychotics associated with the Standardized Medical Dictionary of Regulatory Activities queries "Drug-related hepatic disorders-comprehensive search" (DRHD-CS) and "Drug-related hepatic disorders-severe events only" (DRHD-SEO). RESULTS We found several signals for drug-associated liver injury including signals for severe events: 17 of 30 antipsychotics were associated with DRHD-CS and 10 of 30 antipsychotics with DRHD-SEO. Amisulpride, fluphenazine, levomepromazine, loxapine, olanzapine, perazine, perphenazine, pipamperone, sulpiride, and thioridazine were associated with both, DRHD-CS and DRHD-SEO. No association with fatal outcomes was detected. CONCLUSIONS Several common antipsychotics are associated with hepatotoxicity, partly also with severe hepatotoxicity. Our data do not allow to account for patient-related risk factors for drug-associated liver injury. This should be addressed in further studies.
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Yamada Y, Yokoi Y, Narita Z, Hirabayashi N. High‐dose antipsychotic drug use as a predictor for readmission of inpatients with borderline personality disorder: A retrospective chart review in a Japanese psychiatric hospital. Neuropsychopharmacol Rep 2020; 40:365-370. [PMID: 33037872 PMCID: PMC7722642 DOI: 10.1002/npr2.12140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to determine predictors associated with readmission of inpatients with borderline personality disorder. Methods This observational study evaluated 83 inpatients with borderline personality disorder admitted to the National Center of Neurology and Psychiatry Hospital in Japan from January 2013 to January 2016. Data were retrospectively obtained from electronic medical records. Results There was no significant difference in the daily antipsychotic dose equivalent to chlorpromazine at admission between the readmitted and nonreadmitted groups, which indicated that there was no between‐group difference in the psychiatric disease severity at admission. Multivariate logistic regression analyses revealed that the use of antipsychotics equivalent to >400 mg of chlorpromazine at discharge was associated with readmission within 1 year. Conclusions In conclusion, high‐dose antipsychotic drug use at discharge may be a risk factor for readmission. The present findings may have important clinical implications since they alert physicians to a possible predictor for readmissions of patients with borderline personality disorder. There is limited available information regarding predictors associated with repetitive admission of patients with BPD. This study aimed to evaluate predictors associated with readmission of inpatients with BPD. 1. Multivariate logistic regression analyses revealed that the use of antipsychotics equivalent to >400 mg of chlorpromazine at discharge was associated with readmission within 1 year. 2. High‐dose antipsychotic drug use at discharge may be a risk factor for readmissions.![]()
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Affiliation(s)
- Yuji Yamada
- Department of Psychiatry National Center Hospital National Center of Neurology and Psychiatry Kodaira Japan
| | - Yuma Yokoi
- Department of Psychiatry National Center Hospital National Center of Neurology and Psychiatry Kodaira Japan
| | - Zui Narita
- Department of Mental Health Johns Hopkins Bloomberg School of Public Health Baltimore MarylandUSA
| | - Naotsugu Hirabayashi
- Department of Psychiatry National Center Hospital National Center of Neurology and Psychiatry Kodaira Japan
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