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Sampogna G, Di Vincenzo M, Giuliani L, Menculini G, Mancuso E, Arsenio E, Cipolla S, Della Rocca B, Martiadis V, Signorelli MS, Fiorillo A. A Systematic Review on the Effectiveness of Antipsychotic Drugs on the Quality of Life of Patients with Schizophrenia. Brain Sci 2023; 13:1577. [PMID: 38002537 PMCID: PMC10669728 DOI: 10.3390/brainsci13111577] [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: 10/14/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Pharmacological antipsychotic drug interventions represent the cornerstone of the management of patients with schizophrenia and other psychotic spectrum disorders. The choice of the "best" treatment should be made on the basis of several clinical domains. However, despite available treatments, the quality of life reported by patients with schizophrenia taking antipsychotics is still very poor, and this outcome is rarely taken into account in trials assessing the efficacy and effectiveness of antipsychotic treatments. Therefore, we performed a systematic review in order to assess the impact of antipsychotic treatment on patients' quality of life. In particular, we aimed to identify any differences in the improvement in quality of life according to the (a) type of formulation of antipsychotic drugs (i.e., oral vs. depot vs. long-acting injectable); (b) type of the drug (first vs. second vs. third generation); and (c) patients' clinical characteristics. One hundred and eleven papers were included in the review. The main findings were as follows: (1) quality of life is usually considered a secondary outcome in trials on the efficacy and effectiveness of drugs; (2) second-generation antipsychotics have a more positive effect on quality of life; and (3) long-acting injectable antipsychotics are associated with a more stable improvement in quality of life and with a good safety and tolerability profile. Our systematic review confirms that quality of life represents a central element for selecting the appropriate treatment for people with schizophrenia. In particular, the availability of new treatments with a better tolerability profile, a proven effectiveness on patients' cognitive and social functioning, and with a more stable blood concentration might represent the appropriate strategy for improving the quality of life of people with schizophrenia.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Giulia Menculini
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy
| | - Emiliana Mancuso
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Eleonora Arsenio
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Salvatore Cipolla
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | - Bianca Della Rocca
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
| | | | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy (L.G.); (S.C.)
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Ma N, Zhang L, Zhang W, He Y, Ye C, Li X. Long-Acting Injectable Antipsychotic Treatment for Schizophrenia in Asian Population: A Scoping Review. Neuropsychiatr Dis Treat 2023; 19:1987-2006. [PMID: 37745189 PMCID: PMC10516218 DOI: 10.2147/ndt.s413371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
Evidence of comparative benefits of long-acting injectable (LAI) antipsychotics in Asian patients with schizophrenia has been inconsistent. This scoping review aimed to synthesize the current evidence in the past ten years and provide an overview of efficacy, safety, treatment adherence, patient attitudes, and healthcare resource utilization of LAI in this population. A systematic search was conducted with a pre-defined search strategy in six electronic databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Embase, CINAHL, and PsycArticles. A total of 46 studies were included, including 15 cohort studies, 13 single-arm trials, 10 randomized controlled trials, four mirror-image studies, three cross-sectional studies, and one controlled clinical trial. Paliperidone palmitate once-monthly injection (27/46) and risperidone LAI (14/46) were the most frequently investigated LAIs. Compared with oral antipsychotic medications (OAMs), LAIs demonstrated a lower rate of relapse/hospitalization and comparable improvement in efficacy. Adverse events (AEs) were similar between LAIs and OAMs, although types and incidence varied. Significant reduction in the length of hospitalization and number of outpatient visits/inpatient admission was observed after initiation of LAIs. These findings suggest that LAI demonstrated comparable efficacy and safety among Asian populations with schizophrenia in comparison to OAMs. Better adherence and lower relapse were observed in patients receiving LAIs from published evidence. Future research is warranted to better understand the comprehensive performance of LAI in specific population or context.
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Affiliation(s)
- Ning Ma
- Peking University Sixth Hospital, Beijing, People’s Republic of China
- Peking University Institute of Mental Health, Beijing, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, People’s Republic of China
| | - Lei Zhang
- Xi’an Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China
| | - Wufang Zhang
- Peking University Sixth Hospital, Beijing, People’s Republic of China
- Peking University Institute of Mental Health, Beijing, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, People’s Republic of China
| | - Yingying He
- Peking University Sixth Hospital, Beijing, People’s Republic of China
- Peking University Institute of Mental Health, Beijing, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, People’s Republic of China
| | - Chong Ye
- Xi’an Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China
| | - Xin Li
- Xi’an Janssen Pharmaceutical Ltd, Beijing, People’s Republic of China
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Rosenheck R, Kurtz SG, Anand ST, Hau C, Smedberg D, Sicilia R, Pontzer JF, Ferguson RE. Impact of multi-site clinical trial results on clinical practice: Use of risperidone to treat PTSD nationally in the veterans health administration. Psychiatry Res 2023; 321:115071. [PMID: 36720177 DOI: 10.1016/j.psychres.2023.115071] [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: 11/21/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023]
Abstract
Multi-site randomized effectiveness trials evaluate treatments under real-world conditions. Whether results change practice is under-studied. A 6-month 26-site Veterans Health Administration (VHA) cooperative study published in 2011 compared an oral second-generation antipsychotic, risperidone, to placebo for refractory PTSD with null results. National VHA administrative data compared new starts on risperidone during the 5 years before and after the year of publication. Among the 450,000-841,000 Veterans diagnosed with PTSD annually from 2006 to 2016 the proportion with new starts on risperidone declined every year before and after publication. No evidence of an effect of null study results on VHA clinical practice was observed.
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Affiliation(s)
- Robert Rosenheck
- VA New England Mental Illness, Research, Education and Clinical Center, West Haven, CT, USA; Department of Psychiatry, Yale Medical School, West Haven, CT, USA.
| | | | | | - Cynthia Hau
- VA Boston Healthcare System, Boston, MA, USA
| | | | | | - James F Pontzer
- VA Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA; VA Office of Research and Development, Cooperative Studies Program, Albuquerque, NM, USA
| | - Ryan E Ferguson
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
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Rosenheck R, Anand ST, Kurtz SG, Hau C, Smedberg D, Pontzer JF, Ferguson RE, Davis CR. Can multisite clinical trial results change clinical practice? Use of long-acting injectable risperidone nationally in the Veterans Health Administration. Trials 2023; 24:85. [PMID: 36747254 PMCID: PMC9900548 DOI: 10.1186/s13063-023-07094-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/12/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multisite practical clinical trials evaluate treatments in real-world practice. A multisite randomized Veterans Health Administration (VHA) cooperative study (CSP#555) published in 2011 compared the first long-acting injectable (LAI) second-generation antipsychotic (SGA), Risperidone Consta®, in veterans with a diagnosis of schizophrenia or schizoaffective disorder, to oral antipsychotics, with unexpected null results for effectiveness and cost-effectiveness. Whether null results of this type could change VHA practice has not been studied. METHODS A longitudinal observational analysis was used to evaluate the impact of the trial findings on VHA clinical practices. National administrative data compared new starts on LAI risperidone during the 4 years before the publication of CSP#555 in 2011 to new starts on LAI risperidone during the 4 years after. RESULTS Among 119,565 Veterans with the indicated diagnoses treated with antipsychotics from 2007 to 2015, the number and proportion of new starts on LAI risperidone declined significantly following the study publication, as did the total number of annual users and drug expenditures. However, data from 2007 to 2010 showed the decline in new starts actually preceded the publication of CSP#555. This change was likely explained by the increase in new starts, total use, and expenditures on a newer medicine, LAI paliperidone, a 4-week LAI treatment, in the 2 years prior to the publication of CSP#555. CONCLUSIONS The declining use of LAI risperidone likely primarily reflects the substitution of a longer-acting LAI SGA, paliperidone, that came to market 2 years before the study publication, a substitution that may have been reinforced by null CSP#555 study results for LAI risperidone.
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Affiliation(s)
- Robert Rosenheck
- VA New England Mental Illness, Research, Education and Clinical Center, 151D, 950 Campbell Ave., West Haven, CT, 06516, USA.
- Department of Psychiatry, Yale Medical School, West Haven, CT, USA.
| | - Sonia T Anand
- VA Cooperative Studies Program Coordinating Center, Boston, MA, USA
| | - Stephen G Kurtz
- VA Cooperative Studies Program Coordinating Center, Boston, MA, USA
| | - Cynthia Hau
- VA Cooperative Studies Program Coordinating Center, Boston, MA, USA
| | - Diane Smedberg
- VA Cooperative Studies Program Coordinating Center, Boston, MA, USA
| | - James F Pontzer
- VA Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
- VA Office of Research and Development, Cooperative Studies Program, Albuquerque, NM, USA
| | - Ryan E Ferguson
- VA Cooperative Studies Program Coordinating Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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Goldberg A, Bakhireva LN, Page K, Henrie AM. A Qualitative Scoping Review of Early-Terminated Clinical Trials Sponsored by the Department of Veterans Affairs Cooperative Studies Program From 2010 to 2020. Epidemiol Rev 2022; 44:110-120. [PMID: 36193844 PMCID: PMC10362930 DOI: 10.1093/epirev/mxac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 12/29/2022] Open
Abstract
Increasing attention has been paid to the risks and benefits of terminating large clinical trials before reaching prespecified targets, because such decisions can greatly affect the implementation of findings. The Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) is a research infrastructure dedicated to conducting high-quality clinical research. A scoping review was performed to characterize barriers preventing the attainment of prespecified recruitment, statistical power, or sample-size targets in VA CSP trials. A trial was eligible for inclusion if the trial was sponsored by the VA CSP, primary findings were published within the last 10 years, and a decision was made to terminate enrollment or follow-up before meeting a priori recruitment or endpoint targets. In 11 of 29 included trials (37.9%), a decision was made to terminate the trial early. The most common reason for early termination was related to under-recruitment (n = 5). Other reasons included early detection of safety signals (n = 2), futility (n = 1), and benefit (n = 1). This review highlights recruitment as a critical facet of trial conduct that may hinder the production of high-quality data and thus warrant additional attention. Solutions to enhance recruitment now implemented by the VA CSP, including dedicated enrollment infrastructure and screening facilitated by informatics approaches, show promise in reducing this cause for early termination.
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Affiliation(s)
- Alexa Goldberg
- Correspondence to Dr. Alexa Goldberg, Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, 2401 Centre Avenue, SE, Albuquerque, NM 87106 (e-mail: )
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TAŞCI G, ÖZSOY F. Comparison of prolactin level, sexual function, body mass index, and liver function tests in patients using depot antipsychotics. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1128200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Bu çalışmada uzun etkili antipsikotik ilaç formları (uzun etkili paliperidon palmitat, risperidon depo ve zuklopentiksol depo) kullanan hastalarda cinsel işlev bozuklukları, vücut kitle indeksi, karaciğer fonksiyon testleri ve prolaktin düzeylerinin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Bu çalışmaya şizofreni tanılı ve uzun etkili antipsikotik tedavisi alan hastalar dahil edildi. Tüm katılımcılara demografik veri formu, Pozitif ve Negatif Sendrom Ölçeği (PANSS), Calgary Şizofrenide Depresyon Ölçeği (CŞDÖ) ve Arizona Cinsel Yaşantılar Ölçeği (ACYÖ) uygulandı. Ardından üre, kreatinin, karaciğer fonksiyon testleri, kolesterol ve prolaktin düzeylerini değerlendirmek için venöz kan örnekleri alındı.
Bulgular: Çalışmaya 95 hasta dahil edildi. Dahil edilenlerin 79’u erkek (%83.2) ve 16’sı kadındı (%16.8). Tüm hastaların yaş ortalaması 36.77±10.24 yıl idi. Vücut kitle indeksleri ortalaması ise 27.06±4.95 kg/m2 idi. Gruplar arasında ACYÖ ve CŞDÖ skorları açısından farklılık saptanmadı. Prolaktin değeri paliperidon depo kullanan hastalarda zuklopentiksol depo kullanan hastalardan yüksek olarak hesap edilmiştir.
Sonuç: Sonuçlarımıza göre cinsel işlevleri etkileyen prolaktin değerleri, hastalar semptom belirtmese de uzun etkili antipsikotik kullanan hastalarda göz önünde bulundurulmalıdır. Uzun etkili antipsikotik kullanımının hem prolaktin değerleri hem de diğer laboratuvar parametrelerine olan etkileri konusunda ileri araştırmalar yapılmalıdır.
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Tidmore LM, Keast SL, Waters HC, Pareja KL, Cothran T, Skrepnek GH. Readmissions, costs, and duration to subsequent outpatient visit after hospital discharge among Medicaid beneficiaries utilizing oral versus long-acting injectable antipsychotics in bipolar disorder or schizophrenia. Curr Med Res Opin 2022; 38:1621-1630. [PMID: 35833696 DOI: 10.1080/03007995.2022.2101819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Long-acting injectable antipsychotics (LAIs) may reduce hospitalizations versus oral formulations (OAP) in bipolar disorder (BP) and schizophrenia/schizoaffective disorder (SCZ), but the impact on time to outpatient follow-up is less understood. OBJECTIVES To assess hospital readmissions and medical costs among Medicaid beneficiaries with BP or SCZ utilizing OAP or LAI SGAs. METHODS Cross-sectional and longitudinal analyses utilized comprehensive administrative claims of Oklahoma Medicaid beneficiaries (≥18 years) with BP or SCZ between 1 January 2013 and 31 December 2017. Readmissions, total direct medical costs, and psychiatry-related outpatient visits were assessed via generalized linear models and generalized estimating equations, controlling for demographic and clinical covariates. RESULTS Among 2523 included members, LAI utilization was associated with 1.50 and 1.73 times higher odds of any hospitalization and any readmission, respectively (p < .05). Cases involving both BP and SCZ were associated with a 2.40 times higher odds of any readmission, 2.26 times higher number of readmissions, and 24.5% higher costs (p < .001). Of the 468 members with a subsequent psychiatry-related outpatient visit, LAIs were associated with a 23.9% shorter duration to outpatient visit and 16.4% lower costs (p < .05). CONCLUSION In contrast to prior studies, this real-world investigation noted higher hospitalizations and readmissions among LAIs relative to OAP medications, but among members with a hospitalization or ED visit, LAIs were associated with shorter durations to outpatient visits and lower costs. Those with diagnoses of both BP with SCZ had higher odds of any readmission, number of readmissions, and costs relative to those with bipolar disorder alone and may be a key target for interventions.
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Affiliation(s)
- Laura M Tidmore
- Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Shellie L Keast
- Government Human Services Consulting, Mercer LLC, Phoenix, AZ, USA
| | - Heidi C Waters
- Health Outcomes, Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, NJ, USA
| | - Kristin L Pareja
- Health Outcomes, Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, NJ, USA
| | - Terry Cothran
- Department of Pharmacy, Oklahoma Health Care Authority, Oklahoma City, OK, USA
| | - Grant H Skrepnek
- Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
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Formulation and optimization of Paliperidone palmitate biodegradable injectable microspheres using Box-Behnken design. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wei Y, Yan VKC, Kang W, Wong ICK, Castle DJ, Gao L, Chui CSL, Man KKC, Hayes JF, Chang WC, Chan EW. Association of Long-Acting Injectable Antipsychotics and Oral Antipsychotics With Disease Relapse, Health Care Use, and Adverse Events Among People With Schizophrenia. JAMA Netw Open 2022; 5:e2224163. [PMID: 35900760 PMCID: PMC9335136 DOI: 10.1001/jamanetworkopen.2022.24163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Evidence for improved clinical outcomes with long-acting injectable antipsychotics (LAIAs) vs oral antipsychotics (OAs) is limited in Asian populations and special patient groups, including older people (>65 years), people with substance use, and early initiators of LAIAs. OBJECTIVE To compare the risk of disease relapse, health care use, and adverse events associated with the use of LAIAs vs OAs among people in Hong Kong with schizophrenia. DESIGN, SETTING, AND PARTICIPANTS In this self-controlled case series study, individuals with a diagnosis of schizophrenia who were prescribed LAIAs and OAs between January 1, 2004, and December 31, 2019, were identified from the Clinical Database Analysis and Reporting System of the Hong Kong Hospital Authority. Data analysis was conducted from May to August in 2021. EXPOSURES Use of LAIAs vs OAs. MAIN OUTCOMES AND MEASURES Risk of disease relapse (hospitalizations for psychiatric disorders, hospitalizations for schizophrenia, and suicide attempts), health care use (all-cause emergency department visits and hospitalizations), and adverse events (hospitalizations for somatic disorders, hospitalizations for cardiovascular diseases, and extrapyramidal symptoms) between the period in which patients were treated with LAIAs and the period in which patients were treated with OAs were compared using Poisson regression. RESULTS Of the 70 396 individuals with schizophrenia (37 200 women [52.8%]; mean [SD] age, 44.2 [15.8] years), 23 719 (33.7%) were prescribed both LAIAs and OAs. Compared with OAs, LAIAs were associated with a lower risk of hospitalizations for any cause (n = 20 973; incidence rate ratio [IRR], 0.63 [95% CI, 0.61-0.65]), hospitalizations for psychiatric disorders (n = 19 283; IRR, 0.52 [95% CI, 0.50-0.53]), hospitalizations for schizophrenia (n = 18 385; IRR, 0.53 [95% CI, 0.51-0.55]), and incident suicide attempts (n = 1453; IRR, 0.56 [95% CI, 0.44-0.71]). During full treatment with LAIAs, there was a reduction in hospitalizations for somatic disorders (n = 15 396; IRR, 0.88 [95% CI, 0.85-0.91]), hospitalizations for cardiovascular diseases (n = 3710; IRR, 0.88 [95% CI, 0.81-0.96]), and extrapyramidal symptoms (n = 22 182; IRR, 0.86 [95% CI, 0.82-0.91]) compared with full treatment with OAs. No significant difference was found for emergency department visits. Similar associations were observed during the subsequent treatment periods (beyond 90 days) and among older people and those with substance use, except for an increased risk of extrapyramidal symptoms among older people when initiating LAIAs (first 90 days). Compared with late initiators, early LAIA initiators had a greater reduction in these outcome events. CONCLUSIONS AND RELEVANCE This self-controlled case series study of people in Hong Kong with schizophrenia suggests that LAIAs were associated with a lower risk of disease relapse and hospitalization than OAs, without an increased risk of adverse events. Clinicians should more broadly consider the long-term use of LAIAs for Chinese people with schizophrenia, especially early in the course of illness.
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Affiliation(s)
- Yue Wei
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
| | - Vincent K. C. Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
| | - Wei Kang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
| | - Ian C. K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
| | - David J. Castle
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Le Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
| | - Celine S. L. Chui
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kenneth K. C. Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
| | - Joseph F. Hayes
- Division of Psychiatry, University College London, London, United Kingdom
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Esther W. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, Guangdong, China
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Pippal N, Halder S, Srivastava S, Kar R, Gupta R, Anthonio AE. Correlation between telomere length and efficacy of oral and long-acting injectable antipsychotics on severity and cognitive impairment of schizophrenia. Int J Psychiatry Clin Pract 2022; 26:157-164. [PMID: 34715000 DOI: 10.1080/13651501.2021.1994613] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study the correlation between telomere length (TL) and long-acting injectable (LAI) and oral atypical antipsychotic (OAA) efficacy on schizophrenia (SCZ) severity and cognitive impairment. METHODS Sixty Schizophrenia patients of 18-50 years and of either sex were included in a 12-week study. Thirty patients were recruited in each group, LAI and OAA. Positive and Negative Syndrome Scale (PANSS) and National Institute of Mental Health and Neuro-Sciences (NIMHANS) neuropsychological battery tests were evaluated at baseline and 12 weeks. TL was estimated at baseline. RESULTS Both groups showed a significant improvement in PANSS and NIMHANS battery test scores after treatment (p < 0.001) within the group, though not between the groups. Mean TL at baseline was 407.58 ± 143.93 and 443.40 ± 178.46 in LAI and OAA groups respectively. A significant negative correlation (r = -0.28, p = 0.03) of TL was seen with the mean change in negative PANSS score after treatment. CONCLUSIONS LAI antipsychotics are similar to OAA in decreasing the disorder severity and improving the cognitive impairment in schizophrenia. Also, patients who have shorter TL show greater improvement in the negative PANSS score. Hence, TL holds the potential of predicting antipsychotic drug response in schizophrenia patients.KEY POINTSLong-acting injectable antipsychotic was comparable to oral atypical antipsychotics in bringing out improvement in disorder severity, cognitive functions over 12 weeks.Shorter telomere length has been found to be associated with a greater response in negative symptoms of schizophrenia.
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Affiliation(s)
- Nisha Pippal
- Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Sumita Halder
- Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Shruti Srivastava
- Department of Psychiatry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rajarshi Kar
- Department of Biochemistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rachna Gupta
- Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Almeida Edelbert Anthonio
- Department of Biochemistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Okoli CTC, Kappi A, Wang T, Makowski A, Cooley AT. The effect of long-acting injectable antipsychotic medications compared with oral antipsychotic medications among people with schizophrenia: A systematic review and meta-analysis. Int J Ment Health Nurs 2022; 31:469-535. [PMID: 34931437 DOI: 10.1111/inm.12964] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Long-acting injectable (LAI) antipsychotic medications may be an important modality of reducing costs, improving symptoms, and fostering quality of life outcomes for those with schizophrenia. Our objective was to systematically review and conduct a meta-analysis of the effectiveness of LAIs compared with oral antipsychotics on medication adherence, symptom remission/relapse, rehospitalization, outpatient visits, emergency department visits, healthcare costs, and social functioning. We performed a systematic search of PsycInfo, CINAHL, PubMed, and Scopus databases to examine studies meeting inclusion criteria prior to August 30th, 2020. Randomized controlled trials, retrospective studies, prospective studies among people with schizophrenia with at least 6-month follow-up data were obtained. Overall effect sizes and associated 95% confidence intervals (CI) were estimated with random-effects modeling. We found 75 articles meeting our inclusion criteria, including 341 730 individuals with schizophrenia. Systematic review results indicated that LAIs compared with orals improved medication adherence (25/29 studies), symptom remission/relapse (10/18 studies), rehospitalizations (26/49 studies), emergency department visits (9/17 studies), medical costs (11/15 studies), and social functioning (5/9 studies); however, LAIs also increased outpatient visits (7/16 studies) and pharmacy costs (10/10 studies). Meta-analytic results of studies with similar outcome measures did not find differences between LAIs and orals in respect to outcomes, except lowering emergency department visits and increasing pharmacy costs. The differences between the results of the narrative synthesis and the meta-analyses were possibly because of the low availability of studies with similar outcomes in the pooled analyses. Our overall results suggest that LAIs are at least comparable to orals in supporting important healthcare outcomes for those with schizophrenia. These findings support clinical practice in encouraging providers to prescribe LAIs when indicated.
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Affiliation(s)
| | - Amani Kappi
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Tianyi Wang
- Department of Statistics, University of Kentucky College of Arts and Sciences, Lexington, Kentucky, USA
| | - Andrew Makowski
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Andrew T Cooley
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Portela R, Wainberg ML, Castel S, de Oliveira HN, Ruas CM. Risk factors associated with readmissions of patients with severe mental disorders under treatment with antipsychotics. BMC Psychiatry 2022; 22:189. [PMID: 35300649 PMCID: PMC8931964 DOI: 10.1186/s12888-022-03794-6] [Citation(s) in RCA: 3] [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: 12/22/2020] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the risk of readmission in patients with severe mental disorders, compare it between patients using different types of antipsychotics and determine risk factors for psychiatric readmission. METHODS Medical records of a non-concurrent cohort of 625 patients with severe mental disorders (such as psychoses and severe mood disorders) who were first discharged from January to December 2012 (entry into the cohort), with longitudinal follow-up until December 2017 constitute the sample. Descriptive statistical analysis of characteristics of study sample was performed. The risk factors for readmission were assessed using Cox regression. RESULTS Males represented 51.5% of the cohort, and 75.6% of the patients had no partner. Most patients (89.9%) lived with relatives, and 64.7% did not complete elementary school. Only 17.1% used more than one antipsychotic, 34.2% did not adhere to the treatment, and 13.9% discontinued the medication due to unavailability in public pharmacies. There was a need to change the antipsychotic due to the lack of therapeutic response (11.2% of the patients) and adverse reactions to the antipsychotic (5.3% of the patients). Cox regression showed that the risk of readmission was increased by 25.0% (RR, 1.25; 95% CI, 1.03-1.52) when used typical antipsychotics, compared to those who used atypical ones, and by 92.0% (RR, 1.92; 95% CI, 1.63-2.27) when patients did not adhere to maintenance treatment compared to those who adhered. CONCLUSIONS Use of atypical antipsychotics and adherence to treatment were associated with a lower risk of psychiatric readmissions.
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Affiliation(s)
- Ronaldo Portela
- Faculty of Pharmacy, Social Pharmacy Department, UFMG, PPGMAF, Presidente Antônio Carlos, Av., 6627 - Pampulha CEP: 31270-901, Belo Horizonte MG, Brasil.
| | - Milton Leonard Wainberg
- grid.413734.60000 0000 8499 1112Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, USA
| | - Saulo Castel
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Helian Nunes de Oliveira
- grid.8430.f0000 0001 2181 4888UFMG, Social and Preventive Medicine Department of Medical School, Belo Horizonte, Brazil
| | - Cristina Mariano Ruas
- grid.8430.f0000 0001 2181 4888Faculty of Pharmacy, Social Pharmacy Department, UFMG, PPGMAF, Presidente Antônio Carlos, Av., 6627 - Pampulha CEP: 31270-901, Belo Horizonte MG, Brasil
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Sexual Dysfunction in Schizophrenia: A Narrative Review of the Mechanisms and Clinical Considerations. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint3010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psychiatric disorders, in general, have a high prevalence of sexual problems, whether from the psychopathology of the disorder itself, pre-existing or co-morbid sexual disorder or from side effects of the treatment for mental disorders. Many patients report an already existing sexual dysfunction at the onset of diagnosis. The risk association for developing sexual dysfunction in patients with schizophrenia includes antipsychotic use and resulting hyperprolactinemia, age, gender, and disease severity. Medication side effects lead to nonadherence, and relapses lead to structural changes in the brain, treatment resistance, and worsening of symptoms. Findings in certain studies propose serum prolactin and thyroid-stimulating hormone measurement as a tool for assessing patients with schizophrenia for sexual dysfunction. Regarding specific symptoms, females especially reported decreased desire at baseline and galactorrhea after treatment. The findings of this review, therefore, suggest that sexual dysfunction may be present in patients with schizophrenia before starting antipsychotic treatment and that patients, especially those who are female, are likely to develop hyperprolactinemia with antipsychotic treatment. Aripiprazole may be an emergent treatment for sexual dysfunction in those who use antipsychotics. It is important for patients to consider sexual dysfunction prior to prescribing antipsychotics. Since sexual dysfunction can impact a patient’s quality of life and affect treatment adherence, it is important for physicians to be aware and monitor patients for symptoms.
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Japanese Society of Neuropsychopharmacology: "Guideline for Pharmacological Therapy of Schizophrenia". Neuropsychopharmacol Rep 2021; 41:266-324. [PMID: 34390232 PMCID: PMC8411321 DOI: 10.1002/npr2.12193] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022] Open
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Adams SC, McMillan J, Salline K, Lavery J, Moskowitz CS, Matsoukas K, Chen MMZ, Santa Mina D, Scott JM, Jones LW. Comparing the reporting and conduct quality of exercise and pharmacological randomised controlled trials: a systematic review. BMJ Open 2021; 11:e048218. [PMID: 34380726 PMCID: PMC8359527 DOI: 10.1136/bmjopen-2020-048218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/15/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Evaluate the quality of exercise randomised controlled trial (RCT) reporting and conduct in clinical populations (ie, adults with or at risk of chronic conditions) and compare with matched pharmacological RCTs. DESIGN Systematic review. DATA SOURCES Embase (Elsevier), PubMed (NLM) and CINAHL (EBSCO). STUDY SELECTION RCTs of exercise in clinical populations with matching pharmacological RCTs published in leading clinical, medical and specialist journals with impact factors ≥15. REVIEW METHODS Overall RCT quality was evaluated by two independent reviewers using three research reporting guidelines (ie, Consolidated Standards of Reporting Trials (CONSORT; pharmacological RCTs)/CONSORT for non-pharmacological treatments; exercise RCTs), CONSORT-Harms, Template for Intervention Description and Replication) and two risk of bias assessment (research conduct) tools (ie, Cochrane Risk of Bias, Jadad Scale). We compared research reporting and conduct quality within exercise RCTs with matched pharmacological RCTs, and examined factors associated with quality in exercise and pharmacological RCTs, separately. FINDINGS Forty-eight exercise RCTs (11 658 patients; median sample n=138) and 48 matched pharmacological RCTs were evaluated (18 501 patients; median sample n=160). RCTs were conducted primarily in cardiovascular medicine (43%) or oncology (31%). Overall quality score (composite of all research reporting and conduct quality scores; primary endpoint) for exercise RCTs was 58% (median score 46 of 80; IQR: 39-51) compared with 77% (53 of 68; IQR: 47-58) in the matched pharmacological RCTs (p≤0.001). Individual quality scores for trial reporting and conduct were lower in exercise RCTs compared with matched pharmacological RCTs (p≤0.03). Factors associated with higher overall quality scores for exercise RCTs were journal impact factor (≥25), sample size (≥152) and publication year (≥2013). CONCLUSIONS AND RELEVANCE Research reporting and conduct quality within exercise RCTs is inferior to matched pharmacological RCTs. Suboptimal RCT reporting and conduct impact the fidelity, interpretation, and reproducibility of exercise trials and, ultimately, implementation of exercise in clinical populations. PROSPERO REGISTRATION NUMBER CRD42018095033.
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Affiliation(s)
- Scott C Adams
- Department of Cardiology, Toronto General Research Institute, Toronto, Ontario, Canada
- Ted Rogers Cardiotoxicity Prevention Program, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Julia McMillan
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kirsten Salline
- Internal Medicine, NYU Langone Health, New York, New York, USA
| | - Jessica Lavery
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chaya S Moskowitz
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Maggie M Z Chen
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Santa Mina
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jessica M Scott
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Lee W Jones
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Medicine, Weill Cornell Medical College, New York, New York, USA
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Abstract
BACKGROUND Prazosin has been an accepted treatment for patients with post-traumatic stress disorder (PTSD) who experience sleep disturbances, including nightmares. Results of a recent large randomized control trial did not find benefit of prazosin vs placebo in improving such outcomes. A meta-analysis that includes this most recent trial was conducted to examine the pooled effect of prazosin vs placebo on sleep disturbances and overall PTSD symptoms in patients with PTSD. METHODS A systematic review of the published literature on trials comparing prazosin vs placebo for improvement of overall PTSD scores, nightmares, and sleep quality was conducted. Hedges' g standardized mean differences (SMD) between prazosin and placebo were calculated for each outcome across studies. RESULTS Six randomized placebo-controlled studies representing 429 patients were included in the analysis, including two studies with a crossover design. Results showed prazosin significantly improved overall PTSD scores (SMD = -0.31; 95% confidence intervals [CI]: -0.62, -0.01), nightmares (SMD = -0.75; 95% CI: -1.24, -0.27), and sleep quality (SMD = -0.57; 95% CI: -1.02, -0.13). In the largest trial, prazosin showed a reduction in clinical outcome measures similar to past studies, but a relatively large placebo effect size, particularly for nightmares, contributed to no treatment differences. CONCLUSIONS Despite the results of a recent, large randomized study, pooled effect estimates show that prazosin has a statistically significant benefit on PTSD symptoms and sleep disturbances. Limitations that should be considered include heterogeneity of study design and study populations as well as the small number of studies conducted and included in this meta-analysis.
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Thioritz W, Limoa E, Hutomo JC, Syamsuddin S, Lisal ST. Differentiation in Neurological Soft Sign Scores on Schizophrenic Patients with Antipsychotic Treatment. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Schizophrenia is a chronic mental illness that affects cognitive aspect of a patient which need long term care with antipsychotics. Long term use of antipsychotic itself causes neurobiological change in the brain which results in alteration of cognitive function. The latest research had demonstrated that NSS (Neurological Soft Sign) reflect a rather wide range of cognitive impairments in schizophrenia which was not accounted for by age, education or severity of global cognitive deficits. Therefore, we examined the effects and impact of antipsychotic Haloperidol and Risperidone treatment in schizophrenic patient using NSS scores.
The Study showed that chronic schizophrenia patients had a higher NSS scores than acute patients. NSS also significantly associated with all neuropsychological domains of MMSE in both groups and were confirmed when age, education and severity of global cognitive deficits were not accounted for. This study also obtained a lower NSS score in patients who received Risperidone therapy compared to Haloperidol with p = 0.003. Out of 5 NSS domain in the Heidelberg scale, there was a significant improvement in motor coordination and motor sequencing (p = 0.004) and (p = 0.048) in patients who received Risperidone therapy compared to Haloperidol. There was an association between the chronicity of the disease and NSS, NSS also shows that it’s not influenced by age, education and severity of global cognitive deficits as a screening instrument. Finally the improvement of NSS scores in the Risperidone group was far superior compared to the Haloperidol group particularly in motor coordination and motor sequencing.
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Burkhard C, Cicek S, Barzilay R, Radhakrishnan R, Guloksuz S. Need for Ethnic and Population Diversity in Psychosis Research. Schizophr Bull 2021; 47:889-895. [PMID: 33948664 PMCID: PMC8266627 DOI: 10.1093/schbul/sbab048] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article aims to evaluate "racial", ethnic, and population diversity-or lack thereof-in psychosis research, with a particular focus on socio-environmental studies. Samples of psychosis research remain heavily biased toward Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies. Furthermore, we often fail to acknowledge the lack of diversity, thereby implying that our findings can be generalized to all populations regardless of their social, ethnic, and cultural background. This has major consequences. Clinical trials generate findings that are not generalizable across ethnicity. The genomic-based prediction models are far from being applicable to the "Majority World." Socio-environmental theories of psychosis are solely based on findings of the empirical studies conducted in WEIRD populations. If and how these socio-environmental factors affect individuals in entirely different geographic locations, gene pools, social structures and norms, cultures, and potentially protective counter-factors remain unclear. How socio-environmental factors are assessed and studied is another major shortcoming. By embracing the complexity of environment, the exposome paradigm may facilitate the evaluation of interdependent exposures, which could explain how variations in socio-environmental factors across different social and geographical settings could contribute to divergent paths to psychosis. Testing these divergent paths to psychosis will however require increasing the diversity of study populations that could be achieved by establishing true partnerships between WEIRD societies and the Majority World with the support of funding agencies aspired to foster replicable research across diverse populations. The time has come to make diversity in psychosis research more than a buzzword.
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Affiliation(s)
- Carla Burkhard
- Research Master Student in Cognitive and Clinical Neuroscience Psychopathology Program, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Saba Cicek
- Department of Psychiatry, Gazi University Medical School, Ankara, Turkey
| | - Ran Barzilay
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia (CHOP), Philadelphia, PA,Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, PA,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Sinan Guloksuz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands,To whom correspondence should be addressed; Maastricht University Medical Center, Vijverdalseweg 1, PO Box 616, 6200 MD Maastricht, the Netherlands; tel: +31-433-88-40-71, fax: +31-433-88-4122, e-mail:
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Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. Lancet Psychiatry 2021; 8:387-404. [PMID: 33862018 DOI: 10.1016/s2215-0366(21)00039-0] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence of comparative benefits of long-acting injectable antipsychotics (LAIs) versus oral antipsychotics for schizophrenia has been inconsistent across study designs. The aim of this study was to evaluate the comparative benefits of LAIs versus oral antipsychotics in three study designs to inform clinical decision making. METHODS We did a comprehensive systematic review and meta-analysis comparing LAIs versus oral antipsychotics for schizophrenia covering three study designs: randomised controlled trials (RCTs), cohort studies, and pre-post studies. Our literature search was without language restrictions, in MEDLINE and PubMed, the Cochrane Library, Scopus, and Embase, for studies published from database inception up to a last search on March 13, 2020. We also searched for unpublished studies and ClinicalTrials.gov. We included studies lasting at least 6 months that targeted adults with schizophrenia and related disorders (>80% of participants). Studies on penfluridol (neither an LAI or daily oral antipsychotic), case reports, and case series with fewer than 20 patients were excluded. Two investigators independently extracted study-level data and resolved disagreement by consensus, or via a third investigator. Study authors were contacted to obtain additional information as needed. For our primary outcome we meta-analysed the risk ratio (RR) for hospitalisation or relapse with LAIs versus oral antipsychotics by a random-effects model, with hospitalisation used preferentially over relapse. As secondary analyses, we reversed the preferential order to relapse over hospitalisation, and assessed hospitalisation risk and relapse risk individually. Other secondary outcomes included all meta-analysable data, classed by relevance to effectiveness, efficacy, safety, quality of life, cognitive function, and other outcomes, and analysed by study design. Dichotomous outcomes were expressed as pooled RR and continuous outcomes as standardised mean difference (SMD). The protocol is registered with PROSPERO (CRD42019142094). FINDINGS We identified 14 687 records, of which 137 studies (397 319 patients) met the inclusion criteria (32 RCTs [23·4%; 8577 patients], 65 cohort studies [47·4%; 377 447 patients], and 40 pre-post studies [29·2%; 11 295 patients]) and were analysed. The quality of studies in terms of risk of bias varied across study designs and within each study design from low to high. LAIs were associated with a lower risk of hospitalisation or relapse than oral antipsychotics in each of the three study designs (RCTs: 29 studies, 7833 patients, RR 0·88 [95% CI 0·79-0·99], p=0·033; cohort studies: 44 studies, 106 136 patients, RR 0·92 [0·88-0·98], p=0·0044; pre-post studies: 28 studies, 17 876 patients, RR 0·44 [0·39-0·51], p<0·0001). This association was maintained across the study designs when we reversed the preferential order to risk of relapse over hospitalisation, and in individual analysis of hospitalisation risk. The association was maintained only in pre-post studies for relapse risk alone. In all other outcomes related to effectiveness, efficacy, safety, quality of life, cognitive function, and other outcomes, LAIs were more beneficial than oral antipsychotics in 60 (18·3%) of 328 comparisons, not different in 252 (76·8%) comparisons, and less beneficial in 16 (4·9%) comparisons when analysed by study design. Significant heterogeneity was observed across all three study designs. Publication biases were apparent in cohort and pre-post studies, but effect sizes were similar after trim-and-fill analyses. INTERPRETATION Although study designs have strengths and weaknesses, including potential low quality of observational studies, we consistently identified significant benefit with LAIs versus oral antipsychotics in preventing hospitalisation or relapse, in settings ranging from restricted research (RCTs) to real-word application (cohort and pre-post studies). Our findings suggest that increased clinical use of LAIs could improve outcomes in schizophrenia. FUNDING None. TRANSLATIONS For the Chinese, French, German, Italian, Japanese, Portugese and Spanish translations of the abstract see Supplementary Materials section.
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Yaegashi H, Misawa F, Noda H, Fujii Y, Takeuchi H. Risk of withdrawal of consent for treatment with long-acting injectable versus oral antipsychotics: A meta-analysis of randomized controlled trials. Schizophr Res 2021; 229:94-101. [PMID: 33309187 DOI: 10.1016/j.schres.2020.11.014] [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] [Received: 06/15/2020] [Revised: 09/03/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite the clinical importance of antipsychotic long-acting injections (LAIs) in the treatment of schizophrenia, their use may be limited by patients' reluctance to accept the injections. No studies to date have investigated whether patients are more likely to withdraw their consent to treatment with LAIs than to treatment with oral antipsychotics (OAPs). Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) to compare the risk of withdrawal of consent between the 2 routes of administration. METHODS PubMed, the Cochrane Library, PsycINFO, and CINAHL were systematically searched. RCTs with open-label or rater-masked design that compared LAIs with OAPs were selected. Data on study discontinuation due to withdrawal of consent and/or loss to follow-up were extracted. RESULTS A total of 16 studies (4815 patients) that met the study eligibility criteria were included in the meta-analysis. There was no significant difference between the LAI and OAP groups in the risk of cessation of treatment because of withdrawal of consent. Similarly, there was no significant difference in the risk of study discontinuation because of withdrawal of consent plus loss to follow-up. CONCLUSIONS These findings were unexpected and suggest that patients may not be more hesitant to continue LAIs than OAPs after consenting to or receiving treatment. Nevertheless, patients should be provided detailed explanations about the use of LAIs and a support system that encourages them to continue treatment.
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Affiliation(s)
| | | | - Hokuto Noda
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan
| | - Yasuo Fujii
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan
| | - Hiroyoshi Takeuchi
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Canada.
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Kimura H, Kanahara N, Iyo M. Rationale and neurobiological effects of treatment with antipsychotics in patients with chronic schizophrenia considering dopamine supersensitivity. Behav Brain Res 2021; 403:113126. [PMID: 33460681 DOI: 10.1016/j.bbr.2021.113126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
The long-term treatment of patients with schizophrenia often involves the management of relapses for most patients and the development of treatment resistance in some patients. To stabilize the clinical course and allow as many patients as possible to recover, clinicians need to recognize dopamine supersensitivity, which can be provoked by administration of high dosages of antipsychotics, and deal with it properly. However, no treatment guidelines have addressed this issue. The present review summarized the characteristics of long-acting injectable antipsychotics, dopamine partial agonists, and clozapine in relation to dopamine supersensitivity from the viewpoints of receptor profiles and pharmacokinetics. The potential merits and limitations of these medicines are discussed, as well as the risks of treating patients with established dopamine supersensitivity with these classes of drugs. Finally, the review discussed the biological influence of antipsychotic treatment on the human brain based on findings regarding the relationship between the hippocampus and antipsychotics.
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Affiliation(s)
- Hiroshi Kimura
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Chiba, Japan; Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Psychiatry, Gakuji-kai Kimura Hospital, Chiba, Japan.
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan; Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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Civan Kahve A, Kaya H, Gül Çakıl A, Ünverdi Bıçakçı E, Göksel P, Göka E, Böke Ö. Multiple antipsychotics use in patients with schizophrenia: Why do we use it, what are the results from patient follow-ups? Asian J Psychiatr 2020; 52:102063. [PMID: 32302936 DOI: 10.1016/j.ajp.2020.102063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
In this study, the rates of antipsychotic polypharmacy, factors affecting combined drug use, the relationship between antipsychotic polypharmacy as it relates to duration of hospitalization and re-hospitalization, and treatment compliance were evaluated in schizophrenia patients. The study data was obtained between January 1, 2017 and December 31, 2017 by examining the files of all patients who were hospitalized in Ondokuz Mayıs University Faculty of Medicine Hospital, Ankara Numune Training and Research Hospital, Ankara Gulhane Training and Research Hospital psychiatric services. The inpatients' drug prescriptions at discharge and after one-year outpatient follow-up, as well as treatment compliance and re-hospitalization, were examined. The mean duration of illness was 109.3 ± 109.7 months, and the mean duration of hospitalization was 24.6 ± 19.1 days. For a total of 599 patients, multiple antipsychotic medication was used in 21.2% of hospitalizations. 11.2% of patients using single antipsychotic and 14.2% of patients using multiple antipsychotics were re-hospitalized within one year (X 2 :0.830, p:0.362). Disease duration (Z:-3.654, p < 0.001) and duration of hospitalization (Z:-3.333, p < 0.001) were found to be longer in multiple antipsychotic users. 37.8% of the patients used a depot antipsychotic. There was no significant difference between depot antipsychotic use and oral antipsychotic use as it related re-hospitalization rates. As a conclusion, multiple antipsychotic use has reduced in Turkey. Contrary to popular belief, the use of multiple antipsychotics does not shorten, but rather may prolongs hospitalization, and it has no effect in reducing re-hospitalization. Drug combinations are generally used together with a depot treatment, clozapine treatment is preferred less frequently in combinations, clinicians have proven effectiveness of the drug combination they prefer, and they should give priority to the treatments recommended in treatment guidelines.
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Affiliation(s)
| | - Hasan Kaya
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Atike Gül Çakıl
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | | | - Pelin Göksel
- Ondokuz Mayıs University, Faculty of Medicine, Department of Psychiatry, Samsun, Turkey
| | - Erol Göka
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ömer Böke
- Ondokuz Mayıs University, Faculty of Medicine, Department of Psychiatry, Samsun, Turkey
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Nakonezny PA, Lindow JC, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Byerly MJ. A single assessment with the Brief Adherence Rating Scale (BARS) discriminates responders to long-acting injectable antipsychotic treatment in patients with schizophrenia. Schizophr Res 2020; 220:92-97. [PMID: 32269005 PMCID: PMC7306424 DOI: 10.1016/j.schres.2020.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/30/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine if a single baseline adherence assessment (Brief Adherence Rating Scale [BARS]) could identify patients who are likely to respond to long-acting injectable (LAI) antipsychotic treatment. METHOD The current secondary analysis included a sub-sample of adult outpatients (N = 176) with schizophrenia or schizoaffective disorder who participated in the "A Comparison of Long-Acting Injectable Medications for Schizophrenia (ACLAIMS)" trial and had a baseline BARS assessment and a baseline and month 3 Positive and Negative Syndrome Scale (PANSS) rating. The main outcome was LAI treatment response, defined as a ≥ 20% decrease (baseline to month 3) on the PANSS total score. Receiver Operating Characteristic (ROC) and Area Under the Curve (AUC) analysis was conducted to determine the optimal cutpoint of baseline BARS adherence in discriminating LAI treatment response at month 3. A logistic mixed model estimated the odds of response to LAI treatment at month 3 from the optimal baseline BARS cutpoint. RESULTS The ROC analysis determined that the single baseline BARS rating (cutoff ≤66%), indicating low adherence, best discriminated patients likely to respond to LAI treatment (AUC = 0.603, SE = 0.046, 95% binomial exact CI = 0.527 to 0.676, p = 0.025), with 38% sensitivity and 85% specificity. The logistic mixed model analysis revealed that patients with ≤66% BARS adherence had 3.464 times the predicted odds (95% CI = 1.604 to 7.480, p = 0.001) of responding to LAI treatment than those who were >66% BARS adherent. CONCLUSION A single baseline BARS assessment discriminated response to LAI treatment suggesting it is a reasonable tool to identify candidates for LAI antipsychotic treatment.
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Affiliation(s)
- Paul A. Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390 USA,Department of Population and Data Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Janet C. Lindow
- Department of Psychiatry, University of Arizona, Biomedical Research Foundation of Southern Arizona, and Southern Arizona VA Health Care System, Tucson, AZ 85723 USA
| | - T. Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY 10032 USA
| | - Joseph P. McEvoy
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA 30912 USA
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Robert A. Rosenheck
- Veterans Affairs (VA) New England Mental Illness, Research Education and Clinical Center, VA Connecticut Healthcare System, West Haven, and the Yale School of Medicine, New Haven, CT 06516 USA
| | - Matthew J. Byerly
- Department of Psychiatry, University of Arizona and Southern Arizona VA Health Care System, Tucson, AZ 85723 USA
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Fang SC, Liao DL, Huang CY, Hsu CC, Cheng SL, Shao YHJ. The effectiveness of long-acting injectable antipsychotics versus oral antipsychotics in the maintenance treatment of outpatients with chronic schizophrenia. Hum Psychopharmacol 2020; 35:e2729. [PMID: 32182388 DOI: 10.1002/hup.2729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To compare the psychiatric service utilization between patients who only received long-acting injectable antipsychotics (LAIAs) and those who only received oral antipsychotics (OAPs) in the maintenance treatment of chronic schizophrenia. METHODS We constructed a cohort of chronic schizophrenia patients who underwent maintenance treatment from the Taiwan National Health Insurance Research Database in 2011 and followed these patients for 12 months. We included patients who had been diagnosed with schizophrenia for at least 3 years, were not hospitalized in 2011, and had received 1 year of maintenance treatment. Inverse probability of treatment weighting logistic, linear, and negative binomial regression models were used to estimate associated psychiatric services utilization and adjust for covariate imbalances between the LAIAs and OAPs groups. RESULTS Among 40,194 patients, 948 (2.36%) received only LAIAs and 39,246 (97.64%) received only OAPs. Compared with those who received only OAPs, the sole LAIAs users were associated with a lower percentage of psychiatric hospitalization (8.4% and 5.8%, respectively; odds ratio: 0.63, p < .01), shorter lengths of hospitalization days (82.8 and 65.9, respectively; coefficient [b]: -16.87, p = .03), and fewer emergency room visits (2.3 and 1.8, respectively; b: -0.24, p < .01) per patient. CONCLUSIONS Chronic schizophrenia patients who received only LAIs had a lower risk of disease relapse and a reduction in psychiatric service utilization than those receiving only OAPs.
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Affiliation(s)
- Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan.,Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Ding-Lieh Liao
- Department of General Psychiatry, Taoyuan Psychiatric Center Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Cheng-Yi Huang
- Department of Community Psychiatry, Bali Psychiatric Center Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Chun-Chi Hsu
- Department of General Psychiatry, Taoyuan Psychiatric Center Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Shu-Li Cheng
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Yu-Hsuan J Shao
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.,Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Davis KAS, Farooq S, Hayes JF, John A, Lee W, MacCabe JH, McIntosh A, Osborn DPJ, Stewart RJ, Woelbert E. Pharmacoepidemiology research: delivering evidence about drug safety and effectiveness in mental health. Lancet Psychiatry 2020; 7:363-370. [PMID: 31780306 DOI: 10.1016/s2215-0366(19)30298-6] [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] [Received: 03/21/2019] [Revised: 07/19/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Abstract
Research that provides an evidence base for the pharmacotherapy of people with mental disorders is needed. The abundance of digital data has facilitated pharmacoepidemiology and, in particular, observational research on the effectiveness of real-world medication. Advantages of pharmacoepidemiological research are the availability of large patient samples, and coverage of under-researched subpopulations in their naturalistic conditions. Such research is also cheaper and quicker to do than randomised controlled trials, meaning that issues regarding generic medication, stopping medication (deprescribing), and long-term outcomes are more likely to be addressed. Pharmacoepidemiological methods can also be extended to pharmacovigilance and to aid the development of new purposes for existing drugs. Drawbacks of observational pharmacoepidemiological studies come from the non-randomised nature of treatment selection, leading to confounding by indication. Potential methods for managing this drawback include active comparison groups, within-individual designs, and propensity scoring. Many of the more rigorous pharmacoepidemiology studies have been strengthened through multiple analytical approaches triangulated to improve confidence in inferred causal relationships. With developments in data resources and analytical techniques, it is encouraging that guidelines are beginning to include evidence from robust observational pharmacoepidemiological studies alongside randomised controlled trials. Collaboration between guideline writers and researchers involved in pharmacoepidemiology could help researchers to answer the questions that are important to policy makers and ensure that results are integrated into the evidence base. Further development of statistical and data science techniques, alongside public engagement and capacity building (data resources and researcher base), will be necessary to take full advantage of future opportunities.
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Affiliation(s)
- Katrina A S Davis
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | - Saeed Farooq
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Joseph F Hayes
- Camden and Islington NHS Foundation Trust, London, UK; Division of Psychiatry, University College London, London, UK
| | - Ann John
- Health Data Research UK Institute of Health Informatics Research, Swansea University Medical School, Swansea, UK
| | - William Lee
- University of Exeter Medical School, Exeter, UK
| | - James H MacCabe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrew McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - David P J Osborn
- Camden and Islington NHS Foundation Trust, London, UK; Division of Psychiatry, University College London, London, UK
| | - Robert J Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Patel MX, Bent-Ennakhil N, Sapin C, di Nicola S, Loze JY, Nylander AG, Heres S. Attitudes of European physicians towards the use of long-acting injectable antipsychotics. BMC Psychiatry 2020; 20:123. [PMID: 32169077 PMCID: PMC7071632 DOI: 10.1186/s12888-020-02530-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/04/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prescription rates for long-acting injectable (LAI) antipsychotic formulations remain relatively low in Europe despite improved adherence over alternative oral antipsychotic treatments. This apparent under-prescription of LAI antipsychotics may have multiple contributing factors, including negative mental health practitioner attitudes towards the use of LAIs. METHODS The Antipsychotic Long acTing injection in schizOphrenia (ALTO) non-interventional study (NIS), conducted across several European countries, utilised a questionnaire that was specifically designed to address physicians' attitudes and beliefs towards the treatment of schizophrenia with LAI antipsychotics. Exploratory principal component analysis (PCA) of feedback from the questionnaire aimed to identify and characterize the factors that best explained the physicians' attitudes towards prescription of LAIs. RESULTS Overall, 136/234 solicited physicians returned fully completed questionnaires. Physicians' mean age was 48.5 years, with mean psychiatric experience of 20.0 years; 69.9% were male, 84.6% held a consultant position, and 91.9% had a clinical specialty in general adult care. Most physicians considered themselves to have a high level of clinical experience with LAI antipsychotics (77.2%), with an increased rate of LAI antipsychotics prescription over the last 5 years (59.6%). Although the majority of physicians (69.9%) declared feeling no difference in stress levels when offering LAI compared to oral antipsychotics, feelings of 'no/more stress' versus 'less stress' was found to influence prescription patterns. PCA identified six factors which collectively explained 66.1% of the variance in physician feedback. Multivariate analysis identified a positive correlation between physicians willing to accept usage of LAI antipsychotics and the positive attitude of colleagues (co-efficient 3.67; p = 0.016). CONCLUSIONS The physician questionnaire in the ALTO study is the first to evaluate the attitudes around LAI antipsychotics across several European countries, on a larger scale. Findings from this study offer an important insight into how physician attitudes can influence the acceptance and usage of LAI antipsychotics to treat patients with schizophrenia.
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Affiliation(s)
- Maxine X. Patel
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | | | | | | | | | - Stephan Heres
- grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, Munich Technical University, Munich, Germany
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Berna F, Göritz AS, Behr G, Moritz S. Pill or needle? Determinants of the preference for long-acting injection over oral treatment in people facing chronic illness. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109798. [PMID: 31682893 DOI: 10.1016/j.pnpbp.2019.109798] [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: 07/20/2019] [Revised: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
Although long-acting injection (LAI) is presented as first line treatment option for patients with psychosis, negative attitudes toward this galenic negatively impact the selection of this treatment option. However, these negative attitudes may not be confined to patients but also observed in the general population. A web-based study on 1807 participants was conducted during which participants imagined that they had a particular chronic illness based on clinical vignettes (mental illnesses: schizophrenia, depression; somatic illnesses: multiple sclerosis, rheumatoid arthritis). The frequency of relapse and the intensity of symptoms were experimentally manipulated in the vignettes. Participants rated their subjective distress associated with each vignette, their belief in the effectiveness of treatment, and their treatment preference regarding medication. We examined under which conditions LAI was preferred over pills. Statistical analyses were performed using Bayesian methods. Results showed that participants preferred LAI over pills in 40.5% to 50.8% of cases. LAI was more preferred for illnesses with low frequency of relapse, low subjective distress, and for somatic than for mental illnesses. The perceived advantage for LAI over pills and the belief about the better efficiency of LAI were the main factors that drove the preference for LAI. Keeping in mind some advantages of LAI, the public negative representations of injections might partially influence patients' prejudices against LAI. These attitudes should be named and discussed with the patients when LAI seems to represent a relevant therapeutic option.
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Affiliation(s)
- Fabrice Berna
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Inserm U1114, Strasbourg, France; Fondation FondaMental, Créteil, France.
| | - Anja S Göritz
- Occupational and Consumer Psychology, Freiburg University, Freiburg, Germany.
| | - Guillaume Behr
- Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Inserm U1114, Strasbourg, France.
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany.
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Attitudes Toward Long-Term Medication Use-A Comparison Between Concerned Populations and a Sample From the German General Population: An Example of Real World Evidence. J Clin Psychopharmacol 2020; 39:357-361. [PMID: 31205186 DOI: 10.1097/jcp.0000000000001063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE/BACKGROUND The present study was conducted to investigate the difference in attitudes toward psychiatric drugs, long-term medication, and depot formulations between psychiatric patients and patient-related groups and the German general public. METHODS/PROCEDURES Different groups (n = 50 patients, n = 34 relatives of patients, n = 42 psychiatrists, n = 70 medical students, and n = 58 psychiatric nursing professionals) were surveyed using a questionnaire to investigate their attitude toward depot medication and compared with matched participants from the German general public. FINDINGS/RESULTS Patients did not differ from their matched controls regarding their attitude toward potential reasons to reject a depot, whereas psychiatrists (P = 0.002) and nursing staff (P = 0.003) were more concerned about patients fearing an injection than their matched controls. IMPLICATIONS/CONCLUSIONS Psychiatrists and psychiatric nurses were significantly more concerned about giving an (intragluteal) injection because of concerns about patients' fears of this administration method than their matched controls. In contrast, patients' concerns about receiving an injection did not differ from their matched controls. Furthermore, we found that psychiatrists tended to believe that giving an injection might be time-consuming than giving oral medication. These results may emphasize the fact that the low rate of depot medication use is derived from subjective reservations of medical staff rather than actual negative attitudes or fears of patients.
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Abdel-Baki A, Thibault D, Medrano S, Stip E, Ladouceur M, Tahir R, Potvin S. Long-acting antipsychotic medication as first-line treatment of first-episode psychosis with comorbid substance use disorder. Early Interv Psychiatry 2020; 14:69-79. [PMID: 31125513 DOI: 10.1111/eip.12826] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/11/2019] [Accepted: 04/14/2019] [Indexed: 12/13/2022]
Abstract
AIM Substance use disorder (SUD) is highly prevalent among patients with first-episode psychosis (FEP) and associated with poor adherence and worst treatment outcomes. Although relapses are frequent in FEP, current literature on long-acting injectable antipsychotics (LAI-AP) use in FEP is scarce and studies often exclude patients with SUD. OBJECTIVES To determine the impact of LAI-AP as first-line treatment on psychotic relapses or rehospitalizations in FEP patients with comorbid SUD (FEP-SUD). METHODS This is a naturalistic, longitudinal, 3-year prospective and retrospective study on 237 FEP-SUD admitted in two EIS in Montreal, between 2005 and 2012. The patients were divided on the basis of first-line medication introduced, either oral antipsychotics (OAP, n = 206) or LAI-AP (n = 31). Baseline characteristics were compared using χ² test and analysis of variance, and Kaplan-Meier survival analysis was performed on relapse and rehospitalization. RESULTS Compared to the OAP group, patients in the LAI-AP group presented worse prognostic factors (eg, history of homelessness). Despite this, the LAI-AP group presented a lower relapse rate (67.7% vs 76.7%), higher relapse-free survival time (694 vs 447 days, P = 0.008 in Kaplan-Meier analysis), and trends for reduced rehospitalization rates (48.4% vs 57.3%) and hospitalization-free survival time (813 vs 619 days, P = 0.065 Kaplan-Meier analysis). Of those receiving OAP as first-line, 41.3% were eventually switched to LAI-AP and displayed worst outcome in relapse and rehospitalization. CONCLUSION LAI-AP should be strongly considered as first-line treatment of FEP-SUD patients since this pharmacological option reduces the risk of relapse and rehospitalization even in the individuals with poor prognostic factors.
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Affiliation(s)
- Amal Abdel-Baki
- Department of Psychiatry, University of Montreal, Canada.,Department of Psychiatry, Centre hospitalier de l'Université de Montréal, Canada
| | | | - Sofia Medrano
- Department of Psychiatry, University of Montreal, Canada
| | - Emmanuel Stip
- Department of Psychiatry, University of Montreal, Canada.,Department of Psychiatry, Centre hospitalier de l'Université de Montréal, Canada
| | - Martin Ladouceur
- Centre de recherche duCentre hospitalier de l'Université de Montréal (CRCHUM), Canada
| | - Ramzan Tahir
- Centre de recherche duCentre hospitalier de l'Université de Montréal (CRCHUM), Canada
| | - Stephane Potvin
- Department of Psychiatry, University of Montreal, Canada.,Centre de recherche de l'Institut Universitaire en Santé mentale de Montréal, Canada
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Long-Acting Injectables Versus Oral Antipsychotics: A Retrospective Bidirectional Mirror-Image Study. J Clin Psychopharmacol 2020; 39:441-445. [PMID: 31415288 DOI: 10.1097/jcp.0000000000001082] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Mirror-image studies, which compare equal periods of time before and after a new treatment is introduced, may reflect the real-world impact of that treatment. However, most mirror-image studies that have investigated the impact of long-acting injectable antipsychotics (LAIs) were unidirectional in design, for patients switching from oral antipsychotics (OAPs) to LAIs. Therefore, we conducted a bidirectional mirror-image study comparing LAIs and OAPs. METHODS We included 126 schizophrenia or schizoaffective disorder patients' LAI treatment data from 3 psychiatric hospitals. Patients took OAPs for 6 months or more before initiating LAIs, or the reverse. We obtained data on the number of hospitalizations as a primary outcome, plus the total duration and mean duration of hospitalization as secondary outcomes during the 6 months of the patients' first treatment, and the 6 months after the patients started their second type of treatment. RESULTS The results indicated that there was no significant difference in any outcomes between LAI and OAP treatment when going from LAIs to OAPs (n = 59). However, when patients started with OAPs and switched to LAIs (n = 67), they were hospitalized a significantly fewer number of times, and the duration of their stays was shorter in the LAI phase than in the OAP phase. When combined with bidirectional data, LAI superiority was still observed. CONCLUSIONS The findings endorse the relative effectiveness of LAIs over OAPs in the real world, although the inherent flaws of mirror-image studies such as expectation bias and having no parallel comparator should be considered.
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31
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Health and work disability outcomes in parents of patients with schizophrenia associated with antipsychotic exposure by the offspring. Sci Rep 2020; 10:1219. [PMID: 31988392 PMCID: PMC6985214 DOI: 10.1038/s41598-020-58078-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 01/10/2020] [Indexed: 11/24/2022] Open
Abstract
This study aimed to identify if antipsychotic exposure in offspring is associated with psychiatric and non-psychiatric healthcare service use and work disability of their parents. This Swedish population-based cohort study was based on data comprising 10,883 individuals with schizophrenia, who had at least one identifiable parent in the nationwide registers, and their parents (N = 18,215). The register-based follow-up during 2006–2013 considered the level of antipsychotic exposure and persistence of use of the offspring, further categorized into first (FG) and second generation (SG) antipsychotics, and orals versus long-acting injections (LAIs). The main outcome measure was parental psychiatric healthcare service use, secondary outcomes were non-psychiatric healthcare use and long-term sickness absence. SG-LAI use was associated with a decreased risk (relative risks [RR] 0.81-0.85) of parental psychiatric healthcare use compared with not using SG-LAI, whereas oral antipsychotics were associated with an increased risk (RRs 1.10–1.29). Both FG- and SG-LAI use by the offspring were associated with a lower risk of long-term sickness absence (range of odds ratios 0.34–0.47) for the parents, compared with non-use of these drugs. The choice of antipsychotic treatment for the offspring may have an impact on work disability and healthcare service use of their parents.
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Kim HO, Seo GH, Lee BC. Real-world effectiveness of long-acting injections for reducing recurrent hospitalizations in patients with schizophrenia. Ann Gen Psychiatry 2020; 19:1. [PMID: 31956334 PMCID: PMC6958777 DOI: 10.1186/s12991-019-0254-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/19/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The comparative effectiveness of antipsychotic long-acting injections (LAIs) and oral medication is not clear due to various methodological problems. METHODS To compare the effectiveness of LAIs and oral antipsychotics in preventing readmission in patients with schizophrenia, we performed a within-subject analysis of data collected from 75,274 patients hospitalized with schizophrenia over a 10-year period (2008-2017). Readmission rates were compared according to medication status (non-medication, oral medication alone, and LAI medication). Each admission episodes were compared according to medication status before admission. RESULTS Total 132,028 episodes of admission were analyzed. During 255,664 person-years of total observation, 101,589 outcome events occurred. Comparing LAI to only oral medication, IRR was 0.71 (0.64-0.78, P < 0.001). IRR of LAI to only oral medication of first index admission was 0.74 (0.65-0.86). As hospitalization was repeated, IRR of second, third, and fourth or more index admission decreased 0.65 (0.53-0.79), 0.56 (0.43-0.76), and 0.42 (0.31-0.56), respectively. CONCLUSIONS LAI treatment reduced the readmission rate by 29% compared with oral medication in real-world settings. Moreover, LAIs reduced the readmission rate by 58% in patients with repeated admissions. The more readmissions, the greater the effect of LAIs in reducing the risk of re-hospitalization compared with oral antipsychotics.
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Affiliation(s)
- Hye Ok Kim
- 1Health Insurance Review and Assessment Service, Seoul, South Korea
| | - Gi Hyeon Seo
- 1Health Insurance Review and Assessment Service, Seoul, South Korea
| | - Boung Chul Lee
- 1Health Insurance Review and Assessment Service, Seoul, South Korea.,2Department of Psychiatry, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12, Beodeunaru-ro 7-gil, Yeongdeungpo-gu, 07247 Seoul, South Korea
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Recovery-Oriented Outcomes Associated with Long-Acting Injectable Antipsychotics in an Urban Safety-Net Population. Community Ment Health J 2019; 55:979-982. [PMID: 31102164 DOI: 10.1007/s10597-019-00412-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/13/2019] [Indexed: 02/07/2023]
Abstract
This study examined whether transitioning patients from oral antipsychotics (POs) to long-acting injectable antipsychotics (LAIs) helps patients achieve recovery-oriented goals. Data was extracted from San Francisco County's electronic medical record system for this retrospective pre-post observational study. Patients reflect a safety-net population treated in community-based mental health settings during 2015. The San Francisco Adult Strengths and Needs Assessment (SF ANSA), a measure of psychosocial functioning, was used to assess within-subject change when treated with POs versus LAIs. In our study sample (N = 77), LAI SF ANSA scores showed significant improvements in criminal behaviors (p = .017), medication adherence (p = .008), and spirituality (p = .028), and a non-significant trend for residential stability (p = .073). This is the first study to evaluate improvements in key psychosocial areas after treatment with LAIs. This work suggests that LAIs can be another tool for providers to help patients work towards their recovery-oriented goals.
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Differences in the Effectiveness of Long-Acting Injection and Orally Administered Antipsychotics in Reducing Rehospitalization among Patients with Schizophrenia Receiving Home Care Services. J Clin Med 2019; 8:jcm8060823. [PMID: 31181830 PMCID: PMC6617370 DOI: 10.3390/jcm8060823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 05/30/2019] [Accepted: 06/05/2019] [Indexed: 01/08/2023] Open
Abstract
The current study explored the differences in the effectiveness of first and second generation long-acting injections and orally administered antipsychotics in reducing the rehospitalization rate among patients with schizophrenia receiving home care services in a medical center in Southern Taiwan. Longitudinal data between 1 January 2006, and 31 December 2015, were collected retrospectively. Patients were classified into three treatment groups: First generation antipsychotic (FGA) long-acting injection (LAI), second generation antipsychotic long-acting injection (SGA) (LAI), and oral antipsychotics. The primary outcomes were the rehospitalization rate and the follow-up time (duration of receiving home care services) until psychiatric rehospitalization. A total of 78 patients with schizophrenia were recruited. The average observation time was about 40 months. The oral treatment group tended to be older with a higher number of female patients and a lower level of education. The FGA treatment group tended to have a higher frequency and duration of hospitalization before receiving home care services. We found no significant differences in the follow-up time or psychiatric rehospitalization rate after receiving home care services among the three treatment groups. We propose that oral and LAI antipsychotics were equally effective when patients received home care services. Our results can serve as a reference for the choice of treatment for patients with schizophrenia in a home care program.
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35
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Olagunju AT, Clark SR, Baune BT. Long-acting atypical antipsychotics in schizophrenia: A systematic review and meta-analyses of effects on functional outcome. Aust N Z J Psychiatry 2019; 53:509-527. [PMID: 30957510 DOI: 10.1177/0004867419837358] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Impairment in psychosocial function is common in schizophrenia. Long-acting injectable atypical antipsychotics are thought to enhance psychosocial function by boosting adherence. However, no systematic review has examined the effects of long-acting injectable atypical antipsychotics on psychosocial function in clinical trials. METHODS We searched major databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and Clinical Trial Registries for randomised controlled trials that compared long-acting injectable atypical antipsychotics to placebo, oral antipsychotic medications or long-acting injectable atypical antipsychotics for all years till 2018, with no language limits. We performed a systematic review of findings on change in psychosocial function and its predictors in the included reports. Data on change in psychosocial functioning were meta-analysed using a random-effects model. RESULTS A total of 26 studies were included in systematic review, and 19 studies with 8616 adults, 68.1% males were meta-analysed. Long-acting injectable atypical antipsychotics were superior to placebo (standardised mean difference = 0.39; 95% confidence interval = [0.32, 0.47]; p < 0.001; I2 = 0%; 9 studies) and oral antipsychotic medications (standardised mean difference = 0.16; 95% confidence interval = [0.01, 0.31]; p = 0.04; I2 = 77%; 10 studies) for improved psychosocial function and superiority was maintained in short- and long trials. Poor psychosocial function was predicted by longer treatment duration, severe symptoms, poor cognition and poor insight. Functioning was assessed by either a single or a combination of measures, but was not the primary outcome in most studies. Other sources of bias include poor blinding and reporting of randomisation. CONCLUSION Long-acting injectable atypical antipsychotics are beneficial for recovery of psychosocial function in comparison with placebo, but the magnitude of superiority over oral antipsychotic treatment was small. Severe psychopathology at baseline predicted poor psychosocial function. Future effectiveness trials in which post-randomisation involvement is kept to a minimum, and psychosocial function is included as primary outcome a priori, are needed to capture the real-world impact of long-acting injectable atypical antipsychotics and to address methodological biases.
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Affiliation(s)
- Andrew T Olagunju
- 1 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,2 Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Scott R Clark
- 1 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Bernhard T Baune
- 1 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,3 Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia.,4 The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,5 University Hospital for Psychiatry and Psychotherapy, University of Münster, Münster, Germany
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Kim J, Ozzoude M, Nakajima S, Shah P, Caravaggio F, Iwata Y, De Luca V, Graff-Guerrero A, Gerretsen P. Insight and medication adherence in schizophrenia: An analysis of the CATIE trial. Neuropharmacology 2019; 168:107634. [PMID: 31077729 DOI: 10.1016/j.neuropharm.2019.05.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/30/2019] [Accepted: 05/07/2019] [Indexed: 01/11/2023]
Abstract
Adherence to antipsychotic medication is critical for the treatment of patients with schizophrenia. Impaired insight into illness is one of the principal drivers of medication nonadherence, which contributes to negative clinical outcomes. The aims of this study were to examine the relationships between impaired insight and (1) rates of antipsychotic medication nonadherence, and (2) time to medication nonadherence using data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Insight was assessed using the Positive and Negative Syndrome Scale (PANSS) item G12 (lack of judgment and insight). Patients were divided into 3 groups based on their degree of insight impairment, i.e. no impairment (PANSS G12 = 1), minimal impairment (PANSS G12 = 2-3), and moderate-to-severe insight impairment (PANSS G12 ≥ 4). Medication nonadherence was defined as taking less than 80% of monthly pill counts. Kaplan-Meier survival and Cox regression analyses were performed to examine differences in time to medication nonadherence between insight groups. There were significant differences between insight groups in the percentage of nonadherent patients at 6 months (χ2(2) = 8.80, p = 0.012) and 18 months (χ2(2) = 10.04, p = 0.007) after study initiation. Moderate-to-severe insight impairment was associated with earlier nonadherence compared to minimal (χ2 = 4.70, p = 0.030) or no impairment (χ2 = 11.92, p = 0.001). The association remained significant after adjustment for illness severity, substance use, attitudes toward medication, cognition, level of hostility, and depression. The results of this study indicate a strong link between impaired insight and antipsychotic medication nonadherence. Interventions to enhance insight early during treatment may help improve medication adherence, and in turn, long-term clinical and functional outcomes in patients with schizophrenia. This article is part of the issue entitled 'Special Issue on Antipsychotics'.
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Affiliation(s)
- Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Miracle Ozzoude
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Shinichiro Nakajima
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Neuropsychiatry, Keio University, Tokyo, Japan
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vincenzo De Luca
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, CAMH, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.
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Gentile S. Discontinuation rates during long-term, second-generation antipsychotic long-acting injection treatment: A systematic review. Psychiatry Clin Neurosci 2019; 73:216-230. [PMID: 30687998 DOI: 10.1111/pcn.12824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/07/2019] [Accepted: 01/16/2019] [Indexed: 12/11/2022]
Abstract
AIM The aim of this review was to analyze the discontinuation rates during long-term treatment with second-generation antipsychotic long-acting injection (SGA-LAI) in adults with either schizophrenia spectrum or bipolar disorders. METHODS A systematic search (PubMed, Scopus, and the Cochrane Library) of studies published in English (1 January 2001-12 October 2018) identified 1214 abstracts, which were analyzed independently by the author and two colleagues. Studies were retrieved and reviewed if they reported primary data on the discontinuation rate before the study end during treatment lasting ≥36 weeks. Data were extracted from 51 articles meeting the inclusion criteria. RESULTS In all head-to-head comparisons, and studies on patients with schizophrenia spectrum or bipolar disorders, the discontinuation rate before the study end in patients treated with SGA-LAI was, at best, similar to that recorded in patients treated with first-generation antipsychotics in either oral or LAI formulations or with oral SGA. In particular, in most of the SGA-LAI long-term studies, the rate of premature dropout was higher than 50%. CONCLUSION Reviewed data suggest that SGA-LAI show no clear superiority over less expensive drugs (including first-generation antipsychotic LAI and oral antipsychotic formulations) in reducing the risk of premature antipsychotic discontinuation. Thus, alternative strategies should be considered to improve medication persistence and lower discontinuation rates in patients with severe psychiatric disorders. Planning tailored, individualized, and integrated approaches (including frequent clinical evaluations, and behavioral or other flexible techniques adaptable to different settings and patients) may be an effective intervention for improving patient adherence in long-term pharmacological treatment regimens.
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Berardi L, Antonazzo IC, Piccinni C, Raschi E, Forcesi E, Fioritti A, Berardi D, De Ponti F, Piazza A, Poluzzi E. Long-acting injectable antipsychotics: Six-month follow-up of new outpatient treatments in Bologna Community Mental Health Centres. PLoS One 2019; 14:e0211938. [PMID: 30768607 PMCID: PMC6377140 DOI: 10.1371/journal.pone.0211938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 01/24/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose This study aims to describe factors associated to treatment continuity and psychiatric relapses in patients treated with Long Acting Injectable antipsychotics (LAIs) in Bologna Community Mental Health Centers (CMHCs). Methods New LAI treatments administered between July 1, 2010 and June 30, 2015 in CMHCs were selected. The cohort was followed-up for 6 months; predictors of continuity and psychiatric admissions were investigated by using logistic regression- and Cox- analysis respectively. Results Among the cohort of 1 070 patients, only 222 (21%) continued LAI treatment during the follow-up. LAI continuity was higher with first generation agents (OR: 1.71, 95%CI 1.18–2.49) and in case of previous psychiatric hospitalizations (OR 2.00, 95%CI 1.47–2.74). Incidence of psychiatric hospital admissions showed a sharp reduction in the follow-up compared with 6-month period before initiation (from 458 to 212), and was associated with previous psychiatric hospitalizations (HR 3.20, 95%CI 2.22–4.59), immigration (HR 3.13, 95%CI 1.28–7.69) and LAI discontinuation (HR 1.14, 95%Cl 1.01–1.97). Conclusions Psychiatric hospital admission before LAI initiation was the main predictor both of LAI continuity and hospitalization during the follow-up.
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Affiliation(s)
- Lorenzo Berardi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Department of Biomedical and Specialty Surgical Sciences—Clinical psychiatric division, University of Ferrara, Ferrara, Italy
| | | | - Carlo Piccinni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emanuele Forcesi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Angelo Fioritti
- Department of Mental Health, Local Health Authority of Bologna, Bologna, Italy
| | - Domenico Berardi
- Department of Mental Health, Local Health Authority of Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Antonella Piazza
- Department of Mental Health, Local Health Authority of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- * E-mail:
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Sugawara N, Kudo S, Ishioka M, Sato Y, Kubo K, Yasui-Furukori N. Attitudes toward long-acting injectable antipsychotics among patients with schizophrenia in Japan. Neuropsychiatr Dis Treat 2019; 15:205-211. [PMID: 30666117 PMCID: PMC6330975 DOI: 10.2147/ndt.s188337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Long-acting injectable antipsychotics (LAIs) are regarded as an important alternative to oral medication for patients with schizophrenia. However, LAIs remain under-utilized in clinical practice. AIMS The aims of this investigation were to 1) obtain information on patients' attitudes toward LAIs and 2) assess factors associated with patients' acceptance of LAIs, and 3) identify predictors of the discrepancy between patients and referring psychiatrists' opinions regarding the appropriateness for LAIs. METHODS Anonymized data were collected from a questionnaire distributed to 159 patients with schizophrenia and their referring psychiatrists at three psychiatric hospitals between February 2014 and July 2014. The patients completed an original questionnaire developed to evaluate their attitudes regarding LAIs. Regarding the appropriateness of LAI prescription, patients and their referring psychiatrists were asked to rate, on a 5-point scale, how appropriate they felt the depot prescription was for the patients. The participants also answered instruments to assess symptom severity, antipsychotic-induced extrapyramidal symptoms, functions, quality of life, and self-esteem levels. RESULTS Patients currently on LAIs have favorable attitudes toward LAIs with respect to side effects, relapse prevention, efficacy, pain, and cost. Expectation of relapse prevention was significantly associated with patients' acceptance of LAIs (answering that those drugs are appropriate for their own treatment). In addition, the discrepancy between the patients' and referring psychiatrists' opinions regarding the appropriateness of LAI treatment was significantly associated with symptom severity, expectation of relapse prevention, belief that LAIs are painful, and belief that LAIs offer a reduced range of antipsychotic choices. CONCLUSION Attitudes toward LAIs need to be considered when deciding whether to prescribe this formulation. Access to information on LAIs, including their benefit in relapse prevention, might enhance the acceptance and use of this formulation among patients with schizophrenia.
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Affiliation(s)
- Norio Sugawara
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan, .,Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan,
| | - Shuhei Kudo
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan,
| | - Masamichi Ishioka
- Department of Psychiatry, Hirosaki-Aiseikai Hospital, Hirosaki, Japan
| | - Yasushi Sato
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan, .,Department of Psychiatry, Seihoku-Chuoh Hospital, Goshogawara, Japan
| | - Kazutoshi Kubo
- Department of Psychiatry, Hirosaki-Aiseikai Hospital, Hirosaki, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan,
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Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013. Curr Psychiatry Rep 2018; 20:108. [PMID: 30306339 DOI: 10.1007/s11920-018-0971-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Post-traumatic nightmares (PTN) are a common and enduring problem for individuals with post-traumatic stress disorder (PTSD) and other clinical presentations. PTN cause significant distress, are associated with large costs, and are an independent risk factor for suicide. Pharmacological and non-pharmacological treatment options for PTN exist. A previous review in this journal demonstrated that Prazosin, an alpha blocker, was a preferred pharmacological treatment for PTN and imagery rescripting therapy (IRT) was a preferred non-pharmacological treatment. Since that time, new and important research findings create the need for an updated review. RECENT FINDINGS Based on the results of a recent study in the New England Journal of Medicine, Prazosin has been downgraded by both the American Academy of Sleep Medicine (AASM) and the Veterans Health Administration/Department of Defense (VA/DoD) for PTN. In Canada, Nabilone, a synthetic cannabinoid, appears to be promising. Few recent studies have been published on non-pharmacological interventions for PTN; however, recent data is available with regard to using IRT on an inpatient setting, with German combat veterans, and through the use of virtual technology. Recent evidence supports the use of exposure, relaxation, and rescripting therapy (ERRT) with children and individuals with comorbid bipolar disorder and PTN. Prazosin is no longer considered a first-line pharmacological intervention for PTN by AASM and VA/DoD. However, in the absence of a suitable alternative, it will likely remain the preferred option of prescribers. IRT and ERRT remain preferred non-pharmacological treatments of PTN. Combining cognitive behavior therapy for insomnia (CBT-I) with IRT or ERRT may lead to improved outcomes.
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Affiliation(s)
- Jeffrey A Lieberman
- From the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and the New York State Psychiatric Institute - both in New York
| | - Michael B First
- From the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and the New York State Psychiatric Institute - both in New York
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Health service utilization and medical costs among patients with schizophrenia receiving long-acting injectable risperidone versus oral risperidone: a nationwide retrospective matched cohort study in Taiwan. Int Clin Psychopharmacol 2018; 33:204-212. [PMID: 29489495 DOI: 10.1097/yic.0000000000000213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of the nationwide retrospective matched cohort study was to evaluate health service utilization and medical costs between patients with schizophrenia who received long-acting injectable (LAI) risperidone and those who took risperidone orally. Data were sourced from the 2008 to 2013 Psychiatric Inpatient Medical Claim Dataset in Taiwan. The sample selection process was performed by propensity score matching. Finally, there were 691 patients in the exposed cohort and 1382 patients in the unexposed cohort. Each patient was individually followed for a 1-year period. Two-part models and generalized estimating equations were used to evaluate health service utilization and direct medical costs of patients. Analytical results showed that patients receiving LAI risperidone had used outpatient services significantly more, had greater hospital admissions, and had shorter lengths of stay than those who took risperidone orally. Furthermore, compared with their counterparts in the unexposed group, patients in the exposed group had incurred higher medical costs because of costs incurred from increased utilization of outpatient service and hospital admissions, under the special context of the healthcare system in Taiwan, a single-payer universal health coverage system with low copayment rates. In summary, this study suggested that patients with schizophrenia treated with LAI risperidone had shorter lengths of stay, higher medical costs largely because of increased utilization of outpatient service and hospital admissions, compared with those who took risperidone orally.
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Kishimoto T, Hagi K, Nitta M, Leucht S, Olfson M, Kane JM, Correll CU. Effectiveness of Long-Acting Injectable vs Oral Antipsychotics in Patients With Schizophrenia: A Meta-analysis of Prospective and Retrospective Cohort Studies. Schizophr Bull 2018; 44:603-619. [PMID: 29868849 PMCID: PMC5890463 DOI: 10.1093/schbul/sbx090] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Compared with oral antipsychotics (OAPs), long-acting injectable antipsychotics (LAIs) should improve medication adherence and reduce relapses in schizophrenia. However, meta-analyses of randomized trials and mirror-image studies yielded inconsistent results. Nonrandomized cohort studies with parallel comparisons of LAIs and OAPs offer a third design to examine this issue. We meta-analyzed cohort studies with ≥24 weeks duration and hospitalization data. Primary outcome was hospitalization rate, ie, number of hospitalizations per person-year. Secondary outcomes included hospitalization risk, ie, proportion of patients experiencing ≥1 hospitalizations, all-cause discontinuation, and total hospitalization days. Patient severity and/or chronicity at baseline was also meta-analyzed and explored as a potential effect size moderator. Altogether, 42 studies (n = 101 624; follow-up = 18.6 ± 10.0 mo) were meta-analyzed. LAIs were superior to OAPs regarding hospitalization rate (studies = 15, person-years = 68 009, rate ratio = 0.85, 95% CI = 0.78-0.93, P < .001) and all-cause discontinuations (studies = 10, n = 37 293, risk ratio = 0.78, 95% CI = 0.67-0.91, P = .001), but not regarding hospitalization risk (studies = 33, n = 51 733, risk ratio = 0.92, 95% CI = 0.84-1.00, P = .06), and hospitalization days (studies = 11, n = 21 328, Hedges' g = -0.05, 95% CI = -0.16 to 0.06, P = .39). Illness severity/chronicity was significantly greater in patients prescribed LAIs vs OAPs when all available information was pooled together (studies = 23, n = 61 806, Hedges' g = 0.15, 95% CI = 0.03-0.26, P = .01), but not when examined separately. In summary, this meta-analysis of cohort studies, which included patients that are broadly representative of clinical practice, indicates that LAIs are superior to OAPs. The lack of significant superiority of LAIs for hospitalization risk and hospital days needs to be interpreted in the context of naturalistic treatment selection with subsequently greater illness severity/chronicity in LAI-treated patients.
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Affiliation(s)
- Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
- Center of Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Katsuhiko Hagi
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Sumitomo Dainippon Pharma Co., Ltd., Medical Affairs, Tokyo, Japan
| | - Masahiro Nitta
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Sumitomo Dainippon Pharma Co., Ltd., Medical Affairs, Tokyo, Japan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Mark Olfson
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
- Center of Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY
- Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
- Center of Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY
- Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Bronx, NY
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Titus-Lay EN, Ansara ED, Isaacs AN, Ott CA. Evaluation of adherence and persistence with oral versus long-acting injectable antipsychotics in patients with early psychosis. Ment Health Clin 2018; 8:56-62. [PMID: 29955546 PMCID: PMC6007741 DOI: 10.9740/mhc.2018.03.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Despite the theory that long-acting injectable (LAI) antipsychotics should be more likely to improve adherence, reduce gaps in therapy, and prevent relapse compared with oral antipsychotics, there is little published evidence on this issue, specifically in patients with early psychosis. Methods: Patients with a new diagnosis for a psychotic disorder between July 1, 2013, and August 31, 2014, were retrospectively evaluated during a 12-month duration. The primary outcomes were adherence and persistence. Adherence was determined by proportion of days with medication, and persistence was defined as zero gaps in medication therapy. The secondary outcome was the number of times a psychiatric acute care service was used. Patients were divided into 3 groups based on their antipsychotic prescription history: oral only, LAI only, or both formulations at separate times throughout the study period. Results: Forty-seven patients met inclusion criteria. The average proportions of days with medication were 32%, 76%, and 75% for the oral, LAI, and both formulations groups, respectively (P < .001). For medication persistence, there were 32 patients (91%), 3 patients (75%), and 5 patients (63%) with at least 1 gap in therapy for the oral, LAI, and both formulations groups, respectively (P = .098). For acute care services, there was a median number of zero acute care visits for each of the 3 groups (P = .179). A post hoc subgroup analysis found medication adherence to be statistically different between the oral and LAI groups. Discussion: Long-acting injectable antipsychotics were associated with better adherence compared with oral antipsychotics in patients with early psychosis.
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Affiliation(s)
- Erika N Titus-Lay
- Assistant Professor, Department of Clinical and Administrative Sciences, California Northstate University College of Pharmacy, Elk Grove, California,
| | - Elayne D Ansara
- Clinical Pharmacy Specialist, Psychiatry, Department of Pharmacy, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Alex N Isaacs
- Clinical Assistant Professor of Pharmacy Practice, Pharmacy Administration, Purdue University College of Pharmacy, West Lafayette, Indiana; Clinical Pharmacy Specialist, Internal Medicine, Eskenazi Health, Indianapolis, Indiana
| | - Carol A Ott
- Clinical Professor of Pharmacy Practice, Pharmacy Administration, Purdue University College of Pharmacy, West Lafayette, Indiana; Clinical Pharmacy Specialist, Outpatient Psychiatry, Eskenazi Health, Indianapolis, Indiana
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Raskind MA, Peskind ER, Chow B, Harris C, Davis-Karim A, Holmes HA, Hart KL, McFall M, Mellman TA, Reist C, Romesser J, Rosenheck R, Shih MC, Stein MB, Swift R, Gleason T, Lu Y, Huang GD. Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans. N Engl J Med 2018; 378:507-517. [PMID: 29414272 DOI: 10.1056/nejmoa1507598] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In randomized trials, prazosin, an α1-adrenoreceptor antagonist, has been effective in alleviating nightmares associated with post-traumatic stress disorder (PTSD) in military veterans. METHODS We recruited veterans from 13 Department of Veterans Affairs medical centers who had chronic PTSD and reported frequent nightmares. Participants were randomly assigned to receive prazosin or placebo for 26 weeks; the drug or placebo was administered in escalating divided doses over the course of 5 weeks to a daily maximum of 20 mg in men and 12 mg in women. After week 10, participants continued to receive prazosin or placebo in a double-blind fashion for an additional 16 weeks. The three primary outcome measures were the change in score from baseline to 10 weeks on the Clinician-Administered PTSD Scale (CAPS) item B2 ("recurrent distressing dreams"; scores range from 0 to 8, with higher scores indicating more frequent and more distressing dreams); the change in score from baseline to 10 weeks on the Pittsburgh Sleep Quality Index (PSQI; scores range from 0 to 21, with higher scores indicating worse sleep quality); and the Clinical Global Impression of Change (CGIC) score at 10 weeks (scores range from 1 to 7, with lower scores indicating greater improvement and a score of 4 indicating no change). RESULTS A total of 304 participants underwent randomization; 152 were assigned to prazosin, and 152 to placebo. At 10 weeks, there were no significant differences between the prazosin group and the placebo group in the mean change from baseline in the CAPS item B2 score (between-group difference, 0.2; 95% confidence interval [CI], -0.3 to 0.8; P=0.38), in the mean change in PSQI score (between-group difference, 0.1; 95% CI, -0.9 to 1.1; P=0.80), or in the CGIC score (between-group difference, 0; 95% CI, -0.3 to 0.3; P=0.96). There were no significant differences in these measures at 26 weeks (a secondary outcome) or in other secondary outcomes. At 10 weeks, the mean difference between the prazosin group and the placebo group in the change from baseline in supine systolic blood pressure was a decrease of 6.7 mm Hg. The adverse event of new or worsening suicidal ideation occurred in 8% of the participants assigned to prazosin versus 15% of those assigned to placebo. CONCLUSIONS In this trial involving military veterans who had chronic PTSD, prazosin did not alleviate distressing dreams or improve sleep quality. (Funded by the Department of Veterans Affairs Cooperative Studies Program; PACT ClinicalTrials.gov number, NCT00532493 .).
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Affiliation(s)
- Murray A Raskind
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Elaine R Peskind
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Bruce Chow
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Crystal Harris
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Anne Davis-Karim
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Hollie A Holmes
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Kimberly L Hart
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Miles McFall
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Thomas A Mellman
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Christopher Reist
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Jennifer Romesser
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Robert Rosenheck
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Mei-Chiung Shih
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Murray B Stein
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Robert Swift
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Theresa Gleason
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Ying Lu
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
| | - Grant D Huang
- From the Veterans Affairs (VA) Northwest Network Mental Illness Research, Education, and Clinical Center (M.A.R., E.R.P., H.A.H., K.L.H., M.M.) and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine (M.A.R., E.R.P., M.M.), Seattle; VA Cooperative Studies Program Coordinating Center, Palo Alto (B.C., M.-C.S., Y.L.), VA Long Beach Healthcare System, Department of Human Behavior, University of California, Irvine (C.R.), the Department of Health Research and Policy, Stanford University School of Medicine, Stanford (M.-C.S., Y.L.), and the VA San Diego Healthcare System (M.B.S.) and the Departments of Psychiatry and Family Medicine and Public Health, University of California at San Diego (M.B.S.), San Diego - all in California; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (C.H., A.D.-K.); the Department of Psychiatry, Howard University (T.A.M.), and the Cooperative Studies Program Central Office (G.D.H.), Department of Veterans Affairs, Office of Research and Development (T.G.), Washington, DC; VA Salt Lake City, Salt Lake City (J.R.); VA Northeast Program Evaluation Center, West Haven, and the Departments of Psychiatry and Public Health, Yale School of Medicine, New Haven - both in Connecticut (R.R.); and Providence VA Medical Center and the Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI (R.S.)
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Abstract
Summary‘Depot antipsychotics' (‘long-acting injectable antipsychotic medications' or LAIs) are underused in the treatment of schizophrenia (including first episodes) and, possibly, of schizophrenia with comorbid substance use disorders. Patients' and clinicians' beliefs and attitudes, and service barriers, affect best practice and evidence-based care in LAI prescription. Poor medication adherence is a key reason for LAI prescription, but patients receiving LAIs may still relapse or experience significant side-effects. Patients' and clinicians' attitudes towards antipsychotic medication, as well as the quality of their recovery-focused relationship, are key factors in adherence. Clinicians should avoid a dichotomous ‘oralv. LAI’ choice: LAIs may have a place at various stages in the continuum of care and they should be one of the options discussed with any patient requiring long-term treatment, even early in the illness course. Many clinicians need better education about LAIs and greater familiarity with schizophrenia treatment guidelines.
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Abstract
The aim of this study was to design and optimize risperidone (RIS) mucoadhesive buccal tablets for systemic delivery as an alternative route. Direct compression method was used for the preparation of buccal tablets, and screening studies were conducted with different polymers to determine their effects on tablet characteristics. Carbopol® (CP) and sodium alginate (SA) were selected as two polymer types for further optimization studies by applying response surface methodology. Tablet hardness (TH), ex vivo residence time (RT), and peak detachment force (DF) from buccal mucosa were selected as three important responses. Physicochemical compatibility of formulation excipients and RIS was evaluated by using Fourier transform infrared (FT-IR) spectroscopy and differential scanning calorimetry (DSC) analysis. In vitro drug release profiles and release kinetics were investigated; swelling index and matrix erosion studies were conducted. Optimum formulation consisted of 16.4% CP and 20.3% SA, which provided 7.67±0.29 hour ex vivo RT, 45.52±4.85 N TH, and 2.12±0.17 N DF. FT-IR spectroscopy and DSC analysis revealed that there was no chemical interaction present between tablet ingredients. Cumulative RIS release of >90% was achieved after 8 hours of in vitro dissolution studies, which was supported by swelling and matrix erosion analysis. Mechanism of RIS release was fitted best to zero-order model, while release exponent (n) value of 0.77 demonstrated an anomalous (non-Fickian) release, indicating combined erosion and swelling mechanism. The results suggested that optimized buccal tablets of RIS would be a promising and alternative delivery system for the treatment of schizophrenia.
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Affiliation(s)
- Burak Çelik
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Bezmialem Vakıf University, Fatih, Istanbul, Turkey
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Remington G, Addington D, Honer W, Ismail Z, Raedler T, Teehan M. Guidelines for the Pharmacotherapy of Schizophrenia in Adults. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:604-616. [PMID: 28703015 PMCID: PMC5593252 DOI: 10.1177/0706743717720448] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The present guidelines address the pharmacotherapy of schizophrenia in adults across different stages, phases, and symptom domains. METHOD Guidelines were developed using the ADAPTE process, which takes advantage of existing guidelines. Six guidelines were identified for adaptation, with recommendations extracted from each. For those specific to the pharmacotherapy of schizophrenia in adults, a working group selected between guidelines and recommendations to create an adapted guideline. RESULTS Recommendations can be categorized into 6 areas that include 1) first-episode schizophrenia, 2) acute exacerbation, 3) relapse prevention and maintenance treatment, 4) treatment-resistant schizophrenia, 5) clozapine-resistant schizophrenia, and 6) specific symptom domains. For each category, recommendations are made based on the available evidence, which is discussed and linked to other established guidelines. CONCLUSIONS In most cases, evidence-based recommendations are made that can be used to guide current clinical treatment and decision making. Notably, however, there is a paucity of established evidence to guide treatment decision making in the case of clozapine-resistant schizophrenia, a subsample that represents a sizable proportion of those with schizophrenia.
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Affiliation(s)
- Gary Remington
- Departments of Psychiatry and Psychological Clinical Science, University of Toronto, Toronto, Canada
- Schizophrenia Division, Continuing Care and Recovery Program, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Donald Addington
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute and Matheson Centre for Mental Health Research and Education, Calgary, Canada
| | - William Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute and Matheson Centre for Mental Health Research and Education, Calgary, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Thomas Raedler
- Psychopharmacology Research Unit, Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Michael Teehan
- Department of Psychiatry, Dalhousie University, Halifax, Canada
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Verdoux H, Pambrun E, Tournier M, Bezin J, Pariente A. Risk of discontinuation of antipsychotic long-acting injections vs. oral antipsychotics in real-life prescribing practice: a community-based study. Acta Psychiatr Scand 2017; 135:429-438. [PMID: 28332704 DOI: 10.1111/acps.12722] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare the risk of discontinuation of ambulatory antipsychotic treatment in persons treated with antipsychotic long-acting injections (LAIs) or by oral antipsychotics (OAPs). METHODS The study was performed in a representative sample of persons newly treated with OAPs (n = 6904) affiliated to the French Insurance Healthcare system. The risk of all-cause discontinuation was compared in patients prescribed OAPs (n = 246) vs. matched patients prescribed LAIs (n = 246) using multivariate survival analyses. Confounding by indication was minimized by matching on type of antipsychotic drug and by the high-dimensional propensity score method. RESULTS Discontinuation was more frequent with OAPs (69%) compared to LAIs (57%) [adjusted relative risk (aRR) = 1.6, 95% CI 1.23-2.07]. Risk of discontinuation was higher for first-generation (FGA) OAPs vs. FGA LAIs (aRR = 1.94, 95% CI 1.22-3.08) as well as for second-generation (SGA) OAPs vs. SGA LAIs (aRR = 1.58, 95% CI 1.15-2.17). Over the 6-month period after discontinuation of LAIs, a new antipsychotic drug was dispensed in 58% of patients, the most frequent pattern being dispensing of the same LAI as that prescribed before discontinuation. CONCLUSIONS Although less frequent than with OAPs, the rate of ambulatory treatment discontinuation was high with LAIs. Prescription of LAIs should be associated with intervention strategies aimed at promoting medication adherence.
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Affiliation(s)
- H Verdoux
- INSERM, Bordeaux Population Health Research Center, Team Pharmaco-Epidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - E Pambrun
- INSERM, Bordeaux Population Health Research Center, Team Pharmaco-Epidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France
| | - M Tournier
- INSERM, Bordeaux Population Health Research Center, Team Pharmaco-Epidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - J Bezin
- INSERM, Bordeaux Population Health Research Center, Team Pharmaco-Epidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France
| | - A Pariente
- INSERM, Bordeaux Population Health Research Center, Team Pharmaco-Epidemiology, UMR 1219, Université de Bordeaux, Bordeaux, France
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