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Pappa S, Kalniunas A, Maret J. Cariprazine for negative symptoms in early psychosis: a pilot study with a 6-month follow-up. Front Psychiatry 2023; 14:1183912. [PMID: 37426095 PMCID: PMC10323827 DOI: 10.3389/fpsyt.2023.1183912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Background Cariprazine, a novel antipsychotic drug that is a partial agonist with preferential binding to the D3 receptor, has demonstrated efficacy in clinical trials across all symptom domains, including negative symptoms, which can occur early in the course of psychotic illness. However, evidence, to date regarding its effects in early psychosis patients with primary negative symptoms has been limited. Objectives To evaluate the efficacy of cariprazine for negative symptoms in early psychosis patients. Methods Demographic and clinical information of the study population were collected from the electronic records and PANSS scale administered at baseline, 3 and 6 months. Tolerability and discontinuation reasons, where applicable, were also recorded. Results Ten patients with early psychosis (four men and six women, mean age - 25.5 years) with prominent or predominant negative symptoms were treated with cariprazine (range 1.5 - 3 mg). Three patients discontinued cariprazine within the first 3 months due to patient choice, lack of response and non-compliance, respectively. In the remaining patients, there was a significant reduction in the mean negative PANSS score from baseline to 6 months (from 26.3 to 10.6), mean total PANSS score (from 81.4 to 43.3) and in the mean positive PANSS score (from 14.4 to 9.9) which correspond to a 53.1, 41.5, and 28.5% mean score reduction. Conclusion This pilot study suggests that cariprazine is a safe and effective treatment in early psychosis, particularly for the alleviation of negative symptoms which remains an area of unmet treatment need.
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Affiliation(s)
- Sofia Pappa
- West London NHS Trust, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Arturas Kalniunas
- West London NHS Trust, London, United Kingdom
- Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
| | - Jose Maret
- West London NHS Trust, London, United Kingdom
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De Simone G, Mazza B, Vellucci L, Barone A, Ciccarelli M, de Bartolomeis A. Schizophrenia Synaptic Pathology and Antipsychotic Treatment in the Framework of Oxidative and Mitochondrial Dysfunction: Translational Highlights for the Clinics and Treatment. Antioxidants (Basel) 2023; 12:antiox12040975. [PMID: 37107350 PMCID: PMC10135787 DOI: 10.3390/antiox12040975] [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: 03/10/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Schizophrenia is a worldwide mental illness characterized by alterations at dopaminergic and glutamatergic synapses resulting in global dysconnectivity within and between brain networks. Impairments in inflammatory processes, mitochondrial functions, energy expenditure, and oxidative stress have been extensively associated with schizophrenia pathophysiology. Antipsychotics, the mainstay of schizophrenia pharmacological treatment and all sharing the common feature of dopamine D2 receptor occupancy, may affect antioxidant pathways as well as mitochondrial protein levels and gene expression. Here, we systematically reviewed the available evidence on antioxidants' mechanisms in antipsychotic action and the impact of first- and second-generation compounds on mitochondrial functions and oxidative stress. We further focused on clinical trials addressing the efficacy and tolerability of antioxidants as an augmentation strategy of antipsychotic treatment. EMBASE, Scopus, and Medline/PubMed databases were interrogated. The selection process was conducted in respect of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Several mitochondrial proteins involved in cell viability, energy metabolism, and regulation of oxidative systems were reported to be significantly modified by antipsychotic treatment with differences between first- and second-generation drugs. Finally, antioxidants may affect cognitive and psychotic symptoms in patients with schizophrenia, and although the evidence is only preliminary, the results indicate that further studies are warranted.
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Affiliation(s)
- Giuseppe De Simone
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Benedetta Mazza
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Licia Vellucci
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Annarita Barone
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Mariateresa Ciccarelli
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, University of Naples "Federico II", 80131 Naples, Italy
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Reddy LF, Glynn SM, McGovern JE, Sugar CA, Reavis EA, Green MF. A Novel Psychosocial Intervention for Motivational Negative Symptoms in Schizophrenia: Combined Motivational Interviewing and CBT. Am J Psychiatry 2023; 180:367-376. [PMID: 36891649 DOI: 10.1176/appi.ajp.20220243] [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: 03/10/2023]
Abstract
OBJECTIVE Negative symptoms are a primary cause of disability in schizophrenia for which there are no established pharmacotherapies. This study evaluated a novel psychosocial intervention that combined two evidence-based practices-motivational interviewing and cognitive-behavioral therapy (MI-CBT)-for the treatment of motivational negative symptoms. METHODS Seventy-nine participants with schizophrenia and moderate to severe negative symptoms were included in a randomized controlled trial comparing the 12-session MI-CBT treatment with a mindfulness control condition. Participants were assessed at three time points through the study period, which included 12 weeks of active treatment and 12 weeks of follow-up. The primary outcome measures were motivational negative symptoms and community functioning; the secondary outcomes included a posited biomarker of negative symptoms: pupillometric response to cognitive effort. RESULTS Compared with the control group, participants in the MI-CBT group showed significantly greater improvements in motivational negative symptoms over the acute treatment period. Their gains relative to baseline were maintained at follow-up, although the differential benefit relative to control subjects was attenuated. There were nonsignificant effects toward improvements in community functioning and differential change in the pupillometric markers of cognitive effort. CONCLUSIONS The results show that combining motivational interviewing with CBT yields improvements in negative symptoms, a feature of schizophrenia generally thought of as resistant to intervention. Motivational negative symptoms not only responded to the novel treatment, but the gains were maintained over the follow-up period. Implications for future studies and for improving the generalization of the negative symptom gains to daily functioning domains are discussed.
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Affiliation(s)
- L Felice Reddy
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles (Reddy, Glynn, McGovern, Green); UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles (Reddy, Glynn, McGovern, Sugar, Reavis, Green); Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles (Sugar)
| | - Shirley M Glynn
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles (Reddy, Glynn, McGovern, Green); UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles (Reddy, Glynn, McGovern, Sugar, Reavis, Green); Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles (Sugar)
| | - Jessica E McGovern
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles (Reddy, Glynn, McGovern, Green); UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles (Reddy, Glynn, McGovern, Sugar, Reavis, Green); Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles (Sugar)
| | - Catherine A Sugar
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles (Reddy, Glynn, McGovern, Green); UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles (Reddy, Glynn, McGovern, Sugar, Reavis, Green); Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles (Sugar)
| | - Eric A Reavis
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles (Reddy, Glynn, McGovern, Green); UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles (Reddy, Glynn, McGovern, Sugar, Reavis, Green); Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles (Sugar)
| | - Michael F Green
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles (Reddy, Glynn, McGovern, Green); UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles (Reddy, Glynn, McGovern, Sugar, Reavis, Green); Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles (Sugar)
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Dell’Osso B, Bellomo A, Conca APM, Salvi V, Siracusano A, Zaffora C, De Berardis D, Di Giannantonio M. Therapeutic Appropriateness of Cariprazine in the Management of Schizophrenia: Experts' Opinion using a Delphi Approach. Curr Neuropharmacol 2023; 21:2206-2216. [PMID: 37469149 PMCID: PMC10556386 DOI: 10.2174/1570159x21666230719162023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Schizophrenia is a psychiatric disorder whose therapeutic objectives are aimed at reducing symptoms and improving patient's quality of life. First- and second-generation antipsychotics present numerous side effects. Recently introduced in the treatment of schizophrenia, cariprazine has shown to improve positive and negative symptoms as well as cognitive impairment, with good tolerability. OBJECTIVE To assess the level of consensus among Italian psychiatrists in relation to the use of cariprazine in the treatment of schizophrenia by using the Delphi technique. METHOD A Delphi study was undertaken between January and July 2022. Two questionnaires were consecutively sent to a panel of 97 psychiatrists from all over Italy, of which 81 actively participated, anonymously, in at least one of the two consultations with a sufficiently high response rate (83%). RESULTS Broad consensus in terms of the efficacy and safety of cariprazine in the treatment of schizophrenia during all phases of the disorder. The young first-episode schizophrenia patient with or without substance abuse seems to be an excellent candidate for cariprazine therapy. In addition, the lack of side effects makes cariprazine a suitable drug for adult and elderly patients with schizophrenia. However, there is still limited experience with the use of cariprazine, along with little knowledge of the most recent real-life data. CONCLUSION These results could encourage wider dissemination of evidence-based practices with the final aim of optimizing the clinical use of cariprazine in patients with schizophrenia.
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Affiliation(s)
- Bernardo Dell’Osso
- Department of Mental Health and Addiction, University of Milan, ASST Fatebenefratelli-Sacco, Milan, Italy; "Aldo Ravelli" Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | - Andreas Pietro Maria Conca
- NHS, National Health Service, Department of Mental Health, Bolzano, Italy
- Auxiliary University Department, Medical University of Innsbruck and Paracelsus Medizinische Privatuniversität (PMU), Salzburg, Austria
| | - Virginio Salvi
- Department of Clinical Neurosciences/DIMSC, Università Politecnica delle Marche, Ancona, Italy
| | - Alberto Siracusano
- Psychiatric Clinic, PTV Foundation - Policlinico Tor Vergata University of Rome, Rome, Italy
| | - Carmelo Zaffora
- NHS, National Health Service, Department of Mental Health, Azienda Sanitaria Provinciale (ASP 3), Catania, Italy
| | | | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti, Pescara, Chieti, Italy
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Raucher-Chéné D, Thibaudeau E, Sauvé G, Lavigne KM, Lepage M. Understanding others as a mediator between verbal memory and negative symptoms in schizophrenia-spectrum disorder. J Psychiatr Res 2021; 143:429-435. [PMID: 34656875 DOI: 10.1016/j.jpsychires.2021.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 11/17/2022]
Abstract
From the onset of schizophrenia, verbal memory (VM) deficits and negative symptoms are strongly associated, and both additively predict functional outcomes. Emotion recognition (ER) and theory of mind (ToM; the ability to infer others' mental states), two components of social cognition, are also particularly affected in schizophrenia. Explanatory models of negative symptoms have integrated these cognitive impairments as potential precursors and previous studies revealed relationships between ER and/or ToM and VM, as well as with negative symptoms, but the organization of these associations remains unclear. We aimed to determine whether impairments in VM and social cognition sequentially pave the way for negative symptoms in schizophrenia. To this end, we used mediation analyses. One hundred and forty participants with a diagnosis of schizophrenia or schizoaffective disorder were recruited. First, correlational analyses were conducted between our variables of interest. The mediating effect of social cognition between VM and negative symptoms was then examined using the PROCESS macro. Variables of interest were significantly correlated (r = |0.166| to |0.391|), except for ER and negative symptoms. Only the serial multiple mediation model with 2 mediators (ER followed by ToM) revealed a significant indirect effect of VM on negative symptoms (β = - 0.160, 95% CI = -.370 to -.004). This relationship was selective for expressive negative symptoms (e.g., blunted affect and alogia). This study illustrates the richness of the relationship between cognitive deficits and negative symptoms and provides additional information for the involvement of social cognition in negative symptoms' etiology.
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Affiliation(s)
- Delphine Raucher-Chéné
- Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada; Cognition, Health, and Society Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France; Academic Department of Psychiatry, University Hospital of Reims, EPSM Marne, Reims, France
| | - Elisabeth Thibaudeau
- Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada; Department of Education and Pedagogy, Université du Québec À Montréal, Canada
| | - Geneviève Sauvé
- Douglas Mental Health University Institute, Montreal, Canada; Department of Education and Pedagogy, Université du Québec À Montréal, Canada
| | - Katie M Lavigne
- Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada; McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
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