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Schöttle D, Wiedemann K, Correll CU, Janetzky W, Friede M, Jahn H, Brieden A. Response prediction in treatment of patients with schizophrenia after switching from oral aripiprazole to aripiprazole once-monthly. Schizophr Res 2023; 260:183-190. [PMID: 37683508 DOI: 10.1016/j.schres.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/12/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Daniel Schöttle
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Klaus Wiedemann
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | | | | | - Holger Jahn
- AMEOS Kliniken Heiligenhafen, AMEOS Krankenhausgesellschaft Holstein mbH, Oldenburg i. H., Preetz, Kiel, Germany.
| | - Andreas Brieden
- Universität der Bundeswehr München, Werner-Heisenberg-Weg 39, D-85577 Neubiberg, Germany.
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2
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Cepaityte D, Siafis S, Egberts T, Leucht S, Kouvelas D, Papazisis G. Exploring a Safety Signal of Antipsychotic-Associated Pneumonia: A Pharmacovigilance-Pharmacodynamic Study. Schizophr Bull 2021; 47:672-681. [PMID: 33289848 PMCID: PMC8084433 DOI: 10.1093/schbul/sbaa163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
An association between antipsychotic drugs and pneumonia has been demonstrated in several studies; however, the risk for pneumonia caused by specific antipsychotics has not been extensively studied. The underlying mechanism is still unknown, and several receptor mechanisms have been proposed. Therefore, using a combined pharmacovigilance-pharmacodynamic approach, we aimed to investigate safety signals of US Food and Drug Administration (FDA)-approved antipsychotics for reporting pneumonia and the potential receptor mechanisms involved. A disproportionality analysis was performed to detect a signal for reporting "infective-pneumonia" and "pneumonia-aspiration" and antipsychotics using reports submitted between 2004 and 2019 to the FDA adverse events spontaneous reporting system (FAERS) database. Disproportionality was estimated using the crude and the adjusted reporting odds ratio (aROR) and its 95% confidence interval (CI) in a multivariable logistic regression. Linear regressions investigated the relationship between aROR and receptor occupancy, which was estimated using in vitro receptor-binding profiles. Safety signals for reporting infective-pneumonia were identified for clozapine (LL = 95% 3.4, n = 546 [aROR: 4.8]) as well as olanzapine (LL = 95% 1.5, n = 250 [aROR: 2.1]) compared with haloperidol, while aRORs were associated with higher occupancies of muscarinic receptors (beta = .125, P-value = .016), yet other anti-muscarinic drugs were not included as potential confounders. No safety signals for reporting pneumonia-aspiration were detected for individual antipsychotics. Multiple antipsychotic use was associated with both reporting infective-pneumonia (LL 95%: 1.1, n = 369 [aROR:1.2]) and pneumonia-aspiration (LL 95%: 1.7, n = 194 [aROR: 2.0]). Considering the limitations of disproportionality analysis, further pharmacovigilance data and clinical causality assessment are needed to validate this safety signal.
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Affiliation(s)
- Dainora Cepaityte
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridon Siafis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Toine Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Division of Pharmacoepidemiology and Clinical Pharmacology, The Netherlands & Utrecht Institute of Pharmaceutical Science, Faculty of Science, Utrecht University, The Netherlands
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios Kouvelas
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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3
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Noel JM, Jackson CW. ASHP Therapeutic Position Statement on the Use of Antipsychotic Medications in the Treatment of Adults with Schizophrenia and Schizoaffective Disorder. Am J Health Syst Pharm 2020; 77:2114-2132. [PMID: 32871013 PMCID: PMC7499485 DOI: 10.1093/ajhp/zxaa303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Jason M Noel
- University of Maryland School of Pharmacy, Baltimore, MD
| | - Cherry W Jackson
- Auburn University Harrison School of Pharmacy, Auburn, AL.,Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, School of Medicine, Birmingham, AL
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Abstract
AbstractPurposeTo characterise patients with schizophrenia from four European countries treated with ziprasidone, and to compare these with patients treated with other second generation antipsychotics (SGAs) included in this survey.MethodA randomly selected, representative sample of psychiatrists (N = 744), from Germany, Greece, Italy and Spain, collected data on the five last patients with schizophrenia they had seen in consultation (N = 3996), including up to two patients treated with ziprasidone (N = 1096).ResultsZiprasidone was most frequently prescribed to patients requiring a switch from another antipsychotic. Compared to other surveyed SGAs, ziprasisone was more likely to be prescribed to women than to men (OR: 1.52), to patients with mild disease than to those with severe disease (OR: 1.94) and to outpatients than to inpatients (1.30). The most frequently cited reasons for prescribing ziprasidone were good tolerability and efficacy against positive and negative symptoms. Compared to other SGAs included in this survey, it was more likely to be prescribed due to the low risk of weight gain, metabolic syndrome and extrapyramidal symptoms.ConclusionPatients treated by ziprasidone more frequently belong to subgroups composed of more autonomous patients and those with mild to moderate disease severity.
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5
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Country differences in patient characteristics and treatment in schizophrenia: data from a physician-based survey in Europe. Eur Psychiatry 2020; 26:17-28. [DOI: 10.1016/s0924-9338(11)71710-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AbstractSchizophrenia is a frequent psychiatric disorder whose prevalence appears to be relatively stable across different patient groups. However, attitudes to care and resources devoted to mental health care may differ between countries. The objective of this analysis was to compare sociodemographic and psychopathological features of patients, antipsychotic treatment and frequency of hospitalisation between four European countries (Germany, Greece, Italy and Spain) collected as part of a large survey of the characteristics of patients with schizophrenia. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients. Information on 39 variables was collected. A number of between-country differences were observed which tended to distinguish Germany on the one hand, from the Mediterranean countries, and Greece in particular, on the other. While demographic features and clinical features were essentially similar, more patients in Germany were considered to have severe disease by their psychiatrist (59.0% versus 35.9% in Greece) and to be hospitalised (49.3% versus 15.0%). 46.7% of German patients were living alone compared to less than 20% in the Mediterranean countries and 50.2% were living with their family (versus over70% elsewhere). Smoking and addictive behaviours were more frequently reported for patients in Spain. With regard to empirically derived patient subgroups, Subgroup 2, corresponding to well-integrated and autonomous patients with mild to moderate disease severity was most highly represented in Greece (23.6% of patients compared to less than 10% elsewhere) elsewhere, Subgroup 6 (poorly-integrated patients with moderately severe disease who require caregiver support) was under-represented in Germany (4.5% versus over 17% elsewhere). Patterns of treatment were essentially similar, although quetiapine was more frequently prescribed and paliperidone less frequently prescribed in Germany than elsewhere. Reasons for treatment choice were comparable between countries, primarily related to good tolerability and control of positive symptoms. The differences observed may be attributed to differences in mental health care resource provision, socio-cultural or educational differences or to resource issues.
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6
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Peyrière H, Mano Q, Tribout V, Jacquet JM, Ferreira M, De Carvalho E, Brosson I, Verdier J, Derrien J, Rousseau C, Reynes J. Distinct Profiles of Consumers of Psychoactive Substances in People Attending French Sexual Transmitted Infections Centers. AIDS Behav 2019; 23:3375-3383. [PMID: 31102107 DOI: 10.1007/s10461-019-02539-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this cross-sectional survey was to assess the prevalence of psychoactive substance use (PSU) in people attending 11 French Sexual Transmitted Infection Centers, and to specify their profiles (PSU and link with risky sexual behaviors) using the ascending hierarchical clustering method. Among the 5220 individuals who completed the survey, 55.6% were men and the median age was 24 years [IQR: 20-31]. Among the participants, 2751 (52.7%) reported PSU at least once in their life. Ascending hierarchical clustering identified seven distinct profiles of participants based on their PSU. This study shows a high prevalence of PSU and alcohol consumption in this young population. Moreover, subgroup analysis allowed identifying groups of psychoactive substance users who presented specific risks or vulnerabilities and who should be priority targets for interventions, particularly sexual minority groups.
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Affiliation(s)
- H Peyrière
- INSERM U1175/IRD UMI 233, Montpellier University, Montpellier, France.
- Département de Pharmacologie Médicale et Toxicologie, Hôpital Lapeyronie, 191 avenue du Doyen Gaston Giraud, 34295, Cedex 5 Montpellier, France.
| | - Q Mano
- Santé Publique France, French National Public Health Agency, Cire Occitanie, 94415, Saint-Maurice, France
| | - V Tribout
- Sexual Transmitted Infections Center, Montpellier University, Montpellier, France
| | - J M Jacquet
- Department of Infectious Diseases, Montpellier University Hospital, Montpellier, France
| | - M Ferreira
- Sexual Transmitted Infections Center, Perpignan, France
| | | | - I Brosson
- Sexual Transmitted Infections Center, Nîmes, France
| | - J Verdier
- Sexual Transmitted Infections Center, Perpignan, France
| | - J Derrien
- National Team of Intervention and Prevention in Health, Montpellier, France
| | - C Rousseau
- Santé Publique France, French National Public Health Agency, Cire Occitanie, 94415, Saint-Maurice, France
| | - J Reynes
- INSERM U1175/IRD UMI 233, Montpellier University, Montpellier, France
- Department of Infectious Diseases, Montpellier University Hospital, Montpellier, France
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7
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Peyroux E, Prost Z, Danset-Alexandre C, Brenugat-Herne L, Carteau-Martin I, Gaudelus B, Jantac C, Attali D, Amado I, Graux J, Houy-Durand E, Plasse J, Franck N. From "under" to "over" social cognition in schizophrenia: Is there distinct profiles of impairments according to negative and positive symptoms? SCHIZOPHRENIA RESEARCH-COGNITION 2018; 15:21-29. [PMID: 30534527 PMCID: PMC6260279 DOI: 10.1016/j.scog.2018.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 12/04/2022]
Abstract
Interactions between social cognition and symptoms of schizophrenia have been investigated, but mostly component by component. Here we tested the assumption that two categories of deficits exist depending on clinical profiles, one corresponding to a defect in social cognition – “under-social cognition” – and one corresponding to excessive attributions leading to social cognitive impairments – “over-social cognition”. To conduct the investigation, we performed a Hierarchical Clustering Analysis using positive and negative symptoms in seventy patients with schizophrenia and we compared the clusters obtained to a group of healthy controls on social cognitive measures. We distinguished two social cognitive profiles based on prevailing symptoms for emotion processes and Theory of Mind. Actually, patients with negative symptoms showed lower performances in emotion recognition task than both those with positive symptoms and controls. Concerning Theory of Mind, patients with positive symptoms had a significant tendency to make over interpretative errors than both patients with negative symptoms and controls. For other processes assessed, further explorations are needed. Actually, concerning social perception and knowledge both patients' groups presented significant impairments compared to controls. Assessment of attribution bias showed that patients in the positive group presented a significant hostility bias and a higher intentionality score compared to healthy controls. These results favor the existence of different categories of impairments depending more on the clinical characteristics of patients than on nosographical categories, but further investigations are now necessary to specify these profiles. It nevertheless showed the importance of assessing symptoms in relationship with cognitive functioning.
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Affiliation(s)
- Elodie Peyroux
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France.,Reference Center for Rare Diseases (GénoPsy), Le Vinatier hospital, 95 Bd Pinel, 69500 Bron, France
| | - Zelda Prost
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France
| | - Charlotte Danset-Alexandre
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Lindsay Brenugat-Herne
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Isabelle Carteau-Martin
- Espace de la Chevalerie, CHRU Bretonneau, 2 Boulevard Tonnellé, 37044 Tours Cedex 09, France.,UMR INSERM 930, Université François-Rabelais de Tours, 10 Boulevard Tonnellé, Faculté de médecine, 37032 Tours Cedex 01, France
| | - Baptiste Gaudelus
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France
| | - Célia Jantac
- INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - David Attali
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Isabelle Amado
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Jérôme Graux
- Espace de la Chevalerie, CHRU Bretonneau, 2 Boulevard Tonnellé, 37044 Tours Cedex 09, France.,UMR INSERM 930, Université François-Rabelais de Tours, 10 Boulevard Tonnellé, Faculté de médecine, 37032 Tours Cedex 01, France
| | - Emmanuelle Houy-Durand
- UMR INSERM 930, Université François-Rabelais de Tours, 10 Boulevard Tonnellé, Faculté de médecine, 37032 Tours Cedex 01, France.,Centre Universitaire de Pédopsychiatrie, 2 Boulevard Tonnellé, 37044 Tours Cedex 09, France
| | - Julien Plasse
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France
| | - Nicolas Franck
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France.,UMR 5229, CNRS et Université Claude Bernard Lyon 1, Université de Lyon, Institut des Sciences Cognitives Marc Jeannerod, 67 Boulevard Pinel, 69675 Bron Cedex, France
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8
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Lin Y, Peng Y, He S, Xu J, Shi Y, Su Y, Zhu C, Zhang X, Zhou R, Cui D. Serum IL-1ra, a novel biomarker predicting olanzapine-induced hypercholesterolemia and hyperleptinemia in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2018; 84:71-78. [PMID: 29410009 DOI: 10.1016/j.pnpbp.2018.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 12/22/2022]
Abstract
Olanzapine (OLZ) is efficacious whereas leads to adverse metabolic effects thus lead to higher risk of cardiovascular diseases (CVD) on schizophrenia. Cytokines have been found associated with metabolic disorders. Therefore, pretreatment prediction of OLZ-induced adverse metabolic effects is urgently needed. To investigate if baseline cytokine levels could become biomarkers for pathogenesis of schizophrenia or prediction for OLZ-induced adverse metabolic effects, we recruited 75 participants, including 23 schizophrenia inpatients, who were antipsychotic-free over the past 6 months or first episode and drug-naive and 52 matched health controls, in our prospective cohort study and cross-sectional study. We simultaneously examined 7 serum cytokine levels (IFN-γ, IL-1ra, IL-1β, IL-8, TNF-α, MCP-1, VEGF) before OLZ treatment by using liquid suspension array technique and obtained clinical correlates at 4-week intervals in total 8 weeks. The psychopathology was assessed with the Positive and Negative Symptom Scale (PANSS). The metabolic parameters were BMI, TG, total cholesterol, LDL, HDL, ApoA1, ApoB, lipoprotein a, fasting glucose, HbA1c, insulin, and leptin. At baseline, IL-1ra and MCP-1 levels in schizophrenia were significantly higher than health controls (t = 4.55, P = 0.0001, t = 3.08 P = 0.003). BMI, fasting insulin, cholesterol, triglyceride, LDL, ApoB and leptin were significantly increased in patients with schizophrenia after 8 weeks of olanzapine treatment. Correlation analysis showed that the baseline IL-1ra level were significantly correlated with the increased levels of cholesterol (P = 0.004), LDL (P = 0.005), ApoB (P = 0.018) and leptin (P = 0.010), but not with the increased BMI, insulin or triglycerides. Further stepwise multiple linear regression analysis indicated that IL-1ra levels prior to treatment remained significantly associated with increased levels of cholesterol, LDL, ApoB and leptin. Above all, higher IL-1ra and MCP-1 levels may be biomarkers indicating pathogenesis of schizophrenia. Higher serum levels of IL-1ra may predict subsequent higher possibility of hypercholesterolemia and hyperleptinemia following OLZ treatment in schizophrenia patients.
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Affiliation(s)
- Yezhe Lin
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yanmin Peng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Shen He
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinjie Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yuan Shi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yousong Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cuizhen Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Xinyi Zhang
- Psychiatry department, Cooper University Hospital, Camden, NJ, USA
| | - Rubai Zhou
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China; Bio-x institute, Shanghai Jiao Tong University, Shanghai, China.
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9
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Samara MT, Klupp E, Helfer B, Rothe PH, Schneider‐Thoma J, Leucht S. Increasing antipsychotic dose for non response in schizophrenia. Cochrane Database Syst Rev 2018; 5:CD011883. [PMID: 29750432 PMCID: PMC6494602 DOI: 10.1002/14651858.cd011883.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Many people with schizophrenia do not reach a satisfactory clinical response with a standard dose of an initially prescribed antipsychotic drug. In such cases, clinicians face the dilemma of increasing the antipsychotic dose in order to enhance antipsychotic efficacy. OBJECTIVES To examine the efficacy of increasing antipsychotic dose compared to keeping the same dose in the treatment of people with schizophrenia who have not responded (as defined in the individual studies) to an initial antipsychotic drug trial. We also examine the adverse effects associated with such a procedure. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (10 June 2014, 6 October 2015, and 30 March 2017). We examined references of all included studies for further trials. SELECTION CRITERIA All relevant randomised controlled trials (RCTs), reporting useable data, comparing increasing the antipsychotic dose rather than maintaining the original dose for people with schizophrenia who do not respond to their initial antipsychotic treatment. DATA COLLECTION AND ANALYSIS At least two review authors independently extracted data . We analysed dichotomous data using relative risks (RR) and the 95% confidence intervals (CI). We analysed continuous data using mean differences (MD) and their 95% CI. We assessed risk of bias for included studies and used GRADE to create a 'Summary of findings' table. MAIN RESULTS Ten relevant RCTs with 675 participants are included in this review. All trials were double blind except one single blind. All studies had a run-in phase to confirm they did not respond to their initial antipsychotic treatment. The trials were published between 1980 and 2016. In most studies the methods of randomisation, allocation and blinding were poorly reported. In addition sample sizes were often small, limiting the overall quality of the evidence. Overall, no clear difference was found between groups in terms of the number of participants who showed clinically relevant response (RR 1.09, 95% CI 0.86 to 1.40, 9 RCTs, N = 533, low-quality evidence), or left the study early due to adverse effects (RR 1.63, 95% CI 0.52 to 5.07, very low quality evidence), or due to any reason (RR 1.30, 95% CI 0.89 to 1.90, 5 RCTs, N = 353, low-quality evidence). Similarly, no clear difference was found in general mental state as measured by PANSS total score change (MD -1.44, 95% CI -6.85 to 3.97, 3 RCTs, N = 258, very low quality evidence). At least one adverse effect was equivocal between groups (RR 0.91, 95% CI 0.55 to 1.50, 2 RCTs, N = 191, very low quality evidence). Data were not reported for time in hospital or quality-of-life outcomes. Finally, subgroup and sensitivity analyses did not show any effect on the primary outcome but these analyses were clearly underpowered. AUTHORS' CONCLUSIONS Current data do not show any clear differences between increasing or maintaining the antipsychotic dose for people with schizophrenia who do not respond to their initial antipsychotic treatment. Adverse effect reporting was limited and poor. There is an urgent need for further trials in order to determine the optional treatment strategy in such cases.
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Affiliation(s)
- Myrto T Samara
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieIsmaninger Straße 22MünchenGermany81675
| | - Elisabeth Klupp
- Technical University MunichDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der IsarIsmaninger Str. 22MünchenGermany
| | - Bartosz Helfer
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieIsmaninger Straße 22MünchenGermany81675
| | - Philipp H Rothe
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieIsmaninger Straße 22MünchenGermany81675
| | - Johannes Schneider‐Thoma
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieIsmaninger Straße 22MünchenGermany81675
| | - Stefan Leucht
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieIsmaninger Straße 22MünchenGermany81675
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10
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Correll CU, Skuban A, Hobart M, Ouyang J, Weiller E, Weiss C, Kane JM. Efficacy of brexpiprazole in patients with acute schizophrenia: Review of three randomized, double-blind, placebo-controlled studies. Schizophr Res 2016; 174:82-92. [PMID: 27157799 DOI: 10.1016/j.schres.2016.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/06/2016] [Accepted: 04/11/2016] [Indexed: 11/18/2022]
Abstract
Brexpiprazole, a serotonin-dopamine activity modulator, is a partial agonist at 5-HT1A and dopamine D2 receptors, and antagonist at 5-HT2A and noradrenaline α1B and α2C receptors, all at similar potency. Efficacy of brexpiprazole was evaluated in patients with acutely exacerbated schizophrenia in three short-term, randomized, double-blind, placebo-controlled studies. In a Phase 2 study, patients were randomized to brexpiprazole 0.25mg (fixed dose), 1.0±0.5mg, 2.5±0.5mg, 5.0±1mg (flexible-dose ranges), placebo, or aripiprazole 15±5mg. In two Phase 3 studies, patients were randomized to fixed-dose brexpiprazole 0.25mg, 1mg, 2mg, or 4mg, or placebo. For this review, brexpiprazole 2mg and 4mg arms from the Phase 3 studies were combined. Primary efficacy endpoint was change in Positive and Negative Syndrome Scale (PANSS) total score from baseline at week 6; key secondary endpoint was change in Clinical Global Impression-Severity of illness (CGI-S) score at week 6. Primary outcome moderator analyses explored effects of sex, age, race, and illness duration. There were no statistically significant differences vs. placebo in the Phase 2 brexpiprazole and aripiprazole groups for primary and key secondary endpoints. Combined brexpiprazole 2mg (n=359) and 4mg (n=359) were superior to placebo (n=358) in change in PANSS total score (least square mean difference from placebo: -5.46, p=0.0004, and -6.69, p<0.0001, respectively) and CGI-S (-0.25, p=0.0035, and -0.38, p<0.0001, respectively). Changes from baseline in efficacy endpoints were minimal in the 0.25mg group, while the 1mg group exhibited suboptimal improvement. No relevant moderators were identified. Meta-analysis of the pivotal studies indicates brexpiprazole 2mg and 4mg are effective in treating acute schizophrenia.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY 11549, USA.
| | - Aleksandar Skuban
- Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center Drive, 1 University Square Drive, Princeton, NJ 08540, USA.
| | - Mary Hobart
- Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center Drive, 1 University Square Drive, Princeton, NJ 08540, USA.
| | - John Ouyang
- Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center Drive, 1 University Square Drive, Princeton, NJ 08540, USA.
| | | | - Catherine Weiss
- Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center Drive, 1 University Square Drive, Princeton, NJ 08540, USA.
| | - John M Kane
- The Zucker Hillside Hospital, Department of Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA.
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11
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Lang FU, Walther S, Stegmayer K, Anderson-Schmidt H, Schulze TG, Becker T, Jäger M. Subtyping schizophrenia: A comparison of positive/negative and system-specific approaches. Compr Psychiatry 2015; 61:115-21. [PMID: 26104431 DOI: 10.1016/j.comppsych.2015.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/28/2015] [Accepted: 05/28/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Schizophrenia is a heterogeneous disorder. Over the years, different approaches have been proposed to approach this heterogeneity by categorizing symptom patterns. The study aimed to compare positive/negative and system-specific approaches to subtyping. METHODS We used the Positive and Negative Syndrome Scale (PANSS) and Bern Psychopathology Scale (BPS), which consists of subscales for three domains (language, affect and motor behavior) that are hypothesized to be related to specific brain circuits, to assess cross-sectional psychopathological characteristics in a sample of 100 inpatients with schizophrenia spectrum disorders. We then categorized participants into positive/negative and system-specific subgroups to allow comparisons of the two approaches. RESULTS The analyses revealed correlations between the PANSS positive subscore and the BPS affective subscore (r=.446, p<.001) and between the PANSS negative subscore and the BPS motor behavior subscore (r=.227, p=.023). As regards the positive and negative subtype, more participants were classified as positive in the language-dominant subtype (30.3%) and affect-dominant subtype (30.3%), whereas more were classified as negative in the motor behavior-dominant subtype (44.4%). However, most patients met the criteria for the mixed subtype. CONCLUSIONS The results suggest that the positive/negative and system-specific approaches can be regarded as complementary. Future studies should examine both approaches in a longitudinal assessment of psychopathological symptoms and link them with qualitative-phenomenological approaches.
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Affiliation(s)
- F U Lang
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany.
| | - S Walther
- University Hospital of Psychiatry, Bern, Switzerland
| | - K Stegmayer
- University Hospital of Psychiatry, Bern, Switzerland
| | - H Anderson-Schmidt
- Institute of Psychiatric Phenomics and Genomics, Munich, Germany; Department of Psychiatry and Psychotherapy, Georg August University, Göttingen, Germany
| | - T G Schulze
- Institute of Psychiatric Phenomics and Genomics, Munich, Germany; Department of Psychiatry and Psychotherapy, Georg August University, Göttingen, Germany
| | - T Becker
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - M Jäger
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
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12
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Takeuchi H, Fervaha G, Lee J, Agid O, Remington G. Effectiveness of different dosing regimens of risperidone and olanzapine in schizophrenia. Eur Neuropsychopharmacol 2015; 25:295-302. [PMID: 25649680 DOI: 10.1016/j.euroneuro.2014.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 12/16/2014] [Accepted: 12/24/2014] [Indexed: 10/24/2022]
Abstract
The objective of this study was to evaluate the effectiveness and impact of once- versus twice-daily dosing of risperidone and olanzapine on clinical outcomes in patients with schizophrenia. Data from phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia study were used. Patients with schizophrenia were randomly allocated to treatment with risperidone and olanzapine, and were also randomly assigned to once-daily (N=173 and 169, respectively) or twice-daily (N=168 and 167, respectively) dosing and followed for up to 18 months. Discontinuation rate and time to discontinuation were used as primary outcome measures to compare the two groups. The following outcome measures were also analyzed: efficacy, safety, medication adherence, adverse events, and concomitant psychotropic medications. No significant differences in discontinuation rates and time to discontinuation were observed between the once- and twice-daily dosing groups (P>0.05) in patients receiving risperidone or olanzapine. The once-daily dosing group demonstrated significantly lower mean daily doses of risperidone and olanzapine across phase 1, and lower rates of hospitalization for exacerbation of schizophrenia, sleepiness, and orthostatic faintness in patients receiving olanzapine (P<0.05) compared to the twice-daily dosing group. No significant differences were found in any other outcome measures between the two dosing groups. In conclusion, effectiveness and efficacy outcomes between once- and twice-daily dosing for risperidone and olanzapine were not significantly different. However, in view of the lower mean dose and better side effect profile, it is advisable to adhere to a once-daily dosing regimen, especially in the case of olanzapine.
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Affiliation(s)
- Hiroyoshi Takeuchi
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Gagan Fervaha
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jimmy Lee
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of General Psychiatry 1, Institute of Mental Health, Singapore, Singapore; Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Ofer Agid
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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13
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Köster LS, Carbon M, Correll CU. Emerging drugs for schizophrenia: an update. Expert Opin Emerg Drugs 2014; 19:511-31. [DOI: 10.1517/14728214.2014.958148] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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14
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Jäger M, Weiser P, Becker T, Frasch K, Längle G, Croissant D, Steinert T, Jaeger S, Kilian R. Identification of psychopathological course trajectories in schizophrenia. Psychiatry Res 2014; 215:274-9. [PMID: 24374114 DOI: 10.1016/j.psychres.2013.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 11/27/2013] [Accepted: 11/30/2013] [Indexed: 01/17/2023]
Abstract
Course trajectory analyses have been performed primarily for treatment response in acute episodes of schizophrenic disorders. As yet, corresponding data for the long-term course are lacking. Within a multicenter prospective observational study, 268 patients with schizophrenia were assessed at discharge from hospital and followed up after 6, 12, 18, and 24 months. A latent class growth analysis was performed on the scores from the Positive and Negative Syndrome Scale (PANSS). A two-class conditional latent class model showed the best data fit (Entropy: 0.924). The model divided the sample into a group with amelioration in all PANSS subscales (60%) and a group with stable positive/negative and deteriorating general psychopathology symptoms (40%). Global functioning (GAF score), gender, age, living situation and involuntary admission predicted course trajectory class membership. The model was predictive of significant differences between the two groups in health care service costs and quality of life. The results underline the heterogeneous course of the illness, which ranged from amelioration to deterioration over a 2-year period. Statistical models such as trajectory analysis could help to identify more homogenous subtypes in schizophrenia.
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Affiliation(s)
- Markus Jäger
- Ulm University, Department of Psychiatry and Psychotherapy II, BKH Günzburg, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany.
| | - Prisca Weiser
- Ulm University, Department of Psychiatry and Psychotherapy II, BKH Günzburg, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - Thomas Becker
- Ulm University, Department of Psychiatry and Psychotherapy II, BKH Günzburg, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - Karel Frasch
- Ulm University, Department of Psychiatry and Psychotherapy II, BKH Günzburg, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - Gerhard Längle
- Zentrum für Psychiatrie Südwürttemberg, Bad Schussenried, Germany; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Daniela Croissant
- PP.rt Hospital for Psychiatry, Psychotherapy and Psychosomatics, Reutlingen, Germany
| | - Tilman Steinert
- (e)Ulm University, Department of Psychiatry and Psychotherapy I, Ravensburg, Germany; (f)Zentrum für Psychiatrie Südwürttemberg, Weissenau, Ravensburg, Germany
| | - Susanne Jaeger
- (e)Ulm University, Department of Psychiatry and Psychotherapy I, Ravensburg, Germany; (f)Zentrum für Psychiatrie Südwürttemberg, Weissenau, Ravensburg, Germany
| | - Reinhold Kilian
- Ulm University, Department of Psychiatry and Psychotherapy II, BKH Günzburg, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
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15
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Stentebjerg-Olesen M, Jeppesen P, Pagsberg AK, Fink-Jensen A, Kapoor S, Chekuri R, Carbon M, Al-Jadiri A, Kishimoto T, Kane JM, Correll CU. Early nonresponse determined by the clinical global impressions scale predicts poorer outcomes in youth with schizophrenia spectrum disorders naturalistically treated with second-generation antipsychotics. J Child Adolesc Psychopharmacol 2013; 23:665-75. [PMID: 24266529 PMCID: PMC3870605 DOI: 10.1089/cap.2013.0007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The use of early response/nonresponse (ER/ENR) to antipsychotics as a predictor for ultimate response/nonresponse (UR/UNR) may help decrease inefficacious treatment continuation. However, data have been limited to adults, and ER/ENR has only been determined using time-consuming psychopathology rating scales. In the current study, we assessed if early improvement on the Clinical Global Impressions-Improvement (CGI-I) scale predicted UR/UNR in psychiatrically ill youth started on antipsychotic treatment. METHODS Seventy-nine youth aged 6-19 years, with schizophrenia spectrum disorders, treated naturalistically with aripiprazole, olanzapine, quetiapine, risperidone, or ziprasidone and evaluated monthly, were divided into ER/ENR groups at week 4, using at least "minimally improved" on the CGI-I scale. Prediction using week 4 ER/ENR status for UR (CGI-I=at least "much improved"), effectiveness and adverse effect outcomes at 8-12 weeks were assessed. RESULTS At 4 weeks, 45.6% of subjects were ER and 54.4% were ENR without differences regarding baseline demographic, illness, and treatment variables, except for higher age (p=0.034) and maximum risperidone dose (p=0.0043) in ENR. ER/ENR status at 4 weeks predicted UR/UNR at week 12 significantly (p<0.0001): Sensitivity=68.9%, specificity=85.3%, positive predictive value=86.1%, negative predictive value=67.4%. At weeks 4, 8, and 12, ER patients improved significantly more on the CGI-I, CGI-Severity, and Children's Global Assessment of Functioning scales, and more ER patients reached UR compared with ENR patients (83.3% vs. 34.9%, all p<0.0001). ENR patients had more extrapyramidal side effects (EPS) at weeks 4, 8, and 12 (p=0.0019-0.0079). UR was independently associated with ER (odds ratio [OR]=18.09; 95% confidence interval [CI]=4.71-91.68, p<0.0001) and psychosis not otherwise specified (NOS) (OR=4.82 [CI: 1.31-21.41], p=0.017) (r(2)=0.273, p<0.0001). CONCLUSIONS Older age and EPS were associated with ENR; ENR and schizophrenia were associated with UNR in naturalistically treated youth with schizophrenia spectrum disorders. Early CGI-I-based treatment decisions require further consideration and study.
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Affiliation(s)
| | - Pia Jeppesen
- Mental Health Centre for Child and Adolescent Psychiatry, Glostrup, Denmark
| | - Anne K. Pagsberg
- Mental Health Centre for Child and Adolescent Psychiatry, Bispebjerg, Denmark
| | - Anders Fink-Jensen
- Mental Health Centre, Copenhagen, Copenhagen, Denmark
- Laboratory of Neuropsychiatry, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Sandeep Kapoor
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Raja Chekuri
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Maren Carbon
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Aseel Al-Jadiri
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Taishiro Kishimoto
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
- The Feinstein Institute for Medical Research, Manhasset, New York
| | - John M. Kane
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
- The Feinstein Institute for Medical Research, Manhasset, New York
- Albert Einstein College of Medicine, Bronx, New York
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
- The Feinstein Institute for Medical Research, Manhasset, New York
- Albert Einstein College of Medicine, Bronx, New York
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16
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Rossi G, Frediani S, Rossi R, Rossi A. Long-acting antipsychotic drugs for the treatment of schizophrenia: use in daily practice from naturalistic observations. BMC Psychiatry 2012; 12:122. [PMID: 22909285 PMCID: PMC3573926 DOI: 10.1186/1471-244x-12-122] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 08/01/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Current guidelines suggest specific criteria for oral or long-acting injectable antipsychotic drugs (LAIs). This review aims to describe the demographic and clinical characteristics of the ideal profile of the patient with schizophrenia treated with LAIs, through the analysis of nonrandomized studies. METHODS A systematic review of nonrandomized studies in English was performed attempting to analyze the factors related to the choice and use of LAIs in daily practice. The contents were outlined using the Cochrane methods for nonrandomized studies and the variables included demographic as well as clinical characteristics. The available literature did not allow any statistical analysis that could be used to identify the ideal profile of patients with schizophrenia to be treated with LAIs. RESULTS Eighty publications were selected and reviewed. Prevalence of LAI use ranged from 4.8% to 66%. The only demographic characteristics that were consistently assessed through retrieved studies were age (38.5 years in the 1970's, 35.8 years in the 1980's, 39.3 years in the 1990's, to 39.5 years in the 2000's) and gender (male > female).Efficacy was assessed through the use of various symptom scales and other indirect measurements; safety was assessed through extrapyramidal symptoms and the use of anticholinergic drugs, but these data were inconsistent and impossible to pool. Efficacy and safety results reported in the different studies yielded a good therapeutic profile with a maximum of 74% decrease in hospital admissions and the prevalence of extrapyramidal symptoms with LAIs consistently increased at 6, 12, 18, and 24 months (35.4%, 37.1%, 36.9%, and 41.3%, respectively). CONCLUSIONS This analysis of the available literature strongly suggests that further observational studies on patients with schizophrenia treated with LAIs are needed to systematically assess their demographic and clinical characteristics and the relationships between them and patient outcome.Besides the good efficacy and safety profile of LAIs, health care staff must also take into account the importance of establishing a therapeutic alliance with the patient and his/her relatives when selecting the most appropriate treatment. LAIs seem to be a good choice not only because of their good safety and efficacy profile, but also because they improve compliance, a key factor to improving adherence and to establishing a therapeutic alliance between patients with schizophrenia, their relatives, and their health care providers.
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Affiliation(s)
- Giuseppe Rossi
- U.O. Psichiatria, IRCCS "Centro San Giovanni di Dio" Fatebenefratelli, via Pilastroni 4, Brescia, Italy.
| | - Sonia Frediani
- Centro di Salute Mentale La Badia U.S.L. 11, Empoli, Italy
| | - Roberta Rossi
- U.O. Psichiatria, IRCCS “Centro San Giovanni di Dio” Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Andrea Rossi
- Medical Dept. Eli Lilly Italy, Via Gramsci 731, Sesto Fiorentino (FI), Italy
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Correll CU, Kishimoto T, Kane JM. Randomized controlled trials in schizophrenia: opportunities, limitations, and trial design alternatives. DIALOGUES IN CLINICAL NEUROSCIENCE 2011. [PMID: 21842613 PMCID: PMC3182000 DOI: 10.31887/dcns.2011.13.2/ccorrell] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
State-of-the art clinical trial design and methodology are enormously important for the advancement of the field. In contrast, the critical relevance of trial conduct and implementation have only more recently been the focus of discussion and research. Although randomized controlled trials are generally considered the gold standard for the assessment of pharmacologic and nonpharmacologic interventions in medicine, trials are vulnerable to complications and influences that can seriously compromise their success, Like interventions, trial design and conduct are also contextual. They need to be individualized and adapted to a number of relevant variables, such as setting, population, illness phase, interventions, patient and rater expectations and biases, and the overall aims of the investigation. While this means that there is no unified approach possible, certain general principles and guidelines require careful consideration. Knowledge of basic solutions and alternatives, and the recognition of the complex challenges that need to be addressed proactively can help to minimize unwanted outcomes, including trial failure and uninformative or falsely negative outcomes. Moreover, novel design alternatives need to be explored that target sample enrichment according to the study question and enhancement of precision in the measurement of relevant outcomes. We propose two novel design strategies that take advantage of the recently validated early antipsychotic response paradigm (that has also been observed with antidepressants and mood stabilizers). In the “early responder randomized discontinuation design” all patients are assigned to the active drug, and only those who had at least a minimal response at 2 weeks are enrolled in a double-blind, placebo-controlled discontinuation trial, enriching the placebo controlled trial portion with true drug responders. In the mirror image “early nonresponder randomized dose increase or augmentation design,” early nonresponders at 2 weeks are assigned to staying on the medication or going either to a higher dose or an augmentation agent. It is hoped that through increased attention to the issues raised in this article and further refinement of trial methodology and conduct, the field will make much needed additional progress in the prevention and treatment of schizophrenia.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York 11004, USA.
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