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Khan A, Lindenmayer JP, Insel B, Seddo M, Demirli E, DeFazio K, Sullivan M, Hoptman MJ, Ahmed AO. Computerized cognitive and social cognition training in schizophrenia for impulsive aggression. Schizophr Res 2023; 256:117-125. [PMID: 36424289 PMCID: PMC11046975 DOI: 10.1016/j.schres.2022.11.004] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/22/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Schizophrenia is associated with an elevated risk for impulsive aggression for which there are few psychosocial treatment options. Neurocognitive and social cognitive deficits have been associated with aggression with social cognitive deficits seemingly a more proximal contributor. The current study examined the effects of combining cognitive and social cognition treatment on impulsive aggression among inpatients with chronic schizophrenia and schizoaffective disorder and a history of aggression compared to cognitive remediation treatment alone. METHODS The two-center study randomized 130 participants to receive 36 sessions of either a combination of cognitive remediation and social cognition treatment or cognitive remediation plus a computer-based control. Participants had at least one aggressive incident within the past year or a Life History of Aggression (LHA) score of 5 or more. Participants completed measures of neurocognition, social cognition, symptom severity, and aggression at baseline and endpoint. RESULTS Study participants were mostly male (84.5 %), had a mean age 34.9 years, and 11.5 years of education. Both Cognitive Remediation Training (CRT) plus Social Cognition Training (SCT) and CRT plus control groups were associated with significant reductions in aggression measures with no group differences except on a block of the Taylor Aggression Paradigm (TAP), a behavioral task of aggression which favored the CRT plus SCT group. Both groups showed significant improvements in neurocognition and social cognition measures with CRT plus SCT being associated with greater improvements. CONCLUSION CRT proved to be an effective non-pharmacological treatment in reducing impulsive aggression in schizophrenia inpatient participants with a history of aggressive episodes. The addition of social cognitive training did not enhance this anti-aggression treatment effect but did augment the CRT effect on cognitive functions, on emotion recognition and on mentalizing capacity of our participants.
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Affiliation(s)
- Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Orangeburg Road, Orangeburg, NY 10962, USA; Manhattan Psychiatric Center, 1 Wards Island Complex, Wards Island, NY 10035, USA.
| | - Jean-Pierre Lindenmayer
- Nathan S. Kline Institute for Psychiatric Research, 140 Orangeburg Road, Orangeburg, NY 10962, USA; Manhattan Psychiatric Center, 1 Wards Island Complex, Wards Island, NY 10035, USA; New York University School of Medicine, 550 1st Ave., New York, NY 10016, USA
| | - Beverly Insel
- Mount Sinai Medical Center, 5 East 98th Street, New York, NY 10029, USA
| | - Mary Seddo
- Long Island University, 1 University Plaza, Brooklyn, NY 11201, USA
| | - Ecem Demirli
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Kayla DeFazio
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Mark Sullivan
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
| | - Matthew J Hoptman
- Nathan S. Kline Institute for Psychiatric Research, 140 Orangeburg Road, Orangeburg, NY 10962, USA; New York University School of Medicine, 550 1st Ave., New York, NY 10016, USA
| | - Anthony O Ahmed
- Weill Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA
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Adam O, Blay M, Brunoni AR, Chang HA, Gomes JS, Javitt DC, Jung DU, Kantrowitz JT, Koops S, Lindenmayer JP, Palm U, Smith RC, Sommer IE, Valiengo LDCL, Weickert TW, Brunelin J, Mondino M. Efficacy of Transcranial Direct Current Stimulation to Improve Insight in Patients With Schizophrenia: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Schizophr Bull 2022; 48:1284-1294. [PMID: 35820035 PMCID: PMC9673267 DOI: 10.1093/schbul/sbac078] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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 Impaired insight into the illness and its consequences is associated with poor outcomes in schizophrenia. While transcranial direct current stimulation (tDCS) may represent a potentially effective treatment strategy to relieve various symptoms of schizophrenia, its impact on insight remains unclear. To investigate whether tDCS would modulate insight in patients with schizophrenia, we undertook a meta-analysis based on results from previous RCTs that investigated the clinical efficacy of tDCS. We hypothesize that repeated sessions of tDCS will be associated with insight improvement among patients. STUDY DESIGN PubMed and ScienceDirect databases were systematically searched to identify RCTs that delivered at least 10 tDCS sessions in patients with schizophrenia. The primary outcome was the change in insight score, assessed by the Positive and Negative Syndrome Scale (PANSS) item G12 following active tDCS sessions as opposed to sham stimulation. Effect sizes were calculated for all studies and pooled using a random-effects model. Meta-regression and subgroup analyses were conducted. STUDY RESULTS Thirteen studies (587 patients with schizophrenia) were included. A significant pooled effect size (g) of -0.46 (95% CI [-0.78; -0.14]) in favor of active tDCS was observed. Age and G12 score at baseline were identified as significant moderators, while change in total PANSS score was not significant. CONCLUSIONS Ten sessions of active tDCS with either frontotemporoparietal or bifrontal montage may improve insight into the illness in patients with schizophrenia. The effect of this treatment could contribute to the beneficial outcomes observed in patients following stimulation.
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Affiliation(s)
- Ondine Adam
- Pôle Est, Centre Hospitalier Le Vinatier, Bron, France,INSERM U1028; CNRS UMR5292; PSYR2 Team; Lyon Neuroscience Research Center, Université Claude Bernard Lyon 1, Université Jean Monnet, Lyon, France
| | - Martin Blay
- Pôle Est, Centre Hospitalier Le Vinatier, Bron, France
| | - Andre R Brunoni
- Departamento e Instituto de Psiquiatria, Faculdade de Medicina, Laboratório de Neurociências (LIM-27), Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil,Departamento e Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, Serviço Interdisciplinar de Neuromodulação (SIN), Hospital das Clínicas HCFMUSP, São Paulo, Brazil
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - July S Gomes
- Interdisciplinary Laboratory of Clinical Neurosciences, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Daniel C Javitt
- Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Nathan Kline Institute, Orangeburg, NY, USA
| | - Do-Un Jung
- Department of Psychiatry, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Joshua T Kantrowitz
- Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Nathan Kline Institute, Orangeburg, NY, USA
| | - Sanne Koops
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Jean-Pierre Lindenmayer
- Nathan Kline Institute, Orangeburg, NY, USA,New York University School of Medicine, New York, NY, USA,Manhattan Psychiatric Center, New York, NY, USA
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, Hospital of the University of Munich, Munich, Germany,Medical Park Chiemseeblick, Bernau-Felden, Germany
| | - Robert C Smith
- Nathan Kline Institute, Orangeburg, NY, USA,New York University School of Medicine, New York, NY, USA
| | - Iris E Sommer
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Leandro do Costa Lane Valiengo
- Departamento e Instituto de Psiquiatria, Faculdade de Medicina, Laboratório de Neurociências (LIM-27), Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil,Departamento e Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, Serviço Interdisciplinar de Neuromodulação (SIN), Hospital das Clínicas HCFMUSP, São Paulo, Brazil
| | - Thomas W Weickert
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,Neuroscience Research Australia, Sydney, NSW, Australia
| | | | - Marine Mondino
- To whom correspondence should be addressed; PsyR2 team, Centre Hospitalier le Vinatier, batiment 416, 1st floor, 95 boulevard Pinel, 69678 Bron, Cedex BP 30039, France; tel: (+33)4 37 91 55 65, fax: (+33)4 37 91 55 49, e-mail:
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Nemani K, Williams SZ, Olfson M, Leckman-Westin E, Finnerty M, Kammer J, Smith TE, Silverman DJ, Lindenmayer JP, Capichioni G, Clelland J, Goff DC. Association Between the Use of Psychotropic Medications and the Risk of COVID-19 Infection Among Long-term Inpatients With Serious Mental Illness in a New York State-wide Psychiatric Hospital System. JAMA Netw Open 2022; 5:e2210743. [PMID: 35522282 PMCID: PMC9077485 DOI: 10.1001/jamanetworkopen.2022.10743] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE Individuals with serious mental illness are at increased risk of severe COVID-19 infection. Several psychotropic medications have been identified as potential therapeutic agents to prevent or treat COVID-19 but have not been systematically examined in this population. OBJECTIVE To evaluate the associations between the use of psychotropic medications and the risk of COVID-19 infection among adults with serious mental illness receiving long-term inpatient psychiatric treatment. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study assessed adults with serious mental illness hospitalized in a statewide psychiatric hospital system in New York between March 8 and July 1, 2020. The final date of follow-up was December 1, 2020. The study included 1958 consecutive adult inpatients with serious mental illness (affective or nonaffective psychoses) who received testing for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction or antinucleocapsid antibodies and were continuously hospitalized from March 8 until medical discharge or July 1, 2020. EXPOSURES Psychotropic medications prescribed prior to COVID-19 testing. MAIN OUTCOMES AND MEASURES COVID-19 infection was the primary outcome, defined by a positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction or antibody test result. The secondary outcome was COVID-19-related death among patients with laboratory-confirmed infection. RESULTS Of the 2087 adult inpatients with serious mental illness continuously hospitalized during the study period, 1958 (93.8%) underwent testing and were included in the study; 1442 (73.6%) were men, and the mean (SD) age was 51.4 (14.3) years. A total of 969 patients (49.5%) had laboratory-confirmed COVID-19 infection that occurred while they were hospitalized; of those, 38 (3.9%) died. The use of second-generation antipsychotic medications, as a class, was associated with decreased odds of infection (odds ratio [OR], 0.62; 95% CI, 0.45-0.86), whereas the use of mood stabilizers was associated with increased odds of infection (OR, 1.23; 95% CI, 1.03-1.47). In a multivariable model of individual medications, the use of paliperidone was associated with decreased odds of infection (OR, 0.59; 95% CI, 0.41-0.84), and the use of valproic acid was associated with increased odds of infection (OR, 1.39; 95% CI, 1.10-1.76). Clozapine use was associated with reduced odds of mortality in unadjusted analyses (unadjusted OR, 0.25; 95% CI, 0.10-0.62; fully adjusted OR, 0.43; 95% CI, 0.17-1.12). CONCLUSIONS AND RELEVANCE In this cohort study of adults hospitalized with serious mental illness, the use of second-generation antipsychotic medications was associated with decreased risk of COVID-19 infection, whereas the use of valproic acid was associated with increased risk. Further research is needed to assess the mechanisms that underlie these findings.
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Affiliation(s)
- Katlyn Nemani
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
- Department of Psychiatry, New York University Langone Medical Center, New York
| | | | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | | | | | | | | | | | - Jean-Pierre Lindenmayer
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
- Department of Psychiatry, New York University Langone Medical Center, New York
| | - Gillian Capichioni
- Department of Psychiatry, New York University Langone Medical Center, New York
| | - James Clelland
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Donald C. Goff
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
- Department of Psychiatry, New York University Langone Medical Center, New York
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Cohen EA, Skubiak T, Hadzi Boskovic D, Norman K, Knights J, Fang H, Coppin-Renz A, Peters-Strickland T, Lindenmayer JP, Reuteman-Fowler JC. Phase 3b Multicenter, Prospective, Open-label Trial to Evaluate the Effects of a Digital Medicine System on Inpatient Psychiatric Hospitalization Rates for Adults With Schizophrenia. J Clin Psychiatry 2022; 83. [PMID: 35421287 DOI: 10.4088/jcp.21m14132] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 10/18/2022]
Abstract
Objective: Inpatient psychiatric admissions drive the financial burden of schizophrenia, and medication adherence remains challenging. We assessed whether aripiprazole tablets with sensor (AS; system includes ingestible event-marker sensor, wearable sensor patches, and smartphone application) could reduce psychiatric hospitalizations compared with oral standard-of-care (SOC) antipsychotics. Methods: This phase 3b, mirror-image clinical trial was conducted from April 29, 2019-August 11, 2020, in adults with schizophrenia with ≥ 1 hospitalization in the previous 48 months who had been prescribed oral SOC for the preceding 6 months (retrospective phase). All participants used AS for at least 3 months and up to 6 months. Primary endpoint was the inpatient psychiatric hospitalization rate in the modified intent-to-treat (mITT; n = 113) population during prospective months 1-3 versus retrospective phase. Proportion of days covered by medication was the secondary endpoint. Safety endpoints included adverse events related to the medication or patch and suicidality. Results: AS significantly reduced hospitalizations during prospective months 1-3 (-9.7%) and months 1-6 (-21.3% [P ≤ .001 for all comparisons]) in the mITT population versus the corresponding retrospective phase. AS use improved confirmed medication ingestion by 26.5 percentage points in prospective months 1-3 (P ≤ .001) and reduced PANSS scores. Patches were well-tolerated, and no participant reported changes in suicide risk. Conclusions: Compared with oral SOC, AS reduced inpatient psychiatric hospitalization rates for adults with mild-to-moderate schizophrenia. The AS system may aid medication ingestion and is associated with improvements in symptoms, potentially reducing acute-care needs among patients with schizophrenia. Trial Registration: ClinicalTrials.gov identifier: NCT03892889.
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Affiliation(s)
| | - Taisa Skubiak
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey
| | | | - Keinya Norman
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey
| | - Jonathan Knights
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey
| | - Hui Fang
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey
| | - Antonia Coppin-Renz
- Otsuka Pharmaceutical Development & Commercialisation Europe GmbH, Hessen, Germany
| | | | | | - J Corey Reuteman-Fowler
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey.,Corresponding author: J. Corey Reuteman-Fowler, PhD, 38 Hewitt Rd, Lambertville, NJ 08530
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Alphs L, Fu DJ, Williamson D, Jamieson C, Greist J, Harrington M, Lindenmayer JP, McCullumsmith C, Sheehan DV, Shelton RC, Wicks P, Canuso CM. SIBAT-A Computerized Assessment Tool for Suicide Ideation and Behavior: Development and Psychometric Properties. Innov Clin Neurosci 2022; 19:36-47. [PMID: 35958973 PMCID: PMC9341319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Most assessments of suicidal ideation and behavior (SIB) are limited by reliance on a single assessor, typically a clinician or patient, with scant detail on patient-related drivers of SIB and inability to detect rapid change in SIB. Furthermore, many techniques do not include a semistructured interview, increasing rater variability. The Suicide Ideation and Behavior Assessment Tool (SIBAT) addresses these limitations. DESIGN More than 30 experts in scale development, statistics, and clinical management of suicidal patients collaborated over a greater than four-year period to develop the SIBAT. Input for content and validity was received from patients, clinicians, and regulatory authorities in the United States (US) and Europe. Psychometric properties of the SIBAT were evaluated in validation studies. RESULTS The SIBAT is organized into eight independent patient- or clinician-rated modules with branching logic and scoring algorithms, which necessitates computerization. Patient-reported information is first captured in Modules 1 to 5. Thereafter, an experienced clinician reviews the patient's report, conducts a semistructured interview (Module 6), and assesses the patient's suicide risk (Module 7) and optimal antisuicide management (Module 8). Input from cognitive interviews of diverse adult, adolescent, and clinician participants was incorporated into the final version of the SIBAT. Psychometric testing demonstrated good inter-rater reliability (intraclass coefficient range: 0.68-0.82), intra-rater reliability (weighted-kappa range: 0.64-0.76), and concurrent validity with other instruments for assessing SIB. CONCLUSION Patient- and clinician-based assessments and the psychometric studies summarized in this report support the validity and reliability of the SIBAT for capturing critical information related to assessment of SIB in adolescents and adults at risk for suicide.
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Affiliation(s)
- Larry Alphs
- Dr. Alphs is with Denovo Biopharma in San Diego, California (he was with Janssen Scientific Affairs, LLC in Titusville, New Jersey at the time the work reported herein was performed)
| | - Dong-Jing Fu
- Drs. Fu and Canuso are with Janssen Research and Development, LLC in Titusville, New Jersey
| | - David Williamson
- Dr. Williamson is with the Departments of Psychiatry and Neurology at University of South Alabama College of Medicine in Mobile, Alabama and Department of Psychiatry and Health Behavior at Augusta University in Augusta, Georgia (he was with Janssen Scientific Affairs, LLC in Titusville, New Jersey at the time the work reported herein was performed)
| | - Carol Jamieson
- Ms. Jamieson is with Janssen Research and Development, LLC in Milpitas, California
| | - John Greist
- Dr. Greist is a Professor Emeritus–Psychiatry at the University of Wisconsin School of Medicine and Public Health and is with Healthcare Technology Systems, Inc. in Madison, Wisconsin
| | - Magdalena Harrington
- Dr. Harrington is with Pfizer, Inc. in Cambridge, Massachussetts (she was a Psychometrician/Patient-Reported Outcomes at PatientsLikeMe in Cambridge, Massachusetts at the time the work reported herein was performed)
| | - Jean-Pierre Lindenmayer
- Dr. Lindenmayer is with New York University Grossman School of Medicine, Department of Psychiatry in New York City, New York
| | - Cheryl McCullumsmith
- Dr. McCullumsmith is with the University of Toledo, Department of Psychiatry in Toledo, Ohio
| | - David V. Sheehan
- Dr. Sheehan is a Distinguished University Health Professor Emeritus, University of South Florida College of Medicine in Tampa, Florida
| | - Richard C. Shelton
- Dr. Shelton is with the University of Alabama at Birmingham School of Medicine, Department of Psychiatry in Birmingham, Alabama
| | - Paul Wicks
- Dr. Wicks is with Wicks Digital Health Ltd. in Lichfield, United Kingdom (he was with PatientsLikeMe in Cambridge, Massachusetts at the time the work reported herein was performed)
| | - Carla M. Canuso
- Drs. Fu and Canuso are with Janssen Research and Development, LLC in Titusville, New Jersey
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Cochran JM, Fang H, Sonnenberg JG, Cohen EA, Lindenmayer JP, Reuteman-Fowler JC. Healthcare Provider Engagement with a Novel Dashboard for Tracking Medication Ingestion: Impact on Treatment Decisions and Clinical Assessments for Adults with Schizophrenia. Neuropsychiatr Dis Treat 2022; 18:1521-1534. [PMID: 35928793 PMCID: PMC9343256 DOI: 10.2147/ndt.s369123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Schizophrenia is a severe, chronic condition accounting for disproportionate healthcare utilization. Antipsychotics can reduce relapse rates, but the characteristics of schizophrenia may hinder medication adherence. A phase 3b open-label clinical trial used aripiprazole tablets with sensor (AS; includes pills with ingestible event-marker, wearable sensor patches and smartphone application) in adults with schizophrenia. This post hoc analysis explored how healthcare providers' (HCPs) usage of a dashboard that provided medication ingestion information impacted treatment decisions and clinical assessments. PATIENTS AND METHODS Participants used AS for 3-6 months. HCPs were instructed to check the dashboard regularly, identify features used, and report impact on treatment decisions. After stratifying HCPs by frequency of dashboard checks and resulting treatment decisions, changes from baseline were calculated for Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression (CGI)-Severity of Illness and CGI-Improvement (CGI-I), and Personal and Social Performance (PSP), and compared using Mann-Whitney U-tests and rank-biserial correlation coefficient (r) effect sizes. RESULTS To ensure sufficient opportunity for AS engagement, 113 participants who completed ≥3 months on study were analyzed. HCPs most often accessed dashboard data regarding medication ingestion and missed doses. HCPs recommended adherence counseling and participant education most often. Participants whose HCPs used the dashboard more and recommended adherence counseling and participant education (n=61) improved significantly more than participants with less dashboard-active HCPs (n=49) in CGI-I mean score (2.9 versus 3.4 [p=0.004]), total PANSS (mean change: -9.2 versus -3.1 [p=0.0002]), PANSS positive subscale (-3.2 versus -1.5 [p=0.003]), PANSS general subscale (-4.3 versus -1.2 [p=0.02]), and Marder factor for negative symptoms (-1.9 versus 0.0 [p=0.03]). Most HCPs found the dashboard easy to use (74%) and helpful for improving conversations with participants about their treatment plan and progress (78%). CONCLUSION This provider dashboard may facilitate discussions with patients about regular medication-taking, which can improve patient outcomes.
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Affiliation(s)
- Jeffrey M Cochran
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Hui Fang
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - John G Sonnenberg
- Uptown Research Institute, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Jean-Pierre Lindenmayer
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
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Cochran JM, Fang H, Le Gallo C, Peters-Strickland T, Lindenmayer JP, Reuteman-Fowler JC. Participant Engagement and Symptom Improvement: Aripiprazole Tablets with Sensor for the Treatment of Schizophrenia. Patient Prefer Adherence 2022; 16:1805-1817. [PMID: 35923658 PMCID: PMC9342879 DOI: 10.2147/ppa.s362889] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/16/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE A recent, phase 3b, mirror-image clinical trial of outpatients with schizophrenia found that use of aripiprazole tablets with sensor (AS; Abilify MyCite®, comprising an ingestible event-marker sensor embedded in aripiprazole tablets, wearable sensor patches, and a smartphone application) reduced the incidence of psychiatric hospitalizations relative to oral standard-of-care antipsychotics. This analysis explored the relationship between AS engagement by participants and changes in participant performance and symptom-severity measures assessed by clinical raters. PARTICIPANTS AND METHODS This post hoc analysis used prospectively collected clinical data from a phase 3b clinical trial (NCT03892889). Outpatients had schizophrenia, were aged 18-65 years, and had ≥ 1 psychiatric hospitalization in the previous 48 months. Participants were grouped by study completion status and a k-means clustering algorithm based on AS utilization, resulting in 3 groups: discontinued (discontinued AS before month 3 of the study); moderate engagement (completed 3 months, used AS intermittently); and high engagement (completed 3 months, used AS regularly). Baseline to end-of-study differences for the Clinical Global Impression Scale (Severity of Illness and Improvement of Illness scales), Personal and Social Performance Scale, and Positive and Negative Syndrome Scale were calculated. RESULTS A total of 277 outpatients were enrolled (discontinued, n = 164; moderate engagement, n = 63; high engagement, n = 50). All groups experienced symptom improvement from baseline to end-of-study, with significant changes in the more-engaged groups. Highly engaged participants showed significant improvement for all clinical scores and subscores (all P < 0.05) and demonstrated significantly more improvement in symptoms than participants with less engagement. CONCLUSION Participants who completed 3 months of the study and had higher AS engagement experienced significantly greater improvement in their end-of-study clinical assessments versus participants who did not complete 3 months. Improvement may be related to more-consistent medication intake and better engagement with a digital health system.
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Affiliation(s)
- Jeffrey M Cochran
- Medical & Real World Data Analytics, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
- Correspondence: Jeffrey M Cochran, Medical & Real World Data Analytics, Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center, Princeton, NJ, 08540, USA, Tel +1 609 535 9035, Email
| | - Hui Fang
- Biostatistics, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Christophe Le Gallo
- Clinical Programming, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | | | - Jean-Pierre Lindenmayer
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - J Corey Reuteman-Fowler
- Global Clinical Development, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
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Lindenmayer JP, Insel BJ, Khan A, Osborne M, Goldring A, Seddo M. Effects of Clozapine on Neurocognitive Functions in Schizophrenia: A Naturalistic Comparison to Non-clozapine Antipsychotics. Innov Clin Neurosci 2021; 18:40-46. [PMID: 35096483 PMCID: PMC8794480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE While clozapine is recognized as the most effective antipsychotic for individuals with treatment-resistant schizophrenia, its effects on neurocognition remain unclear. This study aimed to compare the neurocognitive effects of clozapine treatment to those of non-clozapine antipsychotics in patients with schizophrenia and to examine the role of anticholinergic burden on cognitive impairments. DESIGN This was a naturalistic study. Cross-sectional data were drawn from participants with chronic schizophrenia in two clinical trials assessing cognition. Cognition was evaluated using the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB). Anticholinergic burden was calculated for each medication using the Anticholinergic Cognitive Burden (ACB) scoring system. We stratified the participants treated with non-clozapine antipsychotics into high ACB score versus low ACB score groups. RESULTS One hundred and seventy participants were enrolled and treated with clozapine (n=58) or non-clozapine antipsychotics (n=112). We observed no significant differences in the MCCB T-scores between the clozapine and the total non-clozapine groups for the cognitive composite score and the seven domain scores. However, the non-clozapine high ACB group showed significant impairments in processing speed and attention/vigilance, in contrast to the non-clozapine low ACB group (p<0.05). CONCLUSION Our results show that cognitive effects of clozapine might be no different from other antipsychotics. Negative effects on neurocognition in participants treated with antipsychotics with a high ACB score were related to their total ACB score.
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Affiliation(s)
- J P Lindenmayer
- Drs. Lindenmayer, Insel, and Khan, Ms. Osborne and Seddo, and Mr. Goldring are with Manhattan Psychiatric Center in New York City, New York
- Drs. Lindenmayer and Khan and Mr. Goldring are with Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Dr. Lindenmayer is with the Department of Psychiatry at New York University in New York City, New York
- Mr. Goldring is with Medgar Evers College, City University of New York in Brooklyn, New York
| | - Beverly J Insel
- Drs. Lindenmayer, Insel, and Khan, Ms. Osborne and Seddo, and Mr. Goldring are with Manhattan Psychiatric Center in New York City, New York
- Drs. Lindenmayer and Khan and Mr. Goldring are with Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Dr. Lindenmayer is with the Department of Psychiatry at New York University in New York City, New York
- Mr. Goldring is with Medgar Evers College, City University of New York in Brooklyn, New York
| | - Anzalee Khan
- Drs. Lindenmayer, Insel, and Khan, Ms. Osborne and Seddo, and Mr. Goldring are with Manhattan Psychiatric Center in New York City, New York
- Drs. Lindenmayer and Khan and Mr. Goldring are with Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Dr. Lindenmayer is with the Department of Psychiatry at New York University in New York City, New York
- Mr. Goldring is with Medgar Evers College, City University of New York in Brooklyn, New York
| | - McKenzie Osborne
- Drs. Lindenmayer, Insel, and Khan, Ms. Osborne and Seddo, and Mr. Goldring are with Manhattan Psychiatric Center in New York City, New York
- Drs. Lindenmayer and Khan and Mr. Goldring are with Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Dr. Lindenmayer is with the Department of Psychiatry at New York University in New York City, New York
- Mr. Goldring is with Medgar Evers College, City University of New York in Brooklyn, New York
| | - Abraham Goldring
- Drs. Lindenmayer, Insel, and Khan, Ms. Osborne and Seddo, and Mr. Goldring are with Manhattan Psychiatric Center in New York City, New York
- Drs. Lindenmayer and Khan and Mr. Goldring are with Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Dr. Lindenmayer is with the Department of Psychiatry at New York University in New York City, New York
- Mr. Goldring is with Medgar Evers College, City University of New York in Brooklyn, New York
| | - Mary Seddo
- Drs. Lindenmayer, Insel, and Khan, Ms. Osborne and Seddo, and Mr. Goldring are with Manhattan Psychiatric Center in New York City, New York
- Drs. Lindenmayer and Khan and Mr. Goldring are with Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York
- Dr. Lindenmayer is with the Department of Psychiatry at New York University in New York City, New York
- Mr. Goldring is with Medgar Evers College, City University of New York in Brooklyn, New York
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Potkin SG, Kane JM, Correll CU, Lindenmayer JP, Agid O, Marder SR, Olfson M, Howes OD. The Neurobiology of Treatment-Resistant Schizophrenia: Paths to Antipsychotic Resistance and A Roadmap for Future Research. Focus (Am Psychiatr Publ) 2020; 18:456-465. [PMID: 33343259 DOI: 10.1176/appi.focus.18309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from NPJ Schizophrenia (2020) 6:1).
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10
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Goldring A, Borne S, Hefner A, Thanju A, Khan A, Lindenmayer JP. The psychometric properties of the Self-Evaluation of Negative Symptoms Scale (SNS) in treatment-resistant schizophrenia (TRS). Schizophr Res 2020; 224:159-166. [PMID: 33071071 DOI: 10.1016/j.schres.2020.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/13/2019] [Revised: 05/04/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Clinician-administered measures of negative symptoms may not capture patients' subjective experiences. The Self-Evaluation of Negative Symptoms (SNS) has shown good psychometric properties when used in outpatients with higher-level functioning schizophrenia. We aimed to evaluate the psychometric properties of the SNS in low functioning participants with treatment-resistant schizophrenia (TRS). METHODS Participants were assessed using the following measures at two time-points; time-point 1: SNS, Wide Range Achievement Test, 4th Edition Reading Subtest (WRAT-4), and Brief Assessment of Cognition in Schizophrenia (BACS). Time-point 2 (within a week of time-point 1): SNS, Negative Symptom Assessment 16 items (NSA-16), Scale to Assess Unawareness in Mental Disorder-Abbreviated (SUMD-A), Clinical Global Impression Severity Scale (CGI-S), Simpson Angus Scale (SAS), Calgary Depression Scale for Schizophrenia (CDSS), and the Patient Feasibility Questionnaire. RESULTS Fifty participants with TRS were enrolled, a mean age of 43.8 years (SD = 11.19, min = 25, max = 64), a mean IQ of 80.62 (SD = 17.12, min = 65, max = 110), and a mean BACS Composite T-Score of 14.08 (SD = 17.16, min = -27, max = 49). Participants responded to SNS prompts with moderate consistency across two time-points. There were no significant correlations between the SNS and the NSA-16 Global Symptom score (Pearson r = 0.207, p = .150, Spearman r = 0.101, p = .483), NSA-16 Global Functioning score (Pearson r = 0.209, p = .145, Spearman r = 0.126, p = .384), nor the NSA-16 total score (Pearson r = 0.149, p = .302, Spearman r = 0.116, p = .421). However, when participants were stratified by BACS Composite T-score, there was a significant positive correlation between the SNS total and the NSA-16 Global Functioning score (Pearson r = 0.500, p = .048, Spearman r = 0.546, p = .029) among participants who demonstrated higher cognitive functioning. CONCLUSION Participants with TRS and low functioning were able to respond to questions on the SNS regarding their subjective assessment of negative symptoms. However, self-reported and clinician-rated negative symptoms were not equivalent, except in a subgroup with higher cognitive functioning. This discrepant self-reporting appeared to relate to their low levels of insight and cognitive impairments.
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Affiliation(s)
- Abraham Goldring
- Nathan Kline Institute, United States of America; Manhattan Psychiatric Center, United States of America; Medgar Evers College, CUNY, United States of America.
| | - Sophia Borne
- Manhattan Psychiatric Center, United States of America; New School for Social Research, United States of America
| | - Amanda Hefner
- Nathan Kline Institute, United States of America; Manhattan Psychiatric Center, United States of America; New York Medical College, United States of America
| | - Amod Thanju
- Nathan Kline Institute, United States of America; Manhattan Psychiatric Center, United States of America
| | - Anzalee Khan
- Nathan Kline Institute, United States of America; Manhattan Psychiatric Center, United States of America
| | - Jean-Pierre Lindenmayer
- Nathan Kline Institute, United States of America; New York University, Department of Psychiatry, United States of America; Manhattan Psychiatric Center, United States of America
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11
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Lindenmayer JP, Goldring A, Borne S, Khan A, Keefe RSE, Insel BJ, Thanju A, Ljuri I, Foreman B. Assessing instrumental activities of daily living (iADL) with a game-based assessment for individuals with schizophrenia. Schizophr Res 2020; 223:166-172. [PMID: 32690346 DOI: 10.1016/j.schres.2020.07.001] [Citation(s) in RCA: 2] [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] [Received: 12/05/2019] [Revised: 04/02/2020] [Accepted: 07/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is an "applied" game-based assessment that uses a multi-level functional task to assess instrumental activities of daily living (iADL). This study examines the feasibility, convergent validity, and predictive ability of the VRFCAT in a sample of inpatients with chronic schizophrenia. METHODS Inpatients with a DSM-5 diagnosis of schizophrenia or schizoaffective disorder, completed the VRFCAT prior to discharge. The UPSA-B, SLOF, and PSP were administered, both at baseline and after four-weeks in the community. VRFCAT performance scores were compared to published data from the VRFCAT validation study. RESULTS All 62 participants completed the VRFCAT. Compared to the performance of stable outpatients, participants performed 1.50 SDs below the VRFCAT mean adjusted total time (ATT) (Validation study: Mean T Score = 32.5, SD = 16.59) with more errors. The VRFCAT ATT T-score was significantly correlated with baseline UPSA-B total score (p = 0.005) and PSP Global score (p = 0.010). 34 participants completed the follow-up period (55%), and 28 were lost to follow-up. There were no statistically significant differences in VRFCAT scores between these two groups (all p > 0.29). The VRFCAT composite score at baseline was significantly associated with the UPSA-B total score (p = 0.010) and the PSP total score (p = 0.008) at four-weeks, as was the PSP Socially Useful Activities subscale score (p = 0.006). CONCLUSION The VRFCAT is a valid measure of iADLs in inpatients with chronic schizophrenia. The VRFCAT predicted instrumental functioning four-weeks post-discharge. Future studies should examine other moderators of measures of functional capacity pre-discharge, predicting function later in the community.
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Affiliation(s)
- Jean-Pierre Lindenmayer
- Manhattan Psychiatric Center, United States of America; New York University, Department of Psychiatry, United States of America; Nathan S. Kline Institute for Psychiatric Research, United States of America
| | - Abraham Goldring
- Manhattan Psychiatric Center, United States of America; Nathan S. Kline Institute for Psychiatric Research, United States of America; Medgar Evers College, CUNY, United States of America.
| | - Sophia Borne
- New School for Social Research, United States of America
| | - Anzalee Khan
- Manhattan Psychiatric Center, United States of America; Nathan S. Kline Institute for Psychiatric Research, United States of America
| | - Richard S E Keefe
- VeraSci, Inc, United States of America; Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America
| | | | - Amod Thanju
- Manhattan Psychiatric Center, United States of America; Nathan S. Kline Institute for Psychiatric Research, United States of America
| | - Isidora Ljuri
- Manhattan Psychiatric Center, United States of America
| | - Bronwen Foreman
- Manhattan Psychiatric Center, United States of America; Duke University School of Medicine, United States of America
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Caroff SN, Citrome L, Meyer J, Sajatovic M, Goldberg JF, Jain R, Lundt L, Lindenmayer JP, McEvoy JP, McIntyre RS, Tohen M, Ketter TA. A Modified Delphi Consensus Study of the Screening, Diagnosis, and Treatment of Tardive Dyskinesia. J Clin Psychiatry 2020; 81. [PMID: 31995677 DOI: 10.4088/jcp.19cs12983] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE A nominal group process followed by a modified Delphi method was used to survey expert opinions on best practices for tardive dyskinesia (TD) screening, diagnosis, and treatment and to identify areas lacking in clinical evidence. PARTICIPANTS A steering committee of 11 TD experts met in nominal group format to prioritize questions to be addressed and identify core bibliographic materials and criteria for survey panelists. Of 60 invited experts, 29 (23 psychiatrists and 6 neurologists) agreed to participate. EVIDENCE A targeted literature search of PubMed (search term: tardive dyskinesia) and recommendations of the steering committee were used to generate core bibliographic material. Inclusion criteria were as follows: (1) review articles, meta-analyses, guidelines, or clinical trials; (2) publication in English between 2007 and 2017; (3) > 3 pages in length; and (4) publication in key clinical journals with impact factors ≥ 2.0. Of 29 references that met these criteria, 18 achieved a score ≥ 5 (calculated as the number of steering committee votes multiplied by journal impact factor and number of citations divided by years since publication) and were included. CONSENSUS PROCESS Two survey rounds were conducted anonymously through electronic media from November 2017 to January 2018; responses were collected, collated, and analyzed. Respondent agreement was defined a priori as unanimous (100%), consensus (75%-99%), or majority (50%-74%). For questions using a 5-point Likert scale, agreement was based on percentage of respondents choosing ≥ 4 ("agree completely" or "agree"). Round 1 survey included questions on TD screening, diagnosis, and treatment. Round 2 questions were refined per panelist feedback and excluded Round 1 questions with < 25% agreement and > 75% agreement (unless feedback suggested further investigation). CONCLUSIONS Consensus was reached that (1) a brief, clinical assessment for TD should be performed at every clinical encounter in patients taking antipsychotics; (2) even mild movements in 1 body area may represent possible TD; (3) management requires an overall evaluation of treatment, including reassessment of antipsychotics and anticholinergics as well as consideration of vesicular monoamine transporter 2 (VMAT2) inhibitors; and (4) informed discussions with patients/caregivers are essential.
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Affiliation(s)
- Stanley N Caroff
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104. .,Corporal Michael J. Crescenz Veterans Affairs Medical Center and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Jonathan Meyer
- Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rakesh Jain
- Department of Psychiatry, Texas Tech University School of Medicine-Permian Basin, Midland, Texas, USA
| | - Leslie Lundt
- Neurocrine Biosciences, Inc, San Diego, California, USA
| | - Jean-Pierre Lindenmayer
- Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Joseph P McEvoy
- Department of Psychiatry, Augusta University, Augusta, Georgia, USA
| | - Roger S McIntyre
- Department of Psychiatry, University Health Network, University of Toronto, Ontario, Canada
| | - Mauricio Tohen
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Terence A Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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13
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Potkin SG, Kane JM, Correll CU, Lindenmayer JP, Agid O, Marder SR, Olfson M, Howes OD. The neurobiology of treatment-resistant schizophrenia: paths to antipsychotic resistance and a roadmap for future research. NPJ Schizophr 2020; 6:1. [PMID: 31911624 PMCID: PMC6946650 DOI: 10.1038/s41537-019-0090-z] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/31/2019] [Indexed: 01/13/2023]
Abstract
Treatment-resistant schizophrenia (TRS), the persistence of positive symptoms despite ≥2 trials of adequate dose and duration of antipsychotic medication with documented adherence, is a serious clinical problem with heterogeneous presentations. TRS can vary in its onset (at the first episode of psychosis or upon relapse), in its severity, and in the response to subsequent therapeutic interventions (i.e., clozapine, electroconvulsive therapy). The heterogeneity of TRS indicates that the underlying neurobiology of TRS may differ not only from treatment-responsive schizophrenia but also among patients with TRS. Several hypotheses have been proposed for the neurobiological mechanisms underlying TRS, including dopamine supersensitivity, hyperdopaminergic and normodopaminergic subtypes, glutamate dysregulation, inflammation and oxidative stress, and serotonin dysregulation. Research supporting these hypotheses is limited in part by variations in the criteria used to define TRS, as well as by the biological and clinical heterogeneity of TRS. Clinical trial designs for new treatments should be informed by this heterogeneity, and further clinical research is needed to more clearly understand the underlying neurobiology of TRS and to optimize treatment for patients with TRS.
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Affiliation(s)
| | - John M Kane
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
- The Zucker Hillside Hospital, Glen Oaks, NY, USA
- The Feinstein Institute for Medical Research, Psychiatric Neuroscience Center of Excellence, Manhasset, NY, USA
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
- The Zucker Hillside Hospital, Glen Oaks, NY, USA
- The Feinstein Institute for Medical Research, Psychiatric Neuroscience Center of Excellence, Manhasset, NY, USA
- Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | | | - Ofer Agid
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Stephen R Marder
- The Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
- The VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
| | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Oliver D Howes
- King's College, London, UK.
- MRC London Institute of Medical Sciences, Imperial College, London, UK.
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14
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Bowie CR, Bell MD, Fiszdon JM, Johannesen JK, Lindenmayer JP, McGurk SR, Medalia AA, Penadés R, Saperstein AM, Twamley EW, Ueland T, Wykes T. Cognitive remediation for schizophrenia: An expert working group white paper on core techniques. Schizophr Res 2020; 215:49-53. [PMID: 31699627 DOI: 10.1016/j.schres.2019.10.047] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 11/28/2022]
Abstract
Cognitive remediation is now widely recognized as an effective treatment for cognitive deficits in schizophrenia. Its effects are meaningful, durable, and related to improvements in everyday functional outcomes. As with many therapies, the evolution of cognitive remediation has resulted in treatment programs that use a variety of specific techniques, yet share common core principles. This paper is the product of a cognitive remediation expert working group consensus meeting to identify core features of the treatment and produce recommendations for its design, conduct, reporting, and implementation. Four techniques were identified as core features of cognitive remediation: facilitation by a therapist, cognitive exercise, procedures to develop problem-solving strategies, and procedures to facilitate transfer to real world functioning. Treatment techniques within each of these core features are presented to facilitate decisions for clinical trials and implementation in clinical settings.
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Affiliation(s)
| | - Morris D Bell
- Department of Psychiatry, Yale School of Medicine, USA
| | - Joanna M Fiszdon
- Department of Psychiatry, Yale School of Medicine, USA; VA Connecticut Healthcare System, USA
| | - Jason K Johannesen
- Department of Psychiatry, Yale School of Medicine, USA; VA Connecticut Healthcare System, USA
| | - Jean-Pierre Lindenmayer
- Nathan Kline Institute for Psychiatric Research, USA; New York University School of Medicine, USA
| | | | | | - Rafael Penadés
- Hospital Clínic Barcelona, University of Barcelona, IDIBAPS-CIBERSAM, Spain
| | | | - Elizabeth W Twamley
- Department of Psychiatry, University of California, San Diego, USA; Center of Excellence for Stress and Mental Health and Research Service, VA San Diego Healthcare System, USA
| | - Torill Ueland
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Norway; Department of Psychology, University of Oslo, Norway
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, UK
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15
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Sevy S, Lindenmayer JP, Khan A, Ljuri I, Kulsa MKC, Jones O. Differential improvement of negative-symptom subfactors after cognitive remediation in low-functioning individuals with schizophrenia. Schizophr Res Cogn 2019; 19:100145. [PMID: 31828020 PMCID: PMC6889361 DOI: 10.1016/j.scog.2019.100145] [Citation(s) in RCA: 2] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
Background Negative symptoms and cognitive deficits have a substantial predictive value for functional deficits and recovery in schizophrenia. However, the relationship between negative symptoms and cognitive abnormalities is unclear possibly due to the heterogeneity of negative symptoms. This study used the model of expressive and experiential negative symptoms subfactors to decrease this heterogeneity. It examined these subfactors and cognition before and after treatment with computerized cognitive remediation training (CRT) in chronically-hospitalized individuals with psychosis and predominant negative symptoms. Methods Seventy-eight adult participants with a DSM-IV-TR diagnosis of schizophrenia or schizoaffective disorder were enrolled in a 12-week CRT program. Assessments of demographic and illness variables, baseline and endpoint assessments of psychopathology (Positive and Negative Syndrome Scale) and cognition (MATRICS Consensus Cognitive Battery - MCCB) were conducted. Results The baseline expressive negative subfactor was associated with Processing Speed (r = −0.352, p ≤ 0.001) and Reasoning/Problem Solving (r = −0.338, p ≤ 0.001). Following CRT, there was a significant decrease in the experiential negative subfactor (p < 0.01) but not of the expressive negative subfactor. Change in MCCB domains after CRT accounted for 51.1% and 50.2% of the variance of change in expressive and experiential negative subfactor scores, respectively. For both subfactors, Visual Learning was a significant predictor of change (p < 0.05). Conclusion Our findings suggest that CRT has benefits for negative symptoms in very low-functioning patients and that this change may be in part mediated by change in cognitive functions after CRT.
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Affiliation(s)
- Serge Sevy
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA
| | - Jean-Pierre Lindenmayer
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.,New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.,NeuroCog Trials, 3211 Shannon Road #300, Durham, NC 27707, USA
| | - Isidora Ljuri
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA
| | - Mila Kirstie C Kulsa
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.,Teachers College Columbia University, 525 West 120 Street, New York, NY 10027, USA
| | - Owen Jones
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA
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16
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Kane JM, Agid O, Baldwin ML, Howes O, Lindenmayer JP, Marder S, Olfson M, Potkin SG, Correll CU. Clinical Guidance on the Identification and Management of Treatment-Resistant Schizophrenia. J Clin Psychiatry 2019; 80. [PMID: 30840788 DOI: 10.4088/jcp.18com12123] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [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: 01/13/2023]
Abstract
Treatment-resistant schizophrenia (TRS) occurs in approximately 30% of individuals diagnosed with schizophrenia. The identification and management of TRS in clinical practice are inconsistent and not evidence based. No established clinically relevant criteria for defining and treating TRS exist, although guidelines have been promulgated for clozapine use among TRS patients. This report summarizes the consensus from a roundtable that focused on defining and identifying TRS, pathways to treatment resistance, current treatments, unmet needs, and disease burden. Nine clinical experts in schizophrenia and TRS participated in a closed meeting on June 23, 2017, sponsored by Lundbeck, at which published literature in key areas of TRS research was reviewed. The findings from published studies were synthesized by experts in each area and presented to the group for review and discussion. It was agreed that inadequate response to 2 different antipsychotics, each taken with adequate dose and duration, is required to establish TRS. This recommendation is consistent with guidelines for clozapine use. For each trial, objective symptom measures should be used to assess treatment response, with medication adherence ensured. Once nonresponse is established (after ≥ 12 weeks for positive symptoms [2 trials of ≥ 6 weeks]), the treatment plan should be reevaluated and alternative pharmacologic or nonpharmacologic treatments considered. With increased awareness, those involved in the care of patients with schizophrenia will be able to identify TRS earlier in its course, thus supporting more informed treatment decisions by clinicians, patients, and caregivers to reduce the overall disease burden.
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Affiliation(s)
- John M Kane
- 75-59 263rd St, Kaufmann Bldg, Ste 103, The Zucker Hillside Hospital, Glen Oaks, NY 11004. .,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,The Zucker Hillside Hospital, Glen Oaks, New York, USA.,The Feinstein Institute for Medical Research, Psychiatric Neuroscience Center of Excellence, Manhasset, New York, USA
| | - Ofer Agid
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Marjorie L Baldwin
- Department of Economics, W. P. Carey School of Business, Arizona State University, Tempe, Arizona, USA
| | - Oliver Howes
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom.,MRC London Institute of Medical Sciences, Imperial College, London, United Kingdom
| | | | - Stephen Marder
- The Semel Institute for Neuroscience at UCLA, Los Angeles, California, USA.,The VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, California, USA
| | - Mark Olfson
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Steven G Potkin
- Department of Psychiatry and Human Behavior, University of California at Irvine, Irvine, California, USA
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,The Zucker Hillside Hospital, Glen Oaks, New York, USA.,The Feinstein Institute for Medical Research, Psychiatric Neuroscience Center of Excellence, Manhasset, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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18
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Lindenmayer JP, Khan A, McGurk SR, Kulsa MKC, Ljuri I, Ozog V, Fregenti S, Capodilupo G, Buccellato K, Thanju A, Goldring A, Parak M, Parker B. Does social cognition training augment response to computer-assisted cognitive remediation for schizophrenia? Schizophr Res 2018; 201:180-186. [PMID: 29910120 DOI: 10.1016/j.schres.2018.06.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/08/2018] [Accepted: 06/08/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cognitive remediation therapy (CRT) has shown significant improvement in cognition in schizophrenia. However, effect sizes of CRT have been reported to be modest raising the issue how to augment the effects of CRT on neurocognition and social cognition. Our aim was to examine whether the addition of computerized social cognition training would enhance the effects on neurocognition and social cognition as compared to CRT alone. METHODS This is a 12-week, parallel group trial of 131 in- and out-patients with schizophrenia randomized to CRT (COGPACK or Brain Fitness) with computerized social cognition training (MRIGE), or CRT alone for 36 sessions. Participants were assessed at baseline and after 12 weeks of treatment. Assessments included neurocognition, social cognition, psychopathology, and functioning. RESULTS The combined intervention, CRT + MRIGE, showed greater improvements in the MCCB indices of Visual Learning, Working Memory, Reasoning and Problem-Solving, and the neurocognitive composite score compared to CRT alone (Bonferroni adjusted p = 0.004, p = 0.005, p = 0.01, respectively), as did social cognition measures (Bonferroni adjusted p = 0.006, p = 0.005, respectively). CONCLUSIONS Supplementing CRT with computerized social cognition training produced greater benefits in neurocognition, including visual learning, memory, executive functions, and social cognition relative to cognitive training alone. These findings favoring the combined training may be contributed to both the greater overall amount of cognitive practice, as well as the specific cognitive functions engaged by the social cognition training.
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Affiliation(s)
- Jean-Pierre Lindenmayer
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; New York University School of Medicine, 550 1st Avenue, New York, NY 10016, United States.
| | - Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; NeuroCog Trials, 3211 Shannon Road #300, Durham, NC 27707, United States.
| | - Susan R McGurk
- Boston University, 1 Silber Way, Boston, MA 02215, United States.
| | - Mila Kirstie C Kulsa
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Teachers College Columbia University, 525 West 120th Street, New York, NY 10027, United States.
| | - Isidora Ljuri
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States.
| | - Veronica Ozog
- Adelphi University, 1 South Avenue, Garden City, NY 11530, United States.
| | - Samantha Fregenti
- Mental Health Service Corps, 425 East 25th Street, New York, NY 10010, United States.
| | - Gianna Capodilupo
- MedAvante-ProPhase, 3 Park Avenue, New York, NY 10016, United States
| | - Kiara Buccellato
- Henry Jackson Foundation at The Walter Reed National Military Medical Center, 901 Rockville Pike, Bethesda, MD 20889, United States
| | - Amod Thanju
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States.
| | - Abraham Goldring
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States.
| | - Mohan Parak
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States.
| | - Benedicto Parker
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY 10035, United States.
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Lindenmayer JP, Kulsa MKC, Sultana T, Kaur A, Yang R, Ljuri I, Parker B, Khan A. Transcranial direct-current stimulation in ultra-treatment-resistant schizophrenia. Brain Stimul 2018; 12:54-61. [PMID: 30316742 DOI: 10.1016/j.brs.2018.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Transcranial direct-current stimulation (tDCS), a non-invasive neurostimulation treatment, has been reported in a number of sham-controlled studies to show significant improvements in treatment-resistant auditory hallucinations in schizophrenia patients, primarily in ambulatory and higher-functioning patients, but little is known of the effects of tDCS on hospitalized, low-functioning inpatients. OBJECTIVE/HYPOTHESIS The purpose of this study was to examine the efficacy and safety of tDCS for auditory hallucinations in hospitalized ultra-treatment-resistant schizophrenia (TRS) and to evaluate the effects of tDCS on cognitive functions. We hypothesized that treatment non-response reported in previous tDCS studies may have been due to the insufficient duration of direct-current stimulation. METHODS Inpatient participants with DSM-V schizophrenia, long-standing treatment-resistance, and auditory verbal hallucinations (AVH) participated in this 4-week sham-controlled, randomized trial. Assessments included the Positive and Negative Syndrome Scale (PANSS) and MATRICS Consensus Cognitive Battery (MCCB) at baseline and endpoint (at the end of Week 4), and the Auditory Hallucinations Rating Scale (AHRS) administered at baseline, endpoint, and weekly throughout the study. Participants were randomized to receive active vs. sham tDCS treatments twice daily for 4 weeks. RESULTS Twenty-eight participants were enrolled (tDCS, n = 15; control, n = 13) and 21 participants completed all 4 weeks of the trial. Results showed a significant reduction for the auditory hallucination total score (p ≤ 0.05). We found a 21.9% decrease in AHRS Total Score for the tDCS group and a 12.6% decrease in AHRS Total Score for the control group. Significant reductions in frequency, number of voices over time, length of auditory hallucinations, and overall psychopathology were also observed for the tDCS group. When assessing cognitive functioning, only Working Memory showed improvement for the tDCS group. CONCLUSION Although there was only a small improvement noted in auditory hallucination scores for the tDCS group, this improvement was meaningful when compared to no standard treatment of the control group. While this makes the interpretation of clinical significance debatable, it does confirm that tDCS combined with pharmacological intervention can provide clinical gains over pharmacological intervention alone. Therefore, tDCS treatment appears to be effective not only for ambulatory, higher-functioning patients, but also for patients with ultra-treatment-resistant schizophrenia.
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Affiliation(s)
- J P Lindenmayer
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA; New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Mila Kirstie C Kulsa
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA; Teachers College Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
| | - Tania Sultana
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA.
| | - Amandeep Kaur
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA.
| | - Ran Yang
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA; Teachers College Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
| | - Isidora Ljuri
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA.
| | - Benedicto Parker
- Manhattan Psychiatric Center, 600 East 125th Street Wards Island, New York, NY, 10035, USA; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA.
| | - Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, 10962, USA; NeuroCog Trials, 3211 Shannon Road #300, Durham, NC, 27707, USA.
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Fu DJ, Turkoz I, Walling D, Lindenmayer JP, Schooler NR, Alphs L. Paliperidone palmitate once-monthly maintains improvement in functioning domains of the Personal and Social Performance scale compared with placebo in subjects with schizoaffective disorder. Schizophr Res 2018; 192:185-193. [PMID: 28454922 DOI: 10.1016/j.schres.2017.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 12/09/2016] [Revised: 03/17/2017] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Evaluate the effect of paliperidone palmitate once-monthly (PP1M) injectable on the specific functioning domains of the Personal and Social Performance (PSP) scale in patients with schizoaffective disorder (SCA) participating in a long-term study. METHODS This study (NCT01193153) included both in- and outpatient subjects with SCA experiencing an acute exacerbation of psychotic and mood symptoms. Subjects were treated with PP1M either as monotherapy or in combination with antidepressants or mood stabilizers during a 25-week open-label (OL) phase. Stabilized subjects were randomly assigned 1:1 (PP1M or placebo) into a 15-month double-blind (DB) relapse-prevention period. Functioning of the randomized subjects during OL and DB phases was evaluated using the PSP scale (four domains: socially useful activities, personal/social relationships, self-care, and disturbing/aggressive behaviors). Three statistical approaches were utilized to analyze PSP scores to assess robustness and consistency of findings. No adjustments were made for multiplicity. RESULTS 334 of 667 enrolled subjects were stabilized with PP1M, randomly assigned to PP1M (n=164) or placebo (n=170) in the DB phase, and included in this analysis. Improvements in all PSP domain scores were observed during the OL phase and were maintained during the DB phase with PP1M, but decreased with placebo. Differences compared to placebo were significant in all four PSP domains during the DB phase (P≤0.008). CONCLUSION The analysis in this study showed that PP1M improves functioning, as measured by the four PSP domain scores, in symptomatic subjects with SCA. Functioning was maintained compared with placebo.
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Affiliation(s)
- Dong-Jing Fu
- Janssen Research & Development, LLC, Titusville, NJ 08560, USA.
| | - Ibrahim Turkoz
- Janssen Research & Development, LLC, Titusville, NJ 08560, USA
| | - David Walling
- Collaborative Neuroscience Network, Inc, Garden Grove, CA, USA
| | | | | | - Larry Alphs
- Janssen Scientific Affairs, LLC, Titusville, NJ, 08560, USA
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Lindenmayer JP. Are Shorter Versions of the Positive and Negative Syndrome Scale (PANSS) Doable? A Critical Review. Innov Clin Neurosci 2017; 14:73-76. [PMID: 29410940 PMCID: PMC5788254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Positive and Negative Syndrome Scale (PANSS) is a well-established assessment tool for measuring symptom severity in schizophrenia. Researchers and clinicians have been interested in the development of a short version of the PANSS that could reduce the burden of its administration for patients and raters. The author presents a comprehensive overview of existing brief PANSS measures, including their strengths and limitations, and discusses some possible next steps. There are two available scales that offer a reduced number of original PANSS items: PANSS-14 and PANSS-19; and two shorter versions that include six items: Brief PANSS and PANSS-6. The PANSS-6 has been tested quite extensively in established trials and appears to demonstrate high sensitivity to change and an established cut off definition for remission. Prospective testing in new antipsychotic treatment trials is still required for these shorter versions of PANSS. In addition, they need to be supplemented with interview guides, as well as provide conversion formulas to translate total scores from the short PANSS versions to the PANSS-30. Both short versions of the PANSS are essentially designed to evaluate response to antipsychotic treatment. Future PANSS scale development needs to address specific measurement of treatment-responsive positive symptoms by including treatment-sensitive items, as well as illness-phase specific PANSS tools.
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Affiliation(s)
- Jean-Pierre Lindenmayer
- Dr. Lindenmayer is Clinical Professor of the Department of Psychiatry at the NYU School of Medicine in New York, New York
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Lindenmayer JP, Fregenti S, Kang G, Ozog V, Ljuri I, Khan A, Goldring A, McGurk SR. The relationship of cognitive improvement after cognitive remediation with social functioning in patients with schizophrenia and severe cognitive deficits. Schizophr Res 2017; 185:154-160. [PMID: 28094171 DOI: 10.1016/j.schres.2017.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 08/16/2016] [Revised: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aims to examine the effects of change in neurocognition on functional outcomes and to examine predictors of change in social functions following a 12-week course of cognitive remediation in patients with schizophrenia and schizoaffective disorder with severe cognitive impairments. METHOD Level of social functioning was assessed using a performance based measure of functional capacity (PSP) in patients prior to and after the completion of 12-week cognitive remediation treatment (CRT). Participants completed a neuropsychological battery (MCCB-MATRICS) and clinical measures at both time points. RESULTS 63 subjects with a mean age of 41.4 (SD=12.2) and with 12.2years of education (SD=2.4) were enrolled. There were significant improvements in overall PSP score from baseline to endpoint (p=0.021) as well as in PSP domain A (socially useful activities) (p≤0.001), domain B (personal and social relationships) (p=0.009), and domain D (disturbing and aggressive behaviors) (p=0.003). There was a significant improvement in the composite MCCB score (p=0.020) and the Working Memory (p<0.046). Stepwise logistic regression yielded a significant association for baseline Visual Learning (Wald=6.537, p=0.011, OR=1.195), Speed of Processing (Wald=4.112, p=0.043, OR=0.850) and level of PANSS positive symptoms (Wald=4.087, p=0.043, OR=0.739) with PSP overall improvement. CONCLUSIONS Faster speed of processing, better visual and verbal learning and less prominent positive symptoms were associated with greater functional improvement after a systematic cognitive intervention within a rehabilitative setting.
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Affiliation(s)
- J P Lindenmayer
- Manhattan Psychiatric Center, 600 E 125th Street, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd, Orangeburg, NY 10962, United States; New York University, Department of Psychiatry, New York, NY, United States.
| | - Samantha Fregenti
- Manhattan Psychiatric Center, 600 E 125th Street, New York, NY 10035, United States.
| | - Guoxin Kang
- Manhattan Psychiatric Center, 600 E 125th Street, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd, Orangeburg, NY 10962, United States.
| | - Veronica Ozog
- Manhattan Psychiatric Center, 600 E 125th Street, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd, Orangeburg, NY 10962, United States.
| | - Isidora Ljuri
- Manhattan Psychiatric Center, 600 E 125th Street, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd, Orangeburg, NY 10962, United States.
| | - Anzalee Khan
- Manhattan Psychiatric Center, 600 E 125th Street, New York, NY 10035, United States; Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd, Orangeburg, NY 10962, United States.
| | - A Goldring
- Manhattan Psychiatric Center, 600 E 125th Street, New York, NY 10035, United States.
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Lindenmayer JP, Ozog VA, Khan A, Ljuri I, Fregenti S, McGurk SR. Predictors of response to cognitive remediation in service recipients with severe mental illness. Psychiatr Rehabil J 2017; 40:61-69. [PMID: 28368180 DOI: 10.1037/prj0000252] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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: 11/08/2022]
Abstract
OBJECTIVE Cognitive challenges are prominent features of individuals diagnosed with schizophrenia, impairing occupational, social, and economic functioning. These challenges are predictive of social and work outcomes. Cognitive remediation has been shown to be effective in improving both cognitive and social functions. However, cognitive remediation does not produce improvement in all participants. We investigated demographic, neurocognitive, and psychopathological predictors associated with improvement following cognitive remediation interventions in service recipients with severe mental illnesses. METHOD One hundred thirty-seven adult participants with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) were enrolled in 12-week cognitive remediation programs. Assessments of demographic and illness variables, together with baseline and end point assessment of psychopathology (Positive and Negative Syndrome Scale [PANSS]), neurocognition (Measurement and Treatment Research to Improve Cognition in Schizophrenia [MATRICS] Consensus Cognitive Battery [MCBB]), and social functions (Personal and Social Performance Scale [PSP]) were conducted. Change in cognitive domains was calculated using the reliable change index. Logistic regression analysis was used to assess predictors of cognitive improvement after the intervention. RESULTS Sixty-two percent of participants improved on at least 1 of the MCCB domains. Higher baseline speed of processing, attention or vigilance, and working memory predicted a positive response to cognitive remediation. Younger age, higher education level, shorter length of stay, and lower PANSS Negative and Disorganized factors were additional predictors. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Our results indicate the clinical usefulness of cognitive remediation and identified a pattern of clinical and cognitive predictors of good response to the intervention. Identification of these predictive factors by clinicians may enhance the outcome and aid in the development of individualized rehabilitative cognitive remediation treatment plans. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | | | - Susan R McGurk
- Department of Occupational Therapy, Boston University Center for Psychiatric Rehabilitation
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Shafrin J, May SG, Shrestha A, Ruetsch C, Gerlanc N, Forma F, Hatch A, Lakdawalla DN, Lindenmayer JP. Access to credible information on schizophrenia patients' medication adherence by prescribers can change their treatment strategies: evidence from an online survey of providers. Patient Prefer Adherence 2017; 11:1071-1081. [PMID: 28721020 PMCID: PMC5499864 DOI: 10.2147/ppa.s135957] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Overestimating patients' medication adherence diminishes the ability of psychiatric care providers to prescribe the most effective treatment and to identify the root causes of treatment resistance in schizophrenia. This study was conducted to determine how credible patient drug adherence information (PDAI) might change prescribers' treatment decisions. METHODS In an online survey containing 8 clinical case vignettes describing patients with schizophrenia, health care practitioners who prescribe antipsychotics to patients with schizophrenia were instructed to choose a preferred treatment recommendation from a set of predefined pharmacologic and non-pharmacologic options. The prescribers were randomly assigned to an experimental or a control group, with only the experimental group receiving PDAI. The primary outcome was the prescribers' treatment choice for each case. Between-group differences were analyzed using multinomial logistic regression. RESULTS A convenience sample (n=219) of prescribers completed the survey. For 3 nonadherent patient vignettes, respondents in the experimental group were more likely to choose a long-acting injectable antipsychotic compared with those in the control group (77.7% experimental vs 25.8% control; P<0.001). For 2 adherent but poorly controlled patient vignettes, prescribers who received PDAI were more likely to increase the antipsychotic dose compared with the control group (49.1% vs 39.1%; P<0.001). For the adherent and well-controlled patient vignette, respondents in both groups made similar treatment recommendations across all choices (P=0.099), but respondents in the experimental arm were more likely to recommend monitoring clinical stability (87.2% experimental vs 75.5% control, reference group). CONCLUSION The results illustrate how credible PDAI can facilitate more appropriate clinical decisions for patients with schizophrenia.
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Affiliation(s)
- Jason Shafrin
- Precision Health Economics, Los Angeles, CA
- Correspondence: Jason Shafrin, Precision Health Economics, 11100 Santa Monica Blvd, Suite 500, Los Angeles, CA 90025, USA, Tel +1 310 984 7705, Fax +1 310 982 6311, Email
| | | | | | | | | | - Felicia Forma
- Otsuka Pharmaceutical Development & Commercialization, Inc
| | | | - Darius N Lakdawalla
- Precision Health Economics, Los Angeles, CA
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
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MacEwan JP, Forma FM, Shafrin J, Hatch A, Lakdawalla DN, Lindenmayer JP. Patterns of Adherence to Oral Atypical Antipsychotics Among Patients Diagnosed with Schizophrenia. J Manag Care Spec Pharm 2016; 22:1349-1361. [PMID: 27783548 PMCID: PMC10397601 DOI: 10.18553/jmcp.2016.22.11.1349] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Poor medication adherence contributes to negative treatment response, symptom relapse, and hospitalizations in schizophrenia. Many health plans use claims-based measures like medication possession ratios or proportion of days covered (PDC) to measure patient adherence to antipsychotics. Classifying patients solely on the basis of a single average PDC measure, however, may mask clinically meaningful variations over time in how patients arrive at an average PDC level. OBJECTIVE To model patterns of medication adherence evolving over time for patients with schizophrenia who initiated treatment with an oral atypical antipsychotic and, based on these patterns, to identify groups of patients with different adherence behaviors. METHODS We analyzed health insurance claims for patients aged ≥ 18 years with schizophrenia and newly prescribed oral atypical antipsychotics in 2007-2013 from 3 U.S. insurance claims databases: Truven MarketScan (Medicaid and commercial) and Humana (Medicare). Group-based trajectory modeling (GBTM) was used to stratify patients into groups with distinct trends in adherence and to estimate trends for each group. The response variable was the probability of adherence (defined as PDC ≥ 80%) in each 30-day period after the patient initiated antipsychotic therapy. GBTM proceeds from the premise that there are multiple distinct adherence groups. Patient demographics, health status characteristics, and health care resource use metrics were used to identify differences in patient populations across adherence trajectory groups. RESULTS Among the 29,607 patients who met the inclusion criteria, 6 distinct adherence trajectory groups emerged from the data: adherent (33%); gradual discontinuation after 3 months (15%), 6 months (7%), and 9 months (5%); stop-start after 6 months (15%); and immediate discontinuation (25%). Compared to patients 18-24 years of age in the adherent group, patients displaying a stop-start pattern after 6 months had greater odds of having a history of drug abuse (OR = 1.46; 95% CI = 1.26-1.66; P < 0.001), alcohol abuse (OR = 1.34; 95% CI = 1.14-1.53; P< 0.001), and a codiagnosis of major depressive disorder (OR = 1.24; 95% CI = 1.05-1.44; P < 0.001) and were less likely to be aged 35-54 years (OR = 0.66; 95% CI = 0.46-0.85; P < 0.001). CONCLUSIONS Longitudinal medication adherence patterns can be expressed as distinct trajectories associated with specific patient characteristics and health care utilization patterns. We found 6 distinct patterns of adherence to antipsychotics over 12 months. Patients in different groups may warrant different types of clinical interventions to prevent hospitalizations, longer hospital stays, and increased clinical complexity. For example, clinicians may consider regular home visits, assertive community treatment, and other related interventions for patients at high risk of immediate discontinuation. Health plans should consider supplementing claims-based adherence measures with new technologies that are able to track patient adherence patterns over time. DISCLOSURES Otsuka Pharmaceutical Development & Commercialization provided support for this research. MacEwan and Shafrin are employees of Precision Health Economics, which was contracted by Otsuka Pharmaceutical Development & Commercialization to conduct this study. Lakdawalla is the Chief Scientific Officer and a founding partner of Precision Health Economics. Forma is an employee of Otsuka Pharmaceutical Development & Commercialization. Hatch is a former employee of Otsuka Pharmaceutical Development & Commercialization and is a current employee of ODH, Inc. Lindenmayer has received grant/research support from Janssen, Lilly, AstraZeneca, Johnson & Johnson, Pfizer, BMS, Otsuka, Dainippon, and Roche and is a consultant for Janssen, Lilly, Merck, Shire, and Lundbeck. Portions of this study were presented as a poster at the American Society of Clinical Psychopharmacology Annual Meeting in Miami Beach, Florida; June 23, 2015; and at the 28th Annual U.S. Psychiatric and Mental Health Congress; San Diego, California; September 12, 2015. Study concept and design were contributed by Forma, Ladkawalla, MacEwan, and Shafrin, along with Hatch and Lindenmayer. MacEwan, Shafrin, Forma, and Lakdawalla collected the data, along with Hatch and Lindenmayer. Data interpretation was performed by Hatch, Lindenmayer, MacEwan, and Shafrin, assisted by Forma and Lakdawalla. The manuscript was written and revised by MacEwan, Forma, and Shafrin, along with Hatch Lakdawalla, and Lindenmayer.
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Affiliation(s)
| | - Felicia M. Forma
- Otsuka Pharmaceutical Development & Commercialization, Rockville, Maryland
| | | | - Ainslie Hatch
- Otsuka Pharmaceutical Development & Commercialization, Rockville, Maryland
| | - Darius N. Lakdawalla
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
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Lindenmayer JP, Khan A, Lachman H, McGurk SR, Goldring A, Thanju A, Kaushik S. COMT genotype and response to cognitive remediation in schizophrenia. Schizophr Res 2015; 168:279-84. [PMID: 26255563 PMCID: PMC4591188 DOI: 10.1016/j.schres.2015.07.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND A functional polymorphism of the catechol-O-methyltransferase (COMT) gene (Val158Met) partially appears to influence cognitive performance in schizophrenia subjects and healthy controls by modulating prefrontal dopaminergic activity. This study evaluated the association of the COMT Val108/158 Met genotype with response to computerized neurocognitive remediation (CRT). METHOD 145 subjects with DSM-IV-TR schizophrenia or schizoaffective disorder were genotyped via saliva sampling. Subjects were evaluated on neurocognitive assessments (MATRICS) and clinical symptoms (PANSS) at baseline and endpoint after 12weeks of CRT. "Improvement" was defined as ≥67% of cognitive domains (≥4) showing performance increases. If ≤67% (≤2) of domains improved, the change was defined as "minimal improvement." A general linear model was conducted for change of each cognitive domain. RESULTS Of 145 subjects, data from 138 subjects were usable. Distribution of COMT genotype: Met/Met: 28 (20.29%), Val/Met: 61 (44.20%), and Val/Val: 49 (35.51%). No significant differences were seen among genotype groups at baseline or across genotype group for "Improvement" vs. "Minimal Improvement." GLM analysis showed significant differences in Verbal Learning (p=0.003), Visual Learning (p=0.014) and Attention/Vigilance (p=0.011) favoring Met/Met and Val/Met groups. CONCLUSIONS The low activity Met allele (Met/Met; Val/Met) was associated with significantly greater improvements in the MATRICS domains of Verbal Learning, Visual Learning and Attention/Vigilance after CRT.
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Affiliation(s)
- Jean-Pierre Lindenmayer
- Manhattan Psychiatric Center, New York, NY, United States; New York University Medical Center, New York, NY, United States; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States.
| | - Anzalee Khan
- Manhattan Psychiatric Center, New York, NY, United States; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States; ProPhase LLC, New York, NY, United States
| | - Herbert Lachman
- Albert Einstein College of Medicine, Bronx, NY, United States
| | | | - Abraham Goldring
- Manhattan Psychiatric Center, New York, NY, United States; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Amod Thanju
- Manhattan Psychiatric Center, New York, NY, United States; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
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Alphs L, Benson C, Cheshire-Kinney K, Lindenmayer JP, Mao L, Rodriguez SC, Starr HL. Real-world outcomes of paliperidone palmitate compared to daily oral antipsychotic therapy in schizophrenia: a randomized, open-label, review board-blinded 15-month study. J Clin Psychiatry 2015; 76:554-61. [PMID: 25938474 DOI: 10.4088/jcp.14m09584] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [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: 10/13/2014] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The Paliperidone Palmitate Research in Demonstrating Effectiveness (PRIDE) study compared the effects of once-monthly paliperidone palmitate with daily oral antipsychotics on treatment failure in adults with schizophrenia. METHOD The PRIDE study is a 15-month, randomized, multicenter study (May 5, 2010, to December 9, 2013) of adult subjects with a DSM-IV diagnosis of schizophrenia and a history of incarceration. Subjects were randomly assigned to once-monthly paliperidone palmitate injections or daily oral antipsychotics (randomly assigned from 7 acceptable, prespecified oral antipsychotics) for 15 months. The primary end point was time to first treatment failure, defined as arrest/incarceration; psychiatric hospitalization; suicide; treatment discontinuation or supplementation due to inadequate efficacy, safety, or tolerability; or increased psychiatric services to prevent hospitalization. Time to first treatment failure was determined by a blinded event-monitoring board and analyzed with the Kaplan-Meier method. RESULTS In this study, 450 patients were randomly assigned, and 444 were included in the intent-to-treat population. Paliperidone palmitate was associated with significant delay in time to first treatment failure versus oral antipsychotics (hazard ratio, 1.43; 95% CI, 1.09-1.88; log rank P = .011). Observed treatment failure rates over 15 months were 39.8% and 53.7%, respectively. Arrest/incarceration and psychiatric hospitalization were the most common reasons for treatment failure in the paliperidone palmitate and oral antipsychotic groups (21.2% vs 29.4% and 8.0% vs 11.9%, respectively). The 5 most common treatment-emergent adverse events for the paliperidone palmitate treatment group were injection site pain (18.6% of subjects), insomnia (16.8%), weight increased (11.9%), akathisia (11.1%), and anxiety (10.6%). CONCLUSIONS In a trial designed to reflect real-world management of schizophrenia, once-monthly paliperidone palmitate demonstrated superiority compared to oral antipsychotics in delaying time to treatment failure. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01157351.
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Affiliation(s)
- Larry Alphs
- Therapeutic Team Leader: Psychiatry, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Rd-A32404, Titusville, NJ 08560
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Fu DJ, Turkoz I, Simonson RB, Walling DP, Schooler NR, Lindenmayer JP, Canuso CM, Alphs L. Paliperidone palmitate once-monthly reduces risk of relapse of psychotic, depressive, and manic symptoms and maintains functioning in a double-blind, randomized study of schizoaffective disorder. J Clin Psychiatry 2015; 76:253-62. [PMID: 25562685 DOI: 10.4088/jcp.14m09416] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Schizoaffective disorder is a complex illness for which optimal treatment is not well established. Results of the first controlled, relapse-prevention study of paliperidone palmitate once-monthly injectable (paliperidone monthly) in schizoaffective disorder are presented. METHOD The study was conducted between September 20, 2010, and October 22, 2013. Patients with schizoaffective disorder (confirmed by the Structured Clinical Interview for DSM-IV Axis I Disorders) experiencing acute exacerbation of psychotic and depressive/manic symptoms were stabilized with paliperidone monthly as monotherapy or as adjunctive therapy to mood stabilizers or antidepressants and randomly assigned (1:1) to paliperidone monthly or placebo in a 15-month, double-blind, relapse-prevention phase. Randomization was stratified by administration as monotherapy or adjunctive therapy and by study center. The primary endpoint was time to relapse. RESULTS 334 patients were evaluated. Paliperidone monthly significantly delayed time to relapse for psychotic, depressive, and manic symptoms compared with placebo (P < .001, log-rank test). Relapse risk was 2.49 times greater for placebo (hazard ratio = 2.49; 95% CI, 1.55 to 3.99; P < .001, Cox proportional hazards model). Overall relapse rates were 33.5% for placebo and 15.2% for paliperidone monthly. For monotherapy, relapse risk was 3.38 times greater with placebo (P = .002), and for adjunctive treatment it was 2.03 times greater with placebo (P = .021). Paliperidone monthly was superior to placebo in maintaining functioning as measured by the Personal and Social Performance scale (P = .014, mixed-model repeated-measures analysis). The most common adverse events (placebo, paliperidone monthly) were increased weight (4.7%, 8.5%), insomnia (7.1%, 4.9%), schizoaffective disorder (5.9%, 3.0%), headache (3.5%, 5.5%), and nasopharyngitis (3.5%, 5.5%). Incidence of any extrapyramidal-related adverse event was 7.1% for placebo and 8.5% for paliperidone monthly. CONCLUSIONS Paliperidone monthly as monotherapy or adjunctive therapy significantly delayed psychotic, depressive, and/or manic relapses; reduced their risk; and better maintained functioning in patients with schizoaffective disorder. Results support the value of maintenance treatment with paliperidone monthly in schizoaffective disorder. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01193153.
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Affiliation(s)
- Dong-Jing Fu
- Clinical Development, Janssen Scientific Affairs, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560
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Karve S, Markowitz M, Fu DJ, Lindenmayer JP, Wang CC, Candrilli SD, Alphs L. Assessing medication adherence and healthcare utilization and cost patterns among hospital-discharged patients with schizoaffective disorder. Appl Health Econ Health Policy 2014; 12:335-346. [PMID: 24756319 PMCID: PMC4026676 DOI: 10.1007/s40258-014-0095-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Hospital-discharged patients with schizoaffective disorder have a high risk of re-hospitalization. However, limited data exist evaluating critical post-discharge periods during which the risk of re-hospitalization is significant. OBJECTIVE Among hospital-discharged patients with schizoaffective disorder, we assessed pharmacotherapy adherence and healthcare utilization and costs during sequential 60-day clinical periods before schizoaffective disorder-related hospitalization and post-hospital discharge. METHODS From the MarketScan(®) Medicaid database (2004-2008), we identified patients (≥18 years) with a schizoaffective disorder-related inpatient admission. Study measures including medication adherence and healthcare utilization and costs were assessed during sequential preadmission and post-discharge periods. We conducted univariate and multivariable regression analyses to compare schizoaffective disorder-related and all-cause healthcare utilization and costs (in 2010 US dollars) between each adjacent 60-day post-discharge periods. No adjustment was made for multiplicity. RESULTS We identified 1,193 hospital-discharged patients with a mean age of 41 years. The mean medication adherence rate was 46% during the 60-day period prior to index inpatient admission, which improved to 80% during the 60-day post-discharge period. Following hospital discharge, schizoaffective disorder-related healthcare costs were significantly greater during the initial 60-day period compared with the 61- to 120-day post-discharge period (mean US$2,370 vs US$1,765; p < 0.001), with rehospitalization (36%) and pharmacy (40%) accounting for over three-fourths of the initial 60-day period costs. Compared with the initial 60-day post-discharge period, both all-cause and schizoaffective disorder-related costs declined during the 61- to 120-day post-discharge period and remained stable for the remaining post-discharge periods (days 121-365). CONCLUSIONS We observed considerably lower (46%) adherence during 60 days prior to the inpatient admission; in comparison, adherence for the overall 6-month period was 8% (54%) higher. Our study findings suggest that both short-term (e.g., 60 days) and long-term (e.g., 6-12 months) medication adherence likely are important characteristics to examine among patients with schizoaffective disorder and help provide a more holistic view of patients' adherence patterns. Furthermore, we observed a high rate of rehospitalization and greater healthcare costs during the initial 60-day period post-discharge among patients with schizoaffective disorder. Further research is required to better understand and manage transitional care after discharge (e.g., monitor adherence), which may help reduce the likelihood of rehospitalization and the associated downstream costs.
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Abstract
The pharmacological choices for the treatment of schizophrenia have been greatly expanded with the availability of the atypical compounds clozapine (Clozaril, Novartis), risperidone (Risperdal, Janssen-Cilag), olanzapine (Zyprexa, Eli Lilly & Co.), quetiapine (Seroquel, AstraZeneca), ziprasidone (Geodon, Pfizer Inc.) and aripiprazole (Abilify, Otsuka Pharmaceutical Co. Ltd). In this article, the effects of the newer antipsychotics and their side effects are reviewed. Key issues in acute and maintenance treatment, often lifelong, will be reviewed. Side-effect management to ensure adherence to an optimal treatment regimen will be discussed. Coexisting syndromes must be treated in concordance with the patient's clinical presentation. For treatment-resistant patients, atypical compounds are generally more effective than their typical counterparts but medication augmentation strategies are frequently recommended. Finally, the results of recent meta-analyses comparing the effects of atypical versus typical compounds will be critically reviewed and remaining gaps in the current pharmacotherapy of schizophrenia will be explored.
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Affiliation(s)
- J P Lindenmayer
- Psychopharmacology Research Unit, Manhattan Psychiatric Center, Wards Island, NY 10035, USA.
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Stauffer VL, Millen BA, Andersen S, Kinon BJ, Lagrandeur L, Lindenmayer JP, Gomez JC. Pomaglumetad methionil: no significant difference as an adjunctive treatment for patients with prominent negative symptoms of schizophrenia compared to placebo. Schizophr Res 2013; 150:434-41. [PMID: 24035403 DOI: 10.1016/j.schres.2013.08.020] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 08/13/2013] [Accepted: 08/15/2013] [Indexed: 12/16/2022]
Abstract
This study tested whether treatment with pomaglumetad methionil (LY2140023 monohydrate), a metabotropic glutamate receptor 2/3 agonist compared with placebo (PBO), when added to a fixed-dose second-generation antipsychotic (SGA) demonstrated significantly greater reduction of negative symptoms, as assessed by the 16-item Negative Symptom Assessment scale (NSA-16), in patients with schizophrenia. This parallel-group, 16-week study enrolled adults with schizophrenia who were receiving standard of care (SOC) therapy, which included ≥3months treatment with one of four SGAs: aripiprazole, olanzapine, risperidone, or quetiapine. Patients received either 20mg of twice daily LY2140023 monohydrate (LY2140023) or concurrent PBO SGA. The primary efficacy measure was change from baseline to final visit in NSA-16 total score. Secondary measures included additional measures of efficacy, cognition, and assessments of safety. Of 352 patients screened, 167 were randomly assigned to treatment, and 110 patients completed the study. Patients treated with LY2140023 and SOC failed to demonstrate a statistically significant improvement over patients treated with PBO and SOC on NSA-16 total score at endpoint or at any point during the study (all p>0.131). Changes in secondary efficacy measures were not significantly different between groups at endpoint. With the exception of vomiting which was greater in the LY2140023 group, there were no statistically significant differences in safety and tolerability measures. This study found no benefit of adjunctive LY2140023 versus PBO for negative symptoms in patients with schizophrenia receiving treatment with SOC. LY2140023 was generally well-tolerated in these patients.
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Marder SR, Alphs L, Anghelescu IG, Arango C, Barnes TRE, Caers I, Daniel DG, Dunayevich E, Fleischhacker WW, Garibaldi G, Green MF, Harvey PD, Kahn RS, Kane JM, Keefe RSE, Kinon B, Leucht S, Lindenmayer JP, Malhotra AK, Stauffer V, Umbricht D, Wesnes K, Kapur S, Rabinowitz J. Issues and perspectives in designing clinical trials for negative symptoms in schizophrenia. Schizophr Res 2013; 150:328-33. [PMID: 24028744 DOI: 10.1016/j.schres.2013.07.058] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/21/2013] [Accepted: 07/22/2013] [Indexed: 11/27/2022]
Abstract
A number of pharmacological agents for treating negative symptoms in schizophrenia are currently in development. Unresolved questions regarding the design of clinical trials in this area were discussed at an international meeting in Florence, Italy in April 2012. Participants included representatives from academia, the pharmaceutical industry, and the European Medicines Agency (EMA). Prior to the meeting, participants submitted key questions for debate and discussion. Responses to the questions guided the discussion during the meeting. The group reached agreement on a number of issues: (1) study subjects should be under the age of 65; (2) subjects should be excluded for symptoms of depression that do not overlap with negative symptoms; (3) functional measures should not be required as a co-primary in negative symptom trials; (4) information from informants should be included for ratings when available; (5) Phase 2 negative symptom trials should be 12weeks and 26weeks is preferred for Phase 3 trials; (6) prior to entry into a negative symptom study, subjects should demonstrate clinical stability for a period of 4 to 6months by collection of retrospective information; and (7) prior to entry, the stability of negative and positive symptoms should be confirmed prospectively for four weeks or longer. The participants could not reach agreement on whether predominant or prominent negative symptoms should be required for study subjects.
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Affiliation(s)
- Stephen R Marder
- Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA; VA Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA.
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Khan A, Lindenmayer JP, Opler M, Yavorsky C, Rothman B, Lucic L. A new Integrated Negative Symptom structure of the Positive and Negative Syndrome Scale (PANSS) in schizophrenia using item response analysis. Schizophr Res 2013; 150:185-96. [PMID: 23911252 DOI: 10.1016/j.schres.2013.07.007] [Citation(s) in RCA: 15] [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] [Received: 03/28/2013] [Revised: 06/27/2013] [Accepted: 07/02/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND Debate persists with regard to how best to categorize the syndromal dimension of negative symptoms in schizophrenia. The aim was to first review published Principle Components Analysis (PCA) of the PANSS, and extract items most frequently included in the negative domain, and secondly, to examine the quality of items using Item Response Theory (IRT) to select items that best represent a measurable dimension (or dimensions) of negative symptoms. METHODS First, 22 factor analyses and PCA met were included. Second, using a large dataset (n=7187) of participants in clinical trials with chronic schizophrenia, we extracted items loading on one or more PCA. Third, items not loading with a value of ≥ 0.5, or loading on more than one component with values of ≥ 0.5 were discarded. Fourth, resulting items were included in a non-parametric IRT and retained based on Option Characteristic Curves (OCCs) and Item Characteristic Curves (ICCs). RESULTS 15 items loaded on a negative domain in at least one study, with Emotional Withdrawal loading on all studies. Non-parametric IRT retained nine items as an Integrated Negative Factor: Emotional Withdrawal, Blunted Affect, Passive/Apathetic Social Withdrawal, Poor Rapport, Lack of Spontaneity/Conversation Flow, Active Social Avoidance, Disturbance of Volition, Stereotyped Thinking and Difficulty in Abstract Thinking. CONCLUSIONS This is the first study to use a psychometric IRT process to arrive at a set of negative symptom items. Future steps will include further examination of these nine items in terms of their stability, sensitivity to change, and correlations with functional and cognitive outcomes.
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Affiliation(s)
- Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States; ProPhase LLC, 3 Park Avenue, 37th Floor, New York, NY 10016, United States; Manhattan Psychiatric Center, 1 Wards Island Complex, NY, NY 10035, United States.
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Lasser RA, Dirks B, Nasrallah H, Kirsch C, Gao J, Pucci ML, Knesevich MA, Lindenmayer JP. Adjunctive lisdexamfetamine dimesylate therapy in adult outpatients with predominant negative symptoms of schizophrenia: open-label and randomized-withdrawal phases. Neuropsychopharmacology 2013; 38:2140-9. [PMID: 23756608 PMCID: PMC3773663 DOI: 10.1038/npp.2013.111] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/09/2013] [Accepted: 04/27/2013] [Indexed: 11/09/2022]
Abstract
Negative symptoms of schizophrenia (NSS), related to hypodopaminergic activity in the mesocortical pathway and prefrontal cortex, are predictive of poor outcomes and have no effective treatment. Use of dopamine-enhancing drugs (eg, psychostimulants) has been limited by potential adverse effects. This multicenter study examined lisdexamfetamine dimesylate (LDX), a d-amphetamine prodrug, as adjunctive therapy to antipsychotics in adults with clinically stable schizophrenia and predominant NSS. Outpatients with stable schizophrenia, predominant NSS, limited positive symptoms, and maintained on stable atypical antipsychotic therapy underwent a 3-week screening, 10-week open-label adjunctive LDX (20-70 mg/day), and 4-week, double-blind, randomized, placebo-controlled withdrawal. Efficacy measures included a modified Scale for the Assessment of Negative Symptoms (SANS-18) and Positive and Negative Syndrome Scale (PANSS) total and subscale scores. Ninety-two participants received open-label LDX; 69 received double-blind therapy with placebo (n=35) or LDX (n=34). At week 10 (last observation carried forward; last open-label visit), mean (95% confidence interval) change in SANS-18 scores was -12.9 (-15.0, -10.8; P<0.0001). At week 10, 52.9% of participants demonstrated a minimum of 20% reduction from baseline in SANS-18 score. Open-label LDX was also associated with significant improvement in PANSS total and subscale scores. During the double-blind/randomized-withdrawal phase, no significant differences (change from randomization baseline) were found between placebo and LDX in SANS-18 or PANSS subscale scores. In adults with clinically stable schizophrenia, open-label LDX appeared to be associated with significant improvements in negative symptoms without positive symptom worsening. Abrupt LDX discontinuation was not associated with positive or negative symptom worsening. Confirmation with larger controlled trials is warranted.
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Affiliation(s)
- Robert A Lasser
- Formerly of Shire Development LLC, Wayne, PA, USA,Department of Neuroscience, inVentiv Health Clinical, 1787 Sentry Parkway West, Suite 300, Building 16, Blue Bell, PA 19422, USA, Tel: +1 215 591 8383, Fax: +1 609 514 2165, E-mail:
| | | | - Henry Nasrallah
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | - Michael L Pucci
- SCI Scientific Communications & Information, Parsippany, NJ, USA
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Lindenmayer JP, Nasrallah H, Pucci M, James S, Citrome L. A systematic review of psychostimulant treatment of negative symptoms of schizophrenia: challenges and therapeutic opportunities. Schizophr Res 2013; 147:241-52. [PMID: 23619055 DOI: 10.1016/j.schres.2013.03.019] [Citation(s) in RCA: 71] [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: 10/11/2012] [Revised: 03/04/2013] [Accepted: 03/18/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Primary negative symptoms of schizophrenia (NSS) contribute heavily to functional disability and treatment of these symptoms continues to be a major unmet need even when the positive (psychotic) symptoms are controlled. The modified dopamine (DA) hypothesis posits that positive symptoms are associated with increased DA activity in the mesolimbic tract whereas NSS and cognitive symptoms are associated with decreased DA activity in the mesocortical (frontal) region. Several studies have reported improvement in NSS with DA agonist use, but with varying degrees of risk for triggering psychotic symptoms, especially in the absence of concurrent antipsychotic drug treatment. This article aims to examine older and newer evidence suggesting that psychostimulants may have a potential therapeutic role in the treatment of NSS together with a thorough review of the potential risks and benefits of psychostimulant administration in individuals with schizophrenia. METHODS A systematic search of relevant literature using electronic databases, reference lists, and data presented at recent meetings was conducted. RESULTS Improvement of NSS after psychostimulant administration is reviewed both in challenge and treatment paradigms with various agents such as methylphenidate, amphetamine, and modafinil or armodafinil. The literature points to evidence that, used adjunctively, DA agonists may improve NSS without worsening of positive symptoms in selected patients who are stable and treated with effective antipsychotic medications. Several areas of inadequate study and limitations are identified including small study samples, single-site trials, varying rigor of bias control, the dose and the duration of adjunctive psychostimulant administration, and the potential for development of tolerance. CONCLUSION Large, controlled clinical trials to further characterize effects of psychostimulants on NSS in carefully selected patients are warranted.
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Filipovic B, Novakovic V, Starcevic A, Radonjic N, Malobabic S, Latas M, Nikolic V, Aksic M, Stijak L, Ilankovic N, Atanasijevic T, Radonjic V, Michaels T, Lindenmayer JP. Co-Occurrence of Large Cavum Septum Pellucidum and the Absence of the Adhesio Interthalamica in Patients with Schizophrenia: A Post Mortem Study. ACTA ACUST UNITED AC 2013. [DOI: 10.2174/2211556011302020007] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lindenmayer JP, McGurk SR, Khan A, Kaushik S, Thanju A, Hoffman L, Valdez G, Wance D, Herrmann E. Improving social cognition in schizophrenia: a pilot intervention combining computerized social cognition training with cognitive remediation. Schizophr Bull 2013; 39:507-17. [PMID: 23125396 PMCID: PMC3627756 DOI: 10.1093/schbul/sbs120] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [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: 11/14/2022]
Abstract
BACKGROUND Social cognition is significantly impaired in schizophrenia and contributes to poor community functioning. This study examined whether cognitive remediation (CR; COGPACK), shown to improve neurocognition, improves an integral component of social cognition, emotion perception, compared with CR combined with a computerized Emotion Perception intervention (Mind Reading: Interactive Guide to Emotions [MRIGE]). METHODS 59 stable schizophrenia or schizoaffective predominantly inpatients were randomized to either CR (N=27) alone or CR+MRIGE (N=32) for 12 weeks. Assessments included the Facial Emotion Identification Task (FEIT), Facial Emotion Discrimination Task (FEDT), MCCB-MATRICS, Personal and Social Performance Scale, and the Positive and Negative Syndrome Scale. RESULTS There was a significant group-by-time effect on FEIT (F=11.509, P=.004); CR+MRIGE demonstrated significantly greater improvement than CR alone (CR+MRIGE, Z=1.89, P=.05; CR alone Z=0.57, P=.13). There was significant group-by-time effect on FEDT (F=5.663, P=.022); CR+MRIGE demonstrated significantly greater improvement than CR alone (CR+MRIGE, Z=1.90, P=.05; CR alone Z=0.67, P=.21). There was also a significant group by time effect for social cognition, measured by the Mayer-Salovey-Caruso Emotional Intelligence Test (F=5.473, P=.050): CR+MRIGE demonstrated significantly greater improvement than CR alone (CR+MRIGE, Z=1.98, P=.02; CR alone, Z=1.00, P=.05). CONCLUSIONS Combined CR with emotion perception remediation produced greater improvements in emotion recognition, emotion discrimination, social functioning, and neurocognition compared with CR alone in chronic schizophrenia.
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Affiliation(s)
- Jean-Pierre Lindenmayer
- Psychopharmacology Research Department, Manhattan Psychiatric Center, 600 E 125 St, Ward's Island, NY 10035, USA.
| | - Susan R. McGurk
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA
| | - Anzalee Khan
- Manhattan Psychiatric Center, New York, NY;,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY;,ProPhase Training Group, New York, NY
| | - Saurabh Kaushik
- Manhattan Psychiatric Center, New York, NY;,New York University Medical Center, New York, NY;,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
| | - Amod Thanju
- Manhattan Psychiatric Center, New York, NY;,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
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Allen MH, Daniel DG, Revicki DA, Canuso CM, Turkoz I, Fu DJ, Alphs L, Ishak KJ, Bartko JJ, Lindenmayer JP. Development and psychometric evaluation of a clinical global impression for schizoaffective disorder scale. Innov Clin Neurosci 2012; 9:15-24. [PMID: 22347687 PMCID: PMC3280074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The Clinical Global Impression for Schizoaffective Disorder scale is a new rating scale adapted from the Clinical Global Impression scale for use in patients with schizoaffective disorder. The psychometric characteristics of the Clinical Global Impression for Schizoaffective Disorder are described. DESIGN Content validity was assessed using an investigator questionnaire. Inter-rater reliability was determined with 12 sets of videotaped interviews rated independently by two trained individuals. Test-retest reliability was assessed using 30 randomly selected raters from clinical trials who evaluated the same videos on separate occasions two weeks apart. Convergent and divergent validity and effect size were evaluated by comparing scores between the Clinical Global Impression for Schizoaffective Disorder and the Positive and Negative Syndrome Scale, 21-item Hamilton Rating Scale for Depression, and Young Mania Rating Scale scales using pooled patient data from two clinical trials. Clinical Global Impression for Schizoaffective Disorder scores were then linked to corresponding Positive and Negative Syndrome Scale scores. RESULTS Content validity was strong. Inter-rater agreement was good to excellent for most scales and subscales (intra-class correlation coefficient ≥ 0.50). Test-retest showed good reproducibility, with intraclass correlation coefficients ranging from 0.444 to 0.898. Spearman correlations between Clinical Global Impression for Schizoaffective Disorder domains and corresponding symptom scales were 0.60 or greater, and effect sizes for Clinical Global Impression for Schizoaffective Disorder overall and domain scores were similar to Positive and Negative Syndrome Scale Young Mania Rating Scale, and 21-item Hamilton Rating Scale for Depression scores. Raters anticipated that the scale might be less effective in distinguishing negative from depressive symptoms, and, in fact, the results here may reflect that clinical reality. CONCLUSION Multiple lines of evidence support the reliability and validity of the Clinical Global Impression for Schizoaffective Disorder for studies in schizoaffective disorder.
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Affiliation(s)
- Michael H Allen
- Colorado Depression Center at the University of Colorado School of Medicine, Aurora, Colorado, and VISN 19 Suicide MIRECC, Denver, Colorado, USA.
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Khan A, Lewis C, Lindenmayer JP. Use of non-parametric item response theory to develop a shortened version of the Positive and Negative Syndrome Scale (PANSS). BMC Psychiatry 2011; 11:178. [PMID: 22087503 PMCID: PMC3256111 DOI: 10.1186/1471-244x-11-178] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 11/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nonparametric item response theory (IRT) was used to examine (a) the performance of the 30 Positive and Negative Syndrome Scale (PANSS) items and their options ((levels of severity), (b) the effectiveness of various subscales to discriminate among differences in symptom severity, and (c) the development of an abbreviated PANSS (Mini-PANSS) based on IRT and a method to link scores to the original PANSS. METHODS Baseline PANSS scores from 7,187 patients with Schizophrenia or Schizoaffective disorder who were enrolled between 1995 and 2005 in psychopharmacology trials were obtained. Option characteristic curves (OCCs) and Item Characteristic Curves (ICCs) were constructed to examine the probability of rating each of seven options within each of 30 PANSS items as a function of subscale severity, and summed-score linking was applied to items selected for the Mini-PANSS. RESULTS The majority of items forming the Positive and Negative subscales (i.e. 19 items) performed very well and discriminate better along symptom severity compared to the General Psychopathology subscale. Six of the seven Positive Symptom items, six of the seven Negative Symptom items, and seven out of the 16 General Psychopathology items were retained for inclusion in the Mini-PANSS. Summed score linking and linear interpolation was able to produce a translation table for comparing total subscale scores of the Mini-PANSS to total subscale scores on the original PANSS. Results show scores on the subscales of the Mini-PANSS can be linked to scores on the original PANSS subscales, with very little bias. CONCLUSIONS The study demonstrated the utility of non-parametric IRT in examining the item properties of the PANSS and to allow selection of items for an abbreviated PANSS scale. The comparisons between the 30-item PANSS and the Mini-PANSS revealed that the shorter version is comparable to the 30-item PANSS, but when applying IRT, the Mini-PANSS is also a good indicator of illness severity.
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Affiliation(s)
- Anzalee Khan
- Fordham University, Department of Psychometrics, Bronx, NY, USA.
| | - Charles Lewis
- Fordham University, Department of Psychometrics, Bronx, NY, USA,Educational Testing Services, ETS, Princeton, NJ, USA
| | - Jean-Pierre Lindenmayer
- New York University, School of Medicine, New York, NY, USA,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA,Manhattan Psychiatric Center, Wards Island, NY, USA
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Shamsi S, Lau A, Lencz T, Burdick KE, DeRosse P, Brenner R, Lindenmayer JP, Malhotra AK. Cognitive and symptomatic predictors of functional disability in schizophrenia. Schizophr Res 2011; 126:257-64. [PMID: 20828991 PMCID: PMC3050077 DOI: 10.1016/j.schres.2010.08.007] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [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: 04/16/2010] [Revised: 08/03/2010] [Accepted: 08/05/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neurocognition and negative symptoms play a major role in predicting functional outcomes in patients with schizophrenia. Few studies have assessed the relationship between functional outcomes and the MATRICS consensus cognition battery (MCCB), which will be central to future clinical trials of cognitive enhancing agents. AIMS To assess the role of individual MCCB domains on functional outcomes. METHOD 185 stable outpatients with schizophrenia were enrolled and assessed with the MCCB, Social Adjustment Scale-II (SAS-II) and Multidimensional Scale for Independent Functioning (MSIF), along with BPRS and SANS. RESULTS We found significant relationships between MCCB neurocognitive domain scores, negative symptoms and aspects of functional outcome in schizophrenia. Specifically, we found that work/education functioning is predicted by working memory performance and negative symptoms; residential status (independent living) is predicted by verbal memory scores; and social functioning is predicted by social cognition, attention and negative symptoms. We also found that negative symptom severity was not related to residential status, even though it demonstrated the predicted associations to work and social functioning. CONCLUSION To our knowledge, this is the first study to assess cognition and functional outcomes using MCCB, SAS II and MSIF. Our results extend prior work and help provide more data on the relationships between cognition, symptoms and functional outcome using "real world" measures.
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Affiliation(s)
- Syed Shamsi
- Department of Psychiatry, Division of Psychiatry Research, Glen Oaks, NY, United States
| | - Adam Lau
- Department of Psychiatry, Division of Psychiatry Research, Glen Oaks, NY, United States
| | - Todd Lencz
- Department of Psychiatry, Division of Psychiatry Research, Glen Oaks, NY, United States, Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, United States, Dept. of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Katherine E. Burdick
- Department of Psychiatry, Division of Psychiatry Research, Glen Oaks, NY, United States, Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, United States, Dept. of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Pamela DeRosse
- Department of Psychiatry, Division of Psychiatry Research, Glen Oaks, NY, United States
| | - Ron Brenner
- Neuro-Behavioral Research Inc., Cedarhurst, NY, United States
| | - Jean-Pierre Lindenmayer
- Dept. of Psychiatry, New York University and Manhattan Psychiatric Centre, New York, NY, United States
| | - Anil K. Malhotra
- Department of Psychiatry, Division of Psychiatry Research, Glen Oaks, NY, United States, Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, United States, Dept. of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, United States, Corresponding author. Department of Psychiatry, Division of Psychiatry Research, Zucker Hillside Hospital, 75-69 263rd street, Glen Oaks, NY 11004, United States. Tel.: +1 718 470 8012. (A.K. Malhotra)
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Lindenmayer JP, Khan A. Galantamine augmentation of long-acting injectable risperidone for cognitive impairments in chronic schizophrenia. Schizophr Res 2011; 125:267-77. [PMID: 20850275 DOI: 10.1016/j.schres.2010.08.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [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: 06/09/2010] [Revised: 08/09/2010] [Accepted: 08/11/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Galantamine, a reversible cholinesterase inhibitor with effects on nicotinic receptors, has shown mixed effects on cognitive impairments in patients with schizophrenia. Given these mixed results we examined whether galantamine compared to adjunctive placebo may improve cognitive functions in patients treated concomitantly with a long acting atypical antipsychotic. METHOD The parent study was a 52-week double-blind, randomized study of treatment with long-acting injectable risperidone 25mg or 50mg every two weeks. Adjunctive galantamine or placebo treatment was administered from Month 6 to 12. Outcome measures were neurocognitive, psychopathology, social and quality of life functions. Patients were randomized to blinded galantamine up to 24mg/day or matching placebo tablets. All patients were maintained on their randomized long-acting injectable risperidone regimen for the duration of the trial. RESULTS 32 patients were included in the intent-to-treat analysis. No statistically significant differences were found for Attention Vigilance, Declarative Memory, Processing Speed, Reasoning/Problem Solving, Working Memory domains and the Neurocognitive Composite Score. Group specific analysis showed a statistically significant group interaction (p=0.043) with the Social Cognition domain showing in the galantamine group significantly lower scores at endpoint than placebo patients. The PANSS general psychopathology subscale showed significantly higher scores in the galantamine group at endpoint (p=0.05). ANCOVA model for within treatment group comparisons showed a significant increase of 7.3 points for the total PANSS score for the galantamine group. CONCLUSION Galantamine showed no ameliorative effects on cognitive measures in this 6month, double-blind study of patients with schizophrenia treated with an assured and stable antipsychotic medication delivery system. Galantamine may not be an appropriate augmentation agent for cognitive impairments in patients with schizophrenia at the dose used.
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Smith RC, Lindenmayer JP, Hu Q, Kelly E, Viviano TF, Cornwell J, Vaidhyanathaswamy S, Marcovina S, Davis JM. Effects of olanzapine and risperidone on lipid metabolism in chronic schizophrenic patients with long-term antipsychotic treatment: a randomized five month study. Schizophr Res 2010; 120:204-9. [PMID: 20457512 DOI: 10.1016/j.schres.2010.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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: 12/20/2009] [Revised: 04/06/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Metabolic syndrome and elevated lipids, related to cardiovascular risk factors, are more prevalent in schizophrenia and there has been much debate about the extent to which specific antipsychotics contribute more to the increased risk of developing hyperlipidemia and metabolic syndrome. Most studies have concentrated on fasting levels in patients recently started on medication. Randomized prospective studies of metabolic effects of 2nd generation antipsychotics using both fasting measures and provocative tests may provide results that are more informative. We present results of a randomized prospective study of lipid metabolism and metabolic syndrome in chronic schizophrenic patients using both fasting and post-prandial lipid measures. METHOD Hospitalized patients with chronic schizophrenia, most of whom had been treated with multiple antipsychotics in the past, were randomly assigned to treatment with a single antipsychotic, olanzapine or risperidone, for a period of 5 months. At baseline and every treatment month thereafter, fasting levels of lipids, free fatty acid (FFA) and leptin were assessed. At baseline and end of month 2 of treatment patients had a fatty meal test (FMT) in which postprandial lipids were measured at several time points before and after meal ingestion. Weight was assessed monthly and waist measures were taken at baseline and month 5. Data was analyzed on 23 patients randomized to risperidone and 23 patients randomized to olanzapine. RESULTS Overall, there were no differential drug effects on any fasting lipid measure and fasting triglycerides did not increase in olanzapine treated patients after 5 months of treatment. However, at 2 months of drug treatment the FMT revealed a significantly greater increase in triglycerides, and very low density (VLDL) cholesterol and triglycerides, in olanzapine compared to risperidone patients (Ps=.05-.01). There was no difference between treatments with olanzapine vs. risperidone on development of metabolic syndrome during the 5 month treatment period. CONCLUSIONS Chronic schizophrenic patients treated for years with first and second generation antipsychotics may have developed tolerance to the effects of olanzapine on increasing fasting triglycerides and other lipids, but some underlying metabolic abnormalities may be revealed in postprandial tests of lipid metabolism. These findings suggest that the development of standardized tests and criteria for measurement of postprandial triglycerides and related lipid levels, in addition to fasting levels, may be helpful in identifying metabolic effects of olanzapine and other second generation antipsychotics in chronically treated schizophrenics. In some reports postprandial increases in triglycerides have been identified as important risk factors for cardiovascular disease, but the actual differential consequences of these lipid metabolic differences for development of atherosclerosis and cardiovascular disease in patients treated with different antipsychotics need more objective outcome measures to determine and quantify cardiovascular risk outcomes.
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Affiliation(s)
- Robert C Smith
- Department of Psychiatry, New York University Medical School, Hewlett, NY 11557, USA.
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Abstract
Medication non-adherence in patients with schizophrenia continues to be a significant problem and threatens successful treatment outcomes. Medication non-adherence is often associated with negative consequences, including symptom exacerbation, more frequent emergency room visits, re-hospitalizations and relapse. Long-acting injectable (LAI) forms of antipsychotics allow for rapid identification of non-adherence, obviate the need for the patient to take the medication on a daily basis and increase adherence to some significant degree. Eli Lilly has developed a long-acting depot formulation of olanzapine, olanzapine pamoate, which has recently been approved by the FDA for the US market, and which will be reviewed here. Olanzapine LAI appears to be an effective antipsychotic at dosages of 210 mg every 2 weeks, 300 mg every 2 weeks and 405 mg every 4 weeks in patients with acute schizophrenia, and at 150 mg every 2 weeks, 300 mg every 2 weeks and at 405 mg every 4 weeks for the maintenance treatment of stable patients. Oral supplementation appears not to be needed, particularly not at the onset of treatment with the LAI as is necessary with risperidone LAI. Its efficacy is in general comparable to the efficacy seen with oral olanzapine at a corresponding dose. The side effect profile is also comparable to the side effects observed with oral olanzapine, including lower rates of extrapyramidal symptoms, prolactin elevation and cardiovascular side effects, but significant metabolic effects. The latter include significant weight gain, lipid abnormalities and glucose dysregulation. While the injection site adverse events are overall mild, the most significant serious adverse event is the post-injection delirium sedation syndrome (PDSS). While rare, this syndrome results from inadvertent intravascular injection of olanzapine LAI and can cause a range of olanzapine overdose-type of symptoms. Olanzapine LAI needs therefore to be administered by trained personnel in settings where a post-injection observation period for at least 3 hours by medical personnel is available. The overall use of olanzapine LAI will probably be limited by the possibility of a PDSS event. Patients who have a history of good response to oral olanzapine and are in need of assured medication administration may present a good indication for its use, provided that the appropriate mental health delivery setting is available.
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Affiliation(s)
- J P Lindenmayer
- Department of Psychiatry, New York University School of Medicine, New York NY, USA.
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Canuso CM, Lindenmayer JP, Kosik-Gonzalez C, Turkoz I, Carothers J, Bossie CA, Schooler NR. A randomized, double-blind, placebo-controlled study of 2 dose ranges of paliperidone extended-release in the treatment of subjects with schizoaffective disorder. J Clin Psychiatry 2010; 71:587-98. [PMID: 20492853 DOI: 10.4088/jcp.09m05564yel] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [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: 07/28/2009] [Accepted: 02/11/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study was designed to assess efficacy and safety of paliperidone extended-release (ER) in patients with schizoaffective disorder. METHOD A randomized, 6-week, double-blind, placebo-controlled study was conducted. Subjects with a Structured Clinical Interview for DSM-IV diagnosis of schizoaffective disorder, Positive and Negative Syndrome Scale (PANSS) total score >or= 60, score >or= 4 on >or= 2 PANSS items (hostility, excitement, tension, uncooperativeness, poor impulse control), and Young Mania Rating Scale and/or Hamilton Depression Rating Scale, 21-item version scores >or= 16 were eligible. Subjects received higher-dose (12 mg/d) or lower-dose (6 mg/d) paliperidone ER. Dose adjustments by 3-mg increments were allowed until day 15. The study was conducted from October 2006 through February 2008. RESULTS A total of 316 subjects were randomly assigned to paliperidone ER lower dose (n = 109), higher dose (n = 100), or placebo (n = 107). Mean +/- SD modal dose in lower- and higher-dose groups: 5.7 +/- 0.9 and 11.6 +/- 1.0 mg/d, respectively. Mean +/- SE PANSS total score (primary outcome) improved significantly with higher-dose paliperidone ER versus placebo (-32.4 +/- 2.1 versus -24.1 +/- 2.1; P = .003). Change with lower-dose paliperidone ER (-27.7 +/- 2.1) was not significantly different from placebo (P = .187). No new safety issues were identified; common adverse events were headache (placebo: 16.8%; paliperidone ER: lower dose, 13.9%, higher dose, 13.3%) and tremor (3.7%, 12.0%, 11.2%, respectively). Mean prolactin and weight changes were greater with active treatment than placebo. CONCLUSIONS Higher-dose paliperidone ER was effective and well tolerated in patients with acute schizoaffective disorder. These findings and those from a companion study constitute the first registration program for antipsychotic treatment in schizoaffective disorder. TRIAL REGISTRATION clincaltrials.gov Identifier: NCT00397033.
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Affiliation(s)
- Carla M Canuso
- Johnson & Johnson Pharmaceutical Research and Development, LLC, 1125 Trenton-Harbourton Rd-E12604, Titusville, NJ 08560, USA.
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Abstract
Impulsive and aggressive behaviors are important clinical challenges in the treatment of patients with schizophrenia. They occur both in the acute phase as well as in the chronic phase of the disorder and call for differentiated treatment interventions. It is important to always first consider behavioral and nonpharmacological interventions. High levels of structure and organization together with a nonconfrontational approach may be very successful interventions. In terms of acute pharmacological interventions, clinicians now have a broad spectrum of intramuscular antipsychotic compounds available with rapid onset of action and relatively little sedation. There is a need for new compounds with a more acceptable tolerability profile for the long-term treatment of these important syndromes.
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Affiliation(s)
- J P Lindenmayer
- Department of Psychiatry, New York University School of Medicine, New York University, Wards Island, New York, NY 10035, USA.
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Smith RC, Lindenmayer JP, Davis JM, Kelly E, Viviano TF, Cornwell J, Hu Q, Khan A, Vaidhyanathaswamy S. Effects of olanzapine and risperidone on glucose metabolism and insulin sensitivity in chronic schizophrenic patients with long-term antipsychotic treatment: a randomized 5-month study. J Clin Psychiatry 2009; 70:1501-13. [PMID: 19814947 DOI: 10.4088/jcp.08m04446yel] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [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: 06/04/2008] [Accepted: 11/04/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND Comparisons of diabetic potential, glucose related metabolic levels, and insulin resistance between olanzapine and risperidone have produced variable results in cross-sectional and epidemiologic studies. Randomized prospective studies of metabolic effects during treatment with these drugs may provide results that are more informative. METHOD Hospitalized patients with chronic schizophrenia (DSM-IV), most of whom had been treated with multiple antipsychotics in the past, were randomly assigned to treatment with a single antipsychotic, olanzapine or risperidone, for a period of 5 months. At baseline and every treatment month thereafter, fasting glucose, insulin, insulin-related metabolic measures, and prolactin were assessed, and an oral glucose tolerance test (OGTT) was performed during baseline and months 1, 2, and 5 of treatment. Weight was assessed monthly, and waist and hip measures were taken at baseline and month 5. Data were analyzed on 23 patients randomly assigned to risperidone and 23 patients randomly assigned to olanzapine. The study was conducted from February 2003 to August 2007. RESULTS Most patients were overweight or obese at baseline (mean body mass index [BMI] = 29.4), but there were no differential drug effects on weight change and no differences between drug groups at the 5-month time point. There were no overall drug treatment differences in fasting glucose or glycohemoglobin or 2-hour glucose levels in OGTT and no differences between the two drug groups at the 5-month time point. There were no consistent drug treatment differences in the number of patients who developed borderline or diabetic glucose levels. Olanzapine-treated patients showed a significantly greater increase than risperidone-treated patients in a fasting measure of insulin resistance (P = .041), and olanzapine patients showed greater decreases in insulin sensitivity during OGTT (P = .023) compared to risperidone-treated patients. Olanzapine-treated patients had a significantly greater increase in 1-hour glucose and insulin levels during OGTT in subsequent months compared to baseline and greater increase in glucose and insulin area under the curve over time than the risperdone-treated patients. Prolactin levels decreased in olanzapine patients and increased in risperidone patients (P values approximately .02). There were no significant drug treatment differences in C-peptide levels or 2 indices proposed as measures of insulin secretion or beta-cell function (homeostasis model assessment of beta-cell function [HOMA-B], BIGTT-acute insulin response surrogate measure [BIGTT-AIR]). Changes in insulin resistance over time were not strongly related to changes in BMI or waist circumference during study drug treatment. CONCLUSIONS The increase in insulin levels during olanzapine treatment may compensate for the increase in insulin resistance and serve to reduce fasting and postprandial glucose levels. This may contribute to the lack of differences between olanzapine and risperidone in indices of diabetic or prediabetic glucose levels or glycohemoglobin. How many years this compensatory mechanism will persist needs further investigation. Periodic OGTT tests measuring glucose and insulin levels would be helpful in assessing the status of beta-cell insulin reserve in patients treated with olanzapine and other second-generation antipsychotics and assessing an individual patient's risk for conversion to type 2 diabetes. TRIAL REGISTRATION clinicaltrials.gov Identifier NCT00287820.
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Affiliation(s)
- Robert C Smith
- Department of Psychiatry, NYU Medical School, Hewlett, NY 11557, USA.
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Lindenmayer JP, Khan A, Wance D, Maccabee N, Kaushik S, Kaushik S. Outcome evaluation of a structured educational wellness program in patients with severe mental illness. J Clin Psychiatry 2009; 70:1385-96. [PMID: 19778494 DOI: 10.4088/jcp.08m04740yel] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [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: 09/24/2008] [Accepted: 01/02/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Obesity is increasing at an alarming rate in the United States, as is the obesity rate in patients with schizophrenia. Our study retrospectively evaluated the effectiveness of the Solutions for Wellness and Team Solutions programs, 2 structured educational patient programs, and evaluated the effects on obesity and other metabolic markers in a large, naturalistic inpatient sample. METHOD Between September 18, 2006, and September 15, 2007, 275 inpatients with DSM-IV-TR-diagnosed chronic mental illness admitted to a tertiary care psychiatric facility were included in the 36-week comprehensive and manualized educational program for healthy lifestyles for patients with chronic mental illness incorporating psychoeducational small-group curricula. Patients were tested before and after each of three 12-week group periods by 30 knowledge-assessment questions, and metabolic markers were recorded at baseline, midpoint, and endpoint. RESULTS Of the 275 included inpatients, 50.5% completed more than 5 modules, 20.4% completed less than or equal to 2 or fewer modules, and 5.1% completed all 11 modules. Significant increases in scores were observed for 7 of the 11 modules in the knowledge assessments (P < .001). Eighty-seven patients (43.72%) had a body mass index (BMI) >/=30 (indicating obesity) at the start of the program. There was a significant mean weight loss of 4.88 lb (P = .035) together with a significant decrease in mean BMI (P = .045). Patients with diabetes showed a reduction in mean weight of 5.98 lb. Significant reductions were observed in glucose and triglyceride levels (both P < .05). Patients with impaired glucose tolerance showed a significantly greater decrease in glucose level (P = .000). Sixty-nine patients (25.46%) met criteria for metabolic syndrome at baseline, and this number was reduced to 53 patients (19.56%) at endpoint; this decrease was significant (P = .027). Regarding relationship of change in knowledge after completion of the modules and metabolic changes, we found a significant correlation between reduction in weight and change in Fitness and Exercise score (r = 0.62, P = .001) and a significant correlation between the change score on Nutrition/Healthy Lifestyles and change in glucose values (r = 0.56, P = .001). CONCLUSIONS We found that a structured wellness program using a psychoeducational curriculum can be successfully implemented in a large, naturalistic psychiatric setting with unselected, chronically mentally ill inpatients. Results may help both clinicians and hospital managers to implement similar programs or to include successful components in existing programs for psychiatric patients.
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Affiliation(s)
- Jean-Pierre Lindenmayer
- Manhattan Psychiatric Center, Department of Psychiatry, New York University School of Medicine, Manhattan, New York, New York, USA
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Hough D, Lindenmayer JP, Gopal S, Melkote R, Lim P, Herben V, Yuen E, Eerdekens M. Safety and tolerability of deltoid and gluteal injections of paliperidone palmitate in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1022-31. [PMID: 19481579 DOI: 10.1016/j.pnpbp.2009.05.014] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/07/2009] [Accepted: 05/21/2009] [Indexed: 10/20/2022]
Abstract
Paliperidone palmitate is an investigational, injectable atypical antipsychotic. The safety and tolerability of initiating treatment with paliperidone palmitate via deltoid versus gluteal injections given once monthly, and of switching injection sites, in adults with stable schizophrenia were assessed. In this crossover trial, stable outpatients (N=252) were randomly assigned 1:1:1 to 3 dose groups (paliperidone palmitate 50, 75, or 100 mg eq.) and 2 treatment sequences (blinded to dose): deltoid muscle (period 1 [13 weeks]) followed by gluteal muscle (period 2 [12 weeks]) or the reverse. The intent-to-treat analysis set had 249 patients: mean age=43 (SD: 12.8) years; 57% men, 81% white, baseline mean Positive and Negative Syndrome Scale (PANSS) total score=56 (SD: 11.5). A total of 170 (68%) patients completed the study, with a similar proportion completing each treatment sequence. The incidence of systemic treatment-emergent adverse events (TEAEs) was similar between the 2 injection sites across doses during period 1 (deltoid [D]: 61% to 67%; gluteus [G]: 58% to 65%), and during the last 8 weeks of the 2 study periods (DG: 32% to 45% [period 1], 29% to 42% [period 2]; GD: 31% to 40% [period 1], 30% to 41% [period 2]). During the first treatment week, median plasma paliperidone concentrations were higher with treatment initiation in the deltoid muscle compared with the gluteal muscle. At apparent steady state, there was little difference in plasma paliperidone concentrations between the deltoid and gluteus sites for a given dose. Local tolerability was slightly better with gluteal injections. Patient preference for injection sites differed between geographical regions, e.g. patients from the US preferred deltoid to gluteal sites. The most common (>or=5% overall) TEAEs were: (period 1) insomnia, anxiety, headache, and agitation; and (period 2) insomnia, psychotic disorder, weight increased, and tachycardia. Paliperidone palmitate treatment was tolerated, irrespective of injection site, and thus could offer the choice of administration into either the deltoid or gluteal muscle to meet patient and physician preference.
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Affiliation(s)
- David Hough
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C, Raritan, NJ, USA.
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