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Tripathi A, Nasrallah HA, Pillai A. Pimavanserin treatment increases plasma brain-derived neurotrophic factor levels in rats. Front Neurosci 2023; 17:1237726. [PMID: 37712092 PMCID: PMC10499044 DOI: 10.3389/fnins.2023.1237726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/04/2023] [Indexed: 09/16/2023] Open
Abstract
Background Pimavanserin, a serotonin 5HT-2A receptor inverse agonist is the first-line, FDA-approved treatment of hallucinations and delusions associated with Parkinson's Disease psychosis (PDP), which occurs in up to 50% of PD patients. The neurobiological mechanism underlying the therapeutic effectiveness of Pimavanserin in PDP remains unknown. Several earlier studies have shown that treatment with 5HT-2A antagonists and other drugs acting on the serotonergic system such as SSRIs increase Brain derived neurotrophic factor (BDNF) levels in rodents. BDNF is synthesized as the precursor proBDNF, that undergoes cleavage intra or extracellularly to produce a mature BDNF (mBDNF) protein. mBDNF is believed to play a key role in neuroplasticity and neurogenesis. The present study tested the hypothesis that treatment with Pimavanserin is associated with higher and sustained elevations of mBDNF. Methods Adult Sprague-Dawley male rats were treated with Pimavanserin, Fluoxetine or vehicle for 4 weeks (chronic) or 2 h (acute). BDNF levels were determined by enzyme-linked Immunosorbent assay (ELISA). Results We found significant increases in plasma mBDNF levels in rats following chronic Pimavanserin treatment, but not in Fluoxetine-treated rats. No significant changes in mBDNF levels were found in the prefrontal cortex or hippocampus following Pimavanserin or Fluoxetine treatment. Conclusion These findings suggest that increase in mBDNF levels could be a contributing mechanism for the neuroprotective potential of Pimavanserin.
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Affiliation(s)
- Ashutosh Tripathi
- Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
| | - Henry A. Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, United States
| | - Anilkumar Pillai
- Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, GA, United States
- Charlie Norwood VA Medical Center, Augusta, GA, United States
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Kwok WY, Stephens V, Nasrallah HA. High-dose armodafinil in treatment-refractory bipolar depression. Ann Clin Psychiatry 2023; 35:195-198. [PMID: 37459498 DOI: 10.12788/acp.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Bipolar depression is a serious neuropsychiatric disorder associated with a high risk of morbidity and suicidality. Standard antidepressants approved for treating major depressive disorder fail to exert efficacy in bipolar depression. Although 5 agents have been developed for the treatment of bipolar depression, treatment resistance is still observed in some patients, and requires off-label pharmacotherapy. Modafinil and armodafinil have been reported to improve treatment-resistant bipolar depression, but with inconsistent results. METHODS We present a case of a 65-year-old woman with severe bipolar depression who failed to respond to electroconvulsive therapy and IV ketamine but later responded to high-dose armodafanil. RESULTS The patient responded to high-dose armodafinil (gradually titrated to 1,000 mg/d) and achieved remission with good tolerability for 5 years. Recently, she contracted COVID-19 and developed muscular weakness. After a lengthy workup, we became concerned for myopathy as an adverse effect from armodafinil. The patient's dose of armodafinil was significantly reduced and she subsequently became very depressed and functionally disabled before improving again when armodafinil 1,000 mg/d was reinstated. CONCLUSIONS We propose that some of the negative results seen in research of armodafinil for bipolar depression may be due to the use of low doses (100 to 200 mg/d), and higher doses may be needed for adequate response in treatment-resistant bipolar depression.
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Affiliation(s)
- Wan Y Kwok
- Department of Psychiatry, University of Illinois Chicago, Chicago, Illinois, USA
| | - Victoria Stephens
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Henry A Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Nasrallah HA, Keshavan M. Controversies and knowledge expansion in psychiatry. Asian J Psychiatr 2023; 82:103535. [PMID: 36948919 DOI: 10.1016/j.ajp.2023.103535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Henry A Nasrallah
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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Nasrallah HA. Is preventing the second psychotic episode a disease-modifying strategy for schizophrenia? Schizophr Res 2023; 252:326-328. [PMID: 36708622 DOI: 10.1016/j.schres.2022.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/11/2022] [Accepted: 12/26/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Henry A Nasrallah
- Department Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson St., Suite 3200, Cincinnati, OH 45219, United States.
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Goldberg JF, Nasrallah HA. Major depression is a serious and potentially fatal brain syndrome requiring pharmacotherapy or neuromodulation, and psychotherapy. Psychol Med 2022; 52:1423-1425. [PMID: 35502638 DOI: 10.1017/s0033291722001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Henry A Nasrallah
- Department of Psychiatry, University of Cincinnati, Cincinnati, OH, USA
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Serafini G, Nasrallah HA, Amore M. The use of modern dopamine partial agonists in bipolar depression: is the evidence sound? Curr Med Res Opin 2022; 38:773-775. [PMID: 35361016 DOI: 10.1080/03007995.2022.2059973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Nasrallah HA. Re-inventing the schizophrenia syndrome: The elusive "theory of everything". Schizophr Res 2022; 242:106-108. [PMID: 34799222 DOI: 10.1016/j.schres.2021.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/19/2021] [Accepted: 11/07/2021] [Indexed: 10/25/2022]
Affiliation(s)
- Henry A Nasrallah
- Neurology and Neuroscience, University of Cincinnati College of Medicine, United States of America.
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Nocera A, Nasrallah HA. The Association of the Gut Microbiota with Clinical Features in Schizophrenia. Behav Sci (Basel) 2022; 12:bs12040089. [PMID: 35447661 PMCID: PMC9025473 DOI: 10.3390/bs12040089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 02/05/2023] Open
Abstract
The connection between gut microbiota and schizophrenia has become a fertile area of research. The relationship is bidirectional and quite complex, but is likely to lead to practical clinical applications. For example, commensal microbiota have been shown to produce inflammatory metabolites that can cross the blood–brain barrier—a possible neurobiological precursor of psychosis. Antipsychotics that treat these individuals have been shown to alter gut microbiota. On the other hand, life style in schizophrenia, such as diet and decreased exercise, can be disruptive to the normal microbiome diversity. In the present paper, we conduct a review of PubMed literature focusing on the relationship of gut microbiota with clinical symptoms of schizophrenia, which, to our knowledge, has not yet been reviewed. Numerous clinical characteristics were identified correlating to gut microbial changes, such as violence, negative symptoms, treatment resistance, and global functioning. The most consistently demonstrated correlations to gut microbial changes across studies were for the overall symptom severity and negative symptom severity. Although numerous studies found changes in these domains, there is much variability between the bacteria that change in abundance between studies, likely due to the regional and methodological differences between studies. The current literature shows promising correlations between gut microbiota profiles and several clinical features of schizophrenia, but initial studies require replication.
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Affiliation(s)
- Henry A Nasrallah
- Neurology and Neuroscience, University of Cincinnati College of Medicine, United States of America.
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Nasrallah HA, Weiden PJ, Walling DP, Du Y, Yao B, Yagoda S, Claxton A. Aripiprazole lauroxil 2-month formulation with 1-day initiation in patients hospitalized for an acute exacerbation of schizophrenia: exploratory efficacy and patient-reported outcomes in the randomized controlled ALPINE study. BMC Psychiatry 2021; 21:492. [PMID: 34625041 PMCID: PMC8501701 DOI: 10.1186/s12888-021-03420-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A randomized, controlled, phase 3b study (ALPINE) evaluated efficacy and safety of a 2-month formulation of aripiprazole lauroxil (AL) using a 1-day initiation regimen in patients hospitalized for an acute exacerbation of schizophrenia. Paliperidone palmitate (PP) was used as an active control. Exploratory endpoint assessments included severity of illness, positive and negative symptoms, quality of life, caregiver burden, and satisfaction with medication. METHODS Adults were randomly assigned to AL 1064 mg q8wk or PP 156 mg q4wk as inpatients, discharged after 2 weeks, and followed through week 25. Exploratory efficacy measures included the 3 original PANSS subscales, Clinical Global Impression-Severity (CGI-S) subscale, and caregiver Burden Assessment Scale. Exploratory patient-reported outcomes (PROs) included the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) and the Medication Satisfaction Questionnaire. Within-group changes from baseline through week 25 were analyzed for AL and PP separately. PROs were summarized based on observed data. RESULTS Of 200 patients randomized (AL, n = 99; PP, n = 101), 99 completed the study (AL, n = 56; PP, n = 43). For AL, PANSS subscale and CGI-S scores improved from baseline through week 25 (mean [SE] change from baseline at week 25: Positive, -7.5 [0.70]; Negative, -3.9 [0.46]; General, -11.8 [0.83]; CGI-S, -1.3 [0.12]). Caregiver burden also improved (mean [SD] changes from baseline at week 9: -8.4 [10.15]; week 25: -8.9 [12.36]). Most AL patients were somewhat/very satisfied with treatment at each timepoint (70.8%-74.7%); mean Q-LES-Q-SF total scores were stable in the outpatient period. For PP, results were similar: PANSS Positive, -7.3 (0.67); Negative, -3.6 (0.69); General, -10.9 (1.22); CGI-S, -1.4 (0.16); caregiver burden, week 9: -8.8 (11.89) and week 25: -9.2 (14.55); satisfaction with treatment, 64.7%-69.3%; and stable Q-LES-Q-SF scores. CONCLUSIONS ALPINE patients initiating the 2-month AL formulation using the 1-day initiation regimen as inpatients and continuing outpatient care experienced schizophrenia symptom improvement, sustained patient satisfaction with medication, stable quality of life, and reduced caregiver burden. A similar benefit pattern was observed for PP. These results support the feasibility of starting either long-acting injectable in the hospital and transitioning to outpatient treatment. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03345979 [trial registration date: 15/11/2017].
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Affiliation(s)
- Henry A Nasrallah
- University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH, 45219, USA.
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Aboraya A, Nasrallah HA, Elswick D, Rastgar Y, Berry J, Hill C, Justice J, Zheng W, Pearson N, Gallucci G, Figgs P, Hustead J, Vogt J, Zafar J, Dohar S, Looper R, Guinan D, Elawady A, Shah O, Lam MW, Shagufta S, Schwartzman N, Hamric E, Mayle L, Miller M, Chandran D, Marshalek P, Moreland R, Tamang TL, Mattancheril S, Berzingi S. Measurement-based care training curriculum in psychiatry residency programs: I: Description of the curriculum and demonstration of implementation. Ann Clin Psychiatry 2021; 33:168-179. [PMID: 34398732 DOI: 10.12788/acp.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent literature shows that most practicing psychiatrists do not receive training in measurement-based care (MBC). Among the primary barriers to MBC implementation are the lack of formal training and curriculums. We present the first comprehensive MBC curriculum for use in adult psychiatric practice, and describe how the curriculum is adapted and implemented in psychiatry residency training programs. METHODS The Standard for Clinicians' Interview in Psychiatry (SCIP) was developed as a measurement-based care tool for clinicians' use. The SCIP is the only instrument that includes 18 reliable and validated clinician-rated scales covering most adult psychiatric disorders. The SCIP has simple, unified rules of measurement that apply to the 18 scales. The MBC curriculum includes 2 instruction manuals, 4 didactic lectures, and 12 videotaped interviews. We describe the annual learning and implementation of MBC curriculum in residency programs. RESULTS The curriculum implementation at West Virginia University and Delaware Psychiatric Center began in 2019 and is ongoing. We present 3 case demonstrations of the implementation of MBC in clinical settings. CONCLUSIONS Comprehensive implementation of MBC curriculum in residency programs has the potential to facilitate research and create a "culture" of MBC in future generations of psychiatrists.
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Affiliation(s)
- Ahmed Aboraya
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Henry A Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Daniel Elswick
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Yasha Rastgar
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - James Berry
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Cheryl Hill
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - John Justice
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Wanhong Zheng
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Nathan Pearson
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Gerard Gallucci
- Division of Substance Abuse and Mental Health, Delaware Psychiatric Center, New Castle, Delaware, USA
| | - Patricia Figgs
- Division of Substance Abuse and Mental Health, Delaware Psychiatric Center, New Castle, Delaware, USA
| | - Jeremy Hustead
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Joel Vogt
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Jawad Zafar
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sheena Dohar
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Robert Looper
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Danielle Guinan
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Akram Elawady
- Division of Substance Abuse and Mental Health, Delaware Psychiatric Center, New Castle, Delaware, USA
| | - Omar Shah
- Division of Substance Abuse and Mental Health, Delaware Psychiatric Center, New Castle, Delaware, USA
| | - Mei Wai Lam
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Shanila Shagufta
- Division of Substance Abuse and Mental Health, Delaware Psychiatric Center, New Castle, Delaware, USA
| | - Noah Schwartzman
- Division of Substance Abuse and Mental Health, Delaware Psychiatric Center, New Castle, Delaware, USA
| | - Eddie Hamric
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Lauren Mayle
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Mark Miller
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Dilip Chandran
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Patrick Marshalek
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Rachel Moreland
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Tenchee Lama Tamang
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sunny Mattancheril
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sara Berzingi
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Nasrallah HA. The pro- and con-debate about the at-risk state and early intervention: A commentary. Schizophr Res 2021; 227:18-19. [PMID: 32527678 DOI: 10.1016/j.schres.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 12/13/2022]
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Abstract
BACKGROUND Neuroimaging, especially diffusion tensor imaging (DTI), has emerged as a helpful tool in assessing and characterizing white matter (WM) integrity. The resultant early treatment from early diagnosis is crucial because treatment is often more efficacious. Borderline personality disorder (BPD) is a challenging disorder to diagnose and treat, and has been reported to have various neurobiologic abnormalities. We conducted a search of the literature to review WM pathology findings in BPD. METHODS A search was conducted to identify systematic reviews and meta-analyses published from January 2000 to September 2019 that assessed WM integrity in BPD. RESULTS Four studies were included. One study demonstrated no difference in WM between BPD and healthy controls. Another study found decreased fractional anisotropy (FA) within the corpus callosum (CC) and orbitofrontal regions. A subsequent randomized controlled trial reported a decrease in FA within the fornix, CC, and right superior/anterior corona radiata with associated increase in radial diffusivity in the left anterior thalamic radiation. The fourth study found a decrease in the axial diffusivity within the cingulum, inferior longitudinal fasciculus, and inferior frontoccipital fasciculus. CONCLUSIONS Our review concludes that BPD is associated with measurable WM pathology. Methods such as DTI might emerge as useful tools in the management of BPD. More controlled studies are needed to validate our conclusions.
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Affiliation(s)
- Raza Sagarwala
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37232 USA. E-MAIL:
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Sagarwala R, Nasrallah HA. White matter pathology is shared across multiple psychiatric brain disorders: Is abnormal diffusivity a transdiagnostic biomarker for psychopathology? Biomark Neuropsychiatry 2020. [DOI: 10.1016/j.bionps.2019.100010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sagarwala R, Nasrallah HA. Changes in inflammatory biomarkers before and after SSRI therapy in PTSD: A review. Ann Clin Psychiatry 2019; 31:292-297. [PMID: 31675389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are regarded as the standard pharmacotherapy for the treatment of posttraumatic stress disorder (PTSD). Recent studies indicate that neuroinflammation is associated with PTSD. We conducted a search of the literature to determine if SSRI efficacy is associated with a decrease in inflammation levels. METHODS A literature search was conducted to identify studies published from January 2000 to January 2019 that measured changes in inflammatory biomarkers before and after SSRI treatment in patients with PTSD. RESULTS Four studies met the criteria for inclusion. In one study, SSRI use significantly reduced interleukein-1beta. An open trial of paroxetine found a significant decline in cortisol. In a third study, paroxetine treatment in patients with PTSD and depression showed no significant changes in cortisol. Finally, analysis of cerebrospinal fluid in patients with PTSD showed no significant changes in corticotropin-releasing factor, interleukin-6, brain-derived neurotrophic factor, or insulin-like growth factor 1. Substance P was found to be decreased. CONCLUSIONS Our review had mixed results regarding whether SSRI therapy for PTSD is associated with a reduction in inflammation. These findings may be due to the heterogeneity of PTSD. More randomized controlled trials are needed due to the potential benefits of SSRIs for reducing inflammation in patients with PTSD (as has been reported in depression studies).
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Affiliation(s)
- Raza Sagarwala
- Saint Louis University School, of Medicine, St. Louis, MO USA. E-MAIL:
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Kahlon CK, Nasrallah HA. Bidirectional relationship between transient ischemic attacks and depression: A review. Ann Clin Psychiatry 2019; 31:214-220. [PMID: 31046038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND An association between cerebrovascular events and psychiatric disorders has been reported. However, the focus has centered on stroke, and there has been a lack of attention to a possible relationship between transient ischemic attacks (TIAs) and depression. METHODS We conducted a review of studies that looked specifically at the risk of depression after TIAs and the risk of TIAs in patients with depression. A total of 8 studies were identified, 4 examining the occurrence of depression following a TIA, and 4 examining the occurrence of TIAs after the onset of depression. RESULTS There was a bidirectional effect: 3 of 4 studies showed an increased risk of TIAs in patients with depression, and 4 of 4 studies found an increase of depression following a TIA. The percentage of patients having a TIA from the pool of patients with depression was 3.18%. The percentage of patients who developed depression after a TIA in the pooled samples was 6.88%. CONCLUSIONS Both depression and TIAs are serious medical disorders and they appear to have a bidirectional relationship. Further clinical and neurobiological studies in this area are warranted.
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Affiliation(s)
- Chanchal K Kahlon
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Monteleone Hall, St. Louis, MO 63104 USA. E-MAIL:
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Douglas J, Nasrallah HA. Low high-density lipoprotein and psychopathology: A review. Ann Clin Psychiatry 2019; 31:209-213. [PMID: 31369659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND An association between the level of total cholesterol and psychopathology has been the focus of numerous studies. Low total cholesterol has been found to be related to depression, personality disorders, and dissociative disorder. High cholesterol has been associated with schizophrenia, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder, and posttraumatic stress disorder. However, no reviews of the psychiatric correlates of high-density lipoprotein (HDL) have been published. We reviewed the literature for studies reporting a significant association between low or high levels of HDL and psychopathology. METHODS A search of major databases (PubMed and CINAHL) was conducted using the following keywords: HDL, depression, anxiety, schizophrenia, OCD, and psychiatric disorders. RESULTS Eight studies met our search criteria. Six of the 8 studies reported significantly higher rates of depression, anxiety, suicide attempts, and violent behaviors in participants with low HDL. CONCLUSIONS Overall, a low HDL may not only be associated with risk for cardiac disease, but also with increased risk for serious psychiatric disorders. Further controlled studies are warranted.
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Affiliation(s)
- Jasmine Douglas
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO USA. E-MAIL:
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Nasrallah HA, Fedora R, Morton R. Successful treatment of clozapine-nonresponsive refractory hallucinations and delusions with pimavanserin, a serotonin 5HT-2A receptor inverse agonist. Schizophr Res 2019; 208:217-220. [PMID: 30837203 DOI: 10.1016/j.schres.2019.02.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clozapine was the widely accepted gold standard treatment for treatment resistant psychotic symptoms. Clozapine has efficacy of about 50% and some responding patients have to discontinue it due to serious adverse effects. The search for novel agents to use for clozapine-non-responders continues. One such possible agent is the non-dopaminergic antipsychotic pimavanserin, an inverse agonist of serotonin 5-HT2A receptors which was recently approved for the hallucinations and delusions of Parkinson's Disease Psychosis. We report here the successful results of using pimavanserin in patients with refractory hallucinations and delusions who failed to respond to clozapine. We also report similar results in refractory psychosis patients who did not receive clozapine. METHODS We present ten cases of patients with schizophrenia and schizoaffective disorder with refractory hallucinations and delusions who received a trial of pimavanserin when clozapine or multiple antipsychotics failed. Six of ten patients had not responded to a clozapine trial. The subjects' ages ranged between 21 and 77 years and were followed up for several months. RESULTS All 10 patients with refractory hallucinations and delusions showed marked response to pimavanserin 34 mg/day within 4-8 weeks, with continuation of the response for several months of follow-up. Improvements in negative symptoms and social functioning were also observed in several patients. DISCUSSION This series of 10 cases of patients with refractory psychosis who responded to pimavanserin is an important new finding that has never been reported before. Controlled studies comparing clozapine and pimavanserin in refractory schizophrenia are warranted to confirm these clinical observations.
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Affiliation(s)
- Henry A Nasrallah
- Saint Louis University, Department of Psychiatry and Behavioral Neuroscience, St. Louis, MO, United States of America.
| | - Rissa Fedora
- Saint Louis University, Department of Psychiatry and Behavioral Neuroscience, St. Louis, MO, United States of America
| | - Robert Morton
- Saint Louis University, Department of Psychiatry and Behavioral Neuroscience, St. Louis, MO, United States of America
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Abstract
BACKGROUND In contrast to over 30 studies reporting neurotoxicity associated with the first-generation antipsychotics (FGAs), several published studies have reported multiple neuroprotective effects associated with the second generation antipsychotics (SGAs). This prompted us to conduct a review of the reported neuroprotective mechanisms of the SGA class of antipsychotics compared to the FGAs. METHODS A PubMed search was conducted using the keywords antipsychotic, neuroprotection, neuroplasticity, neurogenesis, neurotoxicity, toxicity, brain volume, neuroinflammation, oxidative stress, myelin, and oligodendrocyte. No restrictions were placed on the date of the articles or language. Studies with a clearly described methodology were included. RESULTS Animal, cell culture, and human clinical studies were identified. Twenty-four reports met the criteria for the search. All studies included at least one SGA (aripiprazole, clozapine, lurasidone, olanzapine, paliperidone, perospirone, quetiapine, risperidone, and/or ziprasidone). A few also included FGAs as a comparator (predominantly haloperidol). All studies demonstrated at least one neuroprotective mechanism of one or more SGAs, while some studies also showed that FGAs ranged from having no neuroprotective effects to actually exerting neurotoxic effects leading to neuronal death. CONCLUSIONS A review of the literature suggests that in addition to their antipsychotic efficacy and low motoric side effects, SGAs exert measurable neuroprotective effects mediated via multiple molecular mechanisms and often in a dose-dependent manner. The neuroprotective effects of SGAs range from preventative to restorative and may play a salutary role in ameliorating the neurodegenerative effects of psychosis.
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Affiliation(s)
- Alexander T Chen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2010 Zonal Ave 1P10, Los Angeles, CA, USA.
| | - Henry A Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd., Suite 105, Saint Louis, MO, USA.
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Cannon C, Nasrallah HA. A focus on postpartum depression among African American women: A literature review. Ann Clin Psychiatry 2019; 31:138-143. [PMID: 31046035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Some studies have reported a higher rate of postpartum depression in African American vs White women. We reviewed the literature to identify the possible factors associated with a greater risk of postpartum depression in African American women. METHODS A comprehensive literature review was conducted using journal databases such as PubMed and Google Scholar. Keywords used in the search included postpartum depression, ethnicity, and race. Using the PRISMA (Preferred reporting items for systematic reviews and meta-analysis) method for review articles, 8 studies were identified and included. RESULTS We identified 8 studies that met the criteria for our review. Most of the studies showed that African American and Hispanic women had a higher odds ratio of reported postpartum depression due to lack of social support, access, trust, past depression, and other factors. However, 1 study found that although African Americans are more likely to report symptoms of postpartum depression, they are less likely to seek treatment due to cultural stigma regarding mental illness. CONCLUSIONS The data we reviewed confirm the ethnic differences in postpartum depression. Addressing the factors involved will lead to better health outcomes for both mothers and their children.
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Affiliation(s)
- Cornita Cannon
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO 63104 USA. E-MAIL:
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Aboraya A, Nasrallah HA, Elswick DE, Ahmed E, Estephan N, Aboraya D, Berzingi S, Chumbers J, Berzingi S, Justice J, Zafar J, Dohar S. Measurement-based Care in Psychiatry-Past, Present, and Future. Innov Clin Neurosci 2018; 15:13-26. [PMID: 30834167 PMCID: PMC6380611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The authors define measurement-based care (MBC) in psychiatry as the use of validated clinical measurement instruments to objectify the assessment, treatment, and clinical outcomes, including efficacy, safety, tolerability, functioning, and quality of life, in patients with psychiatric disorders. MBC includes two processes: routine assessments, such as measuring the severity of symptoms with rating scales, and the use of assessments in decision-making. MBC implementation was tested in the Texas Medication Algorithm Project and the German Algorithm Project and has been shown to improve patient outcomes. Even though more recent research has shown the many benefits of MBC compared to the usual care, MBC is still not the standard of care in psychiatric practice. This review article addresses the advantages of MBC, the barriers to implementing MBC in clinical practice, and the basic properties of MBC instruments. Recent developments in the 21st century that are expected to accelerate the adoption of MBC in clinical practice, including electronic health records, health information technology, and the development of the Standard for Clinicians' lnterview in Psychiatry (SCIP) as an MBC tool, will be reviewed. The authors recommend including MBC in psychiatry residency training to promote its use in future generations.
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Affiliation(s)
- Ahmed Aboraya
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
| | - Henry A Nasrallah
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
| | - Daniel E Elswick
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
| | - Elshazly Ahmed
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
| | - Nevine Estephan
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
| | - Dalia Aboraya
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
| | - Seher Berzingi
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
| | - Josleen Chumbers
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
| | - Sara Berzingi
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
| | - John Justice
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
| | - Jawad Zafar
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
| | - Sheena Dohar
- Dr. Aboraya is Chief of Psychiatry at William R. Sharpe, Jr. Hospital, Clinical Professor of Psychiatry at West Virginia School of Osteopathic Medicine, and Adjunct Faculty with the School of Public Health West Virginia University, in Weston, West Virginia
- Dr. Nasrallah is the Sydney Souers Professor and Chairman of the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine in St. Louis, Missouri
- Dr. Elswick is Associate Professor at West Virginia University in Morgantown, West Virginia
- Mr. Elshazly is a second year resident at Atlanticare Regional Medical Center in Atlantic City, New Jersey
- Dr. Estephan is Child Psychiatry Fellow at West Virginia University in Morgantown, West Virginia
- Ms. Aboraya is with Ohio Northern University Law School in Ada, Ohio
- Mr. Seher Berzingi and Mses. Chumbers and Sara Berzingi are researchers at West Virginia University in Morgantown, West Virginia
- Dr. Justice is Medical Director of Sharpe Hospital in Weston, West Virginia
- Drs. Zafar and Dohar are psychiatry residents at West Virginia University in Morgantown, West Virginia
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Khoury R, Nasrallah HA. Inflammatory biomarkers in individuals at clinical high risk for psychosis (CHR-P): State or trait? Schizophr Res 2018; 199:31-38. [PMID: 29703661 DOI: 10.1016/j.schres.2018.04.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies linking neuro-inflammation to psychotic episodes has been rapidly expanding. Assessments of changes in inflammatory biomarkers in prodromal patients who subsequently convert to psychosis may help in predicting those likely to transition to psychosis. METHODS We reviewed the literature for original studies that measured inflammatory biomarkers in individuals at clinical high risk for psychosis (CHR-P), and compared pro-inflammatory biomarker data between converters and non-converters to psychosis as well as in healthy controls. RESULTS Our search yielded 15 studies. Our findings suggest a possible role of plasma levels of Interleukins-1β, 7, 8, matrix metalloproteinase (MMP)-8, cortisol, albumin and salivary cortisol, measured at baseline, as predictors of psychotic transition. Both baseline C-reactive protein (CRP) and Interleukin-6 levels were not shown to discriminate between converters and non-converters to psychosis. The dearth of longitudinal biomarker measures, before and after treating the psychotic episodes, was a limitation for assessing inflammatory biomarkers as trait vs state marker properties of biomarkers. DISCUSSION Gaps of data in published studies prevent confirming whether inflammatory biomarkers are state or trait indicators of transition to psychosis in the CHR-P populations. Future investigations should be designed to longitudinally measure inflammatory biomarkers in order to navigate the extensive heterogeneity of the schizophrenia syndrome and its prodrome.
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Affiliation(s)
- Rita Khoury
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, United States.
| | - Henry A Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, United States
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Chen AT, Malmstrom T, Nasrallah HA. Body temperature rises following improvement of depression with ECT. Ann Clin Psychiatry 2018; 30:196-199. [PMID: 30028893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Recent studies have reported hyperthermia is an efficacious treatment for depression. Thus, we hypothesized that a proven depression therapy such as electroconvulsive therapy (ECT) would be associated with an increase in body temperature. METHODS A retrospective chart analysis was conducted on 33 participants who recovered from depression after a course of ECT. All were hospitalized for recurrent, severe symptoms and had no previous ECT treatment. Oral temperature recordings before and after the first and last ECT treatments were collected for each participant. Statistical analysis was performed using paired t test. RESULTS No significant change in mean oral temperature occurred after the first ECT, but a significant increase from baseline was observed after the final ECT treatment when depression symptoms had clinically remitted (P < .009). CONCLUSIONS Improvement in clinical depression with ECT is correlated with an increase in body temperature. Body temperature may have potential as a biomarker for ECT efficacy, and possibly for antidepressant pharmacotherapies.
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Affiliation(s)
- Alexander T Chen
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO 63104 USA; E-MAIL:
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Lu S, Nasrallah HA. The use of memantine in neuropsychiatric disorders: An overview. Ann Clin Psychiatry 2018; 30:234-248. [PMID: 30028898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Memantine is a non-competitive N-methyl-d-aspartate receptor antagonist currently used for the treatment of Alzheimer's disease as an approved indication. However, as knowledge of signaling pathways is increasing, the therapeutic potential of memantine is being applied for the treatment of various psychiatric illnesses. METHODS The PubMed online database was searched for the use of memantine in various psychiatric disorders. Case studies, open-label trials, and controlled trials from the search were included. RESULTS Memantine monotherapy was found to exert efficacy in several neuropsychiatric conditions, including autism spectrum disorder, binge eating disorder, and attention-deficit/hyperactivity disorder. For posttraumatic stress disorder and generalized anxiety disorder, memantine was found efficacious in augmentation with other medications. In obsessive-compulsive disorder (OCD), memantine was used as both an augmentation to selective serotonin reuptake inhibitors and standalone therapy, and most published studies found it to improve OCD symptoms. For schizophrenia, memantine has been reported to be consistently effective for negative symptoms only. The manic phase of bipolar disorder also appears to benefit from memantine. The depressive phase of bipolar disorder and major depressive disorder did not respond significantly to memantine. Catatonia as a symptom of various disorders improved in several case studies when memantine was used in combination with other medications. CONCLUSIONS Memantine may have several therapeutic applications in psychiatry, reflecting the involvement of glutamate pathways in multiple psychiatric disorders.
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Affiliation(s)
- Syshane Lu
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO 63104 USA; E-MAIL:
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Nasrallah HA. Triple advantages of injectable long acting second generation antipsychotics: Relapse prevention, neuroprotection, and lower mortality. Schizophr Res 2018; 197:69-70. [PMID: 29506767 DOI: 10.1016/j.schres.2018.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Henry A Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, Saint Louis, MO, USA.
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Sagarwala R, Malmstrom T, Nasrallah HA. Effects of nonpharmacological therapies on anxiety and cortisol: A meta-analysis. Ann Clin Psychiatry 2018; 30:91-96. [PMID: 29697709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Although pharmacotherapy is considered the standard of care for the treatment of anxiety, a subset of the patients remains resistant or intolerant to iatrogenic adverse effects. Nonpharmacological and nonpsychotherapeutic interventions, sometimes referred to as "complementary treatments," have emerged as possible alternatives in the treatment of anxiety. We conducted a meta-analysis of placebo-controlled studies to assess the efficacy of nonpharmacological therapy on anxiety. In addition, because serum and salivary cortisol levels are elevated during anxiety, we conducted a separate meta-analysis of pre- and posttreatment cortisol levels. METHODS A search was conducted to identify randomized controlled trials published from January 2010 to May 2017 that measured the effects of nonpharmacological therapies on State Trait Anxiety Index (STAI) scores and cortisol levels before and after treatment. RESULTS Four studies met the criteria for inclusion. Our meta-analysis reveals that participants receiving nonpharmacological therapy had a statistically significant decrease in STAI scores (d = -.340; 95% confidence interval [CI], -.639, -.041; P = .026), but no statistically significant decrease in cortisol levels (d = -.085; 95% CI, -.396, .226; P = .591) after intervention. CONCLUSIONS Our meta-analysis data suggest that "complementary" therapies improved the clinical manifestations of anxiety and thus may be useful as adjunctive approaches to drug treatment.
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Affiliation(s)
- Raza Sagarwala
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University. St. Louis, MO 63118 USA. E-MAIL:
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Abstract
INTRODUCTION In addition to being a critical component of the visual system, the retina provides the opportunity for an accessible and noninvasive probe of brain pathology in neuropsychiatric disorders. Several studies have reported various retinal abnormalities in schizophrenia, some primary and others iatrogenic. There is now increasing evidence supporting the existence of retinal anomalies in schizophrenia across structural, neurochemical and physiological parameters. Here, we review the types of retinal pathology in schizophrenia and discuss how these findings may provide novel insights for future research into the neurodevelopmental neurobiology of this syndrome, and possibly as useful biomarkers. METHODS Using the keywords schizophrenia, retina, pathology, electroretinogram (ERG), and/or optical coherence tomography (OCT) on PubMed, all studies using the English language within 30years were reviewed. Methods were examined, and common themes were identified, tabulated, and discussed. RESULTS We classified the reports of retinal pathology into primary and secondary. The major secondary retinal pathology is related to the iatrogenic effects of a once widely prescribed first generation antipsychotic (thioridazine), which was found to be associated with retinal pigment deposits, decreased visual acuity, and suppression of dark adapted ERG responses. The primary retinal findings were obtained via different measures primarily using ERG, OCT, and microvascular imaging. The most consistent findings were 1) decreased ERG wave amplitudes, 2) reduced macular volume, 3) thinning of retinal nerve fiber layer, and 4) widened venule caliber. CONCLUSION The abnormal pathobiological findings of the retina in schizophrenia may represent an important avenue for elucidating some of the neurodevelopmental aberrations in schizophrenia. The well replicated retinal anomalies could serve as biomarkers for schizophrenia and perhaps an endophenotype that may help identify at-risk individuals and to facilitate early intervention.
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Affiliation(s)
- Selin A Adams
- Resident in Psychiatry, Cleveland Clinic, Cleveland, OH, United States
| | - Henry A Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd, St. Louis, MO 63104, United States.
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Abstract
INTRODUCTION In addition to being a critical component of the visual system, the retina provides the opportunity for an accessible and noninvasive probe of brain pathology in neuropsychiatric disorders. Several studies have reported various retinal abnormalities in schizophrenia, some primary and others iatrogenic. There is now increasing evidence supporting the existence of retinal anomalies in schizophrenia across structural, neurochemical and physiological parameters. Here, we review the types of retinal pathology in schizophrenia and discuss how these findings may provide novel insights for future research into the neurodevelopmental neurobiology of this syndrome, and possibly as useful biomarkers. METHODS Using the keywords schizophrenia, retina, pathology, electroretinogram (ERG), and/or optical coherence tomography (OCT) on PubMed, all studies using the English language within 30years were reviewed. Methods were examined, and common themes were identified, tabulated, and discussed. RESULTS We classified the reports of retinal pathology into primary and secondary. The major secondary retinal pathology is related to the iatrogenic effects of a once widely prescribed first generation antipsychotic (thioridazine), which was found to be associated with retinal pigment deposits, decreased visual acuity, and suppression of dark adapted ERG responses. The primary retinal findings were obtained via different measures primarily using ERG, OCT, and microvascular imaging. The most consistent findings were 1) decreased ERG wave amplitudes, 2) reduced macular volume, 3) thinning of retinal nerve fiber layer, and 4) widened venule caliber. CONCLUSION The abnormal pathobiological findings of the retina in schizophrenia may represent an important avenue for elucidating some of the neurodevelopmental aberrations in schizophrenia. The well replicated retinal anomalies could serve as biomarkers for schizophrenia and perhaps an endophenotype that may help identify at-risk individuals and to facilitate early intervention.
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Affiliation(s)
- Selin A Adams
- Resident in Psychiatry, Cleveland Clinic, Cleveland, OH, United States
| | - Henry A Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd, St. Louis, MO 63104, United States.
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Durgam S, Earley W, Li R, Li D, Lu K, Laszlovszky I, Wolfgang Fleischhacker W, Nasrallah HA. Corrigendum to "Long-term cariprazine treatment for the prevention of relapse in patients with schizophrenia: A randomized, double-blind, placebo-controlled trial" [Schizophr. Res. 176 (2016) 264-271]. Schizophr Res 2018; 192:493. [PMID: 28427929 DOI: 10.1016/j.schres.2017.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Rui Li
- Allergan, Inc., Jersey City, NJ, USA
| | - Dayong Li
- Allergan, Inc., Jersey City, NJ, USA
| | | | | | - W Wolfgang Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
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Aboraya A, Leucht S, Nasrallah HA, Samara M, Haro JM, Elshazly A, Zangeneh M. A novel approach to measuring response and remission in schizophrenia in clinical trials. Schizophr Res 2017; 190:123-128. [PMID: 28314680 DOI: 10.1016/j.schres.2017.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pharmaceutical companies conduct clinical trials to show the efficacy and safety of new medications for the treatment of schizophrenia. After the new medications are marketed, clinicians treating patients with schizophrenia discover that a considerable number of patients do not respond to these new medications. The goals of the review are to examine the methodology and design of recent antipsychotic clinical trials, identify common flaws, and propose guidelines to fix the flaws and improve the quality of future clinical trials of antipsychotic medications. METHODS A review of recent antipsychotic clinical trials was conducted using a PubMed search. Ten recent trials published in the past four years were reviewed and their methods analyzed and critiqued. RESULTS The authors identified six major methodological flaws that may explain the suboptimal response in many patients after a drug is approved. Most of the flaws are related to eligibility criteria, the misuse of the Positive and Negative Syndromes Scale (PANSS) and the lack of consensus on how to define remission, response and exacerbation in schizophrenia. Proposed guidelines for a more rigorous use of the PANSS are presented and recommendations are proposed for using uniform criteria for remission, response and exacerbation in schizophrenia. CONCLUSIONS The authors recommend using standardized diagnostic interviews to screen patients for eligibility criteria and using the PANSS according to the author's recommendations and the proposed guidelines. Uniform criteria to define remission, response and exacerbation are recommended for clinical trials examining the efficacy and safety of antipsychotic drugs in schizophrenia.
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Affiliation(s)
- Ahmed Aboraya
- Chief of Psychiatry, William R. Sharpe, Jr. Hospital. Clinical Professor of Psychiatry, West Virginia School of Osteopathic Medicine. Adjunct faculty, School of Public Health, West Virginia University (WVU), USA.
| | - Stefan Leucht
- Dept. of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Germany Ismaningerstr. 22, 81675 München, Germany
| | - Henry A Nasrallah
- The Sydney Souers Professor and Chairman Department of Psychiatry and Behavioral Neuroscience Saint Louis University School of Medicine St. Louis MO, USA
| | - Myrto Samara
- Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu Dr. Antoni Pujadas, 42 08830 - Sant Boi de Llobregat Barcelona, Spain
| | - Ahmed Elshazly
- Atlanticare Regional Medical Center 1925 Pacific Ave Atlantic City, NJ, USA
| | - Masood Zangeneh
- Editor-in-Chief, International Journal of Mental Health & Addiction Consultant, Kuwait Center for Autism, Kuwait
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Nasrallah HA, Earley W, Cutler AJ, Wang Y, Lu K, Laszlovszky I, Németh G, Durgam S. The safety and tolerability of cariprazine in long-term treatment of schizophrenia: a post hoc pooled analysis. BMC Psychiatry 2017; 17:305. [PMID: 28836957 PMCID: PMC5571492 DOI: 10.1186/s12888-017-1459-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/11/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Schizophrenia is a chronic and debilitating neuropsychiatric disorder that often requires long-term pharmacotherapy to manage symptoms and prevent relapse. Cariprazine is a potent dopamine D3 and D2 receptor partial agonist that is FDA-approved in the US for the treatment of schizophrenia and manic or mixed episodes associated with bipolar I disorder in adults; the recommended dose range is 1.5-6 mg/d. METHODS To further characterize the long-term safety of cariprazine, data from two 48-week open-label, flexible-dose extension studies were pooled for post hoc analyses. Outcomes were evaluated in the pooled safety population (patients who received ≥1 dose of cariprazine during an open-label extension period); findings were summarized using descriptive statistics for the overall cariprazine group and in modal daily dose groups (1.5-3, 4.5-6, and 9 mg/d). RESULTS Of the 679 patients in the overall cariprazine safety population, 40.1% completed the study. The only adverse events (AEs) leading to discontinuation of ≥2% of patients in any dose group were akathisia, worsening of schizophrenia, and psychotic disorder. Treatment-emergent AEs (TEAEs) of akathisia, insomnia, weight increased, and headache were reported in ≥10% of the overall population. Mean prolactin levels decreased in all dose groups (overall, -15.4 ng/mL). Clinically insignificant changes in aminotransferase levels and alkaline phosphatase were observed; no dose-response relationship was observed across groups. Mean total (-5.3 mg/dL), low-density lipoprotein (-3.5 mg/dL), and high-density lipoprotein (-0.8 mg/dL) cholesterol levels decreased; no dose-response relationship was observed for metabolic parameters. Mean change in body weight was 1.58 kg; body weight increase and decrease ≥7% occurred in 27% and 11% of patients, respectively. Mean changes in cardiovascular parameters, including blood pressure and pulse, were generally not considered clinically significant. EPS-related TEAEs that occurred in ≥5% of patients were akathisia, tremor, restlessness, and extrapyramidal disorder. CONCLUSION In these post hoc pooled analyses of data from 2 long-term open-label studies, treatment with cariprazine was generally safe and well tolerated. Results support the safety and tolerability of cariprazine within the FDA-recommended dose range of 1.5-6 mg/d for schizophrenia. CLINICAL TRIALS REGISTRATION NCT01104792, NCT00839852.
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Affiliation(s)
- Henry A. Nasrallah
- 0000 0004 1936 9342grid.262962.bSaint Louis University, 1438 South Grand Blvd., Suite 105, St. Louis, MO 63104 USA
| | - Willie Earley
- 0000 0004 0413 7987grid.417882.0Allergan, Harborside 5, 185 Hudson Street, Jersey City, NJ 07311 USA
| | - Andrew J. Cutler
- grid.477126.1Meridien Research, Inc., 8043 Cooper Creek Boulevard #107, Bradenton, FL 34201 USA
| | - Yao Wang
- 0000 0004 0413 7987grid.417882.0Allergan, Harborside 5, 185 Hudson Street, Jersey City, NJ 07311 USA
| | - Kaifeng Lu
- 0000 0004 0413 7987grid.417882.0Allergan, Harborside 5, 185 Hudson Street, Jersey City, NJ 07311 USA
| | - István Laszlovszky
- 0000 0004 0621 5862grid.418137.8Gedeon Richter, Plc, Gyömrői u. 32, Budapest, H-1103 Hungary
| | - György Németh
- 0000 0004 0621 5862grid.418137.8Gedeon Richter, Plc, Gyömrői u. 32, Budapest, H-1103 Hungary
| | - Suresh Durgam
- 0000 0004 0413 7987grid.417882.0Allergan, Harborside 5, 185 Hudson Street, Jersey City, NJ 07311 USA
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Nasrallah HA, Chen AT. Multiple neurotoxic effects of haloperidol resulting in neuronal death. Ann Clin Psychiatry 2017; 29:195-202. [PMID: 28738100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Several published studies have reported an association between antipsychotic medications, especially first-generation agents, and a decline in gray matter volume. This prompted us to review the possible neurotoxic mechanisms of first-generation antipsychotics (FGAs), especially haloperidol, which has been widely used over the past several decades. METHODS A PubMed search was conducted using the keywords haloperidol, antipsychotic, neurotoxicity, apoptosis, oxidative stress, and neuroplasticity. No restrictions were placed on the date of the articles or language. Studies with a clearly described methodology were included. RESULTS Animal, cell culture, and human tissue studies were identified. Thirty reports met the criteria for the search. All studies included haloperidol; a few also included other FGAs (fluphenazine and perphenazine) and/or second-generation agents (SGAs) (aripiprazole, paliperidone, and risperidone). A neurotoxic effect of haloperidol and other FGAs was a common theme across all studies. Minimal (mainly at high doses) or no neurotoxic effects were noted in SGAs. CONCLUSIONS A review of the literature suggests that haloperidol exerts measurable neurotoxic effects at all doses via many molecular mechanisms that lead to neuronal death. A similar effect was observed in 2 other FGAs, but the effect in SGAs was much smaller and occurred mainly at high doses. A stronger binding to serotonin 5HT-2A receptors than to dopamine D2 receptors may have a neuroprotective effect among SGAs. Further studies are warranted to confirm these findings.
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Nasrallah HA, Aquila R, Stanford AD, Jamal HH, Weiden PJ, Risinger R. Metabolic and Endocrine Profiles During 1-Year Treatment of Outpatients with Schizophrenia with Aripiprazole Lauroxil. Psychopharmacol Bull 2017; 47:35-43. [PMID: 28839338 PMCID: PMC5546549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND We assessed long-term metabolic and endocrine profiles of outpatients with schizophrenia participating in a one-year open-label extension study of monthly aripiprazole lauroxil (AL), a long-acting injectable antipsychotic. METHODS Patients (N = 478) were enrolled in a 52-week, open-label extension study of AL monotherapy administered by intramuscular injection every 4 weeks. Of these, most (368) received AL 882 mg and the remainder AL 441 mg as their fixed-dose regimen. Among the patients entering the long-term study, 181 (38%) had already received three prior AL injections. The baseline values for this analysis were obtained from the visit before the first AL injection. Patients were followed for the full year of the extension study unless they discontinued early. Changes in metabolic parameters (weight, fasting blood sugar, lipids) and serum prolactin were assessed over the duration of AL exposure, which could extend to a total of 16 AL injections. Data presented are last observation carried forward from baseline to last visit. RESULTS Most patients remained for most of the follow-up period, with 409 (86%) remaining at 6 months and 326 (68%) completing the one-year treatment period. The mean (standard deviation) changes from baseline in the overall population were: +1.1 (27.5) mg/dL for glucose, +0.07 (0.6)% for glycated hemoglobin (HbA1c), -3.3 (35.8) mg/dL for total cholesterol and -5.3 (101.9) mg/dL for triglycerides. Prolactin change from baseline was -8.7 ng/mL (14.7) for men and -14.9 (43.4) ng/mL for women. Overall, the mean weight change was +0.8 (5.9) kg. In terms of categorical weight change, 88 patients (18%) gained ≥7% body weight, and 59 (12%) lost ≥7% body weight. Overall, there was no clinically meaningful difference between any of these variables and AL dose. CONCLUSION Long-term treatment with AL in outpatients with schizophrenia was associated with a modest lowering of serum prolactin for both genders and relatively modest changes in average weight, fasting glucose, and HbA1c values. There appeared to be little net change in lipid parameters. This presentation extends a recently published report on the short-term metabolic and endocrine effects of AL over a period of 12 weeks. The present study increased the follow-up period to more than a year and was careful to use the first exposure to AL as the baseline. Limitations include lack of a comparison group and difficulty disentangling effects of medication treatment versus factors. Overall, the metabolic, weight, and endocrine effects reported here are consistent with other long-term effects of oral aripiprazole treatment. This study was funded by Alkermes, Inc.
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Affiliation(s)
- Henry A Nasrallah
- Dr. Nasrallah, MD, Department of Psychiatry & Behavioral Neuroscience, Saint Louis School of Medicine, St Louis, MO, USA; Dr. Aquila, MD, Fountain House, New York City, NY, USA; Drs. Stanford, MD, Jamal, MSc, Weiden, MD, Risinger, MD, Clinical Development and Medical Affairs, Alkermes, Inc., Waltham, MA, USA; Dr. Jamal, MSc, Previously at Alkermes, Inc., Waltham, MA, USA; Dr. Risinger, MD, NeuroRx Pharmaceuticals, Wilmington, DE, USA
| | - Ralph Aquila
- Dr. Nasrallah, MD, Department of Psychiatry & Behavioral Neuroscience, Saint Louis School of Medicine, St Louis, MO, USA; Dr. Aquila, MD, Fountain House, New York City, NY, USA; Drs. Stanford, MD, Jamal, MSc, Weiden, MD, Risinger, MD, Clinical Development and Medical Affairs, Alkermes, Inc., Waltham, MA, USA; Dr. Jamal, MSc, Previously at Alkermes, Inc., Waltham, MA, USA; Dr. Risinger, MD, NeuroRx Pharmaceuticals, Wilmington, DE, USA
| | - Arielle D Stanford
- Dr. Nasrallah, MD, Department of Psychiatry & Behavioral Neuroscience, Saint Louis School of Medicine, St Louis, MO, USA; Dr. Aquila, MD, Fountain House, New York City, NY, USA; Drs. Stanford, MD, Jamal, MSc, Weiden, MD, Risinger, MD, Clinical Development and Medical Affairs, Alkermes, Inc., Waltham, MA, USA; Dr. Jamal, MSc, Previously at Alkermes, Inc., Waltham, MA, USA; Dr. Risinger, MD, NeuroRx Pharmaceuticals, Wilmington, DE, USA
| | - Hasan H Jamal
- Dr. Nasrallah, MD, Department of Psychiatry & Behavioral Neuroscience, Saint Louis School of Medicine, St Louis, MO, USA; Dr. Aquila, MD, Fountain House, New York City, NY, USA; Drs. Stanford, MD, Jamal, MSc, Weiden, MD, Risinger, MD, Clinical Development and Medical Affairs, Alkermes, Inc., Waltham, MA, USA; Dr. Jamal, MSc, Previously at Alkermes, Inc., Waltham, MA, USA; Dr. Risinger, MD, NeuroRx Pharmaceuticals, Wilmington, DE, USA
| | - Peter J Weiden
- Dr. Nasrallah, MD, Department of Psychiatry & Behavioral Neuroscience, Saint Louis School of Medicine, St Louis, MO, USA; Dr. Aquila, MD, Fountain House, New York City, NY, USA; Drs. Stanford, MD, Jamal, MSc, Weiden, MD, Risinger, MD, Clinical Development and Medical Affairs, Alkermes, Inc., Waltham, MA, USA; Dr. Jamal, MSc, Previously at Alkermes, Inc., Waltham, MA, USA; Dr. Risinger, MD, NeuroRx Pharmaceuticals, Wilmington, DE, USA
| | - Robert Risinger
- Dr. Nasrallah, MD, Department of Psychiatry & Behavioral Neuroscience, Saint Louis School of Medicine, St Louis, MO, USA; Dr. Aquila, MD, Fountain House, New York City, NY, USA; Drs. Stanford, MD, Jamal, MSc, Weiden, MD, Risinger, MD, Clinical Development and Medical Affairs, Alkermes, Inc., Waltham, MA, USA; Dr. Jamal, MSc, Previously at Alkermes, Inc., Waltham, MA, USA; Dr. Risinger, MD, NeuroRx Pharmaceuticals, Wilmington, DE, USA
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Blanchard JJ, Bradshaw KR, Garcia CP, Nasrallah HA, Harvey PD, Casey D, Csoboth CT, Hudson JI, Julian L, Lentz E, Nuechterlein KH, Perkins DO, Skale TG, Snowden LR, Tandon R, Tek C, Velligan D, Vinogradov S, O'Gorman C. Examining the reliability and validity of the Clinical Assessment Interview for Negative Symptoms within the Management of Schizophrenia in Clinical Practice (MOSAIC) multisite national study. Schizophr Res 2017; 185:137-143. [PMID: 28087270 DOI: 10.1016/j.schres.2017.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 11/28/2022]
Abstract
The current study sought to expand on prior reports of the validity and reliability of the CAINS (CAINS) by examining its performance across diverse non-academic clinical settings as employed by raters not affiliated with the scale's developers and across a longer test-retest follow-up period. The properties of the CAINS were examined within the Management of Schizophrenia in Clinical Practice (MOSAIC) schizophrenia registry. A total of 501 participants with a schizophrenia spectrum diagnosis who were receiving usual care were recruited across 15 national Patient Assessment Centers and evaluated with the CAINS, other negative symptom measures, and assessments of functioning, quality of life and cognition. Temporal stability of negative symptoms was assessed across a 3-month follow-up. Results replicated the two-factor structure of the CAINS reflecting Motivation and Pleasure and expression symptoms. The CAINS scales exhibited high internal consistency and temporal stability. Convergent validity was supported by significant correlations between the CAINS subscales with other negative symptom measures. Additionally, the CAINS was significantly correlated with functioning and quality of life. Discriminant validity was demonstrated by small to moderate associations between the CAINS and positive symptoms, depression, and cognition (and these associations were comparable to those found with other negative symptom scales). Findings suggest that the CAINS is a reliable and valid tool for measuring negative symptoms in schizophrenia across diverse clinical samples and settings.
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Affiliation(s)
| | | | | | - Henry A Nasrallah
- Saint Louis University, 1438 S. Grand Boulevard, Saint Louis, MO 63104 3, USA
| | - Philip D Harvey
- University of Miami, Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, USA
| | - Daniel Casey
- Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | | | - James I Hudson
- Harvard Medical School/McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Laura Julian
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Ellen Lentz
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Keith H Nuechterlein
- University of California, Los Angeles, 300 UCLA Medical Plaza, Los Angeles, CA 90095-6968, USA
| | | | - Tracey G Skale
- Greater Cincinnati Behavioral Health Services, 1501 Madison Road, Walnut Hills, OH 45206, USA
| | | | - Rajiv Tandon
- University of Florida, Gainesville, FL 32611, USA
| | - Cenk Tek
- Yale University/Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519, USA
| | - Dawn Velligan
- University of Texas Health Science Center, 7703 Floyd Curl Dr. San Antonio, San Antonio, TX 78240, USA
| | - Sophia Vinogradov
- University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA; San Francisco Veterans Administration Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Cedric O'Gorman
- Formerly of Genentech. Currently at Intra-Cellular Therapies, Inc., 430 East 29th Street, New York City, NY 10016, USA
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Upadhyaya MA, Nasrallah HA. The intense desire for healthy limb amputation: A dis-proprioceptive neuropsychiatric disorder. Ann Clin Psychiatry 2017; 29:125-132. [PMID: 28463345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The first mention of a condition in which apparently nonpsychotic individuals have a strong, unrelenting desire to amputate ≥1 of their healthy limbs was published nearly 4 decades ago. Once dismissed as a paraphilia, the condition in recent years has been re-investigated with neurologic testing and imaging, yielding evidence suggesting it may be attributable to a neuroanatomical anomaly. METHODS A literature review of data was conducted of recently published studies with pinprick testing, magnetic resonance imaging (MRI)/functional MRI imaging, magnetoencephalography, and interviews of individuals with a desire for limb amputation. RESULTS Published literature on this condition features studies with a limited number of participants. However, the results indicate that affected individuals predominantly desire amputation of the left lower limb, and correspondingly, usually have changes in cortical thickness in the right parietal lobe. CONCLUSIONS Further investigation of this condition is warranted, particularly, more research into the precise nature of the anomalous neuroanatomy, biopsychosocial background of those with the condition, and longitudinal perspective of the childhood onset and evolution of symptoms. Large sample studies involving a collaborative effort across multiple sites are required.
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Durgam S, Landbloom RP, Mackle M, Wu X, Mathews M, Nasrallah HA. Exploring the long-term safety of asenapine in adults with schizophrenia in a double-blind, fixed-dose, extension study. Neuropsychiatr Dis Treat 2017; 13:2021-2035. [PMID: 28814871 PMCID: PMC5546824 DOI: 10.2147/ndt.s130211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The primary objective of this study was to assess long-term safety with sublingual asenapine 2.5 or 5 mg twice daily (BID) in patients with schizophrenia. PATIENTS AND METHODS Actively treated patients on asenapine 2.5 mg BID, asenapine 5 mg BID, or olanzapine 15 mg once daily (QD) who completed a 6-week randomized, double-blind, placebo- and olanzapine-controlled study continued lead-in treatment in this 26-week, multicenter, double-blind, double-dummy, olanzapine-controlled Phase IIIB extension study; placebo patients were assigned to asenapine 2.5 mg BID treatment. Safety analyses were based on the all treated set (patients who received one or more doses of extension trial medication); change from baseline analyses used the acute study baseline. Treatment-emergent adverse events (TEAEs) and changes in laboratory parameters were monitored; weight change for asenapine versus olanzapine was the key secondary objective. Descriptive statistics were used; weight change was analyzed using a mixed-model repeated-measure approach. RESULTS Of the 120 patients in the all-treated set, 60% completed treatment (asenapine 2.5 mg BID 66.1% overall, asenapine 5 mg BID 52.4%, olanzapine 15 mg QD 56.3%). The incidence of TEAEs was higher for placebo patients from the lead-in study who switched to asenapine 2.5 mg BID for extension treatment (71.0%) versus patients continuing asenapine 2.5 mg BID (38.7%), asenapine 5 mg BID (38.1%), or olanzapine 15 mg QD (25.0%). The most common TEAE (≥5% in every group) was worsening of schizophrenia. Least squares mean change in body weight from the acute study baseline to week 26 was +0.6 kg for overall asenapine 2.5 mg BID, +0.8 kg for asenapine 5 mg BID, and +1.2 kg for olanzapine 15 mg QD. There were no clinically relevant changes in metabolic parameters; values were generally similar across treatment groups. CONCLUSION Asenapine 2.5 mg BID and 5 mg BID were generally well tolerated in long-term treatment. Weight gain was less for overall asenapine 2.5 mg BID and 5 mg BID than for olanzapine 15 mg QD.
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Affiliation(s)
| | | | | | | | - Maju Mathews
- Forest Research Institute (now Allergan), Jersey City, NJ
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Nasrallah HA, Newcomer JW, Risinger R, Du Y, Zummo J, Bose A, Stankovic S, Silverman BL, Ehrich EW. Effect of Aripiprazole Lauroxil on Metabolic and Endocrine Profiles and Related Safety Considerations Among Patients With Acute Schizophrenia. J Clin Psychiatry 2016; 77:1519-1525. [PMID: 27574838 DOI: 10.4088/jcp.15m10467] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 03/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Aripiprazole lauroxil, a long-acting injectable antipsychotic, demonstrated safety and efficacy in treating symptoms of schizophrenia in a double-blind, placebo-controlled trial. Because the metabolic profile of antipsychotics is an important safety feature, the effects of aripiprazole lauroxil on body weight, endocrine and metabolic profiles, and safety were examined in a secondary analysis. METHODS Patients with schizophrenia (DSM-IV-TR criteria) were randomly assigned to aripiprazole lauroxil 441 mg, aripiprazole lauroxil 882 mg, or placebo intramuscularly once monthly between December 2011 and March 2014. Changes in body weight, body mass index, fasting blood glucose and serum lipids, glycosylated hemoglobin (HbA1c), and prolactin over 12 weeks were assessed. The incidence of treatment-emergent adverse events (AEs) was evaluated. RESULTS Among 622 randomized patients, no clinically relevant changes from baseline to week 12 were observed for any serum lipid, lipoprotein, plasma glucose, or HbA1c value with placebo or either dose of aripiprazole lauroxil. Both doses of aripiprazole lauroxil were associated with reductions in mean prolactin levels, whereas placebo treatment was not. The mean (standard deviation) change from baseline for body weight was 0.74 (3.9) kg, 0.86 (3.7) kg, and 0.01 (3.6) kg for aripiprazole lauroxil 441 mg, aripiprazole lauroxil 882 mg, and placebo groups, respectively. AEs related to metabolic parameters were reported in 2.4%, 1.4%, and 2.4% of patients in the aripiprazole lauroxil 441 mg, aripiprazole lauroxil 882 mg, and placebo groups, respectively. CONCLUSIONS Aripiprazole lauroxil was well tolerated, with a low-risk metabolic profile relative to published data for other antipsychotics. Changes similar to those observed with placebo were observed in the aripiprazole lauroxil groups for metabolic parameters, with modest weight gain in the active treatment groups over the 12-week course. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01469039.
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Affiliation(s)
- Henry A Nasrallah
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, 1438 S. Grand Blvd, St Louis, MO 63104. .,Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - John W Newcomer
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
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Durgam S, Earley W, Li R, Li D, Lu K, Laszlovszky I, Fleischhacker WW, Nasrallah HA. Long-term cariprazine treatment for the prevention of relapse in patients with schizophrenia: A randomized, double-blind, placebo-controlled trial. Schizophr Res 2016; 176:264-271. [PMID: 27427558 DOI: 10.1016/j.schres.2016.06.030] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 02/04/2023]
Abstract
Cariprazine, a dopamine D3/D2 receptor partial agonist with preference for D3 receptors, has demonstrated efficacy in randomized controlled trials in schizophrenia. This multinational, randomized, double-blind, placebo-controlled, parallel-group study evaluated the efficacy, safety, and tolerability of cariprazine for relapse prevention in adults with schizophrenia; total study duration was up to 97weeks. Schizophrenia symptoms were treated/stabilized with cariprazine 3-9mg/d during 20-week open-label treatment consisting of an 8-week, flexible-dose run-in phase and a 12-week fixed-dose stabilization phase. Stable patients who completed open-label treatment could be randomized to continued cariprazine (3, 6, or 9mg/d) or placebo for double-blind treatment (up to 72weeks). The primary efficacy parameter was time to relapse (worsening of symptom scores, psychiatric hospitalization, aggressive/violent behavior, or suicidal risk); clinical measures were implemented to ensure safety in case of impending relapse. A total of 264/765 patients completed open-label treatment; 200 eligible patients were randomized to double-blind placebo (n=99) or cariprazine (n=101). Time to relapse was significantly longer in cariprazine- versus placebo-treated patients (P=.0010, log-rank test). Relapse occurred in 24.8% of cariprazine- and 47.5% of placebo-treated patients (hazard ratio [95% CI]=0.45 [0.28, 0.73]). Akathisia (19.2%), insomnia (14.4%), and headache (12.0%) were reported in ≥10% of patients during open-label treatment; there were no cariprazine adverse events ≥10% during double-blind treatment. Long-term cariprazine treatment was significantly more effective than placebo for relapse prevention in patients with schizophrenia. The long-term safety profile in this study was consistent with the safety profile observed in previous cariprazine clinical trials. ClincalTrials.gov identifier: NCT01412060.
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Affiliation(s)
| | | | - Rui Li
- Allergan, Inc., Jersey City, NJ, USA
| | - Dayong Li
- Allergan, Inc., Jersey City, NJ, USA
| | | | | | - W Wolfgang Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
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Keshavan MS, Lawler AN, Nasrallah HA, Tandon R. New drug developments in psychosis: Challenges, opportunities and strategies. Prog Neurobiol 2016; 152:3-20. [PMID: 27519538 DOI: 10.1016/j.pneurobio.2016.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 02/06/2023]
Abstract
All currently approved drugs for schizophrenia work mainly by dopaminergic antagonism. While they are efficacious for psychotic symptoms, their efficacy is limited for negative symptoms and cognitive deficits which underlie the substantive disability in this illness. Recent insights into the biological basis of schizophrenia, especially in relation to non-dopaminergic mechanisms, have raised the efforts to find novel and effective drug targets, though with relatively little success thus far. Potential impediments to novel drug discovery include the continued use of symptom based disease definitions which leads to etiological and pathophysiological heterogeneity, lack of valid preclinical models for drug testing, and design limitations in clinical trials. These roadblocks can be addressed by (i) characterizing trans-diagnostic, translational pathophysiological dimensions as potential treatment targets, (ii) efficiency, accountability and, transparency in approaches to the clinical trials process, and (iii) leveraging recent advances in genetics and in vitro phenotypes. Accomplishing these goals is urgent given the significant unmet needs in the pharmacological treatment of schizophrenia. As this happens, it is imperative that clinicians employ optimal dosing, measurement-based care, and other best practices in utilizing existing treatments to optimize outcomes for their patients today.
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Affiliation(s)
- Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, United States.
| | - Ashley N Lawler
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, United States
| | - Henry A Nasrallah
- Department of Neurology & Psychiatry, St Louis University, United States
| | - Rajiv Tandon
- Department of Psychiatry, University of Florida, Gainsville, Florida. and the North FL/South Georgia Veterans' Administration Medical Center, Gainesville, FL 32610, United States; The North Florida/South Georgia Veterans' Administration Medical Center, Gainesville, FL, 32610, United States
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Chen AT, Chibnall JT, Nasrallah HA. Placebo-controlled augmentation trials of the antioxidant NAC in schizophrenia: A review. Ann Clin Psychiatry 2016; 28:190-6. [PMID: 27490835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Several studies have reported that schizophrenia is associated with mitochondrial abnormalities, glutathione deficit, and increased brain oxidative stress (free radicals). N-acetylcysteine (NAC) is a strong antioxidant with potential therapeutic benefit in schizophrenia, according to some reports. We conducted a review of the published controlled studies, with the goal of determining the efficacy profile of NAC as an adjunctive treatment for schizophrenia. METHODS An online search was conducted for all placebo-controlled, double-blind, randomized clinical trials of NAC in schizophrenia, and a review was conducted. RESULTS Two studies met the criteria for inclusion. Berk et al (2008) used NAC as an adjunctive treatment to atypical antipsychotics in subjects with chronic schizophrenia who were stable on antipsychotic medications. Treatment at 8 weeks was less efficacious than placebo, but at 24 weeks produced significant reductions vs placebo in Positive and Negative Syndrome Scale (PANSS) negative (d = 0.52), general (d = 0.46), and total (d = 0.57) scores. Farokhnia et al (2013) used NAC as an adjunctive treatment to risperidone in subjects with chronic schizophrenia who were experiencing an acute exacerbation episode. Eight weeks of treatment led to clinically significant reductions vs placebo in PANSS negative (d = 0.96), general (d = 0.59), and total (d = 0.88) scores. CONCLUSIONS The data suggest that adjunctive NAC may be efficacious in reducing negative and general symptoms in schizophrenia.
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Affiliation(s)
- Alexander T Chen
- Department of Psychiatry, Saint Louis University School of Medicine, St. Louis, MO USA
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Nasrallah HA. A Valedictory from the Founding Editors. Schizophr Res 2016; 175:1. [PMID: 27444217 DOI: 10.1016/j.schres.2016.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Schizophrenic illness encompasses diverse clinical phenomena and consists of unclear underlying pathogeneses. For the past century, the comorbidities in schizophrenia have drawn persistent interest and debate due to its high prevalence rate and a need for better management. However, its clinical and biological diversity continue to challenge both the practicing clinicians and researchers. Emerging clinical and research evidence in the past decade suggest a distinct biopsychosocial pathogenesis and unique clinical attributes in some comorbid disorders in patients with schizophrenia. In addition, current evidence also supports improved outcomes with specific assessment and treatment of these subgroup of schizophrenia. The recent changes in DSV-5 and shift in the NIMH focus towards the real world clinical practice and research provide increased impetus to explore the pathogeneses and treatment of schizophrenia with comorbid disorders.
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Affiliation(s)
- Sun Young Yum
- Department of Clinical Medical Science, Seoul National University, Seoul, South Korea
| | - Michael Y Hwang
- Department of Psychiatry, New York Medical College, Franklin Delano Roosevelt VA Medical Center (116), 2094 Albany Post Road, Montrose, NY 10548, USA.
| | - Henry A Nasrallah
- Department of Psychiatry, St Louis University, St Louis, MO 63104, USA
| | - Lewis A Opler
- Predoctoral Program in Clinical Psychology, Long Island University, Brookville, NY 11548, USA
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Aboraya A, Nasrallah HA. Perspectives on the Positive and Negative Syndrome Scale (PANSS): Use, misuse, drawbacks, and a new alternative for schizophrenia research. Ann Clin Psychiatry 2016; 28:125-31. [PMID: 26855990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND In 1987, Kay et al published the Positive and Negative Syndrome Scale (PANSS) and the PANSS manual to address the limitations of existing instruments for schizophrenia research. The PANSS has been one of the most widely used instruments in schizophrenia research-until now. Because of recent advances in neuroscience research, it has become essential to reevaluate the performance of the PANSS since its development 3 decades ago. METHODS A comprehensive literature review of the PANSS from 1987 to 2015 using a PubMed search was conducted. RESULTS Five drawbacks to the PANSS have been cited in the literature. Although several authors have pointed out flaws of the PANSS, no revisions or modifications have been attempted to address them. In addition, some researchers do not use the PANSS as intended by the authors, and other researchers misuse it. CONCLUSIONS The PANSS is a reliable and valid instrument that has served the scientific research community well for decades. New advances in experimental psychopathology and personalized psychiatry and the new National Institute of Mental Health paradigm of Research Domain Criteria necessitate a new instrument compatible with advances in clinical neuroscience research.
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Affiliation(s)
- Ahmed Aboraya
- William R. Sharpe Jr. Hospital, Weston, West Virginia, USA, West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia, USA, West Virginia University School of Public Health, Morgantown, WV USA. E-mail:
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Gondim FDAA, Thomas FP, Cruz-Flores S, Nasrallah HA, Selhorst JB. Pathological laughter and crying: A case series and proposal for a new classification. Ann Clin Psychiatry 2016; 28:11-21. [PMID: 26855981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Disorders of laughter and crying (DLC) are seen in several neuropsychiatric conditions. Their nomenclature remains under debate. METHODS We present the clinical and imaging findings of 17 patients with DLC and introduce a new classification based on phenomenology and pathogenesis. According to intensity and frequency of laughter and crying (observed behavioral output), patients were divided into hypoactive or hyperactive DLC and subdivided into 5 subtypes: sensory (positive and negative), motor (positive and negative), and mixed. The sensory subtype is represented by disorders of "feeling processing," whereas the motor subtype is represented by disorders of "emotion processing." "Positive" and "negative" describe elicitation by irritative vs destructive lesions, respectively. RESULTS Among the patients studied, DLC resulted from ischemic stroke (n = 12), intracerebral hemorrhage (n = 2), gunshot wound (n = 1), amyotrophic lateral sclerosis (n = 1), or vestibular migraine (n = 1). Ten patients had lesions in the brainstem, 4 in the cerebral hemispheres, and 2 in sub-cortical-diencephalic structures. Six patients had negative motor DLC, 5 had positive sensory DLC, 4 had negative sensory DLC, and 2 had positive motor DLC. Phenomenology changed or progressed to mixed DLC in 7 patients. CONCLUSIONS This novel phenomenological and pathomechanistic nomenclature explains all subtypes of DLC in neurologic, medical, and psychiatric conditions. Future studies are needed to validate it prospectively.
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Affiliation(s)
- Francisco de Assis Aquino Gondim
- Department of Neurology,Saint Louis University School of Medicine, St. Louis, MO, USA, Departamento de Clínica Médica, Universidade Federal do Ceará,Fortaleza, Brazil E-mail:
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Lawson W, Johnston S, Karson C, Offord S, Docherty J, Eramo A, Kamat S, Blanchette CM, Carson W, Nasrallah HA. Racial differences in antipsychotic use: Claims database analysis of Medicaid-insured patients with schizophrenia. Ann Clin Psychiatry 2015; 27:242-52. [PMID: 26554365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Database analyses have indicated that medical treatment for schizophrenia varies among racial groups. This study assessed antipsychotic use and healthcare utilization across races in Medicaid-insured patients with schizophrenia. METHODS A Medicaid database of inpatient/outpatient medical claims and outpatient prescription claims for more than 28 million enrollees in 11 geographically diverse states was analyzed. The primary outcome, racial differences in antipsychotic use in 2012, was examined in 5 multivariable logistic regression models: (1) any antipsychotic, (2) first-generation (FG) long-acting injectables (LAIs), (3) FG oral antipsychotics, (4) second-generation (SG) LAIs, and (5) SG oral antipsychotics. RESULTS Odds ratios and adjusted predicted probabilities were comparable for any antipsychotic use between black and white patients. Black patients were less likely to receive SG oral antipsychotics (P < .001) and more likely to receive SG or FG LAIs (P = .001 and P < .001, respectively) and FG oral antipsychotics (P = .003) vs white patients. Further, black patients had a higher mean number of emergency room visits (P < .001) and a lower mean number of hospitalizations (P < .05) vs white patients; the mean number of physician visits was comparable. CONCLUSIONS Disparities in antipsychotic use and healthcare utilization across races in patients with schizophrenia warrant further investigation and elimination of these disparities should be a national goal.
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Chen AT, Chibnall JT, Nasrallah HA. A meta-analysis of placebo-controlled trials of omega-3 fatty acid augmentation in schizophrenia: Possible stage-specific effects. Ann Clin Psychiatry 2015; 27:289-96. [PMID: 26554370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Omega-3 fatty acids have shown promise as an adjunctive treatment for schizophrenia. However, efficacy across studies has been inconsistent. We conducted a meta-analysis of published controlled studies with the goal of detecting different efficacy profiles at various stages of schizophrenia. METHODS An online search was conducted for randomized, double-blind, placebo-controlled clinical trials, and a meta-analysis was conducted. RESULTS Ten studies met the criteria for inclusion. Among patients in the prodromal phase of schizophrenia, omega-3 supplementation reduced psychotic symptom severity and lowered conversion rates to first-episode psychosis. In patients with first-episode schizophrenia, omega-3 decreased nonpsychotic symptoms, required lower antipsychotic medication dosages, and improved early treatment response rates. Omega-3 had mixed results in patients with stable chronic schizophrenia, with only some patients experiencing significant benefits. Among patients with chronic schizophrenia, use of omega-3 fatty acids both by those experiencing acute exacerbations and those who had discontinued antipsychotic medications resulted in worsening of psychotic symptoms. CONCLUSIONS The data suggest that omega-3 fatty acids may be efficacious in reducing clinical symptoms for patients in the earlier stages of schizophrenia (prodrome and first episode), while producing mixed results for patients in the chronic stages. Based on these results, omega-3 fatty acids would not be recommended for acute exacerbations in patients with chronic schizophrenia nor for relapse prevention after discontinuation of antipsychotics.
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Affiliation(s)
- Alexander T Chen
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, MO USA. E-MAIL:
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Abstract
Bipolar depression is difficult to diagnose and is often mistaken for unipolar depression. Unfortunately, this misdiagnosis creates a cascade of negative outcomes. Patients will probably receive inadequate or inappropriate treatment that will not alleviate the symptoms or impairment of the disorder and may even further destabilize their mood. These individuals are then at risk for experiencing numerous social and occupational impairments, alcohol or substance abuse, and suicidal behavior. An accurate diagnosis and appropriate treatment of bipolar disorder are necessary to prevent this chain of potentially disastrous events.
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Affiliation(s)
- Henry A Nasrallah
- From the Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, MO
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Serafini G, Gonda X, Rihmer Z, Pompili M, Girardi P, Nasrallah HA, Amore M. NMDA receptor antagonists for depression: Critical considerations. Ann Clin Psychiatry 2015; 27:213-20. [PMID: 26247220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Research studies suggest that glutamate dysfunction, in particular N-methyl-D-aspartate receptors (NMDARs) abnormalities, may be involved in the pathophysiology of major neuropsychiatric conditions. Increased glutamatergic excitotoxic activity may be found in some brain circuits of patients with major depression. According to several published reports, NMDAR antagonists may exert antidepressant activity, but the molecular changes associated with abnormal glutamatergic neurotransmission remain unclear. METHODS We have critically reviewed the current literature in order to investigate the role of NMDAR antagonists in major depression. RESULTS NMDAR antagonists, such as ketamine, may be considered novel and promising pharmacological options for the rapid treatment of treatment-resistant depression patients. This is in contrast to the delayed action of the currently available antidepressant medications. Studies suggest that glutamatergic receptor modulation may enhance neuroplasticity mechanisms and neurogenesis together with the release of some neurotransmitters. Unfortunately, the use of ketamine is currently limited by some transient adverse events, including dissociative symptoms. CONCLUSIONS Targeting NMDARs using antagonists represents an important alternative antidepressant option in major depression. However, NMDAR antagonists may exert different actions based on the differential brain location of NMDAR.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy . E-MAIL:
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