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Franz M, Papiol S, Simon MS, Barton BB, Glockner C, Spellmann I, Riedel M, Heilbronner U, Zill P, Schulze TG, Musil R. Association of clinical parameters and polygenic risk scores for body mass index, schizophrenia, and diabetes with antipsychotic-induced weight gain. J Psychiatr Res 2024; 169:184-190. [PMID: 38042056 DOI: 10.1016/j.jpsychires.2023.11.038] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023]
Abstract
Antipsychotic-induced weight gain (AIWG) is a common adverse event in schizophrenia. Genome-wide association studies (GWAS) and polygenic risk scores (PRS) for other diseases or traits are recent approaches to disentangling the genetic architecture of AIWG. 200 patients with schizophrenia treated monotherapeutically with antipsychotics were included in this study. A multiple linear regression analysis with ten-fold crossvalidation was performed to predict the percentage weight change after five weeks of treatment. Independent variables were sex, age, body mass index (BMI) at baseline, medication-associated risk, and PRSs (BMI, schizophrenia, diabetes, and metabolic syndrome). An explorative GWAS analysis was performed on the same subjects and traits. PRSs for BMI (β = 3.78; p = 0.0041), schizophrenia (β = 5.38; p = 0.021) and diabetes type 2 (β = 13.4; p = 0.046) were significantly associated with AIWG. Other significant factors were sex, baseline BMI and medication. Compared to the model without genetic factors, the addition of PRSs for BMI, schizophrenia, and diabetes type 2 increased the goodness of fit by 6.5 %. The GWAS identified the association of three variants (rs10668573, rs10249381 and rs1988834) with AIWG at a genome-wide level of p < 1 · 10-6. Using PRS for schizophrenia, BMI, and diabetes type 2 increased the explained variation of predicted weight gain, compared to a model without PRSs. For more precise results, PRSs derived from other traits (ideally AIWG) should be investigated. Potential risk variants identified in our GWAS need to be further investigated and replicated in independent samples.
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Affiliation(s)
- Maria Franz
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Sergi Papiol
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany; Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, 80336, Germany
| | - Maria S Simon
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany.
| | - Barbara B Barton
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Catherine Glockner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Ilja Spellmann
- Zentrum für Seelische Gesundheit, Klinikum Stuttgart, Stuttgart, 70174, Germany
| | | | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, 80336, Germany
| | - Peter Zill
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, 80336, Germany; Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany
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Heres S, Cordes J, Feyerabend S, Schmidt-Kraepelin C, Musil R, Riedel M, Spellmann I, Langguth B, Landgrebe M, Fran E, Petcu C C, Hahn E, Ta TMT, Matei V, Dehelean L, Papava I, Leweke FM, van der List T, Tamasan SC, Lang FU, Naber D, Ruhrmann S, Wolff-Menzler C, Juckel G, Ladea M, Stefanescu C, Lautenschlager M, Bauer M, Zamora D, Horowitz M, Davis JM, Leucht S. Changing the Antipsychotic in Early Nonimprovers to Amisulpride or Olanzapine: Randomized, Double-Blind Trial in Patients With Schizophrenia. Schizophr Bull 2022; 48:1273-1283. [PMID: 35857811 PMCID: PMC9673269 DOI: 10.1093/schbul/sbac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Meta-analyses have shown that the majority of patients with schizophrenia who have not improved after 2 weeks of treatment with an antipsychotic drug are unlikely to fully respond later. We hypothesized that switching to another antipsychotic with a different receptor binding profile is an effective strategy in such a situation. STUDY DESIGN In total, 327 inpatients with an acute exacerbation of schizophrenia were randomized to double-blind treatment with either olanzapine (5-20 mg/day) or amisulpride (200-800 mg/day). Those patients who had not reached at least 25% Positive-and-Negative-Syndrome-Scale (PANSS) total score reduction from baseline after 2 weeks (the "non-improvers") were rerandomized double-blind to either staying on the same compound ("stayers") or to switching to the other antipsychotic ("switchers") for another 6 weeks. The primary outcome was the difference in the number of patients in symptomatic remission between the combined "switchers" and the "stayers" after 8 weeks of treatment, analyzed by logistic regression. STUDY RESULTS A total of 142 nonimprovers were rerandomized at week two. 25 (45.5 %) of the 'stayers' compared to 41 (68.3 %) of the "switchers" reached remission at endpoint (p = .006). Differences in secondary efficacy outcomes were not significant, except for the PANSS negative subscore and the Clinical-Global-Impression-Scale. "Switchers" and "stayers" did not differ in safety outcomes. CONCLUSIONS Switching "non-improvers" from amisulpride to olanzapine or vice-versa increased remission rates and was safe. The superiority in the primary outcome was, however, not paralleled by significant differences in most secondary efficacy outcomes and the effect was only apparent at the last visit making replications of longer duration necessary.
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Affiliation(s)
- Stephan Heres
- To whom correspondence should be addressed; Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine Kbo-Klinik für Psychiatrie und Psychotherapie Nord, Schwabing, kbo-Tagesklinik und Institutsambulanz Nord des Isar-Amper-Klinikums München Ost Kölner Platz 1, Haus 7 80804 Munich, Germany, tel: 49 (0) 89 412 006 158, fax: 49 (0) 89 412 006 172, e-mail:
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, LVR-Clinic Düsseldorf, Medical Faculty, Heinrich-Heine-University, Duesseldorf NW, Germany,Department of Psychiatry and Psychotherapy, Kaiserswerther Diakonie, Florence Nightingale Hospital, Düsseldorf NW, Germany
| | - Sandra Feyerabend
- Department of Psychiatry and Psychotherapy, LVR-Clinic Düsseldorf, Medical Faculty, Heinrich-Heine-University, Duesseldorf NW, Germany,Department of Psychiatry and Psychotherapy, Kaiserswerther Diakonie, Florence Nightingale Hospital, Düsseldorf NW, Germany
| | - Christian Schmidt-Kraepelin
- Department of Psychiatry and Psychotherapy, LVR-Clinic Düsseldorf, Medical Faculty, Heinrich-Heine-University, Duesseldorf NW, Germany,Department of Psychiatry and Psychotherapy, Kaiserswerther Diakonie, Florence Nightingale Hospital, Düsseldorf NW, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University of Munich, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University of Munich, Munich, Germany,Marion von Tessin Memory-Zentrum GmbH, Munich BY, Germany
| | - Ilja Spellmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University of Munich, Munich, Germany,Klinikum Stuttgart, Zentrum für Seelische Gesundheit, Stuttgart BW, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg BY, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg BY, Germany,Department of Psychiatry and Psychotherapy, kbo Lech-Mangfall-Hospital Agatharied, St.-Agatha-Str. 1a, 83734 Hausham BY, Germany
| | - Elmar Fran
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg BY, Germany
| | - Camelia Petcu C
- Psychiatry Department, University of Medicine and Pharmacy ”Carol Davila” Bucharest, ”Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Berceni Str 10-12, Bucharest, Romania
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Tam M T Ta
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Valentin Matei
- Psychiatry Department, University of Medicine and Pharmacy ”Carol Davila” Bucharest, ”Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Berceni Str 10-12, Bucharest, Romania
| | - Liana Dehelean
- Department of Neurosciences-Psychiatry, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Centre for Cognitive Research in Neuropsychiatric Pathology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Center for Translational Research, and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Center for Studies in Preventive Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania
| | - Ion Papava
- Department of Neurosciences-Psychiatry, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Centre for Cognitive Research in Neuropsychiatric Pathology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania
| | - F Markus Leweke
- Brain and Mind Centre, The University of Sydney, 94 Mallet St, Camperdown NSW 2050, Sydney, Australia,Central Institute of Mental Health, Heidelberg University I5, 68159 Mannheim BW, Germany
| | - Till van der List
- Central Institute of Mental Health, Heidelberg University I5, 68159 Mannheim BW, Germany,Practise for Psychiatry and Psychotherapie Nowackanlage 15, 76137 Karlsruhe BW, Germany
| | - Simona C Tamasan
- Liaison Psychiatry, “Pius Branzeu” County Emergency Hospital, Timisoara TS, Romania
| | - Fabian U Lang
- Department of Psychiatry II, Ulm University, Ulm BW, Germany
| | - Dieter Naber
- Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne NW, Germany
| | - Claus Wolff-Menzler
- Klinik für Psychiatrie und Psychotherapie Universitätsmedizin Göttingen, Göttingen, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL University Hospital, Psychotherapy and Preventive Medicine Ruhr University, Bochum, Germany
| | - Maria Ladea
- DMU IMPACT (Departement Medico-Universitaire de Psychiatrie et d'Addictologie) Groupe Hospitalier Henri MONDOR, Créteil, France
| | | | - Marion Lautenschlager
- ZfP Südwürttemberg, Bad Schussenried, Germany,Charité University Medicine, Campus Mitte, Berlin BE, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| | - Daisy Zamora
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany,Department of Psychiatry, UNC School of Medicine, 321 S Columbia St, Chapel Hill, NC 27599, USA
| | - Mark Horowitz
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
| | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
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Seemüller F, Riedel M, Obermeier M, Schennach-Wolff R, Spellmann I, Meyer S, Bauer M, Adli M, Kronmüller K, Ising M, Brieger P, Laux G, Bender W, Heuser I, Zeiler J, Gaebel W, Möller HJ. The validity of self-rated psychotic symptoms in depressed inpatients. Eur Psychiatry 2020; 27:547-52. [DOI: 10.1016/j.eurpsy.2011.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/23/2010] [Accepted: 01/03/2011] [Indexed: 12/22/2022] Open
Abstract
AbstractBackgroundSelf-ratings of psychotic experiences might be biased by depressive symptoms.MethodData from a large naturalistic multicentre trial on depressed inpatients (n = 488) who were assessed on a biweekly basis until discharge were analyzed. Self-rated psychotic symptoms as assessed with the 90-Item Symptom Checklist (SCL-90) were correlated with the SCL-90 total score, the SCL-90 depression score, the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale 21 item (HAMD-21) total score, the Montgomery Åsberg Depression Rating Scale (MADRS) total score and the clinician-rated paranoid-hallucinatory score of the Association for Methodology and Documentation in Psychiatry (AMDP) scale.ResultsAt discharge the SCL-90 psychosis score correlated highest with the SCL-90 depression score (0.78, P<0.001) and with the BDI total score (0.64, P<0.001). Moderate correlations were found for the MADRS (0.34, P<0.001), HAMD (0.37, P<0.001) and AMDP depression score (0.33, P<0.001). Only a weak correlation was found between the SCL-90 psychosis score and the AMDP paranoid-hallucinatory syndrome score (0.15, P<0.001). Linear regression showed that change in self-rated psychotic symptoms over the treatment course was best explained by a change in the SCL-90 depression score (P<0.001). The change in clinician-rated AMDP paranoid-hallucinatory score had lesser influence (P = 0.02).ConclusionsIn depressed patients self-rated psychotic symptoms correlate poorly with clinician-rated psychotic symptoms. Caution is warranted when interpreting results from epidemiological surveys using self-rated psychotic symptom questionnaires as indicators of psychotic symptoms. Depressive symptoms which are highly prevalent in the general population might influence such self-ratings.
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Schennach R, Riedel M, Spellmann I, Musil R, Obermeier M, Jäger M, Bottlender R, Schmauss M, Laux G, Möller HJ. Correction: Comparing Schizophrenia Patients With a Predicted High/Low Risk of Nonresponse Receiving Treatment with Ziprasidone and Haloperidol: A Randomized-Controlled Study. Pharmacopsychiatry 2020; 52:e1. [PMID: 32102096 DOI: 10.1055/a-1123-8803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Rebecca Schennach
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Michael Riedel
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Psychiatric Clinic Rodewisch, Rodewisch, Germany
| | - Ilja Spellmann
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Psychiatric Clinic, Stuttgart, Germany
| | - Richard Musil
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Obermeier
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Markus Jäger
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Psychiatric Clinic, District Hospital Kempten, Kempten, Germany
| | - Roland Bottlender
- Psychiatric Clinic, District Hospital Lüdenscheid, Lüdenscheid, Germany
| | - Max Schmauss
- Psychiatric Clinic, District Hospital Augsburg, Augsburg, Germany
| | - Gerd Laux
- Psychiatric Clinic, Inn-Salzach Hospital Wasserburg/Inn, Wasserburg, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
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Schennach R, Obermeier M, Spellmann I, Seemüller F, Musil R, Jäger M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Bauer M, Adli M, Zeiler J, Bender W, Kronmüller KT, Ising M, Brieger P, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Möller HJ, Riedel M. Remission in schizophrenia - What are we measuring? Comparing the consensus remission criteria to a CGI-based definition of remission and to remission in major depression. Schizophr Res 2019; 209:185-192. [PMID: 31138482 DOI: 10.1016/j.schres.2019.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 03/03/2019] [Accepted: 04/26/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite being recommended for use in clinical trials, the consensus remission criteria were found to leave patients with persisting symptoms, relevant areas of functional impairment and a decreased sense of wellbeing. Therefore, to evaluate the appropriateness of the schizophrenia consensus criteria, a definition of remission based on the Clinical Global Impression Scale (CGI) was developed and remitter subgroups were compared. METHODS 239 patients with a schizophrenia spectrum disorder were evaluated regarding their remission status after inpatient treatment. Remission in schizophrenia was defined according to the symptom-severity component of the consensus criteria by Andreasen et al. and a CGI based definition was calculated using sensitivity and specificity using receiver operating curves (asymptomatic remitter). Both remitter groups (schizophrenia consensus versus asymptomatic remitters) were compared regarding different clinical variables at discharge as well as the likelihood to relapse within a 1-year follow-up period. Both schizophrenia remitter subgroups were compared to remitters in major depression as a reference value. RESULTS Following the consensus criteria, 63% of the schizophrenia patients were in remission compared to only 18% following the asymptomatic criterion. The schizophrenia consensus remitters were less likely to be concurrent treatment responders (p < 0.0001), had a significantly greater illness severity (p < 0.0001) and less functioning (p = 0.0358) as well as a significantly greater risk to relapse (p = 0.0174) compared to the schizophrenia asymptomatic remitters as well as the depressed remitters. CONCLUSION It should be critically re-evaluated if the currently proposed consensus criteria are adequate to measure what is traditionally understood to be remission.
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Affiliation(s)
- Rebecca Schennach
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Schön Clinic Roseneck, Germany.
| | - Michael Obermeier
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Ilja Spellmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Department of Special Psychiatry, Social Psychiatry and Psychotherapy, Klinikum Stuttgart, Germany
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Markus Jäger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Department of Psychiatry, Psychosomatic and Psychotherapy, Bezirkskrankenhaus Kempten, Germany
| | - Max Schmauss
- Psychiatric Clinic, District Hospital Augsburg, Germany
| | - Gerd Laux
- Psychiatric Clinic, Inn-Salzach Hospital Wasserburg/Inn, Germany
| | - Herbert Pfeiffer
- Department of Psychiatry and Psychotherapy Munich East, kbo-Isar-Amper-Klinikum Haar, Germany
| | - Dieter Naber
- Department of Psychiatry and Psychotherapy, University of Hamburg, Germany
| | - Lutz G Schmidt
- Department of Psychiatry and Psychotherapy, University of Mainz, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Dusseldorf, Germany
| | | | - Isabella Heuser
- Department of Psychiatry and Psychotherapy, Charite Berlin, Campus Benjamin Franklin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Joachim Zeiler
- Department of Psychiatry and Psychotherapy, Auguste-Viktoria-Krankenhaus Berlin, Germany
| | - Wolfram Bender
- Department of Psychiatry and Psychotherapy Munich East, kbo-Isar-Amper-Klinikum Haar, Germany
| | | | - Marcus Ising
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Peter Brieger
- Department of Psychiatry and Psychotherapy Munich East, kbo-Isar-Amper-Klinikum Haar, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Germany
| | | | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - Markus Gastpar
- Department of Psychiatry and Psychotherapy, University of Essen, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Psychiatric Clinic Rodewisch, Rodewisch, Germany
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Schennach R, Riedel M, Spellmann I, Musil R, Obermeier M, Jäger M, Bottlender R, Schmauss M, Laux G, Möller HJ. Comparing Schizophrenia Patients With a Predicted High/Low Risk of Nonresponse Receiving Treatment with Ziprasidone and Haloperidol: A Randomized-Controlled Study. Pharmacopsychiatry 2018; 52:180-185. [PMID: 30235496 DOI: 10.1055/a-0669-9461] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The aim of this double-blind randomized study was to evaluate the response to antipsychotic treatment in schizophrenia patients with predicted high/low risk of nonresponse identified by applying a set of well-established scales and predictors of outcome and to compare efficacy between ziprasidone and haloperidol. METHODS One hundred twelve schizophrenia patients (ziprasidone: n=54; haloperidol: n=58) were rated weekly on the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Global Assessment of Functioning Scale (GAF), the Social and Occupational Functioning Scale (SOFAS), the Simpson-Angus Scale (SAS), and Hillside Akathisia Scale (HAS). RESULTS Ninety-two patients (82%) were predicted to have a high risk of nonresponse. No significant difference regarding PANSS improvement in this subsample was found comparing ziprasidone and haloperidol (p=0.563). Also, for the total patient sample, no significant difference was found regarding the course of the PANSS total score, GAF (p=0.921), and SOFAS (p=0.658) between ziprasidone and haloperidol. Haloperidol resulted in higher scores on the SAS (p=0.001) and HAS (p=0.011). DISCUSSION An alarmingly high number of patients were at high risk of nonresponse to antipsychotic treatment.
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Affiliation(s)
- Rebecca Schennach
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Michael Riedel
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Psychiatric Clinic Rodewisch, Rodewisch, Germany
| | - Ilja Spellmann
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Psychiatric Clinic, Stuttgart, Germany
| | - Richard Musil
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Obermeier
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Markus Jäger
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Psychiatric Clinic, District Hospital Kempten, Kempten, Germany
| | - Roland Bottlender
- Psychiatric Clinic, District Hospital Lüdenscheid, Lüdenscheid, Germany
| | - Max Schmauss
- Psychiatric Clinic, District Hospital Augsburg, Augsburg, Germany
| | - Gerd Laux
- Psychiatric Clinic, Inn-Salzach Hospital Wasserburg/Inn, Wasserburg, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
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7
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Affiliation(s)
- Richard Musil
- Ludwig-Maximilians University, Department of Psychiatry & Psychotherapy, Nußbaumstr. 7, 80336 München, Germany
| | - Ilja Spellmann
- Klinikum Stuttgart, Department of Special Psychiatry, Social Psychiatry & Psychotherapy, Prießnitzweg 24, 70374 Stuttgart, Germany
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8
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Musil R, Seemüller F, Meyer S, Spellmann I, Adli M, Bauer M, Kronmüller KT, Brieger P, Laux G, Bender W, Heuser I, Fisher R, Gaebel W, Schennach R, Möller HJ, Riedel M. Subtypes of depression and their overlap in a naturalistic inpatient sample of major depressive disorder. Int J Methods Psychiatr Res 2018; 27:e1569. [PMID: 29498147 PMCID: PMC6877097 DOI: 10.1002/mpr.1569] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 05/22/2016] [Revised: 03/31/2017] [Accepted: 04/10/2017] [Indexed: 12/18/2022] Open
Abstract
Subtyping depression is important in order to further delineate biological causes of depressive syndromes. The aim of this study was to evaluate clinical and outcome characteristics of distinct subtypes of depression and to assess proportion and features of patients fulfilling criteria for more than one subtype. Melancholic, atypical and anxious subtypes of depression were assessed in a naturalistic sample of 833 inpatients using DSM-IV specifiers based on operationalized criteria. Baseline characteristics and outcome criteria at discharge were compared between distinct subtypes and their overlap. A substantial proportion of patients (16%) were classified with more than one subtype of depression, 28% were of the distinct anxious, 7% of the distinct atypical and 5% of the distinct melancholic subtype. Distinct melancholic patients had shortest duration of episode, highest baseline depression severity, but were more often early improvers; distinct anxious patients had higher NEO-Five Factor Inventory (NEO-FFI) neuroticism scores compared with patients with unspecific subtype. Melancholic patients with overlap of anxious features had worse treatment outcome compared to distinct melancholic and distinct anxious subtype. Distinct subtypes differed in only few variables and patients with overlap of depression subtypes may have independent clinical and outcome characteristics. Studies investigating biological causes of subtypes of depression should take influence of features of other subtypes into account.
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Affiliation(s)
- Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, kbo-Lech-Mangfall-Klinik, Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Sebastian Meyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.,Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland.,Institute of Medical Informatics, Biometry, and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ilja Spellmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.,Bezirkskrankenhaus Kaufbeuren, Bezirkskliniken Schwaben, Kaufbeuren, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (CCM), Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Klaus-Thomas Kronmüller
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Heidelberg, Germany.,LWL-Klinikum, Gütersloh, Germany
| | - Peter Brieger
- Department of Psychiatry and Psychotherapy, Martin-Luther University Halle-Wittenberg, Halle, Germany.,Department of Psychiatry and Psychotherapy, kbo-Isar-Amper-Klinikum Munich East, Haar, Gemany
| | - Gerd Laux
- kbo-Inn-Salzach-Klinikum, Department of Psychiatry and Psychotherapy, Wasserburg, Gemany
| | - Wolfram Bender
- Department of Psychiatry and Psychotherapy, kbo-Isar-Amper-Klinikum Munich East, Haar, Gemany
| | - Isabella Heuser
- Department of Psychiatry, Charité - Campus Benjamin Franklin (CBF), Berlin, Germany
| | - Robert Fisher
- Department of Psychiatry and Psychotherapy, Auguste-Viktoria-Krankenhaus, Berlin, Germany.,South Hackney CMHT, Donald WinniCott Centre, London, UK
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rebecca Schennach
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.,Schön Klinik Roseneck, Prien, Rosenheim, Prien am Chiemsee, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.,Klinik für Psychiatrie & Psychotherapie II, Zentrum für Psychiatrie Calw Klinikum Nordschwarzwald, Calw-Hirsau, Germany
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9
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Spellmann I, Riedel M, Städtler J, Zill P, Obermeier M, Cerovecki A, Dehning S, Schennach R, Epple M, Opgen-Rhein M, Müller N, Bondy B, Möller HJ, Musil R. Associations of NEUROD2 polymorphisms and change of cognitive dysfunctions in schizophrenia and schizoaffective disorder after eight weeks of antipsychotic treatment. Cogn Neuropsychiatry 2017; 22:280-297. [PMID: 28470106 DOI: 10.1080/13546805.2017.1322502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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] [Indexed: 02/01/2023]
Abstract
INTRODUCTION NEUROD2 is a neurospecific helix-loop-helix transcription factor which has an impact on the regulation of glutamatergic and GABAergic genes. We investigated an association of NEUROD2 with neurocognitive dysfunctions in schizophrenia and schizoaffective disorder patients before and during treatment with different second-generation antipsychotics. METHODS Patients were genotyped for four different polymorphisms of the NEUROD2 gene ((rs9889354(A/G), rs1877032(C/T), rs12453682(C/T) and rs11078918(C/G)). Cognitive function was assessed at baseline and week 8. Results of individual neuropsychological tests were assigned to six cognitive domains (reaction time and quality; executive function; working, verbal and visual memory) and a general cognitive index. RESULTS 167 patients were included in the study. The NEUROD2 exonic polymorphism rs11078918 showed significant associations with verbal memory and executive functions, whereas the NEUROD2 polymorphism rs12453682 was significantly associated with working and verbal memory, executive functions and with a cognitive index. Significant associations were found at baseline and after eight weeks. Moreover, significant associations between the change in neuropsychological test results during antipsychotic treatment and the NEUROD2 polymorphisms rs11078918 and rs12453682 were observed. CONCLUSIONS Our findings suggest that the NEUROD2 gene could play a role in the pathophysiology of neurocognitive dysfunctions as well as in the change of cognitive symptoms under antipsychotic treatment in schizophrenia and schizoaffective disorder.
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Affiliation(s)
- Ilja Spellmann
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Michael Riedel
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Julia Städtler
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Peter Zill
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Michael Obermeier
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Anja Cerovecki
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Sandra Dehning
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Rebecca Schennach
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Maria Epple
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Markus Opgen-Rhein
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Norbert Müller
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Brigitta Bondy
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Hans-Jürgen Möller
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Richard Musil
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University Munich , Munich , Germany
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10
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Schennach R, Obermeier M, Seemüller F, Jäger M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Spellmann I, Musil R, Möller HJ, Riedel M. Add-on Antidepressants in the Naturalistic Treatment of Schizophrenia Spectrum Disorder - When, Who, and How? Pharmacopsychiatry 2017; 50:136-144. [PMID: 28505669 DOI: 10.1055/s-0043-106436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to evaluate antidepressant add-on treatment within the acute treatment of schizophrenia spectrum disorder patients. Antidepressant add-on was evaluated in 365 patients within a naturalistic multicenter study. Patients with/without antidepressant add-on were compared regarding clinical and treatment-related variables, response and remission, and remission of depressive and negative symptoms. The efficacy of antidepressant add-on treatment was furthermore analyzed applying marginal structure models. Twenty-three percent of the patients received antidepressant add-on for a mean duration of 50.28 (33.42) days. Patients with the diagnosis of a schizoaffective disorder, multiple illness episodes, and a longer duration of their illness as well as those with significantly fewer baseline positive symptoms, more negative and depressive symptoms, more side effects, and less subjective well-being were augmented with antidepressants. At discharge no significant effect of antidepressant add-on treatment was observed in terms of a 25% improvement (p=0.2623), a 50% improvement (p=0.3946), remission (p=0.0552), or remission of depressive (p=0.6336) and negative symptoms (p=0.8756). Also, when analyzing marginal structure models considering the diagnostic subgroups, no significant effect was found. Add-on with antidepressants is common. A final recommendation in terms of this strategy's efficacy cannot be given.
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Affiliation(s)
- Rebecca Schennach
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Michael Obermeier
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Seemüller
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Markus Jäger
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Max Schmauss
- Psychiatric Clinic, District Hospital Augsburg, Augsburg, Germany
| | - Gerd Laux
- Psychiatric Clinic, Inn-Salzach Hospital, Wasserburg/Inn, Germany
| | | | - Dieter Naber
- Department of Psychiatry, University of Hamburg, Hamburg, Germany
| | - Lutz G Schmidt
- Department of Psychiatry, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Isabella Heuser
- Department of Psychiatry, Charite Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | | | - Eckart Rüther
- Department of Psychiatry, University of Göttingen, Göttingen, Germany
| | - Stefan Klingberg
- Department of Psychiatry, University of Tübingen, Tübingen, Germany
| | - Markus Gastpar
- Department of Psychiatry, University of Essen, Essen, Germany
| | - Ilja Spellmann
- Psychiatric Clinic, District Hospital Kaufbeuren, Kaufbeuren, Germany
| | - Richard Musil
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.,Psychiatric Clinic Nordschwarzwald, Calw, Germany
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11
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Schennach R, Möller HJ, Obermeier M, Seemüller F, Jäger M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Musil R, Spellmann I, Riedel M. Challenging the understanding of significant improvement and outcome in schizophrenia - the concept of reliable and clinically significant change methods. Int J Methods Psychiatr Res 2016; 25:3-11. [PMID: 26178421 PMCID: PMC6877263 DOI: 10.1002/mpr.1476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/23/2014] [Revised: 03/08/2015] [Accepted: 03/23/2015] [Indexed: 11/10/2022] Open
Abstract
Significant changes of schizophrenia patients during inpatient treatment were evalutaed and compared to established outcome criteria. The concept of reliable and clinically significant change methods was applied to three hundred and ninety-six patients suffering from a schizophrenia spectrum disorder. First, information on whether or not the change of the patient's condition is sufficient in order to declare that it is beyond a measurement error or random effect (= reliable change) was evaluated and in a second step it was observed if the reliable change was clinically meaningful (= clinically significant change). Different Positive and Negative Syndrome Scale for Schizophrenia (PANSS) thresholds were applied to define the clinically significant change (40, 45 and 50 points). These changes were then compared to established outcome criteria such as response and remission. Seventy-nine of the 396 patients (20%) showed a reliable improvement of symptoms, whereas 70% improved without achieving a reliable change of their condition. Of the 79 patients achieving a reliable change during treatment 8-15% concurrently showed a clinically significant change depending on the respective PANSS threshold. In contrast, 56% of the patients achieved response and 60% were in remission at discharge when applying established outcome criteria. Our results showed that a rather small number of schizophrenia patients were found to reliably change during inpatient treatment, with even less patients achieving a clinically significant change. The concept of reliable and clinically significant changes revealed to be a lot more stringent than today's established outcome criteria and should be critically evaluated regarding its use in schizophrenia patients.
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Affiliation(s)
- Rebecca Schennach
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Obermeier
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Markus Jäger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Max Schmauss
- Psychiatric Clinic, District Hospital Augsburg, Germany
| | - Gerd Laux
- Psychiatric Clinic, Inn-Salzach Hospital Wasserburg/Inn, Germany
| | | | - Dieter Naber
- Department of Psychiatry and Psychotherapy, University of Hamburg, Germany
| | - Lutz G Schmidt
- Department of Psychiatry and Psychotherapy, University of Mainz, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Duesseldorf, Germany
| | | | - Isabella Heuser
- Department of Psychiatry and Psychotherapy, Charite Berlin, Campus Benjamin Franklin, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Germany
| | | | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - Markus Gastpar
- Department of Psychiatry and Psychotherapy, University of Essen, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Ilja Spellmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.,Psychiatric Clinic, Vinzenz-von-Paul-Hospital, Rottweil, Germany
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12
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Hamann J, Lipp ML, Christ-Zapp S, Spellmann I, Kissling W. Psychiatrist and patient responses to suspected medication nonadherence in schizophrenia spectrum disorders. Psychiatr Serv 2014; 65:881-7. [PMID: 24686753 DOI: 10.1176/appi.ps.201300322] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/30/2022]
Abstract
OBJECTIVE Long-term results in schizophrenia treatment continue to be unsatisfactory, with many patients nonadherent to treatment and relapsing frequently. This study aimed to examine how perceived nonadherence leads psychiatrists to implement adherence-enhancing measures and to identify barriers and facilitators for the implementation of adherence-enhancing measures. METHODS A cross-sectional survey was conducted with German hospital psychiatrists and their inpatients who had a diagnosis of schizophrenia or schizoaffective disorder. RESULTS Interviews were conducted with 121 psychiatrists or resident psychiatrists and their 213 inpatients. Psychiatrists recognized nonadherence as an important factor for hospital admission only when directly asked about it. Psychiatrists implemented a plethora of adherence interventions that in many cases constituted only intensive talks and no structured interventions. Of four core interventions addressed in the survey-depot administration of medication, psychoeducation for patients, psychoeducation for relatives, and arrangement of first follow-up visit-the implementation rates were surprisingly high for depot prescription of antipsychotics (>30%) and psychoeducation for patients but dramatically low for arrangement of follow-up visits and psychoeducation for relatives. Patients with poor previous adherence (according to the physician's estimate) received more adherence measures. In addition, patients with involuntary admission were more likely to receive depot medications, and psychoeducation was more often implemented for younger patients and for patients at university hospitals. CONCLUSIONS Treatment nonadherence is often underestimated by psychiatrists. Obstacles to the implementation of adherence-enhancing interventions occur in routine daily care. Integrated-care programs addressing adherence issues, communication between inpatient and outpatient treatment, implementation of adherence measures, and better involvement of patients in clinical decisions may help to overcome these barriers.
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Affiliation(s)
- Johannes Hamann
- Dr. Hamann, Ms. Lipp, Dr. Christ-Zapp, and Dr. Kissling are with the Psychiatry Department, Technische Universität München, Munich, Germany (e-mail: ). Dr. Spellmann is with Bezirkskliniken Schwaben Kaufbeuren, Kaufbeuren, Germany
| | - Marie-Luise Lipp
- Dr. Hamann, Ms. Lipp, Dr. Christ-Zapp, and Dr. Kissling are with the Psychiatry Department, Technische Universität München, Munich, Germany (e-mail: ). Dr. Spellmann is with Bezirkskliniken Schwaben Kaufbeuren, Kaufbeuren, Germany
| | - Sarah Christ-Zapp
- Dr. Hamann, Ms. Lipp, Dr. Christ-Zapp, and Dr. Kissling are with the Psychiatry Department, Technische Universität München, Munich, Germany (e-mail: ). Dr. Spellmann is with Bezirkskliniken Schwaben Kaufbeuren, Kaufbeuren, Germany
| | - Ilja Spellmann
- Dr. Hamann, Ms. Lipp, Dr. Christ-Zapp, and Dr. Kissling are with the Psychiatry Department, Technische Universität München, Munich, Germany (e-mail: ). Dr. Spellmann is with Bezirkskliniken Schwaben Kaufbeuren, Kaufbeuren, Germany
| | - Werner Kissling
- Dr. Hamann, Ms. Lipp, Dr. Christ-Zapp, and Dr. Kissling are with the Psychiatry Department, Technische Universität München, Munich, Germany (e-mail: ). Dr. Spellmann is with Bezirkskliniken Schwaben Kaufbeuren, Kaufbeuren, Germany
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13
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Spellmann I, Rujescu D, Musil R, Meyerwas S, Giegling I, Genius J, Zill P, Dehning S, Cerovecki A, Seemüller F, Schennach R, Hartmann AM, Schäfer M, Müller N, Möller HJ, Riedel M. Pleckstrin homology domain containing 6 protein (PLEKHA6) polymorphisms are associated with psychopathology and response to treatment in schizophrenic patients. Prog Neuropsychopharmacol Biol Psychiatry 2014; 51:190-5. [PMID: 24576533 DOI: 10.1016/j.pnpbp.2014.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 12/01/2013] [Revised: 02/13/2014] [Accepted: 02/18/2014] [Indexed: 12/21/2022]
Abstract
Pleckstrin homology domain (PH domain) comprises approximately 120 amino acids and is integrated in a wide range of proteins involved in intracellular signaling or as constituents of the cytoskeleton. This domain can bind phosphatidylinositol (3,4,5)-triphosphate and phosphatidylinositol (4,5)-biphosphate and proteins such as the βγ-subunits of heterotrimeric G proteins and protein kinase C. Associations with psychiatric diseases have not been investigated yet. To identify genes involved in response to antipsychotics, mice were treated with haloperidol (1mg/kg, n = 11) or saline (n = 12) for one week. By analyzing microarray data, we observed an increase of pleckstrin homology domain containing 6 (PLEKHA6) gene expression. Furthermore, we genotyped 263 schizophrenic patients, who were treated monotherapeutically with different antipsychotics within randomized-controlled trials. Psychopathology was measured weekly using the PANSS for a minimum of four and a maximum of twelve weeks. Correlations between PANSS subscale scores at baseline and PANSS improvement scores after four weeks of treatment and genotypes were calculated by using a linear model for all investigated SNPs. We found associations between four PLEKHA6 polymorphisms (rs17333933 (T/G), rs3126209 (C/T), rs4951338 (A/G) and rs100900571 (T/C)) and different PANSS subscales at baseline. Furthermore two different polymorphisms (rs7513240 (T/C), rs4951353 (A/G)) were found to be associated with therapy response in terms of a significant correlation with different PANSS improvement subscores after four weeks of antipsychotic treatment. Our observation of an association between genetic polymorphisms of a protein of the PH domain and psychopathology data in schizophrenic patients might be indicative for an involvement of PLEKHA6 in the pathophysiology of schizophrenia and the therapy response towards antipsychotics.
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Affiliation(s)
- Ilja Spellmann
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Bezirkskrankenhaus Kaufbeuren, Department of Psychiatry and Psychotherapy.
| | - Dan Rujescu
- Martin Luther University of Halle (Saale), Department of Psychiatry and Psychotherapy
| | - Richard Musil
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Bezirkskrankenhaus Kaufbeuren, Department of Psychiatry and Psychotherapy
| | | | - Ina Giegling
- Martin Luther University of Halle (Saale), Department of Psychiatry and Psychotherapy
| | - Just Genius
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy
| | - Peter Zill
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Bezirkskrankenhaus Kaufbeuren, Department of Psychiatry and Psychotherapy
| | - Sandra Dehning
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Bezirkskrankenhaus Kaufbeuren, Department of Psychiatry and Psychotherapy
| | - Anja Cerovecki
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Bezirkskrankenhaus Kaufbeuren, Department of Psychiatry and Psychotherapy
| | - Florian Seemüller
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Bezirkskrankenhaus Kaufbeuren, Department of Psychiatry and Psychotherapy
| | - Rebecca Schennach
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Bezirkskrankenhaus Kaufbeuren, Department of Psychiatry and Psychotherapy
| | - Annette M Hartmann
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Bezirkskrankenhaus Kaufbeuren, Department of Psychiatry and Psychotherapy
| | - Martin Schäfer
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Bezirkskrankenhaus Kaufbeuren, Department of Psychiatry and Psychotherapy
| | - Norbert Müller
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Bezirkskrankenhaus Kaufbeuren, Department of Psychiatry and Psychotherapy
| | - Hans-Jürgen Möller
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Bezirkskrankenhaus Kaufbeuren, Department of Psychiatry and Psychotherapy
| | - Michael Riedel
- Ludwig Maximilians University of Munich, Department of Psychiatry and Psychotherapy and Vinzenz-von-Paul-Hospital Rottweil
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14
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Musil R, Spellmann I, Riedel M, Rospleszcz S, Borck A, Falkai P, Zill P. EPA-1415 – Pharmacogenetics of antipsychotic-induced weight gain in schizophrenic patients. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78619-5] [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: 10/25/2022] Open
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15
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Musil R, Zill P, Seemüller F, Bondy B, Obermeier M, Spellmann I, Bender W, Adli M, Heuser I, Zeiler J, Gaebel W, Maier W, Rietschel M, Rujescu D, Schennach R, Möller HJ, Riedel M. No influence of brain-derived neurotrophic factor (BDNF) polymorphisms on treatment response in a naturalistic sample of patients with major depression. Eur Arch Psychiatry Clin Neurosci 2013; 263:405-12. [PMID: 22965830 DOI: 10.1007/s00406-012-0364-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 12/29/2011] [Accepted: 08/23/2012] [Indexed: 02/03/2023]
Abstract
The role of the brain-derived neurotrophic factor (BDNF) in the pathophysiology of major depressive disorder (MDD) remains to be elucidated. Recent post hoc analyses indicated a potential association of three polymorphisms in the BDNF gene with worse treatment outcome in patients with the subtype of melancholic depression. We aimed at replicating these findings in a German naturalistic multicenter follow-up. Three polymorphisms in the BDNF gene (rs7103411, rs6265 (Val66Met) and rs7124442) were genotyped in 324 patients with MDD and 470 healthy controls. We applied univariate tests and logistic regression models stratifying for depression subtype and gender. The three polymorphisms were not associated with MDD as diagnosis. Further, no associations were found in univariate tests. With logistic regression, we only found a tendency towards an association of the rs6265 (Val66Met) polymorphism with overall response to treatment (response rates: GG (val/val) < GA (val/met) < AA (met/met); p = 0.0129) and some gender differences for the rs6265 (Val66Met) and rs7103411 polymorphisms. Treatment outcome stratified for subtypes of depression did not differ significantly between the investigated polymorphisms or using haplotype analyses. However, results showed a tendency towards significance. At this stage, we cannot support an influence of these three polymorphisms. Further studies in larger patient samples to increase sample sizes of subgroups are warranted.
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Affiliation(s)
- Richard Musil
- Department of Psychiatry and Psychotherapy, Psychiatric Clinic, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
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16
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Musil R, Zill P, Seemüller F, Bondy B, Meyer S, Spellmann I, Bender W, Adli M, Heuser I, Fisher R, Gaebel W, Maier W, Rietschel M, Rujescu D, Schennach R, Möller HJ, Riedel M. Genetics of emergent suicidality during antidepressive treatment--data from a naturalistic study on a large sample of inpatients with a major depressive episode. Eur Neuropsychopharmacol 2013; 23:663-74. [PMID: 23063133 DOI: 10.1016/j.euroneuro.2012.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 11/30/2011] [Revised: 08/05/2012] [Accepted: 08/06/2012] [Indexed: 11/26/2022]
Abstract
Factors contributing to treatment-emergent suicidal ideation (TESI) using antidepressants have been in the focus of recent research strategies. We investigated previously established clinical predictors of TESI and combined these with several polymorphisms of candidate genes in patients with major depressive disorder. Common polymorphisms involved in the tryptophan hydroxylase 1 (TPH1) and 2 (TPH2), serotonin transporter, monoamine oxidase A (MAOA) and brain-derived neurotrophic factor (BDNF) were investigated in a naturalistic inpatient study of the German research network on depression. We compared patients showing TESI with non-TESI suicidal patients and with non-suicidal patients using univariate tests to detect relevant factors, which were further tested in logistic regression and CART (Classification and Regression Trees) analyses. Of the 269 patients, TESI occurred in 22 patients (17 female), 117 patients were defined as non-TESI suicidal patients, and 130 patients were classified as non-suicidal. When comparing cases with both control groups we found the TPH2 rs1386494 (C/T) polymorphism to be moderately associated with TESI (Univariate tests: TESI vs. non-suicidality: p=0.005; adjusted: p=0.09; TESI vs. non-TESI suicidal patients: p=0.0024; adjusted: p=0.086). This polymorphism remained the only significant genetic factor in addition to clinical predictors in logistic regression and CART analyses. CART analyses suggested interactions with several clinical predictors. Haplotype analyses further supported a contribution of this polymorphism in TESI. The TPH2 rs1386494 (C/T) polymorphism might contribute to the genetic background of TESI. This polymorphism has been previously associated with committed suicide and major depressive disorder. The small number of cases warrants replication in larger patient samples. Lack of a placebo control group hampers definite conclusions on an association with antidepressive treatment.
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Affiliation(s)
- Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336 Munich, Germany.
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Schennach R, Zill P, Obermeier M, Hauer D, Dehning S, Cerovecki A, Opgen-Rhein M, Musil R, Spellmann I, Matz J, Krause D, Seemüller F, Müller N, Möller HJ, Bondy B, Riedel M. The CNR1 gene in depression and schizophrenia - is there an association with early improvement and response? Psychiatry Res 2012; 196:160. [PMID: 22370152 DOI: 10.1016/j.psychres.2011.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 11/18/2011] [Accepted: 11/23/2011] [Indexed: 11/17/2022]
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Musil R, Schwarz MJ, Riedel M, Dehning S, Cerovecki A, Spellmann I, Arolt V, Müller N. Elevated macrophage migration inhibitory factor and decreased transforming growth factor-beta levels in major depression--no influence of celecoxib treatment. J Affect Disord 2011; 134:217-25. [PMID: 21684012 DOI: 10.1016/j.jad.2011.05.047] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [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: 03/03/2011] [Revised: 05/26/2011] [Accepted: 05/26/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The involvement of an immune process in the pathophysiology of major depression disorder (MDD) was substantiated by studies demonstrating elevated levels of proinflammatory cytokines and prostaglandin E(2) (PGE(2)). Cyclooxygenase-2 (COX-2) inhibitors lead to a reduced production of PGE(2) and have been shown to improve depressive symptoms. We investigated the three immune parameters macrophage migration inhibitory factor (MIF), transforming growth factor-β (TGF-β) and soluble CD14 (sCD14) in a randomized, placebo-controlled trial of the COX-2 inhibitor celecoxib as add-on therapy in patients with MDD treated with reboxetine. METHODS Thirty-two patients with depression and 20 healthy controls participated in the study. The patients were treated with reboxetine and celecoxib or placebo. Immune parameters were measured from serum at baseline, after three and five weeks using ELISA. RESULTS Celecoxib as add-on strategy resulted in a significant reduction of Hamilton Depression Scale scores compared to placebo. Depressed patients showed significantly elevated MIF (p < 0.001) and reduced TGF-β (p = 0.006) concentrations at baseline. There was no difference in sCD14-concentrations. There was no difference between the placebo and the celecoxib group and no change over time. LIMITATIONS Limitations of the study are the relatively small sample size and lack of functional assessment of HPA axis in parallel. CONCLUSIONS MIF is a promising new candidate in the neuro-immune interplay that may link depressive symptoms, altered immune state and HPA-axis dysregulation. Reduced levels of TGF-β replicate previous findings and support the importance of this regulatory cytokine in major depressive disorder.
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Affiliation(s)
- R Musil
- Psychiatric Clinic of University Munich, Nussbaumstrasse 7, 80336 Munich, Germany.
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Spellmann I, Rujescu D, Musil R, Mayr A, Giegling I, Genius J, Zill P, Dehning S, Opgen-Rhein M, Cerovecki A, Hartmann AM, Schäfer M, Bondy B, Müller N, Möller HJ, Riedel M. Homer-1 polymorphisms are associated with psychopathology and response to treatment in schizophrenic patients. J Psychiatr Res 2011; 45:234-41. [PMID: 20598711 DOI: 10.1016/j.jpsychires.2010.06.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [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: 01/21/2010] [Revised: 05/17/2010] [Accepted: 06/07/2010] [Indexed: 11/30/2022]
Abstract
The HOMER 1 protein plays a crucial role in mediating glutamatergic neurotransmission. It has previously shown to be a candidate gene for etiology and pathophysiology of different psychiatric diseases such as schizophrenia. To identify genes involved in response to antipsychotics, subgroups of animals were treated with haloperidol (1 mg/kg, n = 11) or saline (n = 12) for one week. By analyzing microarray data, we replicated the observed increase of Homer 1 gene expression. Furthermore, we genotyped 267 schizophrenic patients, who were treated monotherapeutically with different antipsychotics within randomized-controlled trials. Psychopathology was measured weekly using the PANSS for a minimum of four and a maximum of twelve weeks. Correlations between PANSS subscale scores at baseline and PANSS improvement scores after four weeks of treatment and genotypes were calculated by using a linear model for all investigated SNP's. We found an association between two HOMER 1 polymorphisms (rs2290639 and rs4704560) and different PANSS subscales at baseline. Furthermore all seven investigated polymorphisms were found to be associated with therapy response in terms of a significant correlation with different PANSS improvement subscores after four weeks of antipsychotic treatment. Most significant associations have been shown between the rs2290639 HOMER 1 polymorphism and PANSS subscales both at baseline conditions and after four weeks of antipsychotic treatment. This is the first study which shows an association between HOMER 1 polymorphisms and psychopathology data at baseline and therapy response in a clinical sample of schizophrenic patients. Thus, these data might further help in detecting differential therapy response in individuals with schizophrenia.
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Affiliation(s)
- Ilja Spellmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich, Nußbaumstrasse 7, 80336 Munich, Germany.
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Riedel M, Spellmann I, Schennach-Wolff R, Obermeier M, Musil R. The RSM-scale: a pilot study on a new specific scale for self- and observer-rated quality of life in patients with schizophrenia. Qual Life Res 2010; 20:263-72. [PMID: 20922485 DOI: 10.1007/s11136-010-9744-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To develop and evaluate a self- and observer-rating scale on quality of life in patients suffering from schizophrenia with regard to the efficacy of atypical antipsychotics based on different dimensions and to apply within a pilot study. METHODS Following review of existing scales and a prevalidation phase, the Riedel-Spellmann-Musil (RSM) scale was developed comprising 36 items assigned to different subscales. As reference scales, the Quality of Life Scale (QLS) and the Subjective Well-being Under Neuroleptic Treatment Scale-short version (SWN-K) were performed, psychopathology and adverse events were measured at all visits. Reliability was assessed using Cronbach's alpha, Pearson's correlation coefficients were used to assess construct validity, and Intraclass Correlation Coefficients (ICCs) were used for test-retest reliability. T tests were performed in normal distributed samples; otherwise Wilcoxon tests were used. RESULTS One hundred and thirty-six patients were included in the study. Cronbach`s α was 0.917 for the self-rating and 0.915 for the interviewer-rating part. ICCs were >0.70 for all subscales. The self-rating part correlated strongly with the SWN-K and the observer part with the QLS. Changes in psychopathology over the study period and different levels of functioning were detected. CONCLUSION The RSM-scale is a new scale to assess the quality of life in different dimensions of patients with schizophrenia treated with antipsychotics and shows good internal consistency, test-retest reliability, construct and discriminant validity.
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Affiliation(s)
- M Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, 80336, Munich, Germany
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Riedel M, Musil R, Seemüller F, Spellmann I, Möller HJ, Schennach-Wolff R. Safety evaluation of zotepine for the treatment of schizophrenia. Expert Opin Drug Saf 2010; 9:659-66. [DOI: 10.1517/14740338.2010.486787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Riedel M, Schennach-Wolff R, Musil R, Dehning S, Cerovecki A, Opgen-Rhein M, Matz J, Seemüller F, Obermeier M, Engel RR, Müller N, Möller HJ, Spellmann I. Neurocognition and its influencing factors in the treatment of schizophrenia-effects of aripiprazole, olanzapine, quetiapine and risperidone. Hum Psychopharmacol 2010; 25:116-25. [PMID: 20196179 DOI: 10.1002/hup.1101] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [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: 11/07/2022]
Abstract
BACKGROUND To examine influencing variables of neurocognition in patients with schizophrenia and to predict cognition during antipsychotic treatment. METHODS Data were obtained from patients with an acute episode of schizophrenia participating in two double-blind and one open label trial comparing the effects of different atypical antipsychotics on cognition. In total, 129 patients were enrolled in this analysis. Cognitive function was assessed at admission, week 4 and 8. Efficacy and tolerability were assessed weekly using the Positive and Negative Syndrome Scale (PANSS) and the Simpson Angus Sale (SAS). Patients were treated with aripirazole, olanzapine, quetiapine and risperidone. Regression analysis including mixed effect models was performed. RESULTS A significant improvement in all cognitive domains was observed from baseline to week 8. Regarding the antipsychotic treatment applied quetiapine seemed to achieve the most favourable cognitive improvement. Negative and depressive symptoms, the patient's age and the concomitant and antipsychotic treatment applied were observed to significantly influence and predict neurocognition. CONCLUSION The results may indicate that schizophrenia is a static disorder with trait and state dependent cognitive components especially in the memory domains. The influence of negative and depressive symptoms should be considered in daily clinical routine.
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Affiliation(s)
- M Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
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Spellmann I, Rujescu D, Musil R, Mayr A, Giegling I, Genius J, Zill P, Dehning S, Hartmann A, Bondy B, Müller N, Möller HJ, Riedel M. S28-03 - Pharmacogenetics of therapy response in schizophrenia. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70063-8] [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: 10/19/2022] Open
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Riedel M, Spellmann I, Schennach-Wolff R, Musil R, Dehning S, Cerovecki A, Opgen-Rhein M, Matz J, Seemüller F, Obermeier M, Severus E, Engel RR, Müller N, Möller HJ. Effect of aripiprazole on cognition in the treatment of patients with schizophrenia. Pharmacopsychiatry 2009; 43:50-7. [PMID: 20336597 DOI: 10.1055/s-0029-1239539] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to assess the cognitive effects of aripiprazole in inpatients with schizophrenia. METHODS This was an investigator-initiated, open label eight-week trial evaluating 56 inpatients with the DSM-IV diagnosis of schizophrenia. Efficacy was assessed weekly using the Positive and Negative Syndrome Scale (PANSS) and tolerability was assessed each week using the Udvalg for Klinske Undersogelser side effect rating scale (UKU). Cognitive function was assessed at baseline, week 4 and week 8. RESULTS Aripiprazole showed significant improvement in PANSS total score and all subscores between baseline and endpoint visit. The substance was very well tolerated. Patients improved significantly in verbal memory, reaction time and reaction quality/attention from baseline to week eight. Furthermore, mean z-values of individual cognitive domains summarized in a global cognitive index improved significantly from baseline to week eight. DISCUSSION Our results suggest that aripiprazole provides a valuable treatment option for patients with schizophrenia.
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Affiliation(s)
- M Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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Riedel M, Spellmann I, Schennach-Wolff R, Obermeier M, Musil R. Validation of a new scale to assess quality of life in schizophrenic patients treated with antipsychotic drugs, the RSM-scale. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Spellmann I, Rujescu D, Musil R, Giegling I, Mayr A, Zill P, Dehning S, Cerovecki A, Bondy B, Müller N, Möller HJ, Riedel M. Pharmacogenetics of therapy response in schizophrenia. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Musil R, Spellmann I, Riedel M, Dehning S, Douhet A, Maino K, Zill P, Müller N, Möller HJ, Bondy B. SNAP-25 gene polymorphisms and weight gain in schizophrenic patients. J Psychiatr Res 2008; 42:963-70. [PMID: 18191416 DOI: 10.1016/j.jpsychires.2007.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [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: 07/29/2007] [Revised: 10/16/2007] [Accepted: 11/06/2007] [Indexed: 10/22/2022]
Abstract
Drug induced weight gain is a serious side effect of several atypical antipsychotics. As genetic factors play an important role in the homeostasis of hunger/satiety we tried to replicate a preliminary previous finding about an impact of three polymorphisms in the synaptosomal-associated protein of 25kDa (SNAP-25; sites MnlI, TaiI and DdelI in the 3(')-UTR) on clinical response and antipsychotic induced weight gain. We genotyped 162 schizophrenic patients being treated in monotherapy with atypical antipsychotics and 312 healthy control subjects for the three polymorphisms in the SNAP-25 gene using PCR. PANSS scores and weight were measured weekly for a minimum of five weeks. We found significant associations between the TaiI and MnlI polymorphisms and serum triglyceride levels at baseline and for the DdelI polymorphism and weight gain. In conclusion our study can at least partly replicate the previous findings concerning the impact of SNAP-25 gene polymorphisms on weight gain during antipsychotic treatment.
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Affiliation(s)
- Richard Musil
- Psychiatric Clinic of University Munich, Nussbaumstrasse 7, 80336 Munich, Germany.
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Schwarz MJ, Myint AM, Opgen-Rhein M, Musil R, Spellmann I, Riedel M. Relationship between Serum Aripiprazole, Dehydroaripiprazole, Prolactin and Testosterone Concentrations and Clinical Response to Aripiprazole in Male Schizophrenic Patients. Pharmacopsychiatry 2008. [DOI: 10.1055/s-0028-1088268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Riedel M, Müller N, Spellmann I, Engel RR, Musil R, Valdevit R, Dehning S, Douhet A, Cerovecki A, Strassnig M, Möller HJ. Efficacy of olanzapine versus quetiapine on cognitive dysfunctions in patients with an acute episode of schizophrenia. Eur Arch Psychiatry Clin Neurosci 2007; 257:402-12. [PMID: 17629725 DOI: 10.1007/s00406-007-0748-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [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] [Received: 12/12/2006] [Accepted: 05/03/2007] [Indexed: 10/23/2022]
Abstract
Neurocognitive impairment is a core feature in the pathology of schizophrenia and considered to be relatively persistent towards psychopharmacological interventions. There are hints that atypical antipsychotics can influence neurocognitive dysfunctions more favorable than conventional compounds. But little is known about differences in efficacy on neurocognitive dysfunctions linked to the variety of receptor profiles of different atypical antipsychotics. This study compared the effects of the atypical antipsychotics quetiapine and olanzapine on cognitive function in patients with an acute episode of schizophrenia. Patients were randomized to receive quetiapine or olanzapine for 8 weeks. Cognitive function was assessed at baseline, week 4 and week 8. Efficacy was assessed weekly using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Improvement Scale (CGI). Tolerability was assessed each week using the Extrapyramidal Symptom Rating Scale (ESRS), the Barnes Akathisia Scale (BAS) and the Udvalg for Kliniske Undersogelser Side Effect Rating Scale (UKU). In total, 52 patients were enrolled in the study. Data from the 33 patients who completed cognitive assessments at two or more time points out of three (baseline, Week 4 and Week 8) are analyzed here. Both quetiapine and olanzapine improved global cognitive index z-scores, however, this was more marked with quetiapine. Between-group comparisons showed significantly greater improvements in reaction quality/attention with quetiapine than olanzapine. Quetiapine and olanzapine produced significant improvements from baseline to week 8 in PANSS total and subscale scores. Both treatments were well tolerated, especially no EPS occurred during 8 weeks of treatment. Both quetiapine and olanzapine improved cognition; however, the improvement in cognitive index scores was more marked in patients receiving quetiapine. Furthermore, quetiapine produced a significantly greater improvement in reaction quality/attention than olanzapine.
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Affiliation(s)
- Michael Riedel
- Dept. of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich, Nussbaumstrasse 7, 80336 Munich, Germany
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Musil R, Spellmann I, Zill P, Bondy B, Douhet A, Dehning S, Severus E, Müller N, Möller HJ, Riedel M. Homer 1 and metabotropic glutamate-receptor 5 polymorphisms are associated with response to treatment in schizophrenic patients. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Spellmann I, Müller N, Musil R, Zill P, Douhet A, Dehning S, Cerovecki A, Bondy B, Möller HJ, Riedel M. Influences of SNAP-25 polymorphisms on cognitive dysfunctions in schizophrenic patients during an atypical antipsychotic treatment. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Riedel M, Spellmann I, Strassnig M, Douhet A, Dehning S, Opgen-Rhein M, Valdevit R, Engel RR, Kleindienst N, Müller N, Möller HJ. Effects of risperidone and quetiapine on cognition in patients with schizophrenia and predominantly negative symptoms. Eur Arch Psychiatry Clin Neurosci 2007; 257:360-70. [PMID: 17629731 DOI: 10.1007/s00406-007-0739-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [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] [Received: 12/13/2006] [Accepted: 02/10/2007] [Indexed: 11/28/2022]
Abstract
Evidence suggests that neurocognitive impairment is a key factor in the pathology of schizophrenia and is linked with the negative symptoms of the disease. In this study the effects of the atypical antipsychotics quetiapine and risperidone on cognitive function in patients with schizophrenia and with predominantly negative symptoms were compared. Patients were randomly assigned to double-blind treatment with quetiapine or risperidone for 12 weeks. Cognitive function was assessed at baseline, Week 6 and Week 12. Efficacy was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Scale for the Assessment of Negative Symptoms (SANS) at baseline, Week 6 and Week 12. Extrapyramidal side-effects were assessed each week using the Simpson-Angus Scale (SAS), adverse events were recorded as additional indicators of tolerability throughout the trial. In total, 44 patients were enrolled in the study. Data from the 34 patients who completed cognitive assessments at two or more time points out of three (baseline, Week 6 and Week 12) are analysed here. Quetiapine improved significantly global cognitive index z-scores at both Week 6 (p<0.001 vs. baseline) and Week 12 (p<0.01 vs. baseline), whereas risperidone improved significantly global cognitive index z-scores at Week 12 (p<0.05). Between-group comparisons at Week 6 showed significantly greater improvements in working memory and verbal memory with quetiapine than risperidone (p<0.05) and a significantly greater improvement in reaction quality/attention with quetiapine than risperidone at Week 12 (p<0.05). Quetiapine and risperidone produced significant improvements from baseline in PANSS total (p<0.001) and subscale scores at Week 12. Significant improvements in SANS total score were also seen in both the quetiapine (p<0.001) and risperidone (p<0.01) groups at Week 12 compared with baseline. SAS scores, measuring the incidence of extrapyramidal side-effects, were higher in patients receiving risperidone compared with those receiving quetiapine, and significant differences were seen at Weeks 3, 4, 5 and 7. Both quetiapine and risperidone improved cognition according to changes in cognitive index scores from baseline to Week 12. These results suggest that quetiapine and risperidone provide valuable treatment options for patients with schizophrenia with predominantly negative symptoms. Also, the improvements in cognition following treatment with quetiapine and risperidone may enhance long-term outcomes for these patients.
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Affiliation(s)
- Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
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Riedel M, Spellmann I, Müller N, Möller HJ. [Schizophrenic patients in the family practice]. MMW Fortschr Med 2007; 149 Suppl 2:98-101. [PMID: 17724979] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
For over 50 years, therapy with antipsychotics represented the mainstay for the treatment of schizophrenia. While pharmacological antipsychotic approaches are especially important during the acute course of the disease, other therapeutic procedures such as psychotherapy and sociotherapy have become increasingly important for maintenance and relapse therapies. Treatment with newer atypical antipsychotics provides a pharmacological therapy that can be adapted to the needs of the individual patient and includes aspects such as favourable side effect profiles, better quality of life and hence, increased medication compliance. Negative symptoms still represent a therapeutic challenge, especially in conjunction with chronic residual symptoms.
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Affiliation(s)
- Michael Riedel
- Klinik für Psychiatrie und Psychotherapie der Universität München.
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Abstract
Quetiapine was developed in 1985 by scientists at AstraZeneca (formerly Zeneca) Pharmaceuticals. It received official US Food and Drug Administration approval in September 1997 and approval in Germany in 2000. Since then, quetiapine has been used in the treatment of severe mental illness in approximately 70 countries including Canada, most Western European countries, and Japan. Quetiapine is a dibenzothiazepine derivative with a relatively broad receptor binding profile. It has major affinity to cerebral serotonergic (5HT(2A)), histaminergic (H1), and dopaminergic D(1) and D(2) receptors, moderate affinity to alpha(1)- und alpha(2)-adrenergic receptors, and minor affinity to muscarinergic M1 receptors; it demonstrates a substantial selectivity for the limbic system. This receptor occupancy profile with relatively higher affinity for the 5HT(2A) receptor compared with the D(2) receptor is in part responsible for the antipsychotic characteristics and low incidence of extrapyramidal side-effects of quetiapine. The efficacy of quetiapine in reducing positive and negative symptoms of schizophrenia has been proven in several clinical trials with placebo-controlled comparators. Quetiapine has also demonstrated robust efficacy for treatment of cognitive, anxious-depressive, and aggressive symptoms in schizophrenia. Long-term trials show sustained tolerability for a broad spectrum of symptoms. Quetiapine has also proven efficacy and tolerability in the treatment of moderate to severe manic episodes, and in the treatment of juveniles with oppositional-defiant or conduct disorders, and in the geriatric dementia population. Recent data indicate that quetiapine may also be effective in the treatment of bipolar depressive symptoms without increasing the risk of triggering manic episodes, and in borderline personality disorder. In comparison with other antipsychotics, quetiapine has a favorable side-effect profile. In clinical trials only small insignificant prolongations of the QT interval were observed. Weight-gain liabilities and new-onset metabolic side-effects occupy a middle-ground among newer antipsychotics. As a result of its good efficacy and tolerability profile quetiapine has become well established in the treatment of schizophrenia and manic episodes.
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Affiliation(s)
- Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany
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Abstract
PURPOSE OF REVIEW The concept of individualized drug therapy on the basis of pharmacogenetics has become a central focus in psychopharmacology of schizophrenia. This article reviews recent advances in this field with respect to their importance for the clinician. RECENT FINDINGS First, there is an increasing agreement about the importance of polymorphisms in cytochrome P450 enzymes and the effects of drug-drug interactions in relation to the incidence of adverse effects. Secondly, prediction of response on the basis of variants in candidate genes is incipient and remains elusive. Thirdly, some advances have been made in understanding the pharmacogenetics of weight gain. SUMMARY Despite much effort, only a few of the results are now ready for translation into clinical practice. Cytochrome P450 genotyping would be a big step forward towards a more individualized drug treatment based on molecular diagnostics and could improve treatment, reduce adverse effects and increase compliance of the patients. Another promising field may be that of predicting the antipsychotic-induced weight gain and it is hoped that commercially available DNA tests may be available within the next few years. Prediction of response is still hampered by many methodological and clinical problems and is not yet available to the clinician.
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Riedel M, Spellmann I, Schwarz MJ, Strassnig M, Sikorski C, Möller HJ, Müller N. Decreased T cellular immune response in schizophrenic patients. J Psychiatr Res 2007; 41:3-7. [PMID: 16434055 DOI: 10.1016/j.jpsychires.2005.11.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [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] [Received: 05/17/2005] [Revised: 11/04/2005] [Accepted: 11/11/2005] [Indexed: 11/30/2022]
Abstract
The involvement of an alteration of the immune system in the pathogenesis of schizophrenia is discussed since many years. In particular, in vitro studies give evidence that the T helper-1 (Th1) mediated cellular immune response is deficient in schizophrenia. We therefore hypothesized that the type-IV delayed skin hypersensitivity reaction, which is effected by the Th1 immune response, is attenuated in schizophrenia patients. A prospective case-control study was performed to assess skin reactivity of 30 patients vs. 30 age and sex matched healthy controls. A standardized device with seven different antigens (Multitest Immignost) was applied intracutaneously; after 48h, the skin reactions were quantified. In general, the mean skin reaction of the schizophrenic patients were significantly smaller as compared to the healthy control group. Moreover, significantly more schizophrenic patients showed a diminished skin reaction to distinct antigens. Our findings demonstrate a markedly attenuated in vivo type-1 mediated cellular immune response in schizophrenic patients, further confirming the hypothesis of a relative Th2 shift in schizophrenia.
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Affiliation(s)
- Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich, Nussbaumstrasse 7, D-80336 Munich, Germany
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Meisenzahl EM, Scheuerecker J, Zipse M, Ufer S, Wiesmann M, Frodl T, Koutsouleris N, Zetzsche T, Schmitt G, Riedel M, Spellmann I, Dehning S, Linn J, Brückmann H, Möller HJ. Effects of treatment with the atypical neuroleptic quetiapine on working memory function: a functional MRI follow-up investigation. Eur Arch Psychiatry Clin Neurosci 2006; 256:522-31. [PMID: 17151834 DOI: 10.1007/s00406-006-0687-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [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] [Received: 03/20/2006] [Accepted: 07/25/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Working memory as a part of higher-order executive functions is defined by the parallel storage and processing of information. Recent functional fMRI studies have revealed a functional, interregional disintegration of a neuronal network connecting cortical, subcortical and cerebellar regions in schizophrenic patients (SZ). Cognitive impairment in working memory is a core psychopathological correlate of schizophrenic symptoms. Atypical neuroleptics such as quetiapine have shown good efficacy in treating positive and negative symptoms. The presented study evaluated the impact of a neuroleptic steady state treatment with quetiapine on the altered working memory activation patterns in schizophrenia. METHODS Patients were examined by fMRI at baseline and after 12 weeks of steady state treatment with quetiapine. Matched healthy controls (HC) underwent baseline examination. In the scanner, stimuli were presented in a 2-back and 0-back condition of a working memory (wm) paradigm, whereby a degraded and a non-degraded version were used each time. Additionally, behavioural responses (reaction time to target stimuli and error ratio) were measured. RESULTS At baseline, healthy controls revealed increased activity in the frontal lobe, especially in regions of the prefrontal cortex. Compared to HC, SZ showed hypoactivation in the right dorsolateral prefrontal cortex (DLPFC) and the ventrolateral prefrontal cortex (VLPFC) bilaterally for the 2-back condition. In the 2-back degraded condition there was a hypoactivation in both, the right DLPFC and the VLPFC. Additionally, patients showed bilaterally decreased activation in the basalganglia in the 2-back and in the right caudatus in the 2-back degraded condition compared to healthy controls. After treatment with quetiapine, patients activations patterns were increased. The pre-post comparison of the 2-back condition revealed a significant increase of activation in the left VLPFC at a significance level of 0.001 (uncorrected). The 2-back degraded condition led to a significant activation pattern in the lingual gyrus and the right precuneus. In both wm conditions, at baseline there were no differences in reaction time but only a worse performance in SZ. After treatment, behavioural measurement of responses, including reaction time and performance, showed slight improvements in SZ, although these did not reach statistical significance. CONCLUSIONS The neuronal networks underlying working memory are clearly altered in schizophrenia. After 12 weeks of treatment with quetiapine monotherapy, patients showed significant clinical improvement and revealed increased BOLD activity in the VLPFC during a working memory task, although there was no improvement of cognitive performance.
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Affiliation(s)
- E M Meisenzahl
- Dept. of Psychiatry, Ludwig-Maximilians-University of Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
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de la Fontaine L, Schwarz MJ, Riedel M, Dehning S, Douhet A, Spellmann I, Kleindienst N, Zill P, Plischke H, Gruber R, Müller N. Investigating disease susceptibility and the negative correlation of schizophrenia and rheumatoid arthritis focusing on MIF and CD14 gene polymorphisms. Psychiatry Res 2006; 144:39-47. [PMID: 16916546 DOI: 10.1016/j.psychres.2006.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [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] [Received: 05/19/2005] [Revised: 12/19/2005] [Accepted: 01/06/2006] [Indexed: 12/19/2022]
Abstract
Schizophrenia and rheumatoid arthritis (RA) are both chronic diseases with an estimated genetic component of 60%. While RA is a well-known autoimmune inflammatory joint disease, recent data point to an active immune process also being involved in schizophrenia. Several studies confirmed the negative association between schizophrenia and RA, indicating genetic factors that predispose to the one disorder, while protecting from the other. Macrophage migration inhibitory factor (MIF) and the monocytes surface receptor CD14 are involved in the development and maintenance of chronic inflammation. We therefore investigated if the -G173C single nucleotide polymorphism (SNP) and the tetranucleotide repeat CATT (5 - 8) at position -794 of the MIF gene and the CD14 - C159T transition are candidates for genetic liability to schizophrenia and RA or could explain the negative association between them. In our study 157 schizophrenic patients, 119 patients suffering from RA, and 225 healthy individuals were genotyped. All subjects were Caucasians. The CD14- and MIF-genotypes were equally distributed in all three groups. From our results, we cannot confirm the hypothesis that the investigated genetic mutations within the MIF and/or the CD14 gene are involved in the aetiology of either disease or could explain the negative correlation of schizophrenia and RA.
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Affiliation(s)
- Larissa de la Fontaine
- Klinik für Psychiatrie und Psychotherapie, Nüssbaumstr. 7, Ludwig-Maximilians-Universität, D-80336 München, Germany
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Müller N, Schwarz MJ, Dehning S, Douhe A, Cerovecki A, Goldstein-Müller B, Spellmann I, Hetzel G, Maino K, Kleindienst N, Möller HJ, Arolt V, Riedel M. The cyclooxygenase-2 inhibitor celecoxib has therapeutic effects in major depression: results of a double-blind, randomized, placebo controlled, add-on pilot study to reboxetine. Mol Psychiatry 2006; 11:680-4. [PMID: 16491133 DOI: 10.1038/sj.mp.4001805] [Citation(s) in RCA: 535] [Impact Index Per Article: 29.7] [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: 12/22/2022]
Abstract
Signs of an inflammatory process, in particular increased pro-inflammatory cytokines and increased levels of prostaglandine E(2) (PGE(2)), have repeatedly been described in major depression (MD). As cyclooxygenase-2 (COX-2) inhibitors inhibit the PGE(2) production and the production of pro-inflammatory cytokines, we performed a therapeutic trial with the COX-2 inhibitor celecoxib. In a prospective, double-blind, add-on study, 40 patients suffering from an acute depressive episode were randomly assigned to either reboxetine and celecoxib or to reboxetine plus placebo. After a wash-out period, 20 patients received 4-10 mg reboxetine plus placebo and 20 received reboxetine plus 400 mg celecoxib for 6 weeks. The treatment effect was calculated by analysis of variance. There were no significant differences between groups in age, sex, duration or severity of disease or psychopathology, or reboxetine dose or plasma levels. Over 6 weeks, both groups of patients showed significant improvement in scores of the Hamilton Depression Scale. However, the celecoxib group showed significantly greater improvement compared to the reboxetine-alone group. Additional treatment with celecoxib has significant positive effects on the therapeutic action of reboxetine with regard to depressive symptomatology. Moreover, the fact that treatment with an anti-inflammatory drug showed beneficial effects on MD indicates that inflammation is related to the pathomechanism of the disorder, although the exact mechanisms remain to become elucidated.
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Affiliation(s)
- N Müller
- Hospital for Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, München, Germany.
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Schwarz MJ, Krönig H, Riedel M, Dehning S, Douhet A, Spellmann I, Ackenheil M, Möller HJ, Müller N. IL-2 and IL-4 polymorphisms as candidate genes in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2006; 256:72-6. [PMID: 16091861 DOI: 10.1007/s00406-005-0603-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [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] [Received: 12/15/2004] [Accepted: 05/24/2005] [Indexed: 01/14/2023]
Abstract
An immune process, characterized by a relative predominance of the T helper-2 (Th2) system and possibly induced by a viral infection,may be involved in the pathophysiology of schizophrenia. In this context, functional polymorphisms in the Interleukin-2 (IL-2) and Interleukin-4 (IL-4) genes appear to be principal candidates for genetic schizophrenia research. Further evidence for these candidate genes comes from several linkage analyses, pointing to susceptibility gene loci on chromosomes 4q and 5q, where the genes coding for IL- 2 and IL-4 are located. We carried out a case-control study including 230 schizophrenic patients and 251 healthy persons, investigating the IL-2 -330 T/G single nucleotide polymorphism (SNP) and the IL-4 -590 C/T SNP. A significant association of the IL-2 -330 TT genotype and of the IL-4 -590 CC genotype with schizophrenia could be identified. Our findings may partly account for the relative predominance of the Th2 system in schizophrenia, although they cannot directly explain this immunological imbalance, but may be related to an altered antiviral immune response in patients with schizophrenia.
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Affiliation(s)
- Markus J Schwarz
- Psychiatric Hospital, Ludwig-Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany
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Riedel M, Müller N, Strassnig M, Spellmann I, Engel RR, Musil R, Dehning S, Douhet A, Schwarz MJ, Möller HJ. Quetiapine has equivalent efficacy and superior tolerability to risperidone in the treatment of schizophrenia with predominantly negative symptoms. Eur Arch Psychiatry Clin Neurosci 2005; 255:432-7. [PMID: 16267634 DOI: 10.1007/s00406-005-0622-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [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] [Received: 02/21/2005] [Accepted: 09/07/2005] [Indexed: 11/30/2022]
Abstract
Atypical antipsychotics are generally thought to be more effective than conventional agents in treating the negative symptoms of schizophrenia; however, there have been few direct comparisons among atypicals. We therefore investigated risperidone and quetiapine with respect to their efficacy against negative symptoms in a 12-week,double-blind, comparative pilot study involving 44 patients with schizophrenia with predominantly negative symptoms, as defined by Positive and Negative Syndrome Scale (PANSS) scores. Other efficacy measures included the Scale for the Assessment of Negative Symptoms (SANS) and the Clinical Global Impression (CGI) rating scale. Antipsychotic tolerability was assessed using the Simpson-Angus Scale (SAS) and various laboratory measures. Mean doses were 589.7 mg/ day quetiapine and 4.9 mg/day risperidone (observed cases). Both antipsychotics produced significant decreases in PANSS total, positive and negative scores, and SANS scores. Patients receiving risperidone were significantly more likely to experience extrapyramidal symptoms (EPS) [p <0.05], or to require anticholinergic medication (p <0.05), and had significantly higher prolactin levels (p <0.001) than quetiapine-treated patients. In conclusion, there is no significant difference in efficacy between quetiapine and risperidone in alleviating the negative symptoms of schizophrenia. Quetiapine is also well tolerated, with a lower incidence of EPS and prolactin increase than risperidone.
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Affiliation(s)
- Michael Riedel
- Ludwig-Maximilians-University of Munich, Dept. of Psychiatry and Psychotherapy, Nussbaumstrasse 7, 80336, Munich, Germany.
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Spellmann I, Riedel M, Müller N, Strassnig M, Douhet A, Dehning S, Möller HJ. Cognitive benefits of quetiapine versus risperidone in schizophrenia. Pharmacopsychiatry 2005. [DOI: 10.1055/s-2005-918844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Douhet A, Riedel M, Spellmann I, Dehning S, Cerovecki A, Zill P, Müller N, Möller HJ, Bondy B. Genetic polymorphisms of the beta2-adrenoceptor gene might influence metabolic disturbances during antipsychotic treatment. Pharmacopsychiatry 2005. [DOI: 10.1055/s-2005-918665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Musil R, Schwarz M, Riedel M, Dehning S, Douhet A, Spellmann I, Müller N. Immune parameters in patients with depression versus healthy controls during an open-label, placebo-controlled, randomized trial of reboxetine and celecoxib. Pharmacopsychiatry 2005. [DOI: 10.1055/s-2005-918792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Riedel M, Schwarz MJ, Strassnig M, Spellmann I, Müller-Arends A, Weber K, Zach J, Müller N, Möller HJ. Risperidone plasma levels, clinical response and side-effects. Eur Arch Psychiatry Clin Neurosci 2005; 255:261-8. [PMID: 15565299 DOI: 10.1007/s00406-004-0556-4] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [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] [Received: 07/14/2004] [Accepted: 09/27/2004] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Assessment of the relation between oral risperidone dose, serum drug levels and clinical response may provide important information for rational treatment decisions. Inter-individual differences in the liver cytochrome P450 system, especially in the CYP2D6 subsystem, which account for a significant portion of risperidone metabolism, may also influence plasma drug levels and alter clinical response parameters. We thus prospectively investigated risperidone serum concentrations in relation to clinical efficacy and side-effects and genotyped major CYP2D6 polymorphisms to determine their effect upon these parameters. METHODS Neuroleptic monotherapy with risperidone was administered to schizophrenia patients in a 6-week open dose clinical trial. Weekly assessments including CGI and PANSS ratings to assess psychopathology; SAS to assess medication side effects; and blood draws to quantify steady state plasma levels of risperidone and 9-OH-risperidone were carried out. In addition, major CYP2D6 polymorphisms including alleles *4, *6 and *14 were genotyped. RESULTS Eighty-two patients were recruited. Mean oral dose of risperidone was 4.3 +/- 0.9 mg. Mean plasma level of both risperidone and 9-OH-risperidone together ("active moiety") was 41.6 +/- 26.6 ng/ml. Significant improvements in PANSS scales and the various subscales ensued. There was a positive linear correlation between active moiety plasma levels and dose (r = 0.291, p = 0.015) and between risperidone and 9-OH-risperidone levels (r = 0.262; p = 0.016). Nonresponders to pharmacotherapy (PANSS-Improvement < 30%) showed significantly higher active moiety plasma levels (49.9 +/- 30.7 ng/ml) than responders (38.2 +/- 17.0 ng/ml; p = 0.045) without significantly higher oral doses (p = 0.601). Patients with longer illness duration (> or = 3 years) had significantly higher plasma drug levels than those with a shorter course (< 3 years; p = 0.039). Extrapyramidal side effects (EPS) and plasma levels were not correlated (r = 0.028; p = 0.843), but higher plasma levels at week 2 predicted an incidence for EPS (p < 0.050). Accordingly, patients initially receiving higher oral doses of risperidone were significantly more likely to respond with EPS in the trial course. Eight patients (9.8%) were heterozygous carriers of the CYP2D6 allele *4. CYP2D6 polymorphisms did not predict clinical response, but predicted a tendential increase in the plasma risperidone to 9-OH-risperidone ratio (0.5 +/- 0.6 vs. 1.9 +/- 1.8; p = 0.120). DISCUSSION The major finding was that responders to risperidone treatment had significantly lower blood levels of risperidone and 9-OH risperidone than patients who did not respond to the treatment despite administration of similar oral doses. The observed CYP2D6 polymorphisms did not contribute to altered clinical efficacy, but affected risperidone to 9-OH-risperidone ratios. Increased plasma levels of the active moiety in patients with longer illness may represent general aging effects. Conversely, the observed higher plasma levels in nonresponders may derive from unaccounted genetic metabolism abnormalities or Phase II metabolism disturbances. Patients initially receiving higher oral risperidone doses were more likely to respond with extrapyramidal side effects which reaffirms the need for careful titration. The high inter-individual variability in risperidone and 9-OH-risperidone metabolization and the relationship between clinical outcome and plasma levels warrants regular plasma level monitoring of both compounds to assess for the clinically relevant active moiety.
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Affiliation(s)
- Michael Riedel
- Dept. of Psychiatry and Psychotherapy, University of Munich, 80336 Munich, Germany.
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Schwarz MJ, Spellmann I, Müller-Arends A, Strassnig M, Zach J, Weber K, Müller N, Möller HJ, Riedel M. Risperidone Plasma Levels, Clinical Response and Side-Effects. Pharmacopsychiatry 2005. [DOI: 10.1055/s-2005-862693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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