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Gargano SP, Santos MG, Taylor SM, Pastis I. A closer look to neural pathways and psychopharmacology of obsessive compulsive disorder. Front Behav Neurosci 2023; 17:1282246. [PMID: 38033477 PMCID: PMC10687174 DOI: 10.3389/fnbeh.2023.1282246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/12/2023] [Indexed: 12/02/2023] Open
Abstract
The intricate neural pathways involved in obsessive-compulsive disorder (OCD) affect areas of our brain that control executive functioning, organization, and planning. OCD is a chronic condition that can be debilitating, afflicting millions of people worldwide. The lifetime prevalence of OCD in the US is 2.3%. OCD is predominantly characterized by obsessions consisting of intrusive and unwanted thoughts, often with impulses that are strongly associated with anxiety. Compulsions with OCD encompass repetitive behaviors or mental acts to satisfy their afflicted obsessions or impulses. While these factors can be unique to each individual, it has been widely established that the etiology of OCD is complex as it relates to neuronal pathways, psychopharmacology, and brain chemistry involved and warrants further exploration.
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Affiliation(s)
- Steven P. Gargano
- East Carolina University Brody School of Medicine, Greenville, NC, United States
| | - Melody G. Santos
- Internal Medicine and Psychiatry Combined Program, Department of Psychiatry and Behavioral Medicine, East Carolina University, Greenville, NC, United States
| | - Sydney M. Taylor
- East Carolina University Brody School of Medicine, Greenville, NC, United States
| | - Irene Pastis
- Department of Psychiatry and Behavioral Medicine, East Carolina University, Greenville, NC, United States
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2
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Juza R, Musilek K, Mezeiova E, Soukup O, Korabecny J. Recent advances in dopamine D 2 receptor ligands in the treatment of neuropsychiatric disorders. Med Res Rev 2023; 43:55-211. [PMID: 36111795 DOI: 10.1002/med.21923] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
Dopamine is a biologically active amine synthesized in the central and peripheral nervous system. This biogenic monoamine acts by activating five types of dopamine receptors (D1-5 Rs), which belong to the G protein-coupled receptor family. Antagonists and partial agonists of D2 Rs are used to treat schizophrenia, Parkinson's disease, depression, and anxiety. The typical pharmacophore with high D2 R affinity comprises four main areas, namely aromatic moiety, cyclic amine, central linker and aromatic/heteroaromatic lipophilic fragment. From the literature reviewed herein, we can conclude that 4-(2,3-dichlorophenyl), 4-(2-methoxyphenyl)-, 4-(benzo[b]thiophen-4-yl)-1-substituted piperazine, and 4-(6-fluorobenzo[d]isoxazol-3-yl)piperidine moieties are critical for high D2 R affinity. Four to six atoms chains are optimal for D2 R affinity with 4-butoxyl as the most pronounced one. The bicyclic aromatic/heteroaromatic systems are most frequently occurring as lipophilic appendages to retain high D2 R affinity. In this review, we provide a thorough overview of the therapeutic potential of D2 R modulators in the treatment of the aforementioned disorders. In addition, this review summarizes current knowledge about these diseases, with a focus on the dopaminergic pathway underlying these pathologies. Major attention is paid to the structure, function, and pharmacology of novel D2 R ligands, which have been developed in the last decade (2010-2021), and belong to the 1,4-disubstituted aromatic cyclic amine group. Due to the abundance of data, allosteric D2 R ligands and D2 R modulators from patents are not discussed in this review.
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Affiliation(s)
- Radomir Juza
- Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Kamil Musilek
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic.,Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Eva Mezeiova
- Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Ondrej Soukup
- Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Korabecny
- Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Biomedical Research Centre, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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3
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Cai H, Zeng C, Zhang X, Liu Y, Wu R, Guo W, Wang J, Wu H, Tang H, Ge X, Yu Y, Zhang S, Cao T, Li N, Liang X, Yang P, Zhang B. Diminished treatment response in relapsed versus first-episode schizophrenia as revealed by a panel of blood-based biomarkers: A combined cross-sectional and longitudinal study. Psychiatry Res 2022; 316:114762. [PMID: 35940088 DOI: 10.1016/j.psychres.2022.114762] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 12/19/2022]
Abstract
There is a paucity of biomarkers for the prediction of treatment response in schizophrenia. In this study, we aimed to investigate whether diminished antipsychotic treatment response in relapsed versus first-episode schizophrenia can be revealed and predicted by a panel of blood-based biomarkers. A cross-sectional cohort consisting of 655 schizophrenia patients at different episodes and 606 healthy controls, and a longitudinal cohort including 52 first-episode antipsychotic-naïve schizophrenia patients treated with the same antipsychotic drugs during the 5-year follow-up of their first three episodes were enrolled. Plasma biomarker changes and symptom improvement were compared between the drug-free phase of psychosis onset and after 4 weeks of atypical antipsychotic drug (AAPD) treatment. In response to treatment, the extent of changes in the biomarkers of bioenergetic, purinergic, phospholipid and neurosteroid metabolisms dwindled down as number of episode and illness duration increased in relapsed schizophrenia. The changes of creatine, inosine, progesterone, allopregnanolone, cortisol and PE(16:0/22:6) were significantly correlated with the improvement of symptomatology. Inosine and progesterone at baseline were shown to be strong predictive biomarkers of treatment response. The results suggest that AAPD treatment response is diminished in the context of relapse, and our findings open new avenues for understanding the pathophysiology of treatment-resistance schizophrenia.
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Affiliation(s)
- Hualin Cai
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China; International Research Center for Precision Medicine, Transformative Technology and Software Services, Hunan, China.
| | - Cuirong Zeng
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Bejing, China; Department of Psychology, University of Chinese Academy of Sciences, Bejing, China
| | - Yong Liu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Renrong Wu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Jianjian Wang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Haishan Wu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Hui Tang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center on Mental Disorders, Changsha, China
| | - Xiaoping Ge
- Department of Psychiatry, Changsha Psychiatric Hospital, Changsha, China
| | - Yan Yu
- Department of Psychiatry, Changsha Psychiatric Hospital, Changsha, China
| | - Shuangyang Zhang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ting Cao
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Nana Li
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Xiaoli Liang
- Department of Psychiatry, Hunan Brain Hospital, 427# Furong Road, Changsha, Hunan 410000, China
| | - Ping Yang
- Department of Psychiatry, Hunan Brain Hospital, 427# Furong Road, Changsha, Hunan 410000, China.
| | - Bikui Zhang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Institute of Clinical Pharmacy, Central South University, 139# Renmin Road, Changsha, Hunan 410011, China; Institute of Clinical Pharmacy, Central South University, Changsha, China; International Research Center for Precision Medicine, Transformative Technology and Software Services, Hunan, China.
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4
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Li N, Yang P, Tang M, Liu Y, Guo W, Lang B, Wang J, Wu H, Tang H, Yu Y, Wu X, Zeng C, Cao T, Cai H. Reduced erythrocyte membrane polyunsaturated fatty acid levels indicate diminished treatment response in patients with multi- versus first-episode schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:7. [PMID: 35217671 PMCID: PMC8881498 DOI: 10.1038/s41537-022-00214-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/01/2022] [Indexed: 11/09/2022]
Abstract
Antipsychotic effects seem to decrease in relapsed schizophrenia patients and the underlying mechanisms remain to be elucidated. Based on the essential role of polyunsaturated fatty acids in brain function and the treatment of schizophrenia, we hypothesize that disordered fatty acid metabolism may contribute to treatment resistance in multi-episode patients. We analyzed the erythrocyte membrane fatty acids in 327 schizophrenia patients under various episodes (numbers of patients: first-episode drug naïve 89; 2–3 episodes 110; 4–6 episodes 80; over 6 episodes 48) and 159 age- and gender-matched healthy controls. Membrane fatty acid levels and PANSS scales were assessed at baseline of antipsychotic-free period and one-month of follow-up after treatment. Totally, both saturated and unsaturated fatty acids were reduced at baseline when compared to healthy controls. Subgroup analyses among different episodes indicated that in response to atypical antipsychotic treatment, the membrane fatty acids were only increased in patients within 3 episodes, and this therapeutic effects on omega-3 index were merely present in the first episode. Results of fatty acid ratios suggested that dysregulations of enzymes such as D6 desaturase, D5 desaturase, and elongases for polyunsaturated fatty acids in patients with multi-episode schizophrenia could account for the differences. Additionally, certain fatty acid level/ratio changes were positively correlated with symptom improvement. The alterations of C22:5n3 and omega-3 index, gender, and the number of episodes were significant risk factors correlated with treatment responsiveness. Using targeted metabolomic approach, we revealed the potential mechanisms underlying abnormal fatty acid metabolism responsible for reduced treatment response in patients with multi-episode schizophrenia.
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Affiliation(s)
- Nana Li
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,Institute of Clinical Pharmacy, Central South University, Changsha, Hunan Province, China
| | - Ping Yang
- Department of Psychiatry, the Second People's Hospital of Hunan Province, Changsha, Hunan Province, China
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,Institute of Hospital Pharmacy, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yong Liu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan Province, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan Province, China
| | - Bing Lang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan Province, China
| | - Jianjian Wang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan Province, China
| | - Haishan Wu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan Province, China
| | - Hui Tang
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,National Clinical Research Center on Mental Disorders, Changsha, Hunan Province, China
| | - Yan Yu
- Department of Psychiatry, Changsha Psychiatric Hospital, Changsha, Hunan Province, China
| | - Xiangxin Wu
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,Institute of Clinical Pharmacy, Central South University, Changsha, Hunan Province, China
| | - Cuirong Zeng
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,Institute of Clinical Pharmacy, Central South University, Changsha, Hunan Province, China
| | - Ting Cao
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.,Institute of Clinical Pharmacy, Central South University, Changsha, Hunan Province, China
| | - Hualin Cai
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China. .,Institute of Clinical Pharmacy, Central South University, Changsha, Hunan Province, China.
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5
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Dar SA, Wani RA, Haq I. A Comparative Study of Aripiprazole, Olanzapine, and L-Methylfolate Augmentation in Treatment Resistant Obsessive-Compulsive Disorder. Psychiatr Q 2021; 92:1413-1424. [PMID: 33830427 DOI: 10.1007/s11126-021-09892-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 10/21/2022]
Abstract
About half of the patients with Obsessive-compulsive disorder (OCD) do not respond to serotonin reuptake inhibitors (SRIs) or have a partial improvement in their symptoms. This study aimed to compare the efficiency and safety of aripiprazole, olanzapine, and L-methyl folate in patients with resistant OCD. The study consisted of an open-label prospective phase of 12-weeks to ascertain resistance to SRIs and a second 6-week open-label addition phase for non or, partial responders of the first phase. One-hundred-fifteen patients entered the 16-week open-label phase. Fifty patients (43.47%) responded to the SRIs monotherapy, two patients developed adverse effects and another three were lost to the follow up. Sixty patients (52.2%) were considered treatment-resistant and entered the 6-week open-label aripiprazole, olanzapine, or L-methyl folate addition phase; Patients showed a significant improvement over 6-week study period in olanzapine and aripiprazole group as measured by YBOCS total score (p < 0.001) while there was no change in the L-methyl folate group at the end as compared with baseline (p = 0.150). Clinical Global Impression-Severity decreased from 4.90 to 2.90 in olanzapine and aripiprazole group at the end of 6 weeks while there was no change in the L-methyl folate group. The CGI-I was significant in the olanzapine and aripiprazole group (p < 0.001) while it was insignificant in the L-methyl folate group (p = 0.088). Augmentation of SRIs with olanzapine or aripiprazole could be a promising option for resistant OCD. L-methyl folate though shown to be effective in resistant depression was not effective in treatment resistant OCD.
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Affiliation(s)
- Shabir Ahmad Dar
- Department of Psychiatry, Government Medical College, Srinagar, 190003, India.
| | - Rayees Ahmad Wani
- Department of Psychiatry, Government Medical College, Srinagar, 190003, India
| | - Inaamul Haq
- Department of Social and Preventive Medicine, Government Medical College, Srinagar, India
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Hashimoto N, Yasui-Furukori N, Hasegawa N, Ishikawa S, Numata S, Hori H, Iida H, Ichihashi K, Furihata R, Murata A, Tsuboi T, Takeshima M, Kyou Y, Komatsu H, Kubota C, Ochi S, Takaesu Y, Usami M, Nagasawa T, Hishimoto A, Miura K, Matsumoto J, Ohi K, Yamada H, Inada K, Watanabe K, Shimoda K, Hashimoto R. Characteristics of discharge prescriptions for patients with schizophrenia or major depressive disorder: Real-world evidence from the Effectiveness of Guidelines for Dissemination and Education (EGUIDE) psychiatric treatment project. Asian J Psychiatr 2021; 63:102744. [PMID: 34325252 DOI: 10.1016/j.ajp.2021.102744] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/25/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Monopharmacy with antipsychotics and antidepressants is the first-line treatment for schizophrenia and major depressive disorder (MDD) in most clinical guidelines, while polypharmacy with psychotropic agents in the treatment of schizophrenia is common in clinical practice. There are no detailed data on the prescription patterns for inpatients with mental illness with reliable diagnoses made by treating psychiatrists. METHODS We gathered prescription data at discharge from 2177 patients with schizophrenia and 1238 patients with MDD from October 2016 to March 2018. RESULTS The patients with schizophrenia aged between 60 and 79 were prescribed lower doses of antipsychotics and hypnotics/anxiolytics than those aged between 40 and 59. There were significant differences between the prescription rate of antipsychotics in the patients with schizophrenia and that of antidepressants in the patients with MDD. The frequency of concomitant drugs such as anti-Parkinson drugs, anxiolytics/hypnotics and mood stabilizers in the subjects with schizophrenia prescribed antipsychotic polypharmacy was significantly higher than that with monotherapy. For the patients with schizophrenia, olanzapine, risperidone, aripiprazole, quetiapine, and blonanserin were the five most prescribed antipsychotics. For the patients with MDD, mirtazapine, duloxetine, escitalopram, trazodone and sertraline were the five most prescribed antidepressants. CONCLUSIONS Our results showed the use of high doses of antipsychotics, high percentages of antipsychotic polypharmacy and concurrent use of hypnotics/anxiolytics in patients with schizophrenia. Notably, these data were collected before intensive instruction regarding the guidelines; therefore, we need to assess the change in the prescription pattern post guideline instruction.
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Affiliation(s)
- Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan.
| | - Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shuhei Ishikawa
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Hikaru Hori
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | | | - Atsunobu Murata
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshitaka Kyou
- Department of Psychiatry, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Chika Kubota
- National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and Function, Graduate School of Medicine, Ehime University, Ehime, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Tatsuya Nagasawa
- Department of NeuroPsychiatry Kanazawa Medical University, Ishikawa, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazutaka Ohi
- Department of Psychiatry and Psychotherapy, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Al-Hakeim HK, Mousa RF, Al-Dujaili AH, Maes M. In schizophrenia, non-remitters and partial remitters to treatment with antipsychotics are qualitatively distinct classes with respect to neurocognitive deficits and neuro-immune biomarkers: results of soft independent modeling of class analogy. Metab Brain Dis 2021; 36:939-955. [PMID: 33580860 DOI: 10.1007/s11011-021-00685-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/31/2021] [Indexed: 01/02/2023]
Abstract
Around one third of schizophrenia patients are non-responders to antipsychotic therapy. The present study aimed to delineate the pathway-phenotypes of non-remitters (NRTT) and partial remitters (PRTT) to treatment with antipsychotics as defined using the Global Clinical Impression scales. We recruited 60 NRTT, 50 PRTT and 43 healthy controls and measured schizophrenia symptoms, neurocognitive tests, plasma CCL11, interleukin-(IL)-6, IL-10, Dickkopf protein 1 (DKK1), high mobility group box-1 protein (HMGB1), κ- and μ-opioid receptors (KOR and MOR, respectively), endomorphin-2 (EM-2), and β-endorphin. Soft independent modeling of class analogy (SIMCA) showed that NRTT and PRTT are significantly discriminated with a cross-validated accuracy of 94.7% and are qualitatively distinct classes using symptomatome, and neuro-immune-opioid-cognitome (NIOC) features as modeling variables. Moreover, a NIOC pathway phenotype discriminated PRTT from healthy controls with an accuracy of 100% indicating that PRTT and controls are two qualitative distinct classes. Using NIOC features as discriminatory variables in SIMCA showed that all PRTT were rejected as belonging to the normal control class and authenticated as belonging to their target class. In conclusion, a non-response to treatment can best be profiled using a SIMCA model constructed using symptomatome and NIOC features. A partial response should be delineated using SIMCA by authenticating patients as controls or PRTT instead of using scale-derived cut-off values or a number of scale items being rated mild or better. The results show that PRTT is characterized by an active NIOC pathway phenotype and that both NRTT and PRTT should be treated by targeting neuro-immune and opioid pathways.
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Affiliation(s)
| | - Rana Fadhil Mousa
- Faculty of Veterinary Medicine, University of Kerbala, Kerbala, Iraq
| | | | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
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8
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Wu YW, Chao MW, Tu HJ, Chen LC, Hsu KC, Liou JP, Yang CR, Yen SC, HuangFu WC, Pan SL. A novel dual HDAC and HSP90 inhibitor, MPT0G449, downregulates oncogenic pathways in human acute leukemia in vitro and in vivo. Oncogenesis 2021; 10:39. [PMID: 33986242 PMCID: PMC8119482 DOI: 10.1038/s41389-021-00331-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 01/06/2023] Open
Abstract
Acute leukemia is a highly heterogeneous disease; therefore, combination therapy is commonly used for patient treatment. Drug–drug interaction is a major concern of combined therapy; hence, dual/multi-target inhibitors have become a dominant approach for cancer drug development. HDACs and HSP90 are involved in the activation of various oncogenic signaling pathways, including PI3K/AKT/mTOR, JAK/STAT, and RAF/MEK/ERK, which are also highly enriched in acute leukemia gene expression profiles. Therefore, we suggest that dual HDAC and HSP90 inhibitors could represent a novel therapeutic approach for acute leukemia. MPT0G449 is a dual effect inhibitor, and it showed cytotoxic effectiveness in acute leukemia cells. Molecular docking analysis indicated that MPT0G449 possessed dual HDAC and HSP90 inhibitory abilities. Furthermore, MPT0G449 induced G2 arrest and caspase-mediated cell apoptosis in acute leukemia cells. The oncogenic signaling molecules AKT, mTOR, STAT3, STAT5, MEK, and ERK were significantly downregulated after MPT0G449 treatment in HL-60 and MOLT-4 cells. In vivo xenograft models confirmed the antitumor activity and showed the upregulation of acetyl-histone H3 and HSP70, biomarkers of pan-HDAC and HSP90 inhibition, with MPT0G449 treatment. These findings suggest that the dual inhibition of HDAC and HSP90 can suppress the expression of oncogenic pathways in acute leukemia, and MPT0G449 represents a novel therapeutic for anticancer treatment.
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Affiliation(s)
- Yi-Wen Wu
- Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei, Taiwan
| | - Min-Wu Chao
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Huang-Ju Tu
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Liang-Chieh Chen
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Warshel Institute for Computational Biology, The Chinese University of Hong Kong, Shenzhen, Guangdong, P. R. China
| | - Kai-Cheng Hsu
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.,TMU Biomedical Commercialization Center, Taipei Medical University, Taipei, Taiwan.,TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jing-Ping Liou
- TMU Biomedical Commercialization Center, Taipei Medical University, Taipei, Taiwan.,School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chia-Ron Yang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Chung Yen
- School of Life and Health Sciences, The Chinese University of Hong Kong, Shenzhen, Guangdong, P. R. China
| | - Wei-Chun HuangFu
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. .,Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. .,Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei, Taiwan. .,TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Shiow-Lin Pan
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. .,Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. .,Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei, Taiwan. .,TMU Biomedical Commercialization Center, Taipei Medical University, Taipei, Taiwan. .,TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan.
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9
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Ruud T, Drivenes K, Drake RE, Haaland VØ, Landers M, Stensrud B, Heiervang KS, Tanum L, Bond GR. The Antipsychotic Medication Management Fidelity Scale: Psychometric properties. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:911-919. [PMID: 32030595 PMCID: PMC7547997 DOI: 10.1007/s10488-020-01018-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The paper describes the Antipsychotic Medication Management Fidelity Scale and its psychometric properties, including interrater reliability, frequency distribution, sensitivity to change and feasibility. Fidelity assessors conducted fidelity reviews four times over 18 months at eight sites receiving implementation support for evidence-based antipsychotic medication management. Data analyses shows good to fair interrater reliability, adequate sensitivity to change over time and good feasibility. At 18 months, item ratings varied from poor to full fidelity on most items. Use of the scale can assess fidelity to evidence-based guidelines for antipsychotic medication management and guide efforts to improve practice. Further research should improve and better calibrate some items, and improve the procedures for access to information.Trial registration: ClinicalTrials.gov Identifier: NCT03271242.
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Affiliation(s)
- Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
- Institute of Clincial Medicine, University of Oslo, Oslo, Norway.
| | - Karin Drivenes
- Division of Mental Health, Sørlandet Hospital, Kristiansand, Norway
- South Eastern Norway Hospital Pharmacy Enterprise, Kristiansand, Norway
| | | | - Vegard Øksendal Haaland
- Sørlandet Hospital, Kristiansand, Norway
- Clinical Neuroscience Research Group, Department of Psychology, The Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | | | - Bjørn Stensrud
- Division of Mental Health, Innlandet Hospital Trust, Brumunddal, Norway
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Brumunddal, Norway
| | - Kristin S Heiervang
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Lars Tanum
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Oslo Metropolitan University, Oslo, Norway
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10
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di Giacomo E, Stefana A, Candini V, Bianconi G, Canal L, Clerici M, Conte G, Ferla MT, Iozzino L, Sbravati G, Tura G, Micciolo R, de Girolamo G. Prescribing Patterns of Psychotropic Drugs and Risk of Violent Behavior: A Prospective, Multicenter Study in Italy. Int J Neuropsychopharmacol 2020; 23:300-310. [PMID: 31993630 PMCID: PMC7251633 DOI: 10.1093/ijnp/pyaa005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/03/2020] [Accepted: 01/23/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND This prospective cohort study aimed at evaluating patterns of polypharmacy and aggressive and violent behavior during a 1-year follow-up in patients with severe mental disorders. METHODS A total of 340 patients (125 inpatients from residential facilities and 215 outpatients) were evaluated at baseline with the Structured Clinical Interview for DSM-IV Axis I and II, Brief Psychiatric Rating Scale, Specific Levels of Functioning scale, Brown-Goodwin Lifetime History of Aggression, Buss-Durkee Hostility Inventory, Barratt Impulsiveness Scale, and State-Trait Anger Expression Inventory-2. Aggressive behavior was rated every 15 days with the Modified Overt Aggression Scale and treatment compliance with the Medication Adherence Rating Scale. RESULTS The whole sample was prescribed mainly antipsychotics with high levels of polypharmacy. Clozapine prescription and higher compliance were associated with lower levels of aggressive and violent behavior. Patients with a history of violence who took clozapine were prescribed the highest number of drugs. The patterns of cumulative Modified Overt Aggression Scale mean scores of patients taking clozapine (n = 46), other antipsychotics (n = 257), and no antipsychotics (n = 37) were significantly different (P = .001). Patients taking clozapine showed a time trend at 1-year follow-up (24 evaluations) indicating a significantly lower level of aggressive behavior. Patient higher compliance was also associated with lower Modified Overt Aggression Scale ratings during the 1-year follow-up. CONCLUSION Both inpatients and outpatients showed high levels of polypharmacy. Clozapine prescription was associated with lower Modified Overt Aggression Scale ratings compared with any other antipsychotics or other psychotropic drugs. Higher compliance was associated with lower levels of aggressive and violent behavior.
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Affiliation(s)
- E di Giacomo
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy,Department of Psychiatry, Asst Monza, Italy,Correspondence: Giovanni de Girolamo, MD, St John of God Clinical Research Centre, Brescia, via Pilastroni 4, 25125 Brescia, Italy ()
| | - A Stefana
- Department of Mental Health, ASST Spedali Civili of Brescia, Italy
| | - V Candini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G Bianconi
- Department of Mental Health, ASST Ovest Milanese, Milano, Italy
| | - L Canal
- Department of Psychology and Cognitive Sciences, University of Trento
| | - M Clerici
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy,Department of Psychiatry, Asst Monza, Italy
| | - G Conte
- Department of Mental Health, ASST Spedali Civili of Brescia, Italy
| | - M T Ferla
- Department of Mental Health, Asst-Rhodense G.Salvini di Garbagnate, Milano, Italy
| | - L Iozzino
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G Sbravati
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G Tura
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - R Micciolo
- Department of Psychology and Cognitive Sciences, University of Trento
| | - G de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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11
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Srivastava P, Hira SK, Paladhi A, Singh R, Gupta U, Srivastava DN, Singh RA, Manna PP. Studies on interaction potency model based on drug synergy and therapeutic potential of triple stimuli-responsive delivery of doxorubicin and 5-fluoro-2-deoxyuridine against lymphoma using disulfide-bridged cysteine over mesoporous silica nanoparticles. J Mater Chem B 2020; 8:1411-1421. [PMID: 31974541 DOI: 10.1039/c9tb02628b] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A triple stimuli-responsive drug delivery platform involving doxorubicin, 5-fluoro-2-deoxy uridine and folic acid was fabricated on mesoporous silica nanoparticles for targeting delivery against a highly aggressive murine lymphoma called Dalton's lymphoma. Fabrication of the unique construct by amalgamating active and passive targeting mechanisms offers a novel hyper-chimeric platform for a stimuli-responsive drug delivery system. The novel construct enables efficient and precise delivery of the precious cargo to the tumor sites. Active targeting by folic acid directs the doxorubicin and 5-fluoro-2-deoxy uridine in the close proximities of the tumor cells, causing efficient killing and significant growth inhibition. Isobologram models, zero interaction potency dose-response surface plots and matrices were generated to evaluate the combination synergism of the two drugs. Therapy with the dual drug-bearing construct in mice with established tumors significantly reduced the tumor load and enhanced the survival of the animals compared with the untreated control. Therapy with the dual delivery system also augmented the innate and adaptive immune defense mechanisms of the treated animals. CD8+ T cells, natural killer cells and the dendritic cells from the treated group following successful therapy with the novel construct showed enhanced cytotoxicity and growth inhibitory capacities against DL tumor cells.
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Affiliation(s)
- Prateek Srivastava
- Immunobiology Laboratory, Department of Zoology, Centre of Advanced Study, Institute of Science, Banaras Hindu University, Varanasi 221005, India.
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12
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Baandrup L. Polypharmacy in schizophrenia. Basic Clin Pharmacol Toxicol 2020; 126:183-192. [PMID: 31908124 DOI: 10.1111/bcpt.13384] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022]
Abstract
Schizophrenia is a severe mental disorder characterized by a heterogeneous symptom profile which comprises a clinical platform for widespread use of polypharmacy even though antipsychotic monotherapy is the recommended treatment regimen. This narrative review provides a summary of the current gap between evidence and practice for use of antipsychotic combination therapy in patients with schizophrenia. Antipsychotic polypharmacy is frequently prescribed instead of following international consensus of clozapine monotherapy in treatment-resistant patients. Antipsychotic-benzodiazepine combination therapy clearly has a role in the treatment of acute agitation whereas there is no evidence to support an effect on core schizophrenia symptoms when chronically prescribed. Antidepressants are typically added to antipsychotic treatment in case of persistent negative symptoms. Available evidence suggests that antidepressants may improve negative symptom control in schizophrenia. Combining an antipsychotic with an antiepileptic is not supported by any firm evidence, but individual mood stabilizers have come out positively in single trials. Generally, the evidence base for polypharmacy in schizophrenia maintenance treatment is sparse but may be warranted in certain clinical situations. Therapeutic benefits and side effects should be carefully monitored and considered to ensure a beneficial risk-benefit ratio if prescribing polypharmacy for specific clinical indications.
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Affiliation(s)
- Lone Baandrup
- Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Glostrup, Denmark.,Mental Health Centre Copenhagen, Hellerup, Denmark
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13
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Varanasi R, Nayak D. Homoeopathy in the management of infectious diseases: Different facets of its use and implications for the future. INDIAN JOURNAL OF RESEARCH IN HOMOEOPATHY 2020. [DOI: 10.4103/ijrh.ijrh_40_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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14
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Positive impact of clinical pharmacist interventions on antipsychotic use in patients on excessive polypharmacy evidenced in a retrospective cohort study. ACTA ACUST UNITED AC 2019. [DOI: 10.2478/gp-2019-0013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Objectives
Although antipsychotic prescribing in elderly patients using polypharmacy has not been studied in well-designed clinical trials and meta-analyses, there is an urgent need to monitor prescribing practice in this population. One of the possible approaches to optimize pharmacotherapy may be the involvement of clinical pharmacists (CPs). The aim of this research was to examine whether the involvement of a CP can improve treatment guidelines adherence and change the total number of medications per patient in older patients who are treated with excessive polypharmacy that includes antipsychotics.
Methods
This cohort retrospective study included older patients (65 years or older) treated with at least one antipsychotic and excessive polypharmacy (10 or more medications concurrently) between 2012 and 2014 in primary care. The main outcome measures were antipsychotic treatment guidelines’ adherence and the total number of medications per patient after the CP’s interventions. Only interventions including antipsychotics were studied in detail (i.e., discontinuation, switching, initiation, dose adjustment, change of another medication because of a drug-related problem). Data on diagnoses, patient pharmacotherapy and the CP’s interventions were obtained from clinical records and medical reviews. Age and acceptance of the CP’s interventions were used as predictive factors for antipsychotic treatment guidelines’ adherence.
Results
Forty-nine patients were included. The CP suggested 21 different interventions of which nine (42.8%) were accepted by the general practitioners. The number of medications that patients received decreased after the CP’s interventions (N of medications before: 15.4; N of medications after: 12.0, p < 0.05). The acceptance of the CP’s recommendations, but not age, improved antipsychotic treatment guidelines’ adherence (p = 0.041).
Conclusions
These results show that a collaborative care approach including a CP in primary care significantly improved the adherence to treatment guidelines. The results also support the implementation of this service in the Slovenian healthcare system, although more studies are needed.
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15
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de Avila RCS, do Nascimento LG, Porto RLDM, Fontenelle L, Filho ECM, Brakoulias V, Ferrão YA. Level of Insight in Patients With Obsessive-Compulsive Disorder: An Exploratory Comparative Study Between Patients With "Good Insight" and "Poor Insight". Front Psychiatry 2019; 10:413. [PMID: 31333508 PMCID: PMC6619338 DOI: 10.3389/fpsyt.2019.00413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/24/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Insight may be defined as the ability to perceive and evaluate external reality and to separate it from its subjective aspects. It also refers to the ability to self-assess difficulties and personal qualities. Insight may be a predictor of success in the treatment of obsessive-compulsive disorder (OCD), so that individuals with poor insight tend to become refractory to treatment. The objective of this study is to investigate factors associated with poor insight in individuals with OCD. Methods: This cross-sectional exploratory study used the Brown Belief Assessment Scale as a parameter for the creation of the comparison groups: individuals who obtained null scores (zero) composed the group with preserved or good insight (n = 148), and those with scores above the 75% percentile composed the group with poor insight (n = 124); those with intermediate scores were excluded. Sociodemographic characteristics and clinical and psychopathological aspects, intrinsic and extrinsic to the typical symptoms of OCD, were compared in a univariate analysis. A logistic regression was used to determine which factors associated with critical judgment remained significant. Results: Individuals in the poor insight group differed from those with good insight in regard to: more prevalent use of neuroleptics (p = 0.05); higher untreated time interval (p < 0.001); higher total Yale-Brown obsessive-compulsive scale score and the obsessions and compulsions factors (all factors with p < 0.001); higher dimensional Yale-Brown obsessive-compulsive scale total and dimensional scores (p from 0.04 to 0.001); higher prevalence of contamination/cleaning (p = 0.006) and hoarding (p < 0.001) symptoms dimensions; more prevalent sensory phenomena (p = 0.023); higher levels of depression (p = 0.007); and more prevalent comorbidity with bipolar affective disorder (p = 0.05) and post-traumatic stress disorder (PTSD) (p = 0.04). After analyzing the logistic regression, we conclude that the most important factors associated with poor insight are: the presence of any sensory phenomena (OR: 2.24), use of neuroleptics (OR: 1.66), and hoarding symptoms (OR: 1.15). Conclusion: The variability of insight in patients with OCD seems to be an important psychopathological characteristic in the differentiation of possible subtypes of OCD, since the poor insight is associated with sensory phenomena and greater use of neuroleptics, which makes it possible to conjecture the role of dopaminergic neurocircuits in the neurobiology of this disorder. In addition, there is also an association with the symptoms of hoarding content, admittedly one of the symptomatic contents with less response to conventional OCD treatments. Studies based on neurobiological aspects such as neuroimaging and neuropsychology may help to elucidate more consistently the role of insight in patients with OCD and the repercussions concerning available treatments.
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Affiliation(s)
- Richard Chuquel Silveira de Avila
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Laura Gratsch do Nascimento
- Departamento de Psicologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Rafaella Landell de Moura Porto
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Leonardo Fontenelle
- Departamento de Psiquiatria, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Vlasios Brakoulias
- School of Medicine of Western Sydney University, University of Sydney, Sydney, NSW, Australia
| | - Ygor Arzeno Ferrão
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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16
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Caldiroli A, Buoli M, van Haren NEM, de Nijs J, Altamura AC, Cahn W. The relationship of IQ and emotional processing with insula volume in schizophrenia. Schizophr Res 2018; 202:141-148. [PMID: 29954697 DOI: 10.1016/j.schres.2018.06.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The insula is involved in general and social cognition, in particular emotion regulation. Aim of this study is to investigate whether insula volume is associated with Intelligence Quotient (IQ) and emotional processing in schizophrenia patients versus healthy controls (HC). METHODS Magnetic resonance imaging (MRI) brain scans, IQ and emotional processing tests (Benton Facial Recognition Test [BFRT], Degraded Facial Affect Recognition Task [DFAR], Emotional Mentalizing Task [EMT]) were administered in 246 subjects (133 schizophrenia patients and 113 controls). First order linear regression analyses were performed with group as independent variable and IQ/emotional processing test scores as dependent variables. Second order stepwise linear regression analyses were performed with IQ/emotional processing test scores as independent variables (as well as intracranial volumes, age, gender and cannabis abuse) and right/left insula volumes as dependent ones. A final mediation analysis (Sobel test) was performed to verify if IQ or emotional processing test scores could explain the eventual differences in insula volumes between the two groups. RESULTS Schizophrenia patients presented lower insula volumes (left: F = 9.72, p < 0.01; right: F = 10.93, p < 0.01) as compared with healthy controls. Smaller insula volumes in schizophrenia patients are mediated by lower IQ scores (Sobel tests: 3.07, p < 0.01 for right insula; 2.72, p < 0.01 for left insula), but not by impairments in emotion processing. CONCLUSIONS IQ, but not emotional processing mediates smaller insula volumes in schizophrenia patients.
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Affiliation(s)
- Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, the Netherlands
| | - Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, the Netherlands.
| | - Neeltje E M van Haren
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jessica de Nijs
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, the Netherlands
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Wiepke Cahn
- University Medical Center Utrecht, Department of Psychiatry, Brain Center Rudolf Magnus, the Netherlands
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17
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Brakoulias V, Stockings E. A systematic review of the use of risperidone, paliperidone and aripiprazole as augmenting agents for obsessive-compulsive disorder. Expert Opin Pharmacother 2018; 20:47-53. [PMID: 30360669 DOI: 10.1080/14656566.2018.1540590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is often viewed as a difficult to treat disorder. In some patients, antipsychotics are used to augment the action of serotonin reuptake inhibitors (SRIs), particularly when there is only a partial response to treatment. AREAS COVERED This comprehensive literature review aims to assess the effectiveness and tolerability of three commonly used atypical antipsychotic agents: risperidone, paliperidone and aripiprazole, as augmentation agents in the treatment of OCD. EXPERT OPINION Antipsychotic augmentation should only be trialed once treatment with selective SRIs at high dose and exposure and response prevention therapy have failed. Currently, there is evidence to support the use of risperidone, paliperidone and aripiprazole as augmentation agents for OCD in adult samples but more studies with larger samples are needed to assess predictors of response to antipsychotic augmentation and to detect any differential effects between the three agents. At this point in time, the choice of antipsychotic is best determined by the side effect profile of the drug and a patient's medication history.
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Affiliation(s)
- Vlasios Brakoulias
- a Department of Psychiatry , The University of Sydney and Nepean Hospital, Sydney Medical School - Nepean, Discipline of Psychiatry , Sydney/Penrith , NSW , Australia.,b UNSW/Usyd Co-Chair for Research Collaboration for Early and Mid-Career Researchers , Sydney , NSW , Australia
| | - Emily Stockings
- b UNSW/Usyd Co-Chair for Research Collaboration for Early and Mid-Career Researchers , Sydney , NSW , Australia.,c National Drug and Alcohol Research Centre , UNSW , Sydney , NSW , Australia
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18
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Characteristics of Medicaid Recipients Receiving Persistent Antipsychotic Polypharmacy. Community Ment Health J 2018; 54:699-706. [PMID: 29127560 PMCID: PMC6427065 DOI: 10.1007/s10597-017-0183-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
Antipsychotic polypharmacy (APP) is a common strategy despite guidelines advising against this practice. This article seeks to quantify the prevalence and correlates of APP using Medicaid Analytic eXtract files from 2003 to 2004. Nineteen percent of Medicaid recipients who received an antipsychotic were treated with APP. Individuals who received APP were more likely to be white, male, disabled, between the ages of 18-29, diagnosed with a psychotic disorder, and diagnosed with a higher number of psychiatric conditions. Geographic variation in APP rates was also observed. Quality improvement initiatives may help reduce APP for medically vulnerable patients.
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19
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Galling B, Vernon JA, Pagsberg AK, Wadhwa A, Grudnikoff E, Seidman AJ, Tsoy-Podosenin M, Poyurovsky M, Kane JM, Correll CU. Efficacy and safety of antidepressant augmentation of continued antipsychotic treatment in patients with schizophrenia. Acta Psychiatr Scand 2018; 137:187-205. [PMID: 29431197 DOI: 10.1111/acps.12854] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of antidepressant augmentation of antipsychotics in schizophrenia. METHODS Systematic literature search (PubMed/MEDLINE/PsycINFO/Cochrane Library) from database inception until 10/10/2017 for randomized, double-blind, efficacy-focused trials comparing adjunctive antidepressants vs. placebo in schizophrenia. RESULTS In a random-effects meta-analysis (studies = 42, n = 1934, duration = 10.1 ± 8.1 weeks), antidepressant augmentation outperformed placebo regarding total symptom reduction [standardized mean difference (SMD) = -0.37, 95% confidence interval (CI) = -0.57 to -0.17, P < 0.001], driven by negative (SMD = -0.25, 95% CI = -0.44-0.06, P = 0.010), but not positive (P = 0.190) or general (P = 0.089) symptom reduction. Superiority regarding negative symptoms was confirmed in studies augmenting first-generation antipsychotics (FGAs) (SMD = -0.42, 95% CI = -0.77, -0.07, P = 0.019), but not second-generation antipsychotics (P = 0.144). Uniquely, superiority in total symptom reduction by NaSSAs (SMD = -0.71, 95% CI = -1.21, -0.20, P = 0.006) was not driven by negative (P = 0.438), but by positive symptom reduction (SMD = -0.43, 95% CI = -0.77, -0.09, P = 0.012). Antidepressants did not improve depressive symptoms more than placebo (P = 0.185). Except for more dry mouth [risk ratio (RR) = 1.57, 95% CI = 1.04-2.36, P = 0.03], antidepressant augmentation was not associated with more adverse events or all-cause/specific-cause discontinuation. CONCLUSIONS For schizophrenia patients on stable antipsychotic treatment, adjunctive antidepressants are effective for total and particularly negative symptom reduction. However, effects are small-to-medium, differ across antidepressants, and negative symptom improvement seems restricted to the augmentation of FGAs.
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Affiliation(s)
- B Galling
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.,The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA
| | - J A Vernon
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
| | - A K Pagsberg
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A Wadhwa
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
| | | | - A J Seidman
- Department of Psychology, Iowa State University, Ames, IA, USA
| | - M Tsoy-Podosenin
- Department of Psychiatry, St John's Episcopal Hospital, New York, NY, USA
| | - M Poyurovsky
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.,Tirat Carmel Mental Health Center, tirat Carmel, Israel
| | - J M Kane
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - C U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.,The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
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20
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Galling B, Roldán A, Hagi K, Rietschel L, Walyzada F, Zheng W, Cao X, Xiang Y, Zink M, Kane JM, Nielsen J, Leucht S, Correll CU. Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and meta-regression analysis. World Psychiatry 2017; 16:77-89. [PMID: 28127934 PMCID: PMC5269492 DOI: 10.1002/wps.20387] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safety. We conducted a systematic literature search and a random effects meta-analysis of randomized trials comparing augmentation with a second antipsychotic vs. continued antipsychotic monotherapy in schizophrenia. Co-primary outcomes were total symptom reduction and study-defined response. Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction (16 studies, N=694, standardized mean difference, SMD=-0.53, 95% CI: -0.87 to -0.19, p=0.002). However, superiority was only apparent in open-label and low-quality trials (both p<0.001), but not in double-blind and high-quality ones (p=0.120 and 0.226, respectively). Study-defined response was similar between antipsychotic augmentation and monotherapy (14 studies, N=938, risk ratio = 1.19, 95% CI: 0.99 to 1.42, p=0.061), being clearly non-significant in double-blind and high-quality studies (both p=0.990). Findings were replicated in clozapine and non-clozapine augmentation studies. No differences emerged regarding all-cause/specific-cause discontinuation, global clinical impression, as well as positive, general and depressive symptoms. Negative symptoms improved more with augmentation treatment (18 studies, N=931, SMD=-0.38, 95% CI: -0.63 to -0.13, p<0.003), but only in studies augmenting with aripiprazole (8 studies, N=532, SMD=-0.41, 95% CI: -0.79 to -0.03, p=0.036). Few adverse effect differences emerged: D2 antagonist augmentation was associated with less insomnia (p=0.028), but more prolactin elevation (p=0.015), while aripiprazole augmentation was associated with reduced prolactin levels (p<0.001) and body weight (p=0.030). These data suggest that the common practice of antipsychotic augmentation in schizophrenia lacks double-blind/high-quality evidence for efficacy, except for negative symptom reduction with aripiprazole augmentation.
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Affiliation(s)
- Britta Galling
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitätsmedizin BerlinBerlinGermany,Zucker Hillside Hospital, Psychiatry Research, Northwell HealthGlen OaksNYUSA,Hofstra Northwell School of MedicineHempsteadNYUSA
| | - Alexandra Roldán
- Department of PsychiatryInstitut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Katsuhiko Hagi
- Zucker Hillside Hospital, Psychiatry Research, Northwell HealthGlen OaksNYUSA,Sumitomo Dainippon Pharma Co.TokyoJapan
| | - Liz Rietschel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBernSwitzerland
| | - Frozan Walyzada
- Zucker Hillside Hospital, Psychiatry Research, Northwell HealthGlen OaksNYUSA
| | - Wei Zheng
- Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Xiao‐Lan Cao
- Department of PsychiatryChinese University of Hong KongHong Kong SARChina
| | - Yu‐Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of MacaoTaipa, MacaoSARChina
| | - Mathias Zink
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg UniversityMannheimGermany
| | - John M. Kane
- Zucker Hillside Hospital, Psychiatry Research, Northwell HealthGlen OaksNYUSA,Hofstra Northwell School of MedicineHempsteadNYUSA,Feinstein Institute for Medical ResearchManhassetNYUSA,Albert Einstein College of MedicineBronxNYUSA
| | - Jimmi Nielsen
- Department of PsychiatryAalborg University HospitalAalborgDenmark,Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Stefan Leucht
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität MünchenMunichGermany
| | - Christoph U. Correll
- Zucker Hillside Hospital, Psychiatry Research, Northwell HealthGlen OaksNYUSA,Hofstra Northwell School of MedicineHempsteadNYUSA,Feinstein Institute for Medical ResearchManhassetNYUSA,Albert Einstein College of MedicineBronxNYUSA
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Fava M, Okame T, Matsushima Y, Perry P, Weiller E, Baker RA. Switching from Inadequate Adjunctive or Combination Treatment Options to Brexpiprazole Adjunctive to Antidepressant: An Open-Label Study on the Effects on Depressive Symptoms and Cognitive and Physical Functioning. Int J Neuropsychopharmacol 2016; 20:22-30. [PMID: 27784751 PMCID: PMC5412581 DOI: 10.1093/ijnp/pyw087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/28/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Approximately 50% of patients with major depressive disorder do not respond adequately to their antidepressant treatment, underscoring the need for more effective treatment options. The objective of this study was to investigate the effect of adjunctive brexpiprazole on depressive symptoms in patients with major depressive disorder who were not responding to adjunctive or combination therapy of their current antidepressant treatments with several different classes of agents (NCT02012218). METHODS In this 6-week, open-label, phase 3b study, patients with major depressive disorder who had an inadequate response to ≥1 adjunctive or combination therapy, in addition to history of ≥1 failure to monotherapy antidepressant treatment, were switched to adjunctive brexpiprazole. Efficacy was assessed by change from baseline to week 6 in Montgomery-Åsberg Depression Rating Scale total score. Patient functioning was assessed using the Sheehan Disability Scale and the Cognitive and Physical Functioning Questionnaire. Safety and tolerability were also assessed. RESULTS A total of 51/61 (83.6%) patients completed 6 weeks of treatment with adjunctive brexpiprazole. Improvements in depressive symptoms were observed (least squares mean change from baseline to week 6 in Montgomery-Åsberg Depression Rating Scale total score, -17.3 [P < .0001]) as well as improvements in general and cognitive functioning (mean changes from baseline to week 6: Sheehan Disability Scale, -3.1 [P < .0001]; Massachusetts General Hospital-Cognitive and Physical Functioning Questionnaire, -9.2 [P < .0001]). The most common adverse event was fatigue (14.8%); akathisia was reported by 8.2% of patients. CONCLUSIONS In patients with major depressive disorder who had switched to open-label adjunctive brexpiprazole following inadequate response to previous adjunctive or combination therapy, improvements were observed in depressive symptoms, general functioning, cognitive function, and energy/alertness.
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Affiliation(s)
- Maurizio Fava
- Massachusetts General Hospital, Boston, MA (Dr Fava); Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan (Mr Okame and Mr Matsushima); Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ (Ms Perry and Dr Baker); H. Lundbeck A/S, Valby, Denmark (Dr Weiller)
| | - Takao Okame
- Massachusetts General Hospital, Boston, MA (Dr Fava); Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan (Mr Okame and Mr Matsushima); Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ (Ms Perry and Dr Baker); H. Lundbeck A/S, Valby, Denmark (Dr Weiller)
| | - Yuki Matsushima
- Massachusetts General Hospital, Boston, MA (Dr Fava); Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan (Mr Okame and Mr Matsushima); Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ (Ms Perry and Dr Baker); H. Lundbeck A/S, Valby, Denmark (Dr Weiller)
| | - Pamela Perry
- Massachusetts General Hospital, Boston, MA (Dr Fava); Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan (Mr Okame and Mr Matsushima); Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ (Ms Perry and Dr Baker); H. Lundbeck A/S, Valby, Denmark (Dr Weiller)
| | - Emmanuelle Weiller
- Massachusetts General Hospital, Boston, MA (Dr Fava); Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan (Mr Okame and Mr Matsushima); Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ (Ms Perry and Dr Baker); H. Lundbeck A/S, Valby, Denmark (Dr Weiller)
| | - Ross A. Baker
- Massachusetts General Hospital, Boston, MA (Dr Fava); Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan (Mr Okame and Mr Matsushima); Otsuka Pharmaceutical Development and Commercialization Inc., Princeton, NJ (Ms Perry and Dr Baker); H. Lundbeck A/S, Valby, Denmark (Dr Weiller)
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Thongsai S, Gray R, Bressington D. The physical health of people with schizophrenia in Asia: Baseline findings from a physical health check programme. J Psychiatr Ment Health Nurs 2016; 23:255-66. [PMID: 27090192 DOI: 10.1111/jpm.12300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2016] [Indexed: 01/22/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Physical health problems, especially cardiovascular disease and metabolic disorders are far more common in people with severe mental illness (SMI) than the general population. While there are a considerable number of studies that have examined the physical health and health behaviours of people with SMI in Western countries, there have been few studies that have done this in Asia. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Unhealthy body mass index (BMI) values were observed in 44% of Thai service users diagnosed with schizophrenia despite desirable levels of exercise and relatively good diets being reported by the majority of participants. Being prescribed two or more antipsychotics was significantly associated with greater body weight and a higher BMI than in people prescribed only one antipsychotic. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health professionals in Asia should be particularly aware of the additional risks of obesity that seem to be associated with antipsychotic polypharmacy when they are promoting the physical health of people with schizophrenia. ABSTRACT Introduction People with schizophrenia have worse physical health than the general population, and studies in developed countries demonstrate that their health behaviours are often undesirable. However, as no similar studies have been conducted in Asian countries with emerging healthcare systems, the physical health promotion challenges in these settings is unknown. Aim To identify and explore relationships between cardiometabolic health risks, lifestyle and treatment characteristics in people with schizophrenia in Thailand. Method This cross-sectional study reports the baseline findings from a physical health check programme using the Thai version of the Health Improvement Profile. Results Despite desirable levels of exercise and relatively good diets being reported by most of the 105 service users, unhealthy body mass index values were observed in 44% of participants. A BMI>23 kg/m² and central obesity was found to be most likely in women. Being prescribed antipsychotic polypharmacy was significantly associated with a higher BMI than in people prescribed monotherapy. Implications for Practice Mental health professionals in Asia should be aware of the additional risks of obesity that are associated with antipsychotic polypharmacy and may benefit from additional training in order that they may advocate for service users within medication reviews to minimize the potential iatrogenic effects of treatment.
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Affiliation(s)
- S Thongsai
- Head of Mental Health and Psychiatric Nursing Division, Nursing Department, Naresuan University, Phitsanulok, Thailand
| | - R Gray
- Health Services Research Centre, Hamad Medical Corporation, Doha, Qatar.,University of South Australia, Adelaide, Australia
| | - D Bressington
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
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23
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Galling B, Roldán A, Rietschel L, Hagi K, Walyzada F, Zheng W, Cao XL, Xiang YT, Kane JM, Correll CU. Safety and tolerability of antipsychotic co-treatment in patients with schizophrenia: results from a systematic review and meta-analysis of randomized controlled trials. Expert Opin Drug Saf 2016; 15:591-612. [PMID: 26967126 DOI: 10.1517/14740338.2016.1165668] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Antipsychotic co-treatment is common in schizophrenia, despite lacking evidence for its efficacy and safety. Areas: We conducted a systematic search of PubMed/PsycInfo/CJN/WangFan/CBM without language restrictions from database inception until 05/25/2015 for randomized trials comparing antipsychotic monotherapy with antipsychotic co-treatment in ≥20 adults with schizophrenia reporting meta-analyzable adverse events (AEs) data. Meta-analyzing 67 studies (n=4,861, duration=10.3±5.2 weeks), antipsychotic co-treatment was similar to monotherapy regarding intolerability-related discontinuation (risk ratio (RR)=0.84, 95% confidence interval (CI)=0.53-1.33, p=0.455). While incidence of ≥1 AE was lower with antipsychotic co-treatment (RR=0.77, 95%CI=0.66-0.90, p=0.001), these results were solely driven by open-label and efficacy-focused studies. Adjunctive D2-antagonists lead to less nausea (RR=0.220, 95%CI=0.06-0.87, p=0.030) and insomnia (RR=0.26, 95%CI=0.08-0.86, p=0.028), but higher prolactin (SMD=2.20, 95%CI=0.43-3.96, p=0.015). Conversely, adjunctive partial D2-agonists (aripiprazole=100%) resulted in lower electrocardiogram abnormalities (RR=0.43, 95%CI=0.25-0.73, p=0.002), constipation (RR=0.45, 95%CI=0.25-0.79, p=0.006), drooling/hypersalivation (RR=0.14, 95%CI=0.07-0.29, p<0.001), prolactin (SMD=-1.77, 95%CI=-2.38, -1.15, p<0.001), total and LDL-cholesterol (SMD=-0.33, 95%CI=-0.55, -0.11, p=0.003; SMD=-0.33, 95%CI=-0.54, -0.10, p=0.004). EXPERT OPINION No double-blind evidence for altered AE burden associated with antipsychotic co-treatment was found. However, AEs were insufficiently and incompletely reported and follow-up duration was modest. Adjunctive partial D2-agonists might be beneficial for counteracting several AEs. High-quality, long-term studies that comprehensively assess AEs are needed.
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Affiliation(s)
- Britta Galling
- a The Zucker Hillside Hospital , Psychiatry Research, Northwell Health , Glen Oaks , NY , USA
| | - Alexandra Roldán
- b Department of Psychiatry, Institut d'Investigació Biomédica-Sant Pau (IIB-SANT PAU) , Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB) , Barcelona , Spain
| | - Liz Rietschel
- c University Hospital of Child and Adolescent Psychiatry and Psychotherapy , University of Bern , Bern , Switzerland
| | - Katsuhiko Hagi
- a The Zucker Hillside Hospital , Psychiatry Research, Northwell Health , Glen Oaks , NY , USA.,d Sumitomo Dainippon Pharma Co., Ltd., Medical Affairs , Tokyo , Japan
| | - Frozan Walyzada
- a The Zucker Hillside Hospital , Psychiatry Research, Northwell Health , Glen Oaks , NY , USA
| | - Wei Zheng
- e Department of Psychiatry, Guangzhou Brain Hospital (Guangzhou Huiai Hospital), Affilated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Xiao-Lan Cao
- f Department of Psychiatry , Chinese University of Hong Kong , Hong Kong , China
| | - Yu-Tao Xiang
- g Unit of Psychiatry, Faculty of Health Sciences , University of Macau , Macao , China
| | - John M Kane
- a The Zucker Hillside Hospital , Psychiatry Research, Northwell Health , Glen Oaks , NY , USA.,h Hofstra North Shore LIJ School of Medicine , Hempstead , NY , USA.,i The Feinstein Institute for Medical Research , Manhasset , NY , USA.,j Albert Einstein College of Medicine , Bronx , NY , USA
| | - Christoph U Correll
- a The Zucker Hillside Hospital , Psychiatry Research, Northwell Health , Glen Oaks , NY , USA.,h Hofstra North Shore LIJ School of Medicine , Hempstead , NY , USA.,i The Feinstein Institute for Medical Research , Manhasset , NY , USA.,j Albert Einstein College of Medicine , Bronx , NY , USA
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Add-on effects of a low-dose aripiprazole in resolving hyperprolactinemia induced by risperidone or paliperidone. Psychiatry Res 2016; 237:83-9. [PMID: 26921057 DOI: 10.1016/j.psychres.2015.12.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 11/06/2015] [Accepted: 12/25/2015] [Indexed: 11/21/2022]
Abstract
This study investigated the effects of a low-dose aripiprazole adjunctive treatment for risperidone- or paliperidone-induced hyperprolactinemia in Han Chinese women with schizophrenia. After 4 weeks of risperidone or paliperidone treatment, 60 out of 66 patients improved significantly and experienced hyperprolactinemia. They were randomly assigned to the treatment group (aripiprazole adjunctive treatment) (n=30) or control group (non-adjunctive treatment) (n=30). The dosage of risperidone and paliperidone were maintained; and aripiprazole was maintained at 5mg/day during the 8-week study period. The prolactin levels at the end of the 8th week were significantly lower in the treatment group than in the control group. The estradiol level correlated negatively with serum prolactin level both in the treatment group and the control group at the end of the 8th week and the 4th week respectively. The Positive and Negative Syndrome Scale score improved significantly during the 8-week study period in both groups. The incidence of treatment-emergent adverse event was similar in two groups. Low-dose aripiprazole adjunctive treatment is effective in relieving risperidone- and paliperidone-induced hyperprolactinemia in female schizophrenic patients without increasing adverse event.
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25
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26
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Effect of Ziprasidone Augmentation of Serotonin Reuptake Inhibitors in Treatment-Resistant Obsessive-Compulsive Disorder. Clin Neuropharmacol 2016; 39:6-9. [DOI: 10.1097/wnf.0000000000000123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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27
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Song HR, Kwon YJ, Bahk WM, Woo YS, Lee HB, Lee J, Lee DB, Lee SY, Kim MD, Won S, Lee K, Sohn I, Lee JG, Shin YC, Chung S, Jang S, Jae YM, Yoon BH. Current prescription pattern of maintenance treatments for bipolar patients in Korea: A focus on the transition from acute treatments. Psychiatry Clin Neurosci 2016; 70:42-50. [PMID: 26243698 DOI: 10.1111/pcn.12337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 06/23/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Abstract
AIMS We examined prescription patterns in maintenance treatment for recovered bipolar patients and compared these with acute treatments. METHODS Using retrospective methods, the bipolar patients in clinical recovery (Clinical Global Impression Bipolar Version score ≤ 2 for 6 months) after acute episode were selected. We reviewed differences between prescription patterns at remission and after a maintenance period of at least 6 months. RESULTS A total of 340 bipolar disorder patients were selected. During the maintenance period, more than half of the patients (192, 56.5%) took a mood stabilizer (MS) + antipsychotic (AP) combination. Among the MS, valproate (149, 43.8%) was most prescribed, and lithium (98, 28.8%) was second, but as patients moved into maintenance treatment, lithium use decreased, and the use of lamotrigine (86, 25.3%) increased. Preferred AP were quetiapine (125, 36.8%), aripiprazole (67, 19.7%), risperidone (48, 14.1%), and olanzapine (39, 11.5%). The use of olanzapine in maintenance was greatly decreased compared with that during acute treatment (67, 19.7%). Most patients did not take an antidepressant (AD), but the proportion using one or more AD was increased during maintenance (17.9% to 30.3%), and bupropion (28, 8.2%) was the preferred AD. Doses were decreased in all drugs, but lamotrigine was maintained at a dose of 133.2 ± 68.5 mg/day. CONCLUSIONS The most common prescription combination for bipolar maintenance treatment was MS + AP. The use of AP was decreased, whereas the use of AD in combination with MS and/or AP was increased. The doses of MS and AP were generally decreased during the maintenance periods, with the exception of lamotrigine.
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Affiliation(s)
- Hoo Rim Song
- Department of Psychiatry, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Young-Joon Kwon
- Department of Psychiatry, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hwang-Bin Lee
- Department of Psychiatry, Seoul National Hospital, Seoul, Korea
| | - Jonghun Lee
- Department of Psychiatry, College of Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Dae-Bo Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Psychiatry, Gunsan Medical Center, Gunsan, Korea
| | - Sang-Yeol Lee
- Department of Psychiatry, College of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Moon-Doo Kim
- Department of Psychiatry, School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Seunghee Won
- Department of Psychiatry, College of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Kwanghun Lee
- Department of Psychiatry, School of Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Inki Sohn
- Department of Psychiatry, Keyo Hospital, Keyo Medical Foundation, Uiwang, Korea
| | - Jung Goo Lee
- Department of Psychiatry, College of Medicine, Haeudae Paik Hospital and Paik Institute for Clinical Research, Inje University, Busan, Korea.,Department of Health Sciences and Technology, Graduate School of Inje University, Gimhae, Korea
| | - Young-Chul Shin
- Department of Psychiatry, College of Medicine, Sungkyunkwan University Kangbuk Samsung Hospital, Seoul, Korea
| | - Sangkeun Chung
- Department of Psychiatry, College of Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Saeheon Jang
- Department of Psychiatry, Bongseng Memorial Hospital, Busan, Korea
| | - Young Myo Jae
- Department of Psychiatry, Bongseng Memorial Hospital, Busan, Korea
| | - Bo-Hyun Yoon
- Department of Psychiatry, Naju National Hospital, Naju, Korea
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Gaviria AM, Franco JG, Aguado V, Rico G, Labad J, de Pablo J, Vilella E. A Non-Interventional Naturalistic Study of the Prescription Patterns of Antipsychotics in Patients with Schizophrenia from the Spanish Province of Tarragona. PLoS One 2015; 10:e0139403. [PMID: 26427051 PMCID: PMC4591292 DOI: 10.1371/journal.pone.0139403] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/10/2015] [Indexed: 12/28/2022] Open
Abstract
Background The analysis of prescribing patterns in entire catchment areas contributes to global mapping of the use of antipsychotics and may improve treatment outcomes. Objective To determine the pattern of long-term antipsychotic prescription in outpatients with schizophrenia in the province of Tarragona (Catalonia-Spain). Methods A naturalistic, observational, retrospective, non-interventional study based on the analysis of registries of computerized medical records from an anonymized database of 1,765 patients with schizophrenia treated between 2011 and 2013. Results The most used antipsychotic was risperidone, identified in 463 (26.3%) patients, followed by olanzapine in 249 (14.1%), paliperidone in 225 (12.7%), zuclopenthixol in 201 (11.4%), quetiapine in 141 (8%), aripiprazole in 100 (5.7%), and clozapine in 100 (5.7%). Almost 8 out of 10 patients (79.3%) were treated with atypical or second-generation antipsychotics. Long-acting injectable (LAI) formulations were used in 44.8% of patients. Antipsychotics were generally prescribed in their recommended doses, with clozapine, ziprasidone, LAI paliperidone, and LAI risperidone being prescribed at the higher end of their therapeutic ranges. Almost 7 out of 10 patients (69.6%) were on antipsychotic polypharmacy, and 81.4% were on psychiatric medications aside from antipsychotics. Being prescribed quetiapine (OR 14.24, 95% CI 4.94–40.97), LAI (OR 9.99, 95% CI 6.45–15.45), psychiatric co-medications (OR 4.25, 95% CI 2.72–6.64), and paliperidone (OR 3.13, 95% CI 1.23–7.92) were all associated with an increased likelihood of polypharmacy. Being prescribed risperidone (OR 0.54, 95% CI 0.35–0.83) and older age (OR 0.98, 95% CI 0.97–0.99) were related to a low polypharmacy probability. Conclusions Polypharmacy is the most common pattern of antipsychotic use in this region of Spain. Use of atypical antipsychotics is extensive. Most patients receive psychiatric co-medications such as anxiolytics or antidepressants. Polypharmacy is associated with the use of quetiapine or paliperidone, use of a LAI, younger age, and psychiatric co-medication.
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Affiliation(s)
- Ana M. Gaviria
- Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV Reus, Spain
| | - José G. Franco
- Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV Reus, Spain
- * E-mail:
| | - Víctor Aguado
- Hospital Universitari Institut Pere Mata, Reus, Spain
| | - Guillem Rico
- Hospital Universitari Institut Pere Mata, Reus, Spain
| | - Javier Labad
- Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV Reus, Spain
| | - Joan de Pablo
- Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV Reus, Spain
| | - Elisabet Vilella
- Hospital Universitari Institut Pere Mata, Universitat Rovira i Virgili, CIBERSAM, IISPV Reus, Spain
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Cook TB, Reeves GM, Teufel J, Postolache TT. Persistence of racial disparities in prescription of first-generation antipsychotics in the USA. Pharmacoepidemiol Drug Saf 2015; 24:1197-206. [PMID: 26132170 DOI: 10.1002/pds.3819] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/21/2015] [Accepted: 05/27/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to estimate the prevalence of first-generation antipsychotics (FGA) prescribed for treatment of psychiatric and neurological conditions and use of benztropine to reduce extrapyramidal side effects (EPS) by patient race/ethnicity in a nationally representative sample of adult outpatient visits. METHODS The study sample included all outpatient visits (N = 8154) among patients aged 18-69 years where a prescription for one or more antipsychotics was recorded across 6 years of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (2005-2010). Use of FGA was compared by race/ethnicity using multiple logistic regression models accounting for patient and clinical characteristics stratified by neighborhood poverty rate. Frequency of EPS was determined by use of benztropine to reduce or prevent EPS. RESULTS Black patients were significantly more likely than White patients to use FGA (odds ratio = 1.48, p = 0.040) accounting for psychiatric and neurological diagnoses, treatment setting, metabolic factors, neighborhood poverty, and payer source. Black patients were more than twice as likely as White patients to receive higher-potency FGA (haloperidol or fluphenazine), particularly in higher-poverty areas (odds ratio = 2.50, p < 0.001). Use of FGA, higher among Black than White patients, was positively associated with use of benztropine to reduce EPS. CONCLUSIONS Racial disparities in the pharmacological treatment of severe mental disorders persist 30 years after the introduction of second-generation antipsychotics. The relatively high frequency of FGA of use among Black patients compared with White patients despite more Food and Drug Administration-approved indications and lower EPS risk for second-generation antipsychotics requires additional research.
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Affiliation(s)
- Thomas B Cook
- Department of Public Health, Mercyhurst Institute of Public Health, Mercyhurst University, Erie, PA, USA
| | - Gloria M Reeves
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James Teufel
- Department of Public Health, Mercyhurst Institute of Public Health, Mercyhurst University, Erie, PA, USA
| | - Teodor T Postolache
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.,Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Rocky Mountain MIRECC, Denver, CO, USA
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Genetics of second-generation antipsychotic and mood stabilizer-induced weight gain in bipolar disorder. Pharmacogenet Genomics 2015; 25:354-62. [DOI: 10.1097/fpc.0000000000000144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Razzouk D, Kayo M, Sousa A, Gregorio G, Cogo-Moreira H, Cardoso AA, Mari JDJ. The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil. PLoS One 2015; 10:e0124791. [PMID: 25853709 PMCID: PMC4390144 DOI: 10.1371/journal.pone.0124791] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 03/10/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Guidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce. OBJECTIVE To estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil. METHOD A cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider's perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated. RESULTS 147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs. CONCLUSION Antipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle income countries.
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Affiliation(s)
- Denise Razzouk
- Centro de Economia em Saúde Mental (CESM), Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Monica Kayo
- Centro de Economia em Saúde Mental (CESM), Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Aglaé Sousa
- Centro de Economia em Saúde Mental (CESM), Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Guilherme Gregorio
- Centro de Economia em Saúde Mental (CESM), Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Hugo Cogo-Moreira
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Andrea Alves Cardoso
- Centro de Economia em Saúde Mental (CESM), Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
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Pharmacotherapy of acute mania: monotherapy or combination therapy with mood stabilizers and antipsychotics? CNS Drugs 2015; 29:221-7. [PMID: 25711483 DOI: 10.1007/s40263-015-0235-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The use of combination therapy with mood stabilizers and antipsychotics in acute mania in bipolar disorder (BD) is widespread, although most treatment guidelines recommend monotherapy as the first option, and reserve combination therapy, which is associated with more frequent and more severe side effects, for when patients do not respond to the former treatment option. Reasons to prescribe combination therapy include the lack of efficacy of the current treatment (either real or due to undisclosed poor adherence), psychiatric comorbidities, severe previous course of illness, slow cross-tapering during treatment switching, and potential benefits from particular combinations. The decision to start with monotherapy or combination therapy may depend on the patient characteristics, and is still under debate. Clinical trials designed to ascertain whether combination therapy or monotherapy is more advantageous for patients in acute mania and beyond, according to illness severity, are urgently needed. Adding a third monotherapy arm to the conventional two-arm, adjunctive-design trials or initiating combination therapy from the beginning may help to shed some light on the issue.
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Stratford HJ, Cooper MJ, Di Simplicio M, Blackwell SE, Holmes EA. Psychological therapy for anxiety in bipolar spectrum disorders: A systematic review. Clin Psychol Rev 2015; 35:19-34. [DOI: 10.1016/j.cpr.2014.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 10/29/2014] [Accepted: 11/01/2014] [Indexed: 01/12/2023]
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Three-Year long-term outcome of 458 naturalistically treated inpatients with major depressive episode: severe relapse rates and risk factors. Eur Arch Psychiatry Clin Neurosci 2014; 264:567-75. [PMID: 24590257 DOI: 10.1007/s00406-014-0495-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 02/20/2014] [Indexed: 12/16/2022]
Abstract
In randomized controlled trials, maintenance treatment for relapse prevention has been proven to be efficacious in patients responding in acute treatment, its efficacy in long-term outcome in "real-world patients" has yet to be proven. Three-year long-term data from a large naturalistic multisite follow-up were presented. Severe relapse was defined as suicide, severe suicide attempt, or rehospitalization. Next to relapse rates, possible risk factors including antidepressant medication were identified using univariate generalized log-rank tests and multivariate Cox proportional hazards model for time to severe relapse. Overall data of 458 patients were available for analysis. Of all patients, 155 (33.6%) experienced at least one severe relapse during the 3-year follow-up. The following variables were associated with a shorter time to a severe relapse in univariate and multivariate analyses: multiple hospitalizations, presence of avoidant personality disorder, continuing antipsychotic medication, and no further antidepressant treatment. In comparison with other studies, the observed rate of severe relapse during 3-year period is rather low. This is one of the first reports demonstrating a beneficial effect of long-term antidepressant medication on severe relapse rates in naturalistic patients. Concomitant antipsychotic medication may be a proxy marker for treatment resistant and psychotic depression.
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Lee TY, Kim SN, Chon MW, Kwon JS. Effects of the functioning and antipsychotic use on clinical high risk for psychosis: a response to Yung et al. Schizophr Res 2014; 159:254-5. [PMID: 25159095 DOI: 10.1016/j.schres.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Tae Young Lee
- Institute of Human Behavioral Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sung Nyun Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myong-Wuk Chon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Wang P, Si T. Use of antipsychotics in the treatment of depressive disorders. SHANGHAI ARCHIVES OF PSYCHIATRY 2014; 25:134-40. [PMID: 24991148 PMCID: PMC4054548 DOI: 10.3969/j.issn.1002-0829.2013.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Summary There is a long history of using antipsychotic medications in the treatment of depressive disorders. Atypical antipsychotics, which have fewer side effects than traditional antipsychotics, have been used as monotherapy or adjunctively with antidepressants to treat depressive disorders with or without psychotic symptoms. The antidepressant effect of atypical antipsychotics involves regulation of monoamine, glutamate, gamma-aminobutyric acid (GABA), cortisol, and neurotrophic factors. To date, the United States Food and Drug Administration (USFDA) has approved aripiprazole and quetiapine slow-release tablets as adjunctive treatment for depressive disorders, and the combination of olanzapine and fluoxetine for the treatment of treatment-resistant depression. When using atypical antipsychotics in the treatment of depressed patients, clinicians need to monitor patients for the emergence of adverse effects including extrapyramidal symptoms (EPS), weight gain, and hyperglycemia.
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Affiliation(s)
- Ping Wang
- Beijing Shijitan Hospital, Capital University of Medical Sciences, Beijing, China
| | - Tianmei Si
- Peking University Institute of Mental Health, National Key Laboratory of China, Beijing, China
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On 'polypharmacy' and multi-target agents, complementary strategies for improving the treatment of depression: a comparative appraisal. Int J Neuropsychopharmacol 2014; 17:1009-37. [PMID: 23719026 DOI: 10.1017/s1461145712001496] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Major depression is a heterogeneous disorder, both in terms of symptoms, ranging from anhedonia to cognitive impairment, and in terms of pathogenesis, with many interacting genetic, epigenetic, developmental and environmental causes. Accordingly, it seems unlikely that depressive states could be fully controlled by a drug possessing one discrete mechanism of action and, in the wake of disappointing results with several classes of highly selective agent, multi-modal treatment concepts are attracting attention. As concerns pharmacotherapy, there are essentially two core strategies. First, multi-target antidepressants that act via two or more complementary mechanisms and, second, polypharmacy, which refers to co-administration of two distinct drugs, usually in separate pills. Both multi-target agents and polypharmacy ideally couple a therapeutically unexploited action to a clinically established mechanism in order to enhance efficacy, moderate side-effects, accelerate onset of action and treat a broader range of symptoms. The melatonin MT1/MT2 agonist and 5-HT(2C) antagonist, agomelatine, which is effective in the short- and long-term treatment of depression, exemplifies the former approach, while evidence-based polypharmacy is illustrated by the adjunctive use of second-generation antipsychotics with serotonin reuptake inhibitors for treatment of resistant depression. Histone acetylation and methylation, ghrelin signalling, inflammatory modulators, metabotropic glutamate-7 receptors and trace amine-associated-1 receptors comprise attractive substrates for new multi-target and polypharmaceutical strategies. The present article outlines the rationale underpinning multi-modal approaches for treating depression, and critically compares and contrasts the pros and cons of established and potentially novel multi-target vs. polypharmaceutical treatments. On balance, the former appear the most promising for the elaboration, development and clinical implementation of innovative concepts for the more effective management of depression.
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Prevalence and correlates of antipsychotic polypharmacy in children and adolescents receiving antipsychotic treatment. Int J Neuropsychopharmacol 2014; 17:1095-105. [PMID: 23673334 PMCID: PMC4010557 DOI: 10.1017/s1461145712001320] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Antipsychotic polypharmacy (APP), which is common in adults with psychotic disorders, is of unproven efficacy and raises safety concerns. Although youth are increasingly prescribed antipsychotics, little is known about APP in this population. We performed a systematic PubMed search (last update 26 January 2013) of studies reporting the prevalence of APP in antipsychotic-treated youth. Summary statistics and statistical tests were calculated at the study level and not weighted by sample size. Fifteen studies (n = 58 041, range 68-23 183) reported on APP in youth [mean age = 13.4 ± 1.7 yr, 67.1 ± 10.2% male, 77.9 ± 27.4% treated with second-generation antipsychotics (SGAs)]. Data collected in these studies covered 1993-2008. The most common diagnoses were attention-deficit hyperactivity disorder (ADHD; 39.9 ± 23.5%) and conduct disorder/oppositional defiant disorder (CD/ODD; 33.6 ± 24.8). In studies including predominantly children (mean age = <13 yr, N = 5), the most common diagnosis were ADHD (50.6 ± 25.4%) and CD/ODD (39.5 ± 27.5%); while in studies with predominantly adolescents (mean age = ⩾13 yr, N = 7) the most common diagnoses were schizophrenia-spectrum disorders (28.6 ± 23.8%), anxiety disorders (26.9 ± 14.9%) and bipolar-spectrum disorders (26.6 ± 7.0%), followed closely by CD/ODD (25.8 ± 17.7). The prevalence of APP among antipsychotic-treated youth was 9.6 ± 7.2% (5.9 ± 4.5% in child studies, 12.0 ± 7.9% in adolescent studies, p = 0.15). Higher prevalence of APP was correlated with a bipolar disorder or schizophrenia diagnosis (p = 0.019) and APP involving SGA+SGA combinations (p = 0.0027). No correlation was found with APP definition [⩾1 d (N = 10) vs. >30-⩾90 d (N = 5), p = 0.88]. Despite lacking safety and efficacy data, APP in youth is not uncommon, even in samples predominantly consisting of non-psychotic patients. The duration, clinical motivations and effectiveness of this practice require further study.
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Banerjee I, Sathian B, Chakraborty PK, Banerjee I, Roy B, Jauhari AC, Saha A. Pharmacotherapy of Bipolar Affective Disorder: A Hospital based Study from Sub Himalayan Valley of Nepal. J Clin Diagn Res 2014; 8:HC22-7. [PMID: 25121003 DOI: 10.7860/jcdr/2014/8661.4524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/06/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In Bipolar disorder the mood of the patients fluctuates between depression and mania. The main objective of the study was to find out the commonest mood stabilizers used for the treatment of Bipolar affective disorders in Western Nepal in hospitalized patients in an actual clinical set up. METHODS This was a cross-sectional study which was conducted between October 2009 and September 2010 at Psychiatric ward at Manipal teaching hospital, Pokhara, Nepal, a tertiary care hospital situated in Western Nepal. The diagnosis of the disease was based on ICD-10 (Tenth revision) Classification of mental and Behavioural disorders, Diagnostic Criteria for Research. We calculated odds ratio and their 95% confidence intervals (95% CI). p< 0.05 was considered as statistically significant. RESULTS 62.1% of the patients were less than 40 yrs, 56.3% were male, 72.4% were unemployed and 75.9% of the patients were having monthly income <10,000/month. As far as ethnicity is concerned 37.9% of the cases were Brahmin and by occupation 29.9% of the patients were students followed by housewife 25.3%, labour 17.2%, retired 13.8% respectively. Drugs and Psychotherapy [OR 1.4, 95% (CI 0.575, 3.4017)] was prescribed in age <40 years as compared to age>40 yrs. Male patients [OR 7.22, 95% (CI 0.862, 60.499)] and [OR 2.353, 95% (CI 0.857, 6.455)] received drugs by trade names and drugs not from the national drug list of Nepal as compared to females. Monthly income <10,000/month and [OR 2.8, 95% (CI 0.742, 10.56)] tendency of receiving drugs by trade names. Among the mood elevators Sodium valproate was the commonest drug to be prescribed in 51/87(58.6%) patients followed by Lithium in 30/87 (34.5%) cases and Carbamazepine in 6/87 (6.9%) cases. Sodium valproate was prescribed at 1,000 mg/day, Lithium was prescribed at 900 mg/day in and Carbamazepine was prescribed at 800 mg/day. CONCLUSION Among all the mood elevators Sodium valproate is the commonest drug prescribed for the treatment of bipolar affective disorder, recommended that there is a trend of using newer drugs like sodium valproate rather than the conventional mood stabilizers like Lithium for bipolar affective disorder in Western Development region of Nepal.
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Affiliation(s)
- Indrajit Banerjee
- Lecturer, Department of Pharmacology, Manipal College of Medical Sciences , Pokhara, Nepal
| | - Brijesh Sathian
- Assistant Professor, Department of Community Medicine, Manipal College of Medical Sciences , Pokhara, Nepal
| | | | - Indraneel Banerjee
- Post Doctorate Trainee, Department of Urology, SMS Medical College Jaipur , Rajasthan, India
| | - Bedanta Roy
- Assistant Professor, Department of Physiology, Manipal College of Medical Sciences , Pokhara, Nepal
| | | | - Archana Saha
- Professor and Head of the Department of Pharmacology, Manipal College of Medical Sciences , Pokhara, Nepal
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Factors associated with antipsychotic polypharmacy and high-dose antipsychotics among individuals receiving compulsory treatment in the community. J Clin Psychopharmacol 2014; 34:307-12. [PMID: 24717256 DOI: 10.1097/jcp.0000000000000098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Community treatment orders (CTOs) are a form of compulsory treatment of individuals with a mental illness in the community. The objectives of this study were to determine the demographic, clinical, and treatment plan factors associated with antipsychotic polypharmacy and high-dose antipsychotics among individuals issued with a CTO. This was a secondary analysis of all 377 individuals who were prescribed an antipsychotic, extracted from a retrospective study of 378 individuals issued with a CTO by the New South Wales Mental Health Review Tribunal in Australia in 2009. Deidentified information relating to individuals' treatment plans, demographic, and clinical details were systematically extracted. Of the 377 individuals, 121 (32%) were prescribed antipsychotic polypharmacy and 101 (27%) high-dose antipsychotics. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for factors associated with antipsychotic polypharmacy and high-dose antipsychotics were computed using binary logistic regression. There was a strong association between the use of antipsychotic polypharmacy and high-dose antipsychotics (P < 0.001). Only treatment plan factors were associated with antipsychotic polypharmacy and high-dose antipsychotics in adjusted models. Although first-generation long-acting injectable antipsychotics and clozapine were associated with antipsychotic polypharmacy (adjusted OR, 9.12; 95% CI, 4.21-19.74; adjusted OR, 7.97; 95% CI, 2.93-21.72), oral second-generation antipsychotics and risperidone long-acting injection were associated with high-dose antipsychotics (adjusted OR, 5.67; 95% CI, 2.89-11.12; adjusted OR, 8.14; 95% CI, 3.22-20.53). Therefore, the use of antipsychotic polypharmacy and high-dose antipsychotics among individuals issued with CTOs is associated only with the drugs prescribed in their treatment plans and not their individual demographic and clinical characteristics.
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The impact of a change in prescribing policy on antipsychotic prescribing in a general adult psychiatric hospital. Ir J Psychol Med 2014; 31:167-173. [PMID: 30189484 DOI: 10.1017/ipm.2014.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To examine the impact of a change in local prescribing policy on the adherence to evidence-based prescribing guidelines for antipsychotic medication in a general adult psychiatric hospital. METHODS All adult in-patients had their clinical record and medication sheet reviewed. Antipsychotic prescribed, dose prescribed and documented indications for prescribing were recorded. This was done before and after the implementation of the change in hospital antipsychotic prescribing policy. RESULTS There were no significant differences in age, sex, Mental Health Act status, psychiatric diagnosis or documented indications for prescribing multiple or high dose antipsychotics between the two groups. There was an increase in the preferential prescribing of multiple second-generation antipsychotics (p=0.01) in the context of a significant reduction in the prescribing of multiple antipsychotics overall (p=0.02). There were no significant reductions in prescribing of mixed generations of antipsychotics (p=0.12), high dose antipsychotics (p=1.00) or as required (PRN) antipsychotics (p=0.74). CONCLUSIONS Changes in local prescribing policy can improve adherence to quality prescribing guidelines and cause clinically significant improvements in patterns of prescribing in a general adult psychiatric hospital.
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Jaracz J, Tetera-Rudnicka E, Kujath D, Raczyńska A, Stoszek S, Czernaś W, Wierzbiński P, Moniakowski A, Jaracz K, Rybakowski J. The prevalence of antipsychotic polypharmacy in schizophrenic patients discharged from psychiatric units in Poland. Pharmacol Rep 2014; 66:613-7. [PMID: 24948062 DOI: 10.1016/j.pharep.2014.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 01/24/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The term antipsychotic polypharmacy (APP) refers to the concurrent use of two or more antipsychotic drugs in schizophrenia. The aim of this study was to investigate the range of APP in schizophrenic patients discharged from psychiatric units in Poland, and to determine its demographical and clinical correlates. METHODS Data on the pharmacological treatment of 207 patients with a diagnosis of schizophrenia, discharged from six psychiatric hospitals from September-December 2011 were recorded by experienced psychiatrists. Clinical and demographical information was obtained on each patient. The severity of symptoms at admission, and their improvement during hospitalization were assessed using the Clinical Global Impression Scale. RESULTS At discharge, 52.7% of the patients were prescribed one, 42.5% two and 4.8% three antipsychotic drugs (AP). When two AP were applied, it was usually a combination of two second generation antipsychotics (SGA) (46%), or of both first generation antipsychotics (FGA) and SGA (48%). The SGA's olanzapine and risperidone were those most commonly prescribed. Patients treated with two or more AP had a higher number of previous hospitalizations than patients receiving antipsychotic monotherapy. Mood stabilizers were prescribed for nearly one third of the patients, while antidepressants and benzodiazepines were prescribed for fewer than 10%. CONCLUSIONS The prevalence of polypharmacy in Poland is similar to that reported in other countries. This may suggest that, in a substantial proportion of schizophrenic patients clinical response to the antipsychotic monotherapy is unsatisfactory. Further studies focusing on the efficacy and safety of strategies in the treatment of patients with schizophrenia not responding to antipsychotic monotherapy are necessary.
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Affiliation(s)
- Jan Jaracz
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Poznań, Poland.
| | | | - Dominika Kujath
- The Province Hospital for the Nervously and Mentally Ill, "Dziekanka", Gniezno, Poland
| | - Agnieszka Raczyńska
- The Province Hospital for the Nervously and Mentally Ill, "Dziekanka", Gniezno, Poland
| | - Sebastian Stoszek
- The Province Hospital for the Nervously and Mentally Ill, Cibórz, Poland
| | | | - Piotr Wierzbiński
- Department of Adult Psychiatry, Medical University of Łódź, Łódź, Poland
| | | | - Krystyna Jaracz
- Department of Neurological and Psychiatric Nursing, Poznań University of Medical Sciences, Poznań, Poland
| | - Janusz Rybakowski
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Poznań, Poland
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Koo MS, Kim EJ, Roh D, Kim CH. Role of dopamine in the pathophysiology and treatment of obsessive–compulsive disorder. Expert Rev Neurother 2014; 10:275-90. [DOI: 10.1586/ern.09.148] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bourin M, Thibaut F. Can Antipsychotic Agents be Considered as Real Antimanic Treatments? Front Psychiatry 2014; 5:60. [PMID: 24904443 PMCID: PMC4033507 DOI: 10.3389/fpsyt.2014.00060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/14/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Michel Bourin
- Neurobiologie de l'Anxiété et de la Dépression, Faculté de Médecine, University of Nantes , Nantes , France
| | - Florence Thibaut
- Psychiatry and Addictive Disorders, University Hospital Cochin-Tarnier, INSERM 894 CPN, Faculty of Medicine Paris Descartes , Paris , France
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Affiliation(s)
- Ginpreet Kaur
- Department of Pharmacology, SPP School of Pharmacy and Technology Management, SVKM's, Narsee Monjee Institute of Management Studies (NMIMS), Vile Parle (W) Mumbai, India E-mail:
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Petersen AB, Andersen SE, Christensen M, Larsen HL. Adverse effects associated with high-dose olanzapine therapy in patients admitted to inpatient psychiatric care. Clin Toxicol (Phila) 2013; 52:39-43. [DOI: 10.3109/15563650.2013.862258] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hayley S, Litteljohn D. Neuroplasticity and the next wave of antidepressant strategies. Front Cell Neurosci 2013; 7:218. [PMID: 24312008 PMCID: PMC3834236 DOI: 10.3389/fncel.2013.00218] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/29/2013] [Indexed: 12/13/2022] Open
Abstract
Depression is a common chronic psychiatric disorder that is also often co-morbid with numerous neurological and immune diseases. Accumulating evidence indicates that disturbances of neuroplasticity occur with depression, including reductions of hippocampal neurogenesis and cortical synaptogenesis. Improper trophic support stemming from stressor-induced reductions of growth factors, most notably brain derived neurotrophic factor (BDNF), likely drives such aberrant neuroplasticity. We posit that psychological and immune stressors can interact upon a vulnerable genetic background to promote depression by disturbing BDNF and neuroplastic processes. Furthermore, the chronic and commonly relapsing nature of depression is suggested to stem from "faulty wiring" of emotional circuits driven by neuroplastic aberrations. The present review considers depression in such terms and attempts to integrate the available evidence indicating that the efficacy of current and "next wave" antidepressant treatments, whether used alone or in combination, is at least partially tied to their ability to modulate neuroplasticity. We particularly focus on the N-methyl-D-aspartate (NMDA) antagonist, ketamine, which already has well documented rapid antidepressant effects, and the trophic cytokine, erythropoietin (EPO), which we propose as a potential adjunctive antidepressant agent.
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Affiliation(s)
- Shawn Hayley
- Department of Neuroscience, Carleton University Ottawa, ON, Canada
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Jureidini J, Tonkin A, Jureidini E. Combination pharmacotherapy for psychiatric disorders in children and adolescents: prevalence, efficacy, risks and research needs. Paediatr Drugs 2013; 15:377-91. [PMID: 23757196 DOI: 10.1007/s40272-013-0032-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Polypharmacy, defined as the concomitant use of two or more psychotropic drugs, has become increasingly common in the paediatric and adolescent population over the past two decades. Combining psychotropic drugs leads to possible increases in benefits, but also in risks, particularly given the potential for psychotropic drug interactions. Despite the increasing use of concomitant therapy in children and adolescents, there is very little evidence from controlled clinical trials to provide guidance for prescribers. Even while acknowledging the small evidence base, clinical practice guidelines from eminent medical organizations are either relatively silent on or tend to support the use of concomitant treatments more enthusiastically than the evidence would warrant, so that practice and guidance are running ahead of the science. Our narrative review shows that the published evidence for efficacy and safety of concomitant psychotropic drugs in children and adolescents is scanty. A comprehensive search located 37 studies published over the last decade, of which 18 were randomized controlled trials (RCTs). These focused mainly on stimulants, central sympatholytics (such as clonidine), antipsychotics and 'mood stabilizers'. While several small, often methodologically weak, RCTs demonstrated statistically significant advantages for dual pharmacotherapy over monotherapy, only adding central sympatholytics to stimulants for treating attention-deficit hyperactivity disorder (ADHD) symptoms was supported by substantial studies with an effect size large enough to suggest clinical importance. Non-randomized studies tended to have results that supported concomitant treatment, but all have design-related problems that decrease the reliability of the results. Two studies that specifically examined tolerability of combination pharmacotherapy compared with monotherapy showed significant increases in adverse effects, both subjective and objective, and other studies confirmed a statistically significant increase in adverse effects, including sedation and self-harm. Given the extent of combination therapy occurring, particularly in conditions such as ADHD, and the ambiguous evidence for benefit with clear evidence of harm, we propose that further research should be carried out as a matter of urgency. Until such a time, the attitude to combination pharmacotherapy should be conservative, and combining psychotropic medications should be considered as an 'n of 1' trial to be closely monitored.
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Affiliation(s)
- Jon Jureidini
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia,
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Twenty-four months of antipsychotic treatment in children and adolescents with first psychotic episode: discontinuation and tolerability. J Clin Psychopharmacol 2013; 33:463-71. [PMID: 23771198 DOI: 10.1097/jcp.0b013e3182962480] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Child and Adolescent First-Episode Psychosis Study is a longitudinal study of early-onset first psychotic episodes. This report describes the naturalistic psychopharmacological treatment administered during a 24-month follow-up period, as well as discontinuation rates, reasons for discontinuation, and adverse effects. METHODS The sample comprised 110 patients, aged 9 to 17 years, with a first psychotic episode. Pharmacological treatment, changes, reasons for discontinuation, and the UKU (Udvalg for Kliniske Undersogelser) Side Effect Rating Scale were registered at 6, 12, and 24 months of follow-up. RESULTS Second-generation antipsychotics, especially risperidone, quetiapine, and olanzapine, were the most commonly used. The discontinuation rate was 44.5% at 6 months, 59.1% at 12 months, and 70.9% at 24 months. Discontinuation rates or reasons for discontinuation (adverse reaction, insufficient response, and other) did not differ significantly between antipsychotics. At 6 months, significant differences were found in body mass index increase and body mass index z score increase, which were higher with olanzapine, and in neurological effects, which were higher with risperidone; at 12 and 24 months, these differences were no longer significant. High maintenance rates were found in the clozapine group, although they had higher scores on the autonomic subscale of the UKU. CONCLUSIONS A long follow-up period reveals high discontinuation rates similar to those observed in adults, particularly during the first year. No differences were found between antipsychotics. Differences in adverse effects were found at 6 months but not subsequently after changes in treatment. Clozapine had a high maintenance rate, and its tolerability was comparable to that of other antipsychotics.
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Intracellular pathways of antipsychotic combined therapies: implication for psychiatric disorders treatment. Eur J Pharmacol 2013; 718:502-23. [PMID: 23834777 DOI: 10.1016/j.ejphar.2013.06.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 06/11/2013] [Accepted: 06/21/2013] [Indexed: 01/06/2023]
Abstract
Dysfunctions in the interplay among multiple neurotransmitter systems have been implicated in the wide range of behavioral, emotional and cognitive symptoms displayed by major psychiatric disorders, such as schizophrenia, bipolar disorder or major depression. The complex clinical presentation of these pathologies often needs the use of multiple pharmacological treatments, in particular (1) when monotherapy provides insufficient improvement of the core symptoms; (2) when there are concurrent additional symptoms requiring more than one class of medication and (3) in order to improve tolerability, by using two compounds below their individual dose thresholds to limit side effects. To date, the choice of drug combinations is based on empirical paradigm guided by clinical response. Nonetheless, several preclinical studies have demonstrated that drugs commonly used to treat psychiatric disorders may impact common intracellular target molecules (e.g. Akt/GSK-3 pathway, MAP kinases pathway, postsynaptic density proteins). These findings support the hypothesis that convergence at crucial steps of transductional pathways could be responsible for synergistic effects obtained in clinical practice by the co-administration of those apparently heterogeneous pharmacological compounds. Here we review the most recent evidence on the molecular crossroads in antipsychotic combined therapies with antidepressants, mood stabilizers, and benzodiazepines, as well as with antipsychotics. We first discuss clinical clues and efficacy of such combinations. Then we focus on the pharmacodynamics and on the intracellular pathways underpinning the synergistic, or concurrent, effects of each therapeutic add-on strategy, as well as we also critically appraise how pharmacological research may provide new insights on the putative molecular mechanisms underlying major psychiatric disorders.
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