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Allott K, Chopra S, Rogers J, Dauvermann MR, Clark SR. Advancing understanding of the mechanisms of antipsychotic-associated cognitive impairment to minimise harm: a call to action. Mol Psychiatry 2024:10.1038/s41380-024-02503-x. [PMID: 38454078 DOI: 10.1038/s41380-024-02503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Kelly Allott
- Orygen, Parkville, VIC, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Sidhant Chopra
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Jack Rogers
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | | | - Scott Richard Clark
- University of Adelaide, Discipline of Psychiatry, Adelaide, SA, Australia
- Basil Hetzel Institute, Woodville South, SA, Australia
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Shankar A, Tripathi A. Comments on "The effect on relapse rate and psychiatric symptomatology: Switching a combination of first- and second-generation antipsychotic polypharmacy to antipsychotic monotherapy in long-term inpatients with schizophrenia and related disorders. A pragmatic randomized open-label trial (SwAP trial)". Schizophr Res 2024; 264:402-403. [PMID: 38237362 DOI: 10.1016/j.schres.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 11/17/2023] [Accepted: 12/17/2023] [Indexed: 03/01/2024]
Affiliation(s)
- Akanksha Shankar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
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3
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Lagreula J, Dagenais-Beaulé V, de Timary P, Elens L, Dalleur O. Prescribing and deprescribing trends in schizophrenia: An overview of inpatients in Belgium and in the Canadian province of Québec. Basic Clin Pharmacol Toxicol 2023; 133:691-702. [PMID: 36988426 DOI: 10.1111/bcpt.13867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
Although switching to antipsychotic monotherapy improves patient outcomes in schizophrenia, antipsychotic deprescribing is rarely performed, and its use varies between countries, as do psychotropic prescribing patterns. This study aimed to determine factors associated with antipsychotic deprescribing at discharge after a psychiatric hospitalization and to compare psychotropic prescribing patterns between Belgium and Québec, Canada. Data on adult inpatients with schizophrenia were collected retrospectively in seven hospitals. At discharge, the number of antipsychotics had decreased in 22.2% of the 63 Canadian patients and 9.9% of the 516 Belgian patients. A number of factors increased the likelihood of antipsychotic deprescribing: a hospitalization in the Canadian hospital (aOR = 4.13, 95% CI 1.48-11.5), living in a residential facility (aOR = 2.51, 95% CI 1.05-4.39), ≥2 previous antipsychotic trials (aOR = 15.38, 95% CI 3.62-65.36), having an antipsychotic side effect (aOR = 1.86, 95% CI 1.01-3.44) and being in a general hospital (aOR = 2.28, 95% CI 1.09-4.75). Patients on a long-acting injectable antipsychotic (aOR = 0.51, 95% CI 0.26-0.98), with prior clozapine use (aOR = 0.36, 95% CI 0.13-0.95), greater antipsychotic exposure (aOR = 0.35, 95% CI 0.2-0.61) and more hypno-sedatives (aOR = 0.65, 95% CI 0.43-0.98), were less likely to be deprescribed. Specific deprescribing interventions could target patients who are less likely to be deprescribed.
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Affiliation(s)
- Juliette Lagreula
- Clinical Pharmacy Research Group (CLIP)-Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium
- Fonds de la Recherche Scientifique - FNRS, Brussels, Belgium
| | - Vincent Dagenais-Beaulé
- Pharmacy Department & Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
- Faculté de Pharmacie, Université de Montréal, Montreal, Québec, Canada
| | - Philippe de Timary
- Institute of Neuroscience (IoNS), UCLouvain, Brussels, Belgium
- Adult Psychiatry Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laure Elens
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics (PMGK)-Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium
- Louvain Center for Toxicology and Applied Pharmacology (LTAP)-Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, Brussels, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP)-Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium
- Pharmacy Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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4
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Ito S, Ohi K, Yasuda Y, Fujimoto M, Yamamori H, Matsumoto J, Fukumoto K, Kodaka F, Hasegawa N, Ishimaru K, Miura K, Yasui-Furukori N, Hashimoto R. Better adherence to guidelines among psychiatrists providing pharmacological therapy is associated with longer work hours in patients with schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:78. [PMID: 37935686 PMCID: PMC10630392 DOI: 10.1038/s41537-023-00407-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
Schizophrenia is a psychiatric disorder that is associated with various social dysfunctions, including shorter work hours. To measure the degree to which psychiatrists adhere to guidelines for pharmacological therapy of schizophrenia, we recently developed the individual fitness score (IFS) for adherence among psychiatrists in each patient. However, it remains unclear whether better adherence among psychiatrists is associated with higher patients' social functional outcomes, such as work hours. In this study, we examined the relationship between adherence to guidelines among psychiatrists and work hours in patients with schizophrenia. To evaluate the association between adherence to guidelines for pharmacological therapy among psychiatrists for treating schizophrenia and work hours, we used the IFS and social activity assessment, respectively, in 286 patients with schizophrenia. The correlation between IFS values and work hours was investigated in the patients. The adherence among psychiatrists to guidelines was significantly and positively correlated with work hours in patients with schizophrenia (rho = 0.18, p = 2.15 × 10-3). When we divided the patients into treatment-resistant schizophrenia (TRS) and nontreatment-resistant schizophrenia (non-TRS) groups, most patients with TRS (n = 40) had shorter work hours (0-15 h/week). Even after excluding patients with TRS, the positive correlation between adherence to guidelines among psychiatrists and work hours in patients with non-TRS (n = 246) was still significant (rho = 0.19, p = 3.32 × 10-3). We found that work hours were longer in patients who received the guideline-recommended pharmacotherapy. Our findings suggest that widespread education and training for psychiatrists may be necessary to improve functional outcomes in patients with schizophrenia.
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Affiliation(s)
- Satsuki Ito
- Department of Developmental and Clinical Psychology, The Division of Human Developmental Sciences, Graduate School of Humanity and Sciences, Ochanomizu University, Tokyo, Japan
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Life Grow Brilliant Mental Clinic, Medical Corporation Foster, Osaka, Japan
| | - Michiko Fujimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Hidenaga Yamamori
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, Osaka University, Graduate School of Medicine, Osaka, Japan
- Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kentaro Fukumoto
- Department of Neuropsychiatry, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Fumitoshi Kodaka
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, 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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5
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Readmission Rates of Patients Discharged on Antipsychotic Polypharmacy Compared to Antipsychotic Monotherapy. Community Ment Health J 2023; 59:507-511. [PMID: 36242684 DOI: 10.1007/s10597-022-01034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/22/2022] [Indexed: 11/03/2022]
Abstract
Antipsychotic medications are used to treat many psychiatric conditions and are paramount for relapse prevention in patients with mental illnesses. Antipsychotic monotherapy (APM) is a commonly recommended approach, however there is no clear consensus on the use of antipsychotic polypharmacy (APP). A single-center retrospective review was conducted comparing readmission rates of behavioral health patients discharged on APP or APM between August 1st 2019 and July 31st 2021. The primary outcome was the one-year psychiatric readmission rate. Secondary outcomes included further readmission time frame stratification, olanzapine equivalent doses, and use of anticholinergic medications. The total readmission rate was 24.5% (24/98) in the APP group compared to 19.1% (107/560) in the APM group (p = 0.22). Patients discharged on APM were not found to have a statistically significant increase in readmission rate compared to patients discharged on APP. Further research is needed to assess the risks and benefits of APP.
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Watanabe Y, Kanata S, Suga M, Inagaki A, Sato S, Hayashi N, Kunugi H, Ikebuchi E. Characteristic association of symbol coding test score with occupational function in Japanese patients with schizophrenia. Neuropsychopharmacol Rep 2023; 43:141-145. [PMID: 36753404 PMCID: PMC10009408 DOI: 10.1002/npr2.12322] [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: 10/04/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/09/2023] Open
Abstract
AIM Studies showed that cognitive function affects occupational function in patients with schizophrenia. This study aimed to determine the effects of cognitive function on occupational function in Japanese patients with schizophrenia using the Brief Assessment of Cognition in Schizophrenia (BACS). METHODS Participants were 198 outpatients with schizophrenia or schizoaffective disorder (66 females; mean age 34.5 ± 6.8 years). Occupational function was assessed using the work subscale of the Life Assessment Scale for Mental Ill (LASMI-w). Multiple regression analysis was performed using the BACS as the independent variable and LASMI-w as the dependent variable. Furthermore, we divided the LASMI-w score into three groups, <11, 11-20, and >21, and performed a multinomial logistic regression analysis. RESULTS Multiple regression analysis revealed that LASMI-w score was negatively associated with BACS composite score (β = -0.20, p < 0.01). Among the sub-items of the BACS, only the symbol-coding score showed a significant negative association (β = -0.19, p < 0.05). Multinomial logistic analysis showed that the better the composite and symbol coding scores, the smaller the impairment of the occupational function (composite score: β = 2.39 between mild and moderate occupational impairments, p < 0.05; symbol coding score: β = 2.44 between mild and severe impairments, p < 0.05). CONCLUSION The occupational function of patients with schizophrenia was associated with overall cognitive function (composite score). In particular, the symbol coding score of the BACS was suggested to be related to work ability. These results might be useful in the assessment and training of cognitive rehabilitation aimed at employment support.
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Affiliation(s)
- Yukako Watanabe
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Sho Kanata
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Motomu Suga
- Graduate School of Clinical Psychology, Teikyo Heisei University, Toshima-ku, Japan
| | - Akiko Inagaki
- Division of Nursing, Faculty of Healthcare, Tokyo Healthcare University, Shinagawa-ku, Japan
| | - Sayaka Sato
- Department of Community Mental Health & Law National Institute of Mental Health, Kodaira, Japan
| | | | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Emi Ikebuchi
- Graduate School of Clinical Psychology, Teikyo Heisei University, Toshima-ku, Japan
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Griffiths SL, Lalousis PA, Wood SJ, Upthegrove R. Heterogeneity in treatment outcomes and incomplete recovery in first episode psychosis: does one size fit all? Transl Psychiatry 2022; 12:485. [PMID: 36396628 PMCID: PMC9671914 DOI: 10.1038/s41398-022-02256-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
The heterogeneity in recovery outcomes for individuals with First Episode Psychosis (FEP) calls for a strong evidence base to inform practice at an individual level. Between 19-89% of young people with FEP have an incomplete recovery despite gold-standard evidence-based treatments, suggesting current service models, which adopt a 'one-size fits all' approach, may not be addressing the needs of many young people with psychosis. The lack of consistent terminology to define key concepts such as recovery and treatment resistance, the multidimensional nature of these concepts, and common comorbid symptoms are some of the challenges faced by the field in delineating heterogeneity in recovery outcomes. The lack of robust markers for incomplete recovery also results in potential delay in delivering prompt, and effective treatments to individuals at greatest risk. There is a clear need to adopt a stratified approach to care where interventions are targeted at subgroups of patients, and ultimately at the individual level. Novel machine learning, using large, representative data from a range of modalities, may aid in the parsing of heterogeneity, and provide greater precision and sophistication in identifying those on a pathway to incomplete recovery.
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Affiliation(s)
- Siân Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Birmingham, UK. .,Centre for Human Brain Health, University of Birmingham, Birmingham, UK.
| | - Paris Alexandros Lalousis
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,grid.6572.60000 0004 1936 7486Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Stephen J. Wood
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,grid.488501.00000 0004 8032 6923Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Parkville, VIC Australia
| | - Rachel Upthegrove
- grid.6572.60000 0004 1936 7486Institute for Mental Health, University of Birmingham, Birmingham, UK ,grid.6572.60000 0004 1936 7486Centre for Human Brain Health, University of Birmingham, Birmingham, UK ,grid.498025.20000 0004 0376 6175Birmingham Early Interventions Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
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Bighelli I, Rodolico A, Siafis S, Samara MT, Hansen WP, Salomone S, Aguglia E, Cutrufelli P, Bauer I, Baeckers L, Leucht S. Antipsychotic polypharmacy reduction versus polypharmacy continuation for people with schizophrenia. Cochrane Database Syst Rev 2022; 8:CD014383. [PMID: 36042158 PMCID: PMC9427025 DOI: 10.1002/14651858.cd014383.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND In clinical practice, different antipsychotics can be combined in the treatment of people with schizophrenia (polypharmacy). This strategy can aim at increasing efficacy, but might also increase the adverse effects due to drug-drug interactions. Reducing polypharmacy by withdrawing one or more antipsychotics may reduce this problem, but must be done carefully, in order to maintain efficacy. OBJECTIVES To examine the effects and safety of reducing antipsychotic polypharmacy compared to maintaining people with schizophrenia on the same number of antipsychotics. SEARCH METHODS On 10 February 2021, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, CINAHL, ClinicalTrials.Gov, Embase, ISRCTN, MEDLINE, PsycINFO, PubMed and WHO ICTRP. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared reduction in the number of antipsychotics to continuation of the current number of antipsychotics. We included adults with schizophrenia or related disorders who were receiving more than one antipsychotic and were stabilised on their current treatment. DATA COLLECTION AND ANALYSIS Two review authors independently screened all the identified references for inclusion, and all the full papers. We contacted study authors if we needed any further information. Two review authors independently extracted the data, assessed the risk of bias using RoB 2 and the certainty of the evidence using the GRADE approach. The primary outcomes were: quality of life assessed as number of participants with clinically important change in quality of life; service use assessed as number of participants readmitted to hospital and adverse effects assessed with number of participants leaving the study early due to adverse effects. MAIN RESULTS We included five RCTs with 319 participants. Study duration ranged from three months to one year. All studies compared polypharmacy continuation with two antipsychotics to polypharmacy reduction to one antipsychotic. We assessed the risk of bias of results as being of some concern or at high risk of bias. A lower number of participants left the study early due to any reason in the polypharmacy continuation group (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.29 to 0.68; I2 = 0%; 5 RCTs, n = 319; low-certainty evidence), and a lower number of participants left the study early due to inefficacy (RR 0.21, 95% CI 0.07 to 0.65; I2 = 0%; 3 RCTs, n = 201). Polypharmacy continuation resulted in more severe negative symptoms (MD 3.30, 95% CI 1.51 to 5.09; 1 RCT, n = 35). There was no clear difference between polypharmacy reduction and polypharmacy continuation on readmission to hospital, leaving the study early due to adverse effects, functioning, global state, general mental state and positive symptoms, number of participants with at least one adverse effect, weight gain and other specific adverse effects, mortality and cognition. We assessed the certainty of the evidence as very low or low across measured outcomes. No studies reported quality of life, days in hospital, relapse, depressive symptoms, behaviour and satisfaction with care. Due to lack of data, it was not possible to perform some planned sensitivity analyses, including one controlling for increasing the dose of the remaining antipsychotic. As a result, we do not know if the observed results might be influenced by adjustment of dose of remaining antipsychotic compound. AUTHORS' CONCLUSIONS This review summarises the latest evidence on polypharmacy continuation compared with polypharmacy reduction. Our results show that polypharmacy continuation might be associated with a lower number of participants leaving the study early, especially due to inefficacy. However, the evidence is of low and very low certainty and the data analyses based on few study only, so that it is not possible to draw strong conclusions based on the results of the present review. Further high-quality RCTs are needed to investigate this important topic.
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Affiliation(s)
- Irene Bighelli
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Spyridon Siafis
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Myrto T Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | | | - Salvatore Salomone
- Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Pierfelice Cutrufelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Ingrid Bauer
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Lio Baeckers
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Leucht
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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9
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Khandker R, Shepherd J, Chekani F, Qureshi Z, Bailey H, Berry M, Wright J, Massey L. Atypical Treatment Switches in Schizophrenia Patients: Drivers and Associated Outcomes. Neuropsychiatr Dis Treat 2022; 18:1057-1067. [PMID: 35611118 PMCID: PMC9124468 DOI: 10.2147/ndt.s358392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To describe and compare demographics and outcomes among patients with schizophrenia who have switched atypical treatments versus non-switchers. Methods Data were extracted from the Adelphi Schizophrenia Disease Specific Programme™ conducted from January to May 2014 in the United States. Participating physicians provided information on their next 10 consulting schizophrenia patients aged ≥ 18 years; the same patients were invited to voluntarily complete a patient self-completion form (PSC). Patients were considered switchers (S) or non-switchers (NS) based on their physician-provided treatment history. S were patients who had switched, stopped or added an atypical treatment within the last 2 years. NS had no treatment changes within the last 2 years or were receiving their first-line treatment (for ≥ 3 months). Demographics, clinical characteristics and outcomes among S and NS were compared using both descriptive and multivariate statistics. Results One-hundred fifty physicians provided data on 1003 patients with schizophrenia (395 S, 608 NS); 500 patients completed a PSC (170 S, 330 NS). When compared with NS, S were more likely to be unemployed (p=0.0060), have a caregiver (p<0.0001), have greater activity impairment as assessed by Work and Productivity Activity Impairment (p=0.0031), be hospitalized for schizophrenia (p<0.0001) and have had a greater mean number of hospitalizations in the last 12 months (p=0.0012). NS vs S were more likely to have much or very much improved illness (p<0.0001) and less severe disease (p<0.0001) as assessed by Clinical Global Impression. Conclusion Despite switching drugs, some schizophrenia patients continue to have high levels of disease burden, suggesting that currently available therapies are insufficiently effective in these patients.
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10
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Shakir M, Willems AE, van Harten PN, van Lutterveld R, Tenback DE. The effect on relapse rate and psychiatric symptomatology: Switching a combination of first- and second-generation antipsychotic polypharmacy to antipsychotic monotherapy in long-term inpatients with schizophrenia and related disorders. A pragmatic randomized open-label trial (SwAP trial). Schizophr Res 2022; 243:187-194. [PMID: 35397249 DOI: 10.1016/j.schres.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/30/2022] [Accepted: 03/17/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is little evidence to support the use of antipsychotic polypharmacy, and there are concerns about safety and side effects. Nonetheless, it is commonly used in the treatment of long-term inpatients with schizophrenia. This study investigated the effects of switching from a combination of first- and second-generation antipsychotics (FGA and SGA) to monotherapy (FGA or SGA) on relapse rates and psychiatric symptomatology. METHODS Institutionalized patients with chronic psychotic disorders using a combination of SGA and FGA (n = 136) participated in a randomized open-label trial. The SWITCH group discontinued either FGA or SGA, the STAY group continued combination treatment. Relapse and psychotic symptoms were measured at baseline and during follow-up at 3, 6, and 9 months. Psychiatric symptomatology was measured using the Brief Psychiatric Rating Scale (BPRS). Relapse was defined as (i) an increase in BPRS score of at least 2 points on any item, or (ii) an increase of at least 4 points in total BPRS score and an adjustment of antipsychotics. RESULTS A logistic regression model, corrected for sex, showed that the probability of relapse was significantly lower in the SWITCH group: 0.29 (95% CI 0.13-0.62). The protective effect of switching to monotherapy was attributable to patients continuing clozapine as monotherapy. For patients who did not experience a relapse nor dropped out, BPRS total scores decreased significantly more in the SWITCH group (p = 0.0001). CONCLUSION Switching from a combination of FGA and SGA to monotherapy in long-term inpatients does not increase the relapse rate and may even reduce it.
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Affiliation(s)
- Mushde Shakir
- Veldzicht Center for Transcultural Psychiatry, Custodial Institutions Agency (DJI), Ministry of Justice and Security, Balkbrug, the Netherlands; i-psy Haaglanden, Parnassia Group Mental Health Service, Den Haag, the Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, the Netherlands.
| | - Anne E Willems
- Maastricht University, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, the Netherlands; Psychiatric Center GGz Centraal, Amersfoort, the Netherlands
| | - Peter N van Harten
- Maastricht University, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, the Netherlands; Psychiatric Center GGz Centraal, Amersfoort, the Netherlands
| | - Remko van Lutterveld
- Brain Research and Innovation Center, Ministry of Defence, Utrecht, the Netherlands; University Medical Center Utrecht, Department of Psychiatry, Utrecht, the Netherlands
| | - Diederik E Tenback
- Veldzicht Center for Transcultural Psychiatry, Custodial Institutions Agency (DJI), Ministry of Justice and Security, Balkbrug, the Netherlands; FPC de Oostvaarderskliniek, Custodial Institutions Agency (DJI), Ministry of Justice and Security, Almere, the Netherlands
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11
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Lagreula J, de Timary P, Elens L, Dalleur O. Antipsychotic polypharmacy and clozapine prescribing patterns: evolution and correlates before and after a psychiatric hospitalisation. Ther Adv Psychopharmacol 2022; 12:20451253221112587. [PMID: 36051501 PMCID: PMC9425880 DOI: 10.1177/20451253221112587] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Antipsychotic polypharmacy (APP) prescribing and clozapine underuse are considered inappropriate prescribing in schizophrenia. Psychiatric hospitalisations may be suitable occasions to re-evaluate patient pharmacotherapy and to switch to monotherapy. OBJECTIVES To explore the evolution of APP and other psychotropic prescribing patterns during psychiatric hospitalisations, to detect characteristics associated with APP on admission and at discharge, and to examine clozapine prescribing patterns. DESIGN We performed a retrospective observational study based on electronic health records. METHODS Data on adult inpatients diagnosed with schizophrenia spectrum disorders were collected retrospectively from 6 Belgian hospitals in 2020-2021. RESULTS Of the 516 patients included, APP prescribing increased significantly from 47.9% on hospital admission to 59.1% at discharge. On admission and at discharge, APP was associated with prior clozapine use (ORadmission = 2.53, CI = 1.1-5.84, ORdischarge = 11.01, CI = 4.45-27.28), treatment with a first-generation antipsychotic (ORadmission = 26.79, CI = 13.08-54.86, ORdischarge = 25.2, CI = 12.2-52.04), increased antipsychotic exposure (ORadmission = 8.93, CI = 5.13-15.56, ORdischarge = 19.89, CI = 10-39.54), and a greater number of hypno-sedatives (ORadmission = 1.88, CI = 1.23-2.88, ORdischarge = 4.18, CI = 2.53-6.91). APP was negatively associated with involuntary admission (ORadmission = 0.31, CI = 0.14-0.7, ORdischarge = 0.3, CI = 0.13-0.68). When using an alternative definition of monotherapy (i.e. including patients with an add-on low-dose antipsychotic for sleep disorders), alcohol use disorder (ORadmission = 0.26, CI = 0.13-0.54) and higher age (ORdischarge = 0.53, CI = 0.29-0.95) were negatively associated with APP, and living in a residential facility (ORdischarge = 2.39 CI = 1.21-4.71) and a higher daily dosage of benzodiazepines during the stay (ORdischarge = 1.32 CI = 1.03-1.69) increased the odds of being discharged on APP. On admission, 9.3% of patients were being treated with clozapine. Although 28.1% of patients were eligible for clozapine treatment, only 11% of patients were discharged with a clozapine prescription. For 7 of the 10 patients with a new clozapine prescription, it was directly prescribed in combination with another antipsychotic, without a prior trial of clozapine monotherapy. CONCLUSION Suboptimal prescriptions of antipsychotics in patients with schizophrenia persist after psychiatric hospitalisations and are associated with identifiable characteristics.
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Affiliation(s)
- Juliette Lagreula
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, Avenue Mounier 72, 1200 Brussels, Belgium.,Fonds de la Recherche Scientifique (FNRS), Brussels, Belgium
| | - Philippe de Timary
- Institute of Neuroscience, UCLouvain, Brussels, Belgium.,Psychiatry Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laure Elens
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics (PMGK), Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium.,Louvain Centre for Toxicology and Applied Pharmacology (LTAP), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, Brussels, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium.,Pharmacy Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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12
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Hori H, Yasui-Furukori N, Hasegawa N, Iga JI, Ochi S, Ichihashi K, Furihata R, Kyo Y, Takaesu Y, Tsuboi T, Kodaka F, Onitsuka T, Okada T, Murata A, Kashiwagi H, Iida H, Hashimoto N, Ohi K, Yamada H, Ogasawara K, Yasuda Y, Muraoka H, Usami M, Numata S, Takeshima M, Yamagata H, Nagasawa T, Tagata H, Makinodan M, Kido M, Katsumoto E, Komatsu H, Matsumoto J, Kubota C, Miura K, Hishimoto A, Watanabe K, Inada K, Kawasaki H, Hashimoto R. Prescription of Anticholinergic Drugs in Patients With Schizophrenia: Analysis of Antipsychotic Prescription Patterns and Hospital Characteristics. Front Psychiatry 2022; 13:823826. [PMID: 35656353 PMCID: PMC9152135 DOI: 10.3389/fpsyt.2022.823826] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
In several clinical guidelines for schizophrenia, long-term use of anticholinergic drugs is not recommended. We investigated the characteristics of the use of anticholinergics in patients with schizophrenia by considering psychotropic prescription patterns and differences among hospitals. A cross-sectional, retrospective prescription survey at the time of discharge was conducted on 2027 patients with schizophrenia from 69 Japanese hospitals. We examined the relations among psychotropic drug prescriptions regarding anticholinergic prescription. We divided the hospitals into three groups-low rate group (LG), medium rate group (MG), and high rate group (HG)-according to their anticholinergic prescription rates, and analyzed the relationship between anticholinergic prescription rates and antipsychotic prescription. Anticholinergic drugs were prescribed to 618 patients (30.5%), and the prescription rates were significantly higher for high antipsychotic doses, antipsychotic polypharmacy, and first-generation antipsychotics (FGAs) use. The anticholinergic prescription rate varied considerably among hospitals, ranging from 0 to 66.7%, and it was significantly higher in patients with antipsychotic monotherapy, antipsychotic polypharmacy, and normal and high doses of antipsychotics in HG than in those LG and MG. The anticholinergics prescription rate in patients with second-generation antipsychotic monotherapy in HG was also significantly higher than in those LG and MG; however, the difference was no longer significant in patients with FGA monotherapy. Conclusively, in addition to high antipsychotic doses, antipsychotic polypharmacy, and FGA use, hospital characteristics influence the prescribing of anticholinergic drugs.
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Affiliation(s)
- Hikaru Hori
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Naomi Hasegawa
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Jun-Ichi Iga
- Department of Neuropsychiatry Molecules and Function, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry Molecules and Function, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| | - Ryuji Furihata
- Agency for Student Support and Disability Resources, Kyoto University, Kyoto, Japan
| | - Yoshitaka Kyo
- Department of Psychiatry, School of Medicine, Kitasato University, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan
| | - Fumitoshi Kodaka
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Onitsuka
- Department of Neuroimaging Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tsuyoshi Okada
- Department of Psychiatry, Jichi Medical University, Tochigi, Japan
| | - Atsunobu Murata
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Hiroko Kashiwagi
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Japan
| | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hisashi Yamada
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuyoshi Ogasawara
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Japan
| | - Yuka Yasuda
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Life Grow Brilliant Mental Clinic, Medical Corporation Foster, Osaka, Japan
| | - Hiroyuki Muraoka
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Science, Tokushima University, Tokushima, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Tatsuya Nagasawa
- Department of Neuropsychiatry, Kanazawa Medical University, Uchinada, Japan
| | - Hiromi Tagata
- Department of Neuropsychiatry, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Mikio Kido
- Toyama City Hospital, Toyama, Japan.,Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | | | - Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Junya Matsumoto
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Chika Kubota
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Japan
| | - Kenichiro Miura
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan
| | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroaki Kawasaki
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryota Hashimoto
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
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13
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Andreou D, Jørgensen KN, Wortinger LA, Engen K, Vaskinn A, Ueland T, Yolken RH, Andreassen OA, Agartz I. Cytomegalovirus infection and IQ in patients with severe mental illness and healthy individuals. Psychiatry Res 2021; 300:113929. [PMID: 33866186 DOI: 10.1016/j.psychres.2021.113929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 04/05/2021] [Indexed: 11/26/2022]
Abstract
Cytomegalovirus (CMV) infection in immunocompetent adults is usually asymptomatic, but results in lifelong latency. Infection occurring congenitally or in immunodeficiency can lead to cognitive impairment. We aimed to investigate the associations between CMV exposure and intelligence quotient (IQ) in patients with schizophrenia spectrum disorders (SZS), bipolar spectrum disorders (BDS) and healthy controls (HC). CMV immunoglobulin G antibody concentrations were measured by immunoassay and expressed as dichotomous measures (seropositive/CMV+ vs. seronegative/CMV-). Based on a significant CMV-by-diagnosis-by-sex interaction on IQ, we investigated main and interaction effects of CMV and sex on IQ in each diagnostic category. Significant CMV-by-sex interactions were found in patient groups. In SZS, CMV+ female patients (n = 50) had significantly lower IQ than CMV- female patients (n = 33), whereas CMV+ (n = 48) and CMV- (n = 45) male patients did not differ in IQ. In BDS, CMV+ (n = 49) and CMV- (n = 37) female patients did not differ in IQ, whereas CMV+ male patients (n = 33) had significantly higher IQ than CMV- male patients (n = 32). Among HC, CMV+ (n = 138) and CMV- (n = 118) male participants as well as CMV+ (n = 125) and CMV- (n = 93) female participants did not differ in IQ. Our findings suggest that CMV exposure may affect IQ in patients with severe mental illness but not HC.
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Affiliation(s)
- Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; 1st Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.
| | - Kjetil Nordbø Jørgensen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Laura A Wortinger
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Kristine Engen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Anja Vaskinn
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Psychosis Research Section, Oslo University Hospital, Oslo, Norway
| | - Torill Ueland
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Psychosis Research Section, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Robert H Yolken
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
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14
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Nguyen ML, Sunderland B, Lim S, Hattingh L, Chalmers L. A qualitative exploration of factors contributing to non-guideline adherent antipsychotic polypharmacy. Res Social Adm Pharm 2021; 18:2457-2467. [PMID: 33840621 DOI: 10.1016/j.sapharm.2021.03.014] [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: 10/11/2020] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antipsychotic polypharmacy ("polypharmacy") involves the concurrent prescribing of two or more antipsychotics for managing schizophrenia. It occurs frequently despite there being limited clinical evidence for this practice and an increased risk of adverse events. Little is understood about why it occurs outside of treatment guidelines, highlighting a current research gap. OBJECTIVE To explore the factors contributing to non-evidence based polypharmacy practice and possible strategies for addressing these factors. METHODS Three focus groups were conducted between June and August 2018 with doctors and nurses employed at a mental health unit of a Western Australian public hospital. Participants were asked about their perceptions of polypharmacy, why it occurred and what could limit its prevalence. Thematic inductive analysis was mapped to the Theoretical Domains Framework to identify key underlying themes and to establish potential enablers and barriers for practice change. RESULTS Participants understood the risks of polypharmacy and perceived it to largely be perpetuated by external factors, out of which two key themes emerged: system-related issues (e.g.: communication failures whereby de-prescribing plans are not actioned); and patient-related issues (e.g.: misinformed views translating to medication-seeking behaviour). This led to the third theme: a disconnect between clinicians' knowledge and their practices (i.e.: being aware of Australian evidence-based guideline recommendations yet acknowledging polypharmacy still occurred due to the aforementioned issues). Strategies suggested to address these issues included developing medication management plans to bridge communication gaps and managing patients' medication expectations with education. CONCLUSIONS Management of schizophrenia is complex, requiring consideration of many patient-related and systemic factors. Polypharmacy has a place in certain contexts, however, must be well considered and closely monitored to allow for early identification of opportunities to rationalise (i.e.: de-prescribe) therapy, where appropriate. Future research objectives will centre on implementing strategies identified from these focus groups to optimise patient outcomes.
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Affiliation(s)
- My Linh Nguyen
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia; Pharmacy Department, Armadale Kalamunda Group, Mount Nasura, Western Australia, 6112, Australia.
| | - Bruce Sunderland
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia
| | - Stephen Lim
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia
| | - Laetitia Hattingh
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia; Gold Coast Health, Gold Coast, Queensland, 4215, Australia; School of Pharmacy and Pharmacology, Griffith University, Gold Coast, Queensland, 4222, Australia
| | - Leanne Chalmers
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia
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15
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Hori H, Atake K, Katsuki A, Yoshimura R. Effects of the number of hospitalizations on cognitive function in Japanese patients with stable schizophrenia. CNS Spectr 2020; 26:1-6. [PMID: 32883397 DOI: 10.1017/s1092852920001728] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present study aimed to determine whether the number of hospitalizations in schizophrenia patients is associated with reduced cognitive performance, which may in turn imply that recurrences indirectly lead to a worsening in the disorder's progression. METHODS Cognitive performance in stable schizophrenia patients was assessed using the Brief Assessment of Cognition in Schizophrenia, Japanese-language version, on 30 patients who had not experienced any hospitalizations (G0), 57 patients who had experienced only one hospitalization (G1), 47 patients with two hospitalizations (G2), and 59 patients with three or more hospitalizations (G3). RESULTS Significant differences in motor function and attention and processing speed were found between patients with G0 and those with G1. Significant differences in working memory and verbal fluency were found between patients with G1 and those with G2. Patients with G3 performed even more poorly in comparison with those with G1, showing deficits in verbal memory, working memory, executive function, and composite score. The patients with G3 displayed a greater range of impairment and demonstrated deficits in executive function compared with patients with G2. Finally, G2 and G3 performed more poorly than G0, with deficits in the various cognitive areas. CONCLUSION The number of hospitalizations predicted cognitive performance, which suggests that relapse or recurrence may have a long-term neuropsychological impact. Prospective follow-up studies must be completed to explore this effect further because better treatment adherence may have a protective effect on neurocognitive function.
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Affiliation(s)
- Hikaru Hori
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kiyokazu Atake
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Asuka Katsuki
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Reiji Yoshimura
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
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16
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Hata T, Kanazawa T, Hamada T, Nishihara M, Yoneda H, Nakajima M, Katsumata T. The 12-year trend report of antipsychotic usage in a nationwide claims database derived from four million people in Japan. J Psychiatr Res 2020; 127:28-34. [PMID: 32450360 DOI: 10.1016/j.jpsychires.2020.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023]
Abstract
The current study aimed to describe the use of antipsychotics to clarify the gap between clinical guidelines and health care practice in Japan. We used data from the JMDC Claims Database (JMDC Inc., Tokyo, Japan), a nationwide claims database, from 2005 to 2016. Antipsychotics were defined as drugs coded as N05A with the Anatomical Therapeutic and Chemical (ATC) codes. We described the annual changes in proportions based on the number of patients prescribed any antipsychotics. From the database of 4,081,102 people, the data of 12,382 patients was extracted by applying the following exclusion criteria: no use of antipsychotics, missing the prescription date or dose, inpatients, prescribed antipsychotics only for use as needed, prescribed only injectable antipsychotics except for long-acting injections (LAIs), without schizophrenia as the primary disease, not exceeding 75 mg/day chlorpromazine equivalent, and less than 18 years old. The use of second-generation antipsychotics (SGA) has been expanding, while the use of first-generation antipsychotics has been decreasing. Aripiprazole accounted for the highest proportion of prescribed antipsychotics (31.9%) in 2016. Even though clozapine is categorized as a SGA, it accounted for a paltry 0.2%. The proportion of prescribed antipsychotics accounted for by LAIs was less than 5%. Although the use of antipsychotics for schizophrenia in Japan mostly corresponds to various clinical guidelines, limited use of clozapine and LAIs was identified. Further research focusing on the factors affecting the prescription of these underused antipsychotics may help advance the pharmacological therapy of schizophrenia.
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Affiliation(s)
- Takeo Hata
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan; Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-Machi, Kanazawa, Ishikawa, 920-1192, Japan.
| | - Tetsufumi Kanazawa
- Department of Neuropsychiatry, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan; Melbourne Dementia Research Centre, The Florey Institute of Neuroscience and Mental Health, 30 Royal Parade, Parkville, VIC, 3052, Australia
| | - Takeshi Hamada
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masami Nishihara
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Hiroshi Yoneda
- Department of Neuropsychiatry, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Miki Nakajima
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-Machi, Kanazawa, Ishikawa, 920-1192, Japan
| | - Takahiro Katsumata
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
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17
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Farrell C, Brink J. The Prevalence and Factors Associated With Antipsychotic Polypharmacy in a Forensic Psychiatric Sample. Front Psychiatry 2020; 11:263. [PMID: 32528318 PMCID: PMC7247840 DOI: 10.3389/fpsyt.2020.00263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/18/2020] [Indexed: 12/21/2022] Open
Abstract
Despite clinical guidelines limiting the use of multiple concomitant antipsychotics to the most exceptional and treatment resistant cases, the prevalence of antipsychotic polypharmacy has been increasing worldwide. There has been minimal research investigating the prevalence of antipsychotic polypharmacy in forensic psychiatric samples and the correlates associated with antipsychotic polypharmacy. This cross-sectional study aimed to establish the prevalence of antipsychotic polypharmacy in a forensic psychiatric inpatient sample and to investigate the demographical, clinical, and forensic factors associated with polypharmacy. All patients (N = 142) were prescribed at least one antipsychotic at the time of the study. Antipsychotic polypharmacy was prescribed to 54.93% of patients. Logistic regression results indicated increased length of hospitalization, high/medium security level, treatment with clozapine, and depot antipsychotic prescription were predictive of being placed on an antipsychotic polypharmacy regimen. The results suggest that those who are prescribed multiple antipsychotics are long stay patients who present with higher clinical complexity. The results from this study can be used to inform clinical practice leaders about the prevalence of antipsychotic polypharmacy in a forensic psychiatric institution. More research is needed to understand the clinical justifications for prescribing multiple antipsychotics in a forensic psychiatric sample and ways to safely reduce the prevalence of antipsychotic polypharmacy.
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Affiliation(s)
- Christian Farrell
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Johann Brink
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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18
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Matsui K, Tokumasu T, Takekita Y, Inada K, Kanazawa T, Kishimoto T, Takasu S, Tani H, Tarutani S, Hashimoto N, Yamada H, Yamanouchi Y, Takeuchi H. Switching to antipsychotic monotherapy vs. staying on antipsychotic polypharmacy in schizophrenia: A systematic review and meta-analysis. Schizophr Res 2019; 209:50-57. [PMID: 31182319 DOI: 10.1016/j.schres.2019.05.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND While recent meta-analyses have reported the superiority of antipsychotic polypharmacy (APP) over antipsychotic monotherapy (APM) in schizophrenia, switching to APM can be beneficial in terms of side effects. To determine whether patients receiving APP should switch to APM or stay on APP, we conducted a systematic review and meta-analysis. METHODS Randomized controlled trials (RCTs) examining a switch from APP to APM vs. staying on APP were systematically selected from a previous meta-analysis comparing APP with APM in patients with schizophrenia. In addition, we conducted an updated systematic literature search using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Data on study discontinuation, relapse, psychopathology, neurocognition, extrapyramidal symptoms, and body weight/body mass index (BMI) were extracted and synthesized. RESULTS A total of 6 RCTs involving 341 patients were included. All studies examined a switch from 2 antipsychotic agents to a single agent. Clozapine-treated patients were included in 3 studies. There was a significant difference in study discontinuation due to all causes in favor of staying on APP (N = 6, n = 341, RR = 2.28, 95% CI = 1.50-3.46, P < 0.001). There were no significant differences in relapse, any psychopathology, neurocognition, extrapyramidal symptoms, or body weight/BMI between the 2 groups. The quality of evidence was low to very low. CONCLUSIONS The findings suggest that clinicians should closely monitor patient condition when switching to APM after receiving 2 antipsychotics. Given the low to very low overall quality of the evidence, the findings should be considered preliminary and inconclusive.
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Affiliation(s)
- Kentaro Matsui
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahiro Tokumasu
- Department of Neuropsychiatry, Showa University School of Medicine, Tokyo, Japan
| | | | - Ken Inada
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Takasu
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Tani
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Seiichiro Tarutani
- Department of Psychiatry, Shin-abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University School of Medicine, Hokkaido, Japan
| | - Hiroki Yamada
- Department of Neuropsychiatry, Showa University School of Medicine, Tokyo, Japan
| | - Yoshio Yamanouchi
- Department of Neuropsychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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Is the risk of antipsychotic polypharmacy discontinuation dependent on the agents used? Psychiatry Res 2018; 263:238-244. [PMID: 29195836 DOI: 10.1016/j.psychres.2017.09.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/30/2017] [Accepted: 09/21/2017] [Indexed: 11/20/2022]
Abstract
This study assesses the risks and benefits of switching from two to one antipsychotic among participants on two non-clozapine oral antipsychotics, and among those on combinations involving either clozapine or an injectable antipsychotic. Ninety adult participants with schizophrenia or schizoaffective disorder were assigned to stay on polypharmacy or to switch to monotherapy. Half of these participants were receiving combinations of non-clozapine oral antipsychotics and half were receiving combinations involving either clozapine or an injectable antipsychotic. Participants were assessed every 60 days for one year. We examined differences in symptom and side effect trajectories as a function of group assignment and time for both medication groups. Participants who switched from two to one non-clozapine oral antipsychotic experienced significant increases in symptoms relative to stay participants. They also saw significant side effect benefits. Switch participants on combinations involving clozapine or an injectable antipsychotic did not differ over time from stay participants on either symptom or side effect measures. It appears that patients on these combinations can be safely switched to monotherapy. While there may be symptom related risks associated with switching patients on combinations of non-clozapine oral antipsychotics, there are significant health related benefits. Clozapine or injectable antipsychotic monotherapy are recommended options.
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Atake K, Nakamura T, Ueda N, Hori H, Katsuki A, Yoshimura R. The Impact of Aging, Psychotic Symptoms, Medication, and Brain-Derived Neurotrophic Factor on Cognitive Impairment in Japanese Chronic Schizophrenia Patients. Front Psychiatry 2018; 9:232. [PMID: 29896133 PMCID: PMC5987164 DOI: 10.3389/fpsyt.2018.00232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/11/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Cognitive impairment in schizophrenia can result in considerable difficulty in performing functions of daily life or social rehabilitation. Cognitive impairment in schizophrenia is related to various factors, such as the psychotic severity, aging, medication, and brain-derived neurotrophic factor (BDNF). To date, however, no studies investigating the impact of these factors on cognitive functioning in chronic schizophrenia patients have been performed. Objective: The aim of this study is to identify those factors that influence the cognitive functioning in patients with chronic schizophrenia. Methods: Sixty-five of 116 long-term hospitalized chronic schizophrenia patients (63.8 ± 12.1 years old, M/F = 29/36) were enrolled this cross-sectional study. We investigated the relationship among the patients' age, psychotic severity, treatment medication, serum BDNF levels, and cognitive functioning (measured by the Japanese-language version of the Brief Assessment of Cognition in Schizophrenia; BACS-J). Additionally, we performed a multivariable linear regression analysis. Results: According to the partial correlation analysis, certain parameters [i.e., age, chlorpromazine (CP) equivalent, biperiden (BP) equivalent, and serum BDNF] were significantly correlated with cognitive functioning, including working memory (WM), motor function (MF), attention and processing speed (AP), and executive function (EF). For the multivariate analysis, the MF component, which had the highest correlation, was selected as the dependent variable, and the independent variables included age, Manchester Scale for chronic psychosis (ManS) total score, CP equivalent, BP equivalent, serum BDNF, estimated full scale IQ, and years of education. According to the multiple regression analysis of this model, R (multiple regression coefficient) was 0.542, the adjusted R2 (coefficient of determination) was 0.201, and only BP equivalent (β = -0.305, p = 0.030), but not age, ManS score, CP equivalent, or serum BDNF, could significantly explain MF at the 5% significant level. Conclusion: In conclusion, aging, medication (administering more antipsychotics or anticholinergics), and serum BDNF concentration are significantly correlated with cognitive dysfunction in chronic schizophrenia patients but not with the severity of psychotic symptoms. Furthermore, only the anticholinergic dosage had a significant causal relationship with MF. Thus, the use of anticholinergics in chronic schizophrenia patients with deteriorating cognitive functioning must be reconsidered.
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Affiliation(s)
- Kiyokazu Atake
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | - Hikaru Hori
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Asuka Katsuki
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Reiji Yoshimura
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Ortiz‐Orendain J, Castiello‐de Obeso S, Colunga‐Lozano LE, Hu Y, Maayan N, Adams CE. Antipsychotic combinations for schizophrenia. Cochrane Database Syst Rev 2017; 6:CD009005. [PMID: 28658515 PMCID: PMC6481822 DOI: 10.1002/14651858.cd009005.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Many people with schizophrenia do not achieve a satisfactory treatment response with their initial antipsychotic drug treatment. Sometimes a second antipsychotic, in combination with the first, is used in these situations. OBJECTIVES To examine whether:1. treatment with antipsychotic combinations is effective for schizophrenia; and2. treatment with antipsychotic combinations is safe for the same illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group's register which is based on regular searches of CINAHL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. There are no language, time, document type, or publication status limitations for inclusion of records in the register. We ran searches in September 2010, August 2012 and January 2016. We checked for additional trials in the reference lists of included trials. SELECTION CRITERIA We included all randomised and quasi-randomised controlled trials comparing antipsychotic combinations with antipsychotic monotherapy for the treatment of schizophrenia and/or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS We independently extracted data from the included studies. We analysed dichotomous data using risk ratios (RR) and the 95% confidence intervals (CI). We analysed continuous data using mean difference (MD) with a 95% CIs. For the meta-analysis we used a random-effects model. We used GRADE to complete a 'Summary of findings' table and assessed risk of bias for included studies. MAIN RESULTS Sixty-two studies are included in the review, 31 of these compared clozapine monotherapy with clozapine combination. We considered the risk of bias in the included studies to be moderate to high. The majority of trials had unclear allocation concealment, method of randomisation and blinding, and were not free of selective reporting.There is some limited evidence that combination therapy is superior to monotherapy in improving clinical response (RR 0.73, 95% CI 0.63 to 0.85; participants = 2364; studies = 29, very low-quality evidence), although subgroup analyses show that the positive result was due to the studies with clozapine in both the monotherapy and combination groups (RR 0.66, 95% CI 0.53 to 0.83; participants = 1127; studies = 17). Few studies reported on rate of relapse, most likely due to the short length of the studies. Overall, a combination of antipsychotics was not superior or inferior to antipsychotic monotherapy in preventing relapse (RR 0.63, 95% CI 0.31 to 1.29; participants = 512; studies = 3, very low-quality evidence), but the pooled data showed high heterogeneity (I² = 82%). A combination of antipsychotics was not superior or inferior to antipsychotic monotherapy in reducing the number of participants discontinuing treatment early (RR 0.89, 95% CI 0.73 to 1.07; participants = 3103; studies = 43, low-quality evidence). No difference was found between treatment groups in the number of participants hospitalised (RR 0.96, 95% CI 0.36 to 2.55; participants = 202; studies = 3, low-quality evidence) . We did not find evidence of a difference between treatment groups in serious adverse events or those requiring discontinuation (RR 1.05, 95% CI 0.65 to 1.69; participants = 2398; studies = 30, very low-quality evidence). There is as lack of evidence on clinically important change in quality of life, with only four studies reporting average endpoint or change data for this outcome on three different scales, none of which showed a difference between treatment groups. AUTHORS' CONCLUSIONS Currently, most evidence regarding the use of antipsychotic combinations comes from short-term trials, limiting the assessment of long-term efficacy and safety. We found very low-quality evidence that a combination of antipsychotics may improve the clinical response. We also found low-quality evidence that a combination of antipsychotics is may make no difference at preventing participants from leaving the study early, preventing relapse and/or causing more serious adverse events than monotherapy.
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Affiliation(s)
- Javier Ortiz‐Orendain
- University of GuadalajaraCentro Universitario de Ciencias de la SaludSierra Mojada 950Col. IndependenciaGuadalajaraJaliscoMexico44340
| | - Santiago Castiello‐de Obeso
- University of GuadalajaraCenter for Behavior Studies and Investigations180 Fco. de QuevedoCol. Arcos de VallartaGuadalajaraJaliscoMexico44130
| | - Luis Enrique Colunga‐Lozano
- McMaster UniversityDepartments of Health Research Methods, Evidence, and Impact and of Medicine1280 Main Street WestHamiltonOntarioCanadaL8S 4L8
| | - Yue Hu
- Tianjin University of Traditional Chinese MedicineGraduate School314 An Shan Xi RoadNan Kai DistrictTianjinChina300193
| | - Nicola Maayan
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Clive E Adams
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthInnovation Park, Triumph Road,NottinghamUKNG7 2TU
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Takekita Y, Koshikawa Y, Fabbri C, Sakai S, Sunada N, Onohara A, Nishida K, Yoshimura M, Kato M, Serretti A, Kinoshita T. Cognitive function and risperidone long-acting injection vs. paliperidone palmitate in schizophrenia: a 6-month, open-label, randomized, pilot trial. BMC Psychiatry 2016; 16:172. [PMID: 27236412 PMCID: PMC4884618 DOI: 10.1186/s12888-016-0883-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 05/24/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Recently, long-acting injection (LAI) of second-generation antipsychotics has become a valuable strategy for the treatment of schizophrenia. However, few studies have compared the effects of different LAI antipsychotics on cognitive functions so far. The present study aimed to compare the influence of risperidone LAIs (RLAI) and paliperidone palmitate LAIs (PP) on cognitive function in outpatients with schizophrenia. METHODS In this 6-month, open-label, randomized, and controlled study, 30 patients with schizophrenia who were treated with RLAIs were randomly allocated to the RLAI-continued group or the PP group. At baseline and 6 months, the patients were evaluated using the Brief Assessment of Cognition in Schizophrenia (BACS) that was the primary outcome of the study. The Subjective Well-being under Neuroleptic drug treatment-Short form (SWNS), the Positive and Negative Syndrome Scale (PANSS), and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) scores were secondary outcome variables and they were tested at the same time points. RESULTS The two groups did not differ in terms of PANSS, DIEPSS, or SWNS total score changes. However, the BACS score for the attention and processing speed item showed higher improvement in the PP group than the RLAI group (p = 0.039). CONCLUSIONS The results of this preliminary study suggest that PPs may improve attention and processing speed more than RLAIs. Anyway, a replication in a larger and double-blind study is needed. TRIAL REGISTRATION UMIN000014470 . Registered 10 July 2014.
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Affiliation(s)
- Yoshiteru Takekita
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, Bologna, 40123, Italy. .,Department of Neuropsychiatry, Kansai Medical University, 10-15 fumizono-cho, Moriguchi-shi, Osaka, 570-8507, Japan.
| | - Yosuke Koshikawa
- Department of Neuropsychiatry, Kansai Medical University, 10-15 fumizono-cho, Moriguchi-shi, Osaka 570-8507 Japan
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, Bologna, 40123 Italy
| | - Shiho Sakai
- Department of Neuropsychiatry, Kansai Medical University, 10-15 fumizono-cho, Moriguchi-shi, Osaka 570-8507 Japan
| | - Naotaka Sunada
- Department of Neuropsychiatry, Kansai Medical University, 10-15 fumizono-cho, Moriguchi-shi, Osaka 570-8507 Japan
| | - Ai Onohara
- Department of Neuropsychiatry, Kansai Medical University, 10-15 fumizono-cho, Moriguchi-shi, Osaka 570-8507 Japan
| | - Keiichiro Nishida
- Department of Neuropsychiatry, Kansai Medical University, 10-15 fumizono-cho, Moriguchi-shi, Osaka 570-8507 Japan
| | - Masafumi Yoshimura
- Department of Neuropsychiatry, Kansai Medical University, 10-15 fumizono-cho, Moriguchi-shi, Osaka 570-8507 Japan
| | - Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, 10-15 fumizono-cho, Moriguchi-shi, Osaka 570-8507 Japan
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Viale Carlo Pepoli 5, Bologna, 40123 Italy
| | - Toshihiko Kinoshita
- Department of Neuropsychiatry, Kansai Medical University, 10-15 fumizono-cho, Moriguchi-shi, Osaka 570-8507 Japan
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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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Sneider B, Pristed SG, Correll CU, Nielsen J. Frequency and correlates of antipsychotic polypharmacy among patients with schizophrenia in Denmark: A nation-wide pharmacoepidemiological study. Eur Neuropsychopharmacol 2015; 25:1669-76. [PMID: 26256007 DOI: 10.1016/j.euroneuro.2015.04.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/22/2015] [Accepted: 04/26/2015] [Indexed: 12/25/2022]
Abstract
Although evidence for efficacy of antipsychotic polypharmacy (APP) is sparse, APP is common in schizophrenia. The national Danish health registers were accessed to examine in schizophrenia patients: (1) cross-sectional prevalences of APP (1996-2012); (2) geographic variations in APP (2012); and (3) correlates of APP (2012). APP increased from 17.2% in 1996 to 30.8% in 2006 (p<0.001), declining to 24.6% in 2012 (p<0.001) (overall trend 1996-2012: α=0.653, 95% confidence interval (CI):0.327-0.979, p<0.001). Comparing the 1996-2005 and 2006-2012 cohorts APP occurred significantly faster in the 2006 cohort after schizophrenia diagnosis (p<0.0001). The predominant APP type changed from first-generation antipsychotic combinations in 1996 (77.3%) to first+second-generation antipsychotic combinations in 2003 (70.3%) and second-generation antipsychotic combinations in 2012 (59.2%). In 2012, the prevalence of APP varied from 19.4% in Copenhagen to 29.3% in the region of Zealand. Independent correlates of APP, explaining 37.9% of the variance, included a higher number of patients per psychiatrist (OR=1.04/10 patients, CI=1.03-1.06, p<0.001),lower proportion of males (OR=0.80, CI=0.74-0.86), younger age (OR=1.00, CI=0.99-1.00), several schizophrenia subtypes (paranoid: OR=1.24, CI=1.11-1.38,hebephrenic: OR=1.30, CI=1.03-1.63, other: OR=1.95 CI=1.17-3.24, unspecified: OR=1.21 CI=1.05-1.40), living alone (OR=1.12, CI=1.01-1.24), being institutionalized (OR=1.23, CI=1.06-1.42), receiving early retirement pension (OR=1.21, CI=1.10-1.34), higher Charlson Co-morbidity Index score (OR=1.13, CI=1.07-1.19), higher antipsychotic defined daily doses (OR=3.05, CI=-2.95-3.16), treatment with clozapine (OR=3.09, 95% CI=2.78-3.44), and treatment with antidepressants (OR=1.97 (CI=1.83-2.13), long-acting injectable antipsychotics (OR=1.48, CI=1.34-1.63), and anticholinergics (OR=1.74, CI=1.51-2.01). APP remains common in schizophrenia with substantial temporal and geographical variation, being associated with indicators of illness severity and chronicity.
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Affiliation(s)
| | | | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA; Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA
| | - Jimmi Nielsen
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Law S, Haddad PM, Chaudhry IB, Husain N, Drake RJ, Flanagan RJ, David AS, Patel MX. Antipsychotic therapeutic drug monitoring: psychiatrists' attitudes and factors predicting likely future use. Ther Adv Psychopharmacol 2015; 5:214-23. [PMID: 26301077 PMCID: PMC4535047 DOI: 10.1177/2045125315588032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study aimed to explore predictive factors for future use of therapeutic drug monitoring (TDM) and to further examine psychiatrists' current prescribing practices and perspectives regarding antipsychotic TDM using plasma concentrations. METHOD A cross-sectional study for consultant psychiatrists using a postal questionnaire was conducted in north-west England. Data were combined with those of a previous London-based study and principal axis factor analysis was conducted to identify predictors of future use of TDM. RESULTS Most of the 181 participants (82.9%, 95% confidence interval 76.7-87.7%) agreed that 'if TDM for antipsychotics were readily available, I would use it'. Factor analysis identified five factors from the original 35 items regarding TDM. Four of the factors significantly predicted likely future use of antipsychotic TDM and together explained 40% of the variance in a multivariate linear regression model. Likely future use increased with positive attitudes and expectations, and decreased with potential barriers, negative attitudes and negative expectations. Scientific perspectives of TDM and psychiatrist characteristics were not significant predictors. CONCLUSION Most senior psychiatrists indicated that they would use antipsychotic TDM if available. However, psychiatrists' attitudes and expectations and the potential barriers need to be addressed, in addition to the scientific evidence, before widespread use of antipsychotic TDM is likely in clinical practice.
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Affiliation(s)
- Suzanne Law
- Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Peter M Haddad
- Greater Manchester West NHS Foundation Trust, Manchester, UK
| | | | | | - Richard J Drake
- Manchester Mental Health and Social Care Trust, Manchester, UK
| | | | - Anthony S David
- Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Maxine X Patel
- Institute of Psychiatry, King's College London, Box 68, 16 DeCrespigny Park, London SE5 8AF, UK
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The risks and benefits of switching patients with schizophrenia or schizoaffective disorder from two to one antipsychotic medication: a randomized controlled trial. Schizophr Res 2015; 166:194-200. [PMID: 26141142 DOI: 10.1016/j.schres.2015.05.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/24/2015] [Accepted: 05/27/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite little evidence to support its use and practice guidelines discouraging the practice, antipsychotic polypharmacy is widely prevalent in schizophrenia. This randomized controlled trial studied the effects of switching patients stable on two antipsychotic medications to one antipsychotic medication. METHOD 104 adult outpatients with schizophrenia from 7 community mental health centers clinically stable on concurrent treatment with 2 antipsychotics were randomly assigned to stay on polypharmacy or to switch to antipsychotic monotherapy. Participants were followed for 1-year with assessments of symptoms and side effects occurring every 60days (7 total assessments). We examined differences in time trajectories in symptoms (PANSS, CGI) and side effects (EPS, metabolic, other) as a function of group assignment (switch vs. stay) and time, using intention-to-treat analysis. RESULTS Participants who switched to antipsychotic monotherapy experienced greater increases in symptoms than stay patients. These differences emerged in the second 6months of the trial. All-cause discontinuation rates over the 1-year trial were higher in the switch-to-monotherapy group than in the stay-on-polypharmacy group (42% vs. 13%; p<0.01). There were no differences in change over time in any of the side effect measures, except that stay patients experienced a greater decrease in Simpson Angus total scores than switch patients. CONCLUSION Clinicians should be cautious in switching patients with chronic schizophrenia who are stable on 2 antipsychotics to one antipsychotic. Given the challenges in discontinuing antipsychotic polypharmacy, adequate trials of evidence-based treatments such as clozapine and long-acting injectable antipsychotics should be undertaken in inadequately responsive schizophrenia patients before moving to antipsychotic polypharmacy.
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Abstract
PURPOSE OF REVIEW Social cognition represents a fundamental skill for effective social behavior. It is nowadays widely accepted that individuals suffering from serious mental illness are impaired in this domain. RECENT FINDINGS Studies published since June 2012 have been reviewed, with a particular focus on theory of mind, social perception, social knowledge, attributional bias, and emotion processing in patients suffering from schizophrenia and mood disorders. SUMMARY The reviewed literature supports previous studies on deficits in social cognition in schizophrenia, major depressive disorder and bipolar disorder, and underscores their relevance in the psychosocial context.
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Hashimoto K, Sugawara N, Ishioka M, Nakamura K, Yasui-Furukori N. The effects of additional treatment with terguride, a partial dopamine agonist, on hyperprolactinemia induced by antipsychotics in schizophrenia patients: a preliminary study. Neuropsychiatr Dis Treat 2014; 10:1571-6. [PMID: 25187719 PMCID: PMC4149438 DOI: 10.2147/ndt.s68298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Hyperprolactinemia is a frequent consequence of treatment with antipsychotics. Earlier studies have indicated that terguride, which is a partial dopamine agonist, reduces the prolactin levels that are induced by prolactinemia. Thus, we examined the dose effects of adjunctive treatment with terguride on the plasma concentrations of prolactin in patients with elevated prolactin levels resulting from antipsychotic treatment. Terguride was concomitantly administered to 20 schizophrenic patients (10 males and 10 females) receiving paliperidone and risperidone. The dose of terguride was 1.0 mg/day. Sample collections for prolactin were conducted before terguride (baseline) and 2-4 weeks after administration. The samples were obtained after the morning dose of terguride. The average (± standard deviation) plasma prolactin concentration during terguride coadministration was significantly lower than the baseline concentration in females (82.3±37.1 ng/mL versus 56.5±28.5 ng/mL, P<0.01) but not in males (28.8±18.0 ng/mL versus 26.2±13.1 ng/mL, not significant). Additionally, a significant correlation between the ratio of prolactin reduction and the baseline prolactin concentration was identified in males (r s=-0.638, P<0.05) but not in females (r s=-0.152, not significant). Many patients complained of various adverse events following terguride administration, such as insomnia, agitation, and/or the aggravation of hallucinations. This study suggests that additional treatment with terguride decreases the prolactin concentrations in females experiencing high prolactin levels as a result of antipsychotic treatment. However, its utility for schizophrenia may be diminished because of its low tolerability.
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Affiliation(s)
- Kojiro Hashimoto
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Norio Sugawara
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Masamichi Ishioka
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Kazuhiko Nakamura
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
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