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Haddad PM, Correll CU. Long-acting antipsychotics in the treatment of schizophrenia: opportunities and challenges. Expert Opin Pharmacother 2023; 24:473-493. [PMID: 36919576 DOI: 10.1080/14656566.2023.2181073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Maintenance antipsychotic treatment improves multiple outcomes in people with schizophrenia. These benefits are challenged by medication nonadherence, which is a common occurrence. Long-acting injectable antipsychotic (LAI) formulations were developed to reduce nonadherence and thereby improve outcomes. This narrative review is based on a PubMed search (January 2000 - August 2022) for studies on LAI antipsychotics. AREAS COVERED Opportunities and challenges associated with LAIs are reviewed. Advantages, compared to oral antipsychotics (OAs), include improved adherence, reduced relapse and hospitalization risk, delayed and lower relapse risk after stopping treatment, and the ability to differentiate true treatment resistance from 'pseudo'-resistance. Additionally, LAIs are associated with lower all-cause mortality than OAs. LAIs are under-used in many services, partly reflecting negative attitudes, misconceptions, and lack of knowledge among clinicians, patients, and carers. Practical barriers to LAI use include acquisition costs and inadequate service structures to administer/monitor LAI treatment. EXPERT OPINION The education and engagement of clinicians, patients and caregivers can assist more informed decision-making regarding LAIs. Future research regarding LAIs should encompass multiple complementary designs, focus on functionality and recovery outcomes, and include groups at high risk of relapse, including those with comorbid substance use disorders and early in the course of schizophrenia.
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Affiliation(s)
- Peter M Haddad
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Mental Health, Drugs and Alcohol Services (MHDAS), Barwon Health, Geelong, Australia
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
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Khan YS, Khoodoruth MAS, Albobali Y, Haddad PM. SSRI withdrawal syndrome in children and adolescents: a narrative literature review. Expert Opin Drug Saf 2023; 22:381-390. [PMID: 37339264 DOI: 10.1080/14740338.2023.2224557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/08/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION While there is considerable published evidence regarding the nature and severity of Selective Serotonin Reuptake Inhibitor (SSRI) discontinuation symptoms in the adult population, information relating to the child and adolescent population remains scarce. This narrative review examined the published literature on SSRI withdrawal symptoms in the under-18-year-old age group. MEDLINE and PsycINFO were comprehensively searched from inception to 5 May 2023. AREAS COVERED This review highlights the importance of recognizing SSRI withdrawal in children and adolescents and summarizes available literature and guidelines for safe discontinuation. EXPERT OPINION Evidence of the presence of SSRI withdrawal phenomenon in children and adolescents mainly originates from case reports and extrapolated adult data. Existing data on SSRI withdrawal syndrome in children and adolescents is therefore limited, and there is a need for formal research in this specific population to establish with more certainty the nature and extent of SSRI withdrawal syndrome. Nevertheless, there is currently enough evidence available for prescribing clinicians to provide psychoeducation to patients and families about the possibility of withdrawal symptoms when SSRI treatment is considered. The need for gradual and planned discontinuation should also be discussed for safe withdrawal.
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Affiliation(s)
- Yasser Saeed Khan
- Child and Adolescent Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Adil Shah Khoodoruth
- Child and Adolescent Mental Health Service, Hamad Medical Corporation, Doha, Qatar
- Division of Genomics and Precision Medicine, College of Health and Life Sciences, Hamad Bin Khalifa University, Education City, Doha, Qatar
| | - Yahia Albobali
- Child and Adolescent Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - Peter M Haddad
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Iqbal Y, Alabdulla M, Kumar R, Latoo J, Albrahim S, Wadoo O, Haddad PM. Characteristics of 100 consecutive patients with COVID-19 referred to consultation-liaison psychiatry services in Qatar: A comparison of patients with delirium versus other psychiatric diagnoses. Qatar Med J 2022; 2022:28. [PMID: 35836717 PMCID: PMC9247886 DOI: 10.5339/qmj.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/24/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) can present with various neuropsychiatric manifestations. This study reports on patients with COVID-19 who were referred to the consultation–liaison (CL) psychiatry services in Qatar and compares the clinical and sociodemographic characteristics of those diagnosed with delirium versus other psychiatric diagnoses. Methods: This is a retrospective review of the first 100 consecutive patients with COVID-19 who were referred to the CL services. Results: Within the total cohort (n=100), most patients (92%) were male, and the mean age was 46 years. About 27% of patients had asymptomatic COVID-19, 35% had a past psychiatric history, and 48% reported pandemic related psychosocial stress. Delirium was the most common psychiatric diagnosis (n=29), followed by acute stress reaction/adjustment disorder, depression, mania, anxiety, non-affective psychosis, and dementia. Among patients with delirium, agitation was the most common symptom (76%), 86% were treated with psychotropic medications, and 17% died. Higher age, longer hospital stays, lower oxygen saturation, lower lymphocytic count, and higher C-reactive protein (CRP) values were significantly associated with delirium versus other psychiatric diagnoses. Higher age and lower oxygen saturations predicted delirium.Conclusion: Delirium was associated with a range of clinical variables and had significant mortality, despite the relatively young age of the patients. COVID-19 should be considered in patients presenting with delirium. Finally, early identification and management of delirium should be integral to COVID-19 protocols.
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Affiliation(s)
- Yousaf Iqbal
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Majid Alabdulla
- College of Medicine, Qatar University, Qatar
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Rajeev Kumar
- College of Medicine, Qatar University, Qatar
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Javed Latoo
- College of Medicine, Qatar University, Qatar
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Sultan Albrahim
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Ovais Wadoo
- College of Medicine, Qatar University, Qatar
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Peter M. Haddad
- Division of Psychology and Mental Health, University of Manchester, UK
- College of Medicine, Qatar University, Qatar
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
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Khaled SM, Davis V, Amro I, Ali AA, Woodruff PW, Haddad PM. Trends in prevalence of depression and anxiety symptoms and effects of sociodemographic variables before and after the first wave of COVID-19 in Qatar. J Affect Disord 2022; 310:412-421. [PMID: 35413356 PMCID: PMC8994410 DOI: 10.1016/j.jad.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/28/2022] [Accepted: 04/06/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Prevalence trends from Arabic speaking countries on psychiatric symptoms before and after the first wave of the COVID-19 pandemic are lacking. We estimated the point prevalence and change in depression and anxiety symptoms scores in relation to sociodemographic variables following the resolution of the first wave in Qatar compared with before the pandemic. METHODS We conducted a trend analysis using repeated nationally representative cross-sectional surveys spanning 2017, 2018, 2020/2021 and using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to assess depressive and anxiety symptoms. Negative binomial regression was used to model changes in these symptoms in relation sociodemographics and survey year. RESULTS The two-week prevalence of depressive symptoms (≥10 on the PHQ-9) was 6.6% in 2017 and 6.5% in 2020/2021 (p = 0.986). The two-week prevalence of anxiety symptoms (≥10 on the GAD-7) was 3.6% in 2018 and 5.1% in 2020/2021 (p = 0.062). The data for 2020/21 showed a 35.1% and 29.2% decrease in depression and anxiety symptoms scores compared to pre-pandemic years (2017/2018) after adjusting for sociodemographic factors. LIMITATIONS Screening tools rather than structured interviews were used to assess depressive and anxiety symptoms CONCLUSIONS: The prevalence of depression and anxiety after the first COVID wave did not differ significantly to pre-pandemic estimates. The end of the first wave of the pandemic weakened the associations of these symptoms with traditional sociodemographic risk factors. The 2020/21 depression and anxiety symptoms scores remained high for Qataris and Arabs, suggesting that these cultural groups may benefit most from public mental health interventions.
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Affiliation(s)
- Salma M. Khaled
- Social and Economic Survey Research Institute–SESRI, Qatar University, Doha, P.O. Box: 2713, Qatar,Department of Public Health, College of Health Sciences, Qatar University, Doha, P.O. Box 2713, Qatar,Department of Population Medicine, College of Medicine, Qatar University, Doha, P.O. Box 2713, Qatar,Corresponding author at: Social and Economic Survey Research Institute –SESRI, Qatar University, P.O. Box: 2713, Doha, Qatar
| | - Veena Davis
- Social and Economic Survey Research Institute-SESRI, Qatar University, Doha, P.O. Box: 2713, Qatar.
| | - Iman Amro
- Social and Economic Survey Research Institute-SESRI, Qatar University, Doha, P.O. Box: 2713, Qatar.
| | - Amal A.M. Ali
- Social and Economic Survey Research Institute–SESRI, Qatar University, Doha, P.O. Box: 2713, Qatar
| | - Peter W. Woodruff
- Department of Neuroscience, School of Medicine, The University of Sheffield Western Bank, Sheffield S10 2TN, United Kingdom
| | - Peter M. Haddad
- Hamad Medical Corporation, Doha, P.O. Box 3050, Qatar,College of Medicine, Qatar University, Qatar,Division of Psychology and Mental Health, University of Manchester, United Kingdom
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Badanapurkar A, Nelson D, Alabdulla M, Reagu S, Woodruff P, Varghese S, Aly SM, Haddad PM. Psychiatric inpatients' views of their mental health, and their experience of social change, during the pandemic: A report from Qatar. J Psychiatr Ment Health Nurs 2022; 29:451-462. [PMID: 34854177 DOI: 10.1111/jpm.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 10/12/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: There is only limited information on how the COVID-19 pandemic has affected people diagnosed with mental health disorders, especially people admitted to psychiatric wards. We surveyed the views of inpatients at Qatar's only psychiatric hospital regarding how the pandemic had affected their mental health and social changes they had experienced during the pandemic. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Nearly half (43%) of those who completed the survey reported that the pandemic had led to a deterioration in their mental health. Those who reported deterioration in their mental health during the pandemic were significantly more likely to have experienced negative social changes during the pandemic. Examples included increased stress from the home and reduced ability to discuss emotions/feelings with family members. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health services need to ensure ongoing support for patients during and after the pandemic. Mental health nurses have a pivotal role including identifying early warning signs of relapse of mental disorders, delivering talking treatments and providing practical advice and COVID-19-related education. Further work is needed to assess the views of people diagnosed with mental health problems in different countries and at a different time point during the pandemic. ABSTRACT: Introduction The impact of the COVID-19 pandemic on people under the care of mental health services has received relatively little attention in the scientific literature. Aim To assess psychiatric inpatients' views regarding their mental health and experience of social change during the pandemic. Method Cross-sectional survey of consecutive patients admitted to Qatar's only psychiatric hospital between mid-June and mid-October 2020. Results Data were analysed for 114/284 (40%) patients admitted during the study period. 8 (7%) reported a history of COVID-19. 43% reported that the pandemic had led to deterioration in their mental health, 11% to an improvement and 39% that there had been no attributable change. Those reporting worsened mental health, attributable to the pandemic, were significantly more likely to report having experienced four negative social changes during the pandemic, namely reduced ability to discuss emotions/feelings with family members, decreased time spent exercising, decreased time spent relaxing and increased stress from the home. Demographic factors did not distinguish those reporting worsened mental health from those whose mental health was improved or unchanged. Discussion A large proportion of psychiatric inpatients reported negative social and mental health changes during the pandemic. However, the study cannot determine causality. Implications for practice Mental health services should consider the psychological and social aspects of people's lives, including their interactions with family, friends and the community. This is especially relevant during the COVID-19 pandemic due to its wide impact on society. Interventions for people diagnosed with mental health disorders should address their psychological and social needs.
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Affiliation(s)
- Ashishkumar Badanapurkar
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Nelson
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.,Curtin University, Perth, West Australia, Australia
| | - Majid Alabdulla
- Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar
| | | | - Peter Woodruff
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.,Weil Cornell Medical College- Qatar, Doha, Qatar
| | - Sejo Varghese
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | | | - Peter M Haddad
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar
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Badanapurkar A, Nelson D, Varghese S, Singh R, Haddad PM. Support and attitudes of Qatar mental health professionals to a proposed mental health inpatient smoking ban: Results of a cross-sectional survey. J Psychiatr Ment Health Nurs 2022; 29:327-345. [PMID: 34143910 DOI: 10.1111/jpm.12777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Smoking is more common among people with serious mental illness, and it contributes to a reduced life expectancy. Several Western countries have successfully introduced smoke-free policies in inpatient mental health units. There is virtually no information about attitudes to smoking bans in mental health units from countries in the Middle East and North Africa region. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We surveyed mental health professionals working in Qatar's main mental health service to determine support for and attitudes towards a proposed total smoking ban in psychiatric wards. Most staff who completed the survey supported an inpatient smoking ban. However, further analysis, both quantitative and qualitative, showed markedly ambivalent attitudes, that is staff simultaneously held attitudes that supported and opposed a smoking ban. Professionals who did not support a ban were more likely to have not received smoking cessation training in the last 5 years, to be a psychiatrist rather than a nurse or allied mental health professional, to be current smokers and to be a Middle Eastern and North African national. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further staff training is necessary to achieve more consistent attitudes that support a total smoking ban and increase the likelihood of successful implementation. The attitudes in this study showed similarities and differences to those reported for mental health professionals in Western countries. This highlights that local research is necessary to help shape training and successfully implement smoke-free policies. ABSTRACT: Introduction Despite the fact that patients with serious mental illness (SMI) have high rates of smoking and an increased standardized mortality, there is virtually no information about attitudes to smoking bans in mental health units from countries in the Middle East and North Africa region. Aim To assess support for, and attitudes towards, a proposed total smoking ban in psychiatric wards among mental health clinicians in Qatar. Method Cross-sectional survey of mental health professionals working in Qatar's primary mental health service. Results The response rate was 68% (353/520). Support for a ban was assessed with a single-item question; 73% of respondents supported a ban with opposition significantly (p < .05) associated with being a current smoker, a Middle Eastern and North African (MENA) national, a psychiatrist versus a mental health nurse or allied health professional and not receiving smoking cessation training in the last 5 years. A 21-item questionnaire assessed attitudes to a total smoking ban. It showed marked ambivalence with multiple linear regression identifying MENA nationality, male gender and current smoking status as independent variables influencing attitudes. The most strongly held attitude supporting a ban was concern about passive smoking and against a ban was concern it may increase patient agitation. Qualitative data confirmed ambivalent views. Discussion The results show similarities and differences to research from other countries suggesting that cultural factors influence some attitudes to smoke-free policies. Implications for Practice Staff support and smoking cessation education are necessary to achieve more consistent staff attitudes to support smoke-free policies.
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Affiliation(s)
| | - Deborah Nelson
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.,Curtin University, Perth, WA, Australia
| | - Sejo Varghese
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Peter M Haddad
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,University of Manchester, Manchester, UK
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7
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Ponirakis G, Ghandi R, Ahmed A, Gad H, Petropoulos IN, Khan A, Elsotouhy A, Vattoth S, Alshawwaf MKM, Khoodoruth MAS, Ramadan M, Bhagat A, Currie J, Mahfoud Z, Al Hamad H, Own A, M Haddad P, Alabdulla M, Malik RA, Woodruff PW. Abnormal corneal nerve morphology and brain volume in patients with schizophrenia. Sci Rep 2022; 12:1870. [PMID: 35115592 PMCID: PMC8814184 DOI: 10.1038/s41598-022-05609-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/13/2022] [Indexed: 12/27/2022] Open
Abstract
Neurodevelopmental and neurodegenerative pathology occur in Schizophrenia. This study compared the utility of corneal confocal microscopy (CCM), an ophthalmic imaging technique with MRI brain volumetry in quantifying neuronal pathology and its relationship to cognitive dysfunction and symptom severity in schizophrenia. Thirty-six subjects with schizophrenia and 26 controls underwent assessment of cognitive function, symptom severity, CCM and MRI brain volumetry. Subjects with schizophrenia had lower cognitive function (P ≤ 0.01), corneal nerve fiber density (CNFD), length (CNFL), branch density (CNBD), CNBD:CNFD ratio (P < 0.0001) and cingulate gyrus volume (P < 0.05) but comparable volume of whole brain (P = 0.61), cortical gray matter (P = 0.99), ventricle (P = 0.47), hippocampus (P = 0.10) and amygdala (P = 0.68). Corneal nerve measures and cingulate gyrus volume showed no association with symptom severity (P = 0.35–0.86 and P = 0.50) or cognitive function (P = 0.35–0.86 and P = 0.49). Corneal nerve measures were not associated with metabolic syndrome (P = 0.61–0.64) or diabetes (P = 0.057–0.54). The area under the ROC curve distinguishing subjects with schizophrenia from controls was 88% for CNFL, 84% for CNBD and CNBD:CNFD ratio, 79% for CNFD and 73% for the cingulate gyrus volume. This study has identified a reduction in corneal nerve fibers and cingulate gyrus volume in schizophrenia, but no association with symptom severity or cognitive dysfunction. Corneal nerve loss identified using CCM may act as a rapid non-invasive surrogate marker of neurodegeneration in patients with schizophrenia.
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Affiliation(s)
- Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Reem Ghandi
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - Amani Ahmed
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - Hoda Gad
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ioannis N Petropoulos
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ahmed Elsotouhy
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Neuroradiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Surjith Vattoth
- Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Marwan Ramadan
- Geriatric, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Anjushri Bhagat
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - James Currie
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad Mahfoud
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Hanadi Al Hamad
- Geriatric, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroradiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Peter M Haddad
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Majid Alabdulla
- Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar
| | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Institute of Cardiovascular Science, University of Manchester, Manchester, UK
| | - Peter W Woodruff
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar. .,Psychiatry Hospital, Mental Health Service, Hamad Medical Corporation, Doha, Qatar. .,Department of Neuroscience, School of Medicine,, University of Sheffield, Western Bank, Sheffield, S10 2TN, South Yorkshire, UK.
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Affiliation(s)
- Mikkel Højlund
- Department of Psychiatry Aabenraa, Mental Health Services Region of Southern Denmark, Aabenraa, Denmark
| | - Peter M Haddad
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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9
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Karim MA, Al-Baz N, Haddad PM, Reagu SM, Alabdulla M. Buspirone in the management of refractory irritable bowel syndrome: A case report. Medicine (Baltimore) 2021; 100:e28003. [PMID: 34941040 PMCID: PMC8701920 DOI: 10.1097/md.0000000000028003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Irritable bowel syndrome (IBS) is a chronic and debilitating functional disorder of the gastrointestinal tract manifested by abdominal pain and bowel habit dysregulation. The pathophysiology is complex and management targets symptom resolution. Therapeutic interventions range from dietary modification, psychological interventions, exercise, to the use of antispasmodics, antibiotics, and antidepressants. Anecdotal reports have suggested that buspirone may be beneficial in the treatment of functional dyspepsia and IBS and its physiological effect of reducing gastric tone provides a rational for its benefit. PATIENT CONCERNS A 28-year-old man with unremarkable past medical and psychiatric history presented with worsening abdominal pain, bloating, and bowel movement dysregulation of over 6-year duration. DIAGNOSES Physical examination revealed mild distension and discomfort on deep palpation. Thorough blood investigations, stool analysis and culture, and imaging were unremarkable except for the detection of mucus with stool. The patient was diagnosed with irritable bowel syndrome with mixed habits. INTERVENTIONS Dietary adjustment and a range of medications (mebeverine, simethicone, loperamide, rifaximin, sertraline and amitriptyline) yielded unsatisfactory response of were not tolerated. Buspirone was eventually introduced. OUTCOMES Buspirone was associated with a significant and sustained improvement in IBS symptoms and quality of life. LESSONS This case suggests that buspirone was effective in treating refractory IBS. Further research is needed to assess the role of buspirone in IBS management.
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Affiliation(s)
- Mustafa Abdul Karim
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine, Qatar
| | - Nadeen Al-Baz
- Weill Cornell Medicine, Qatar
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Peter M. Haddad
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Shuja M. Reagu
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Majid Alabdulla
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
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10
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Iqbal Y, Alabdulla M, Latoo J, Kumar R, Albrahim S, Wadoo O, M Haddad P. Mania and hypomania associated with COVID-19: a series of 15 cases seen by the consultation-liaison psychiatry service in Qatar. Qatar Med J 2021; 2021:65. [PMID: 34888201 PMCID: PMC8631349 DOI: 10.5339/qmj.2021.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background: A range of neuropsychiatric diagnoses have been reported in association with coronavirus disease 2019 (COVID-19). However, only sporadic cases of mania or hypomania have been reported in patients with COVID-19. This study aimed to report clinical characteristics of 15 consecutive cases of COVID-19-associated mania or hypomania seen in three general hospitals in Qatar in the early months of the pandemic in 2020. Methods: This study is a retrospective case-note review of 15 cases of COVID-19-associated mania or hypomania (confirmed by polymerase chain reaction test), seen as inpatient consultations out of the first 100 consecutive patients managed by consultation-liaison psychiatric teams in Qatar between 2 March 2020 and 7 July 2020. Results: The mean age of the 15 patients was 40 years. Twelve patients had mania, and three had hypomania. Regarding the physical severity of COVID-19, 10 patients were asymptomatic, two had upper respiratory tract symptoms alone and three had pneumonia. None of the patients were intubated. Potential risk factors for mania/hypomania included pandemic-related psychosocial stress before admission (n = 9), past history of mania/bipolar disorder (n = 6) or psychosis (n = 2), raised inflammatory markers (n = 7) and steroid use (n = 3). None had a history of recent substance misuse. Other than one patient with advanced cancer, none had comorbidity regarded as likely to have caused mania or hypomania. Three patients had mild white matter ischaemic changes on brain imaging. Standard pharmacological treatment for mania (i.e. antipsychotic medication supplemented by prn benzodiazepines) was effective. Ten patients were discharged home from the COVID-19 facility where they presented, but five required transfer to Qatar's psychiatric hospital for further treatment of mania. Conclusion: The association of mania or hypomania with COVID-19 may be spurious (e.g. representing an initial presentation of bipolar disorder) or causal. The reported cases illustrate a range of potential aetiological mechanisms by which COVID-19 could cause mania or hypomania. Cohort studies are necessary to determine the incidence, aetiology and prognosis of COVID-19-associated mania/hypomania.
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Affiliation(s)
- Yousaf Iqbal
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Majid Alabdulla
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: .,College of Medicine, Qatar University, Qatar
| | - Javed Latoo
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: .,College of Medicine, Qatar University, Qatar
| | - Rajeev Kumar
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: .,College of Medicine, Qatar University, Qatar
| | - Sultan Albrahim
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Ovais Wadoo
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
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11
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Khaled SM, Amro I, Bader L, Woodruff P, Alabdulla MA, Bellaj T, Marzouk Y, Hasan Y, Al-Kaabi IM, Haddad PM. Factors associated with depression and anxiety in the adult population of Qatar after the first COVID-19 wave: a cross-sectional study. Discov Psychol 2021. [PMCID: PMC8686347 DOI: 10.1007/s44202-021-00009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is limited data from Arabic-speaking countries on risk factors for depression and anxiety during the COVID-19 pandemic. Country-specific data is necessary given differences in culture, demographics, and COVID-19 infection and mortality rates. The main purpose of the study is to identify the factors associated with symptoms of depression-anxiety in the adult population of Qatar during the first year of the COVID-19 pandemic. We conducted a cross-sectional online survey in Qatar between July and December 2020 after Qatar’s first COVID-19 wave and before the beginning of the second wave. Depression-anxiety was defined as a cut-off of 20 or higher on the Patient Health Questionnaire-Anxiety Depression Scale (PHQ-ADS). Of 1138 participants, 71.0% were female, 69.0% Arabs, 70.0% Non-Qataris, and 77.0% were < 40 years (the median age in Qatar is 32 years). In a fully-adjusted model, six variables were significantly associated with moderate-to-severe levels of depression or anxiety on the PHQ-ADS; Arab ethnicity (OR = 1.67, p = 0.026), never married versus married (OR = 1.69, p = 0.015), prior history of psychiatric disorder versus no history (OR = 1.80, p = 0.009), increased worries due to social media use for COVID-related news/updates (OR = 1.72, p = 0.003), a history of COVID-19 (OR = 1.76, p = 0.039), loneliness (OR = 1.91, p < 0.001), and lower levels of religiosity (OR = 0.96, p = 0.039). These associations also pertained in the reduced model, with the exception of religiosity which was only marginally statistically significant (OR = 0.97, p = 0.055). The potential risk factors identified may assist with anxiety and depression prevention in future COVID-19 waves, and similar national events, and assist with early intervention to treat sufferers.
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Affiliation(s)
- Salma Mawfek Khaled
- Social and Economic Survey Research Institute –SESRI, Qatar University, P.O. Box: 2713, Doha, Qatar
- Department of Public Health, College of Health Sciences, Qatar University, P.O. Box 2713, Doha, Qatar
- Department of Population Medicine, College of Medicine, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Iman Amro
- Social and Economic Survey Research Institute –SESRI, Qatar University, P.O. Box: 2713, Doha, Qatar
| | - Lina Bader
- Social and Economic Survey Research Institute –SESRI, Qatar University, P.O. Box: 2713, Doha, Qatar
| | - Peter Woodruff
- University of Sheffield, Western Bank, Sheffield, S10 2TN UK
| | - Majid A. Alabdulla
- Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
- Clinical Science Department, College of Medicine, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Tarek Bellaj
- College of Art and Sciences, Qatar University, P.O. Box: 2713, Doha, Qatar
| | - Yousri Marzouk
- College of Art and Sciences, Qatar University, P.O. Box: 2713, Doha, Qatar
| | - Youssef Hasan
- College of Art and Sciences, Qatar University, P.O. Box: 2713, Doha, Qatar
| | | | - Peter M. Haddad
- Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
- Clinical Science Department, College of Medicine, Qatar University, P.O. Box 2713, Doha, Qatar
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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12
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Abstract
Delirious mania (the coexistence of delirium and mania) is described in the literature but not recognised in standard nosologies. We report a woman in her late 30s, with no psychiatric history, who presented with concurrent symptoms of mania and delirium. She was diagnosed with COVID-19 pneumonia (positive reverse transcription-PCR test). There was no history of substance misuse or concurrent medical illness. CT head scan was normal as were blood investigations, other than elevated inflammatory markers. She received standard treatment for COVID-19 pneumonia and lorazepam and quetiapine to treat her neuropsychiatric symptoms. She made a full recovery after 9 days. She was apyrexial with normal oxygen saturation throughout her illness. The case shows that severe neuropsychiatric symptoms can complicate otherwise mild COVID-19 pneumonia with neuroinflammation being a possible mechanism. A diagnosis of delirious mania appears to better capture the complexity of the presentation than a diagnosis of mania or delirium alone.
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Affiliation(s)
| | - Majid Alabdulla
- Consultation Liaison Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Javed Latoo
- Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Yousaf Iqbal
- Psychiatry, Hamad Medical Corporation, Doha, Qatar
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13
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Latoo J, Haddad PM, Mistry M, Wadoo O, Islam SMS, Jan F, Iqbal Y, Howseman T, Riley D, Alabdulla M. The COVID-19 pandemic: an opportunity to make mental health a higher public health priority. BJPsych Open 2021; 7:e172. [PMID: 34538286 PMCID: PMC8458855 DOI: 10.1192/bjo.2021.1002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) was first recognised in December 2019. The subsequent pandemic has caused 4.3 million deaths and affected the lives of billions. It has increased psychosocial risk factors for mental illness including fear, social isolation and financial insecurity and is likely to lead to an economic recession. COVID-19 is associated with a high rate of neuropsychiatric sequelae. The long-term effects of the pandemic on mental health remain uncertain but could be marked, with some predicting an increased demand for psychiatric services for years to come. COVID-19 has turned a spotlight on mental health for politicians, policy makers and the public and provides an opportunity to make mental health a higher public health priority. We review longstanding reasons for prioritising mental health and the urgency brought by the COVID-19 pandemic, and highlight strategies to improve mental health and reduce the psychiatric fallout of the pandemic.
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Affiliation(s)
- Javed Latoo
- Hamad Medical Corporation and College of Medicine, Qatar University, Doha, Qatar
| | - Peter M Haddad
- Hamad Medical Corporation, College of Medicine, Qatar University, Doha, Qatar; and Manchester University, UK
| | - Minal Mistry
- Department of Psychiatry, Fredericton, New Brunswick, Canada
| | - Ovais Wadoo
- Hamad Medical Corporation, Doha, Qatar; and Middle East Division of the Royal College of Psychiatrists
| | - Sheikh Mohammed Shariful Islam
- National Health and Medical Research Council and Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Farida Jan
- Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | | | - Tom Howseman
- St Luke's Primary Care Centre, Northamptonshire, UK
| | - David Riley
- Department of Palliative Care, Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Majid Alabdulla
- Department of Psychiatry, Hamad Medical Corporation, and College of Medicine, Qatar University, Doha, Qatar
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14
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Højlund M, Kemp AF, Haddad PM, Neill JC, Correll CU. Withdrawal-associated relapse is a potential source of bias - Authors' reply. Lancet Psychiatry 2021; 8:748-749. [PMID: 34419176 DOI: 10.1016/s2215-0366(21)00288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Mikkel Højlund
- Department of Psychiatry Aabenraa, Mental Health Services Region of Southern Denmark, Aabenraa, Denmark; Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Adam F Kemp
- Psychiatric Centre Copenhagen, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark
| | - Peter M Haddad
- Hamad Medical Corporation, Doha, Qatar; Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Joanna C Neill
- Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Science Centre, Manchester, UK
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY 11004, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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15
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Højlund M, Kemp AF, Haddad PM, Neill JC, Correll CU. Standard versus reduced dose of antipsychotics for relapse prevention in multi-episode schizophrenia: a systematic review and meta-analysis of randomised controlled trials. Lancet Psychiatry 2021; 8:471-486. [PMID: 34023019 DOI: 10.1016/s2215-0366(21)00078-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dose reduction of antipsychotic maintenance treatment in individuals with schizophrenia could be desirable to minimise adverse effects, but evidence for this strategy is unclear. We aimed to compare risks and benefits of reduced versus standard doses of antipsychotics. METHODS We searched Embase, Medline, PsycINFO, and the Cochrane Library from database inception until June 17, 2020, for randomised trials in adults with schizophrenia or schizoaffective disorder lasting at least 24 weeks, including individuals clinically stable at baseline, and comparing at least two doses of the same antipsychotic, excluding trials in first-episode psychosis or treatment-resistant schizophrenia. We compared low-dose (within 50-99% of the lower limit of the standard dose) and very-low dose (less than 50% of the lower limit) with standard dose, defined as doses higher than the lower limit of the treatment dose recommended by the International Consensus Study. Data from published reports on number of participants, treatment, sex, age, number of events, and changes in psychopathology scores were extracted independently by at least two authors. Investigators or sponsors were contacted by email to obtain missing information regarding outcomes. Co-primary outcomes were relapse and all-cause discontinuation. Study-level data were meta-analysed using random-effects models, calculating risk ratios (RRs) for dichotomous data, and Hedges' g for continuous data. The protocol was registered with OSF registries. FINDINGS 7853 references were identified in the database search and one additional reference from a manual review of relevant studies. 5744 abstracts were assessed for eligibility, and 101 references were assessed for full-text review. Of these, 79 were excluded for a variety of reasons, resulting in 22 studies being included in the meta-analysis, reporting on 24 trials and 3282 individuals. Study participants had a median age of 38 years (IQR 36-40) with 2166 (65·9%) males and 1116 (34·0%) females. Compared with standard dose, low dose increased the risk of relapse by 44% (16 trials, 1920 participants; RR 1·44, 95% CI 1·10-1·87; p=0·0076; I2=46%) and the risk of all-cause discontinuation by 12% (16 trials, 1932 participants; RR 1·12, 1·03-1·22; p=0·0085; I2=0%). Very low dose increased the risk of relapse by 72% (13 trials, 2058 participants; RR 1·72, 95% CI 1·29-2·29; p=0·0002; I2=70%) and all-cause discontinuation by 31% (11 trials, 1866 participants; RR 1·31, 1·11-1·54; p=0·0011; I2=63%). Compared with low dose, very low dose did not significantly increase the risk of relapse (five trials, 686 participants; RR 1·31, 95% CI 0·96-1·79; p=0·092; I2=51%) or all-cause discontinuation (five trials 686 participants; RR 1·11, 95% CI 0·95-1·30; p=0·18; I2=43%). Subgroup analyses comparing double-blind versus open-label studies, first-generation versus second-generation antipsychotics, and oral versus long-acting injectable antipsychotics were consistent with the overall results. Most studies were classified as having some concerns in the risk of bias assessment, which was mainly caused by absence of publicly available study registrations. INTERPRETATION During maintenance treatment in multi-episode schizophrenia, antipsychotic doses should probably not be reduced below the standard dose range recommended for acute stabilisation, because reducing the dose further is associated with an increased risk of both relapse and all-cause discontinuation. FUNDING None.
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Affiliation(s)
- Mikkel Højlund
- Department of Psychiatry Aabenraa, Metal Health Services Region of Southern Denmark, Aabenraa, Denmark; Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Adam F Kemp
- Department of Psychiatry Aabenraa, Metal Health Services Region of Southern Denmark, Aabenraa, Denmark
| | - Peter M Haddad
- Hamad Medical Corporation, Doha, Qatar; Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Joanna C Neill
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, New York, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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16
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Khaled SM, Petcu C, Bader L, Amro I, Al-Hamadi AMHA, Al Assi M, Ali AAM, Le Trung K, Diop A, Bellaj T, Al-Thani MH, Woodruff PW, Alabdulla M, Haddad PM. Prevalence and Potential Determinants of COVID-19 Vaccine Hesitancy and Resistance in Qatar: Results from a Nationally Representative Survey of Qatari Nationals and Migrants between December 2020 and January 2021. Vaccines (Basel) 2021; 9:471. [PMID: 34067103 PMCID: PMC8151168 DOI: 10.3390/vaccines9050471] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
Global COVID-19 pandemic containment necessitates understanding the risk of hesitance or resistance to vaccine uptake in different populations. The Middle East and North Africa currently lack vital representative vaccine hesitancy data. We conducted the first representative national phone survey among the adult population of Qatar, between December 2020 and January 2021, to estimate the prevalence and identify potential determinants of vaccine willingness: acceptance (strongly agree), resistance (strongly disagree), and hesitance (somewhat agree, neutral, somewhat disagree). Bivariate and multinomial logistic regression models estimated associations between willingness groups and fifteen variables. In the total sample, 42.7% (95% CI: 39.5-46.1) were accepting, 45.2% (95% CI: 41.9-48.4) hesitant, and 12.1% (95% CI: 10.1-14.4) resistant. Vaccine resistant compared with hesistant and accepting groups reported no endorsement source will increase vaccine confidence (58.9% vs. 5.6% vs. 0.2%, respectively). Female gender, Arab ethnicity, migrant status/type, and vaccine side-effects concerns were associated with hesitancy and resistance. COVID-19 related bereavement, infection, and quarantine status were not significantly associated with any willingness group. Absence of or lack of concern about contracting the virus was solely associated with resistance. COVID-19 vaccine resistance, hesitance, and side-effects concerns are high in Qatar's population compared with those globally. Urgent public health engagement should focus on women, Qataris (non-migrants), and those of Arab ethnicity.
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Affiliation(s)
- Salma M. Khaled
- Social and Economic Survey Research Institute, Qatar University, Doha P.O. Box 2713, Qatar; (C.P.); (L.B.); (I.A.); (A.M.H.A.A.-H.); (M.A.A.); (A.A.M.A.); (K.L.T.); (A.D.)
- Department of Public Health, College of Health Sciences, Qatar University, Doha P.O. Box 2713, Qatar
- Department of Population Medicine, College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
| | - Catalina Petcu
- Social and Economic Survey Research Institute, Qatar University, Doha P.O. Box 2713, Qatar; (C.P.); (L.B.); (I.A.); (A.M.H.A.A.-H.); (M.A.A.); (A.A.M.A.); (K.L.T.); (A.D.)
| | - Lina Bader
- Social and Economic Survey Research Institute, Qatar University, Doha P.O. Box 2713, Qatar; (C.P.); (L.B.); (I.A.); (A.M.H.A.A.-H.); (M.A.A.); (A.A.M.A.); (K.L.T.); (A.D.)
| | - Iman Amro
- Social and Economic Survey Research Institute, Qatar University, Doha P.O. Box 2713, Qatar; (C.P.); (L.B.); (I.A.); (A.M.H.A.A.-H.); (M.A.A.); (A.A.M.A.); (K.L.T.); (A.D.)
| | - Aisha Mohammed H. A. Al-Hamadi
- Social and Economic Survey Research Institute, Qatar University, Doha P.O. Box 2713, Qatar; (C.P.); (L.B.); (I.A.); (A.M.H.A.A.-H.); (M.A.A.); (A.A.M.A.); (K.L.T.); (A.D.)
| | - Marwa Al Assi
- Social and Economic Survey Research Institute, Qatar University, Doha P.O. Box 2713, Qatar; (C.P.); (L.B.); (I.A.); (A.M.H.A.A.-H.); (M.A.A.); (A.A.M.A.); (K.L.T.); (A.D.)
| | - Amal Awadalla Mohamed Ali
- Social and Economic Survey Research Institute, Qatar University, Doha P.O. Box 2713, Qatar; (C.P.); (L.B.); (I.A.); (A.M.H.A.A.-H.); (M.A.A.); (A.A.M.A.); (K.L.T.); (A.D.)
| | - Kien Le Trung
- Social and Economic Survey Research Institute, Qatar University, Doha P.O. Box 2713, Qatar; (C.P.); (L.B.); (I.A.); (A.M.H.A.A.-H.); (M.A.A.); (A.A.M.A.); (K.L.T.); (A.D.)
| | - Abdoulaye Diop
- Social and Economic Survey Research Institute, Qatar University, Doha P.O. Box 2713, Qatar; (C.P.); (L.B.); (I.A.); (A.M.H.A.A.-H.); (M.A.A.); (A.A.M.A.); (K.L.T.); (A.D.)
| | - Tarek Bellaj
- College of Art and Sciences, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Mohamed H. Al-Thani
- Department of Public Health, Ministry of Public Health, Al Khaleej Street, Rumaila, Doha P.O. Box 42, Qatar;
| | - Peter W. Woodruff
- Department of Neuroscience, University of Sheffield, The University of Sheffield Western Bank, Sheffield S10 2TN, UK;
| | - Majid Alabdulla
- Department of Psychiatry, Hamad Medical Corporation, Doha P.O Box 3050, Qatar; (M.A.); (P.M.H.)
- Clinical Science Department, College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
| | - Peter M. Haddad
- Department of Psychiatry, Hamad Medical Corporation, Doha P.O Box 3050, Qatar; (M.A.); (P.M.H.)
- Clinical Science Department, College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
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17
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Abdul Karim M, Al-Baz N, Ouanes S, Alabdulla M, Haddad PM. Suspected Agomelatine-induced restless legs syndrome: a case report. BMC Psychiatry 2021; 21:180. [PMID: 33827492 PMCID: PMC8025526 DOI: 10.1186/s12888-021-03175-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/20/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Restless Legs Syndrome (RLS) is a sensorimotor disorder characterized by unpleasant and distressing sensations in the lower limbs that are more pronounced in the evening, commence or worsen at rest, and show partial or complete relief following movement. It can occur as a primary disorder, secondary to medical conditions or treatment with medications including but not limited to antidepressants or antipsychotics. CASE PRESENTATION A 32-year old man with major depressive disorder showed partial response to Escitalopram 10 mg daily. Agomelatine 25 mg at night was added to Escitalopram to treat his residual depressive symptoms, namely insomnia and tiredness. Within two days he developed restlessness and unpleasant sensations in his legs which were worse at night. Symptom severity increased over the following days, prompting an urgent consultation a week later. The patient's presentation met the criteria for RLS. Agomelatine was discontinued leaving the patient on Escitalopram alone. The patient's symptoms improved within 24 h of stopping Agomelatine, with complete resolution four days later. There was no recurrence of RLS during follow-up. The patient scored 6 on Naranjo's adverse drug reaction probability scale, indicating a probable adverse drug reaction caused by Agomelatine. CONCLUSIONS To the best of our knowledge, this is the first case report of suspected Agomelatine-induced RLS. Clinicians need to be aware of RLS to enable prompt diagnosis and management. We suggest adding Agomelatine to the list of agents that can potentially induce RLS.
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Affiliation(s)
- Mustafa Abdul Karim
- Hamad Medical Corporation, Doha, Qatar. .,Weill Cornell Medicine- Qatar, Ar-Rayyan, Qatar.
| | - Nadeen Al-Baz
- grid.413548.f0000 0004 0571 546XHamad Medical Corporation, Doha, Qatar ,Weill Cornell Medicine- Qatar, Ar-Rayyan, Qatar
| | - Sami Ouanes
- grid.413548.f0000 0004 0571 546XHamad Medical Corporation, Doha, Qatar ,grid.412603.20000 0004 0634 1084College of Medicine, Qatar University, Doha, Qatar
| | - Majid Alabdulla
- grid.413548.f0000 0004 0571 546XHamad Medical Corporation, Doha, Qatar ,grid.412603.20000 0004 0634 1084College of Medicine, Qatar University, Doha, Qatar
| | - Peter M. Haddad
- grid.413548.f0000 0004 0571 546XHamad Medical Corporation, Doha, Qatar ,grid.412603.20000 0004 0634 1084College of Medicine, Qatar University, Doha, Qatar
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18
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Iqbal Y, Haddad PM, Latoo J, Alhatou MI, Alabdulla M. Ischaemic stroke as the presenting feature of COVID-19: a series of three cases from Qatar. Oxf Med Case Reports 2021; 2021:omab006. [PMID: 33732485 PMCID: PMC7947264 DOI: 10.1093/omcr/omab006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/08/2020] [Accepted: 01/17/2021] [Indexed: 01/06/2023] Open
Abstract
Most cases of stroke associated with coronavirus disease 2019 (COVID-19) occur during the course of a characteristic COVID-19 respiratory illness. We report three patients where the presenting feature of COVID-19 was stroke. Two patients had no respiratory symptoms throughout their clinical course. In each case, COVID-19 was confirmed by a reverse transcription polymerase chain reaction (RT-PCR) test and the diagnosis of ischaemic stroke by brain imaging. The patients were relatively young (40, 45 and 50 years). None had a prior history of cerebrovascular events. Stroke risk factors were absent in one, limited to overweight and smoking in another but more prominent in the third patient. Two patients had large vessel occlusion and elevated D-dimer levels. Multiple infarcts were seen in two patients. Clinicians should consider the possibility of COVID-19 in patients presenting with stroke and conversely consider investigating for stroke if a patient with COVID-19, even if mildly ill, develops acute neurological symptoms.
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Affiliation(s)
- Yousaf Iqbal
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Peter M Haddad
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Javed Latoo
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | | | - Majid Alabdulla
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
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19
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Zolezzi M, Abouelhassan R, Eltorki Y, Haddad PM, Noorizadeh M. Long-Acting Injectable Antipsychotics: A Systematic Review of Their Non-Systemic Adverse Effect Profile. Neuropsychiatr Dis Treat 2021; 17:1917-1926. [PMID: 34163165 PMCID: PMC8214363 DOI: 10.2147/ndt.s309768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Long acting injectable (LAI) antipsychotics are commonly used in the treatment of schizophrenia to improve adherence and clinical outcomes. Concerns have been reported in relation to their non-systemic or injection site adverse effect profile. As such, this study aims to review and evaluate all evidence reporting injection site adverse effects with LAI antipsychotics. METHODS An electronic search was systematically conducted through four databases (PubMed, Embase, SCOPUS, Cochrane) in order to identify studies investigating injection-site reactions associated with LAI antipsychotics. Unpublished studies such as conference proceedings and clinical trial registries were also searched. The search was limited to literature published in English without year limits. RESULTS Of a total of 189 citations that were identified from the electronic database search, 12 were selected for inclusion in this review. Various injection site reactions were reported in these studies, including pain, bleeding, and swelling. Overall, the studies reported a low incidence of these injection site reactions. Only a minority of the included articles compared injection site reactions between different LAI antipsychotics. CONCLUSION Injection site pain was the most commonly reported injection site adverse effect across all articles reviewed. The low incidence of injection site adverse effects associated with LAI antipsychotics indicates that these formulations appear to be well tolerated by patients. More head-to-head trials comparing second generation LAI antipsychotics are needed.
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Affiliation(s)
- Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Yassin Eltorki
- Mental Health Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Peter M Haddad
- Mental Health Hospital, Hamad Medical Corporation, Doha, Qatar
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20
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Abstract
A 30-year-old man with no significant previous or family psychiatric history became severely anxious about his health after a positive COVID-19 test. Physical symptoms of COVID-19 were mild, with no evidence of hypoxia or pneumonia, throughout his illness. He was admitted to a quarantine facility. He remained highly anxious, and 1 week later, he developed paranoid delusions and auditory hallucinations (his first psychotic episode). He was treated with lorazepam 1 mg four times a day, mirtazapine 30 mg nocte and risperidone 1 mg two times a day. His psychotic symptoms lasted 1 week. He stopped psychiatric medication after 4 weeks and had remained well when reviewed 3 months later. A Diagnostic and Statistical Manual of Mental Disorders fifth edition diagnosis of brief psychotic disorder with marked stressor (brief reactive psychosis) was made. Anxiety about his health and social isolation appeared the main aetiological factors but an inflammatory component cannot be excluded. The case highlights that first episode psychosis can be associated with mild COVID-19.
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Affiliation(s)
- Peter M Haddad
- Psychiatry, Hamad Medical Corporation, Doha, Qatar
- Clinical Department, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Majid Al Abdulla
- Clinical Department, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Javed Latoo
- Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Yousaf Iqbal
- Clinical Department, College of Medicine, QU Health, Qatar University, Doha, Qatar
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21
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Iqbal Y, Al Abdulla MA, Albrahim S, Latoo J, Kumar R, Haddad PM. Psychiatric presentation of patients with acute SARS-CoV-2 infection: a retrospective review of 50 consecutive patients seen by a consultation-liaison psychiatry team. BJPsych Open 2020; 6:e109. [PMID: 32907692 PMCID: PMC7484218 DOI: 10.1192/bjo.2020.85] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Reports of psychiatric morbidity associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection tend to be limited by geography and patients' clinical status. Representative samples are needed to inform service planning and research. AIMS To describe the psychiatric morbidity associated with SARS-CoV-2 infection (confirmed by real-time polymerase chain reaction) in referrals to a consultation-liaison psychiatry service in Qatar. METHOD Retrospective review of 50 consecutive referrals. RESULTS Most patients were male. Median age was 39.5 years. Thirty-one patients were symptomatic (upper respiratory tract symptoms or pneumonia) for coronavirus disease 2019 (COVID-19) and 19 were asymptomatic (no characteristic physical symptoms of COVID-19 infection). Seventeen patients (34%) had a past psychiatric history including eight with bipolar I disorder or psychosis, all of whom relapsed. Thirty patients (60%) had physical comorbidity. The principal psychiatric diagnoses made by the consultation-liaison team were delirium (n = 13), psychosis (n = 9), acute stress reaction (n = 8), anxiety disorder (n = 8), depression (n = 8) and mania (n = 8). Delirium was confined to the COVID-19 symptomatic group (the exception being one asymptomatic patient with concurrent physical illness). The other psychiatric diagnoses spanned the symptomatic and asymptomatic patients with COVID. One patient with COVID-19 pneumonia experienced an ischaemic stroke. Approximately half the patients with mania and psychosis had no past psychiatric history. Three patients self-harmed. The commonest psychiatric symptoms were sleep disturbance (70%), anxiety (64%), agitation (50%), depressed mood (42%) and irritability (36%). CONCLUSIONS A wide range of psychiatric morbidity is associated with SARS-CoV-2 infection and is seen in symptomatic and asymptomatic individuals. Cases of psychosis and mania represented relapses in people with schizophrenia and bipolar disorder and also new onset cases.
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Affiliation(s)
- Yousaf Iqbal
- Psychiatric Hospital, Hamad Medical Corporation, Qatar
| | - Majid Ali Al Abdulla
- Psychiatric Hospital, Hamad Medical Corporation; and College of Medicine, Qatar University, Qatar
| | | | - Javed Latoo
- Psychiatric Hospital, Hamad Medical Corporation, Qatar
| | - Rajeev Kumar
- Psychiatric Hospital, Hamad Medical Corporation, Qatar
| | - Peter M Haddad
- Psychiatric Hospital, Hamad Medical Corporation, Qatar; and College of Medicine, Qatar
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22
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Mattingly GW, Haddad PM, Tocco M, Xu J, Phillips D, Pikalov A, Loebel A. Switching to Lurasidone following 12 months of treatment with Risperidone: results of a 6-month, open-label study. BMC Psychiatry 2020; 20:199. [PMID: 32370778 PMCID: PMC7201608 DOI: 10.1186/s12888-020-02523-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/28/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Patients with a diagnosis of schizophrenia are at an increased risk for developing metabolic syndrome, which is associated with greater cardiovascular morbidity and mortality. Treatment with some commonly used antipsychotic medications may increase the risk of developing metabolic syndrome. The aim of the study was to evaluate the safety of lurasidone in patients who continued lurasidone or switched from risperidone to lurasidone. A secondary aim was assessment of the effect of long-term lurasidone on the Positive and Negative Syndrome Scale (PANSS). METHODS The treatment sample in the current study consisted of clinically stable patients with schizophrenia (N = 223) who had completed a 12-month, double-blind study of lurasidone vs. risperidone. In the current extension study, all patients received 6 months of open-label treatment with lurasidone, either continuing lurasidone assigned during the preceding double-blind trial, or switching from double-blind risperidone to lurasidone. Safety and tolerability parameters included body weight, prolactin, and metabolic laboratory tests. RESULTS Six months of OL treatment with lurasidone was generally well-tolerated, with a low incidence of parkinsonism (4.5%) and akathisia (3.1%). Overall, few adverse events were rated as severe (4.9%), and discontinuation due to an adverse event was low in the lurasidone continuation vs. risperidone switch groups (3.7% vs. 6.9%). In the lurasidone continuation versus risperidone switch groups, change from OL baseline to 6-month endpoint (observed case) was observed in mean body weight (- 0.6 vs. -2.6 kg), median total cholesterol (- 4.0 vs. + 4.5 mg/dL), triglycerides (- 4.5 vs. -5.5 mg/dL), glucose (0.0 vs. -3.0 mg/dL) and prolactin (males, + 0.15 vs. -11.2 ng/mL; females, + 1.3 vs. -30.8 ng/mL). Improvement in PANSS total score was maintained, from OL baseline to endpoint in the continuation vs. switch groups (+ 1.0 vs. -1.0; OC). CONCLUSIONS In this 6-month extension study, lurasidone treatment was generally well-tolerated and associated with minimal effects on weight, metabolic parameters, and prolactin levels. Patients who switched from risperidone to lurasidone experienced reductions in weight, metabolic parameters and prolactin levels commensurate with increases in these safety parameters experienced during the previous 12 months of treatment with risperidone. TRIAL REGISTRATION ClinicalTrials.gov NCT00641745 (Date of Registration: March 24, 2008).
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Affiliation(s)
- Greg W. Mattingly
- grid.4367.60000 0001 2355 7002Washington University School of Medicine, St. Louis, MO USA
| | - Peter M. Haddad
- grid.413548.f0000 0004 0571 546XHamad Medical Corporation, Doha, Qatar ,grid.412603.20000 0004 0634 1084Clinical Professor of Psychiatry, Qatar University, Doha, Qatar ,grid.5379.80000000121662407Honorary Professor of Psychiatry, University of Manchester, Manchester, UK ,grid.451052.70000 0004 0581 2008Honorary Consultant Psychiatrist, GMMH NHS Foundation Trust, Manchester, UK
| | - Michael Tocco
- Sunovion Pharmaceuticals Inc., Fort Lee, NJ, 84 Waterford Dr, Marlborough, MA, 01752, USA.
| | - Jane Xu
- grid.419756.8Sunovion Pharmaceuticals Inc., Fort Lee, NJ, 84 Waterford Dr, Marlborough, MA 01752 USA
| | - Debra Phillips
- grid.419756.8Sunovion Pharmaceuticals Inc., Fort Lee, NJ, 84 Waterford Dr, Marlborough, MA 01752 USA
| | - Andrei Pikalov
- grid.419756.8Sunovion Pharmaceuticals Inc., Fort Lee, NJ, 84 Waterford Dr, Marlborough, MA 01752 USA
| | - Antony Loebel
- grid.419756.8Sunovion Pharmaceuticals Inc., Fort Lee, NJ, 84 Waterford Dr, Marlborough, MA 01752 USA
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23
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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24
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Kurokawa S, Kishimoto T, Su KP, Chang JPC, Chang HC, Yu X, Rodrigues-Silva N, Nielsen J, Unadkat A, Castle D, Haddad PM, Rocha D, Gadelha A, Kaliora S, Petrides G, Agid O, Tazawa Y, Takamiya A, Horigome T, Kane JM. Psychiatrists' perceptions of medication adherence among patients with schizophrenia: An international survey. Schizophr Res 2019; 211:105-107. [PMID: 31371039 DOI: 10.1016/j.schres.2019.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/09/2019] [Accepted: 07/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Shunya Kurokawa
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taishiro Kishimoto
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States.
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, No.91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Jane Pei-Chen Chang
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, No.91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Hui-Chih Chang
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, No.91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Xin Yu
- Peking University Sixth Hospital, No.51 Hua Yuan Bei Road, Haidian District, Beijing, 100191, China
| | - Nuno Rodrigues-Silva
- Department of Psychiatry and Mental Health, Cova da Beira University Healthcare Center, Quinta do Alvito, Covilhã, 6200-251, Portugal
| | - Jimmi Nielsen
- Mental health Centre Glostrup, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Anish Unadkat
- The University of Melbourne and St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, 3065, Australia
| | - David Castle
- The University of Melbourne and St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, 3065, Australia
| | - Peter M Haddad
- Department of Psychiatry, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Deyvis Rocha
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), 650 - 3° andar, São Paulo 04039-032, Brazil
| | - Ary Gadelha
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), 650 - 3° andar, São Paulo 04039-032, Brazil
| | - Styliani Kaliora
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States
| | - Georgios Petrides
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States
| | - Ofer Agid
- Schizophrenia Program, Centre for Addiction and Mental Health (CAMH), Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, CS 732, Toronto, ON M5T 1R8, Canada
| | - Yuki Tazawa
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Akihiro Takamiya
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toshiro Horigome
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - John M Kane
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States
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25
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Pyle M, Broome MR, Joyce E, MacLennan G, Norrie J, Freeman D, Fowler D, Haddad PM, Shiers D, Hollis C, Smith J, Liew A, Byrne RE, French P, Peters S, Hudson J, Davies L, Emsley R, Yung A, Birchwood M, Longden E, Morrison AP. Study protocol for a randomised controlled trial of CBT vs antipsychotics vs both in 14-18-year-olds: Managing Adolescent first episode Psychosis: a feasibility study (MAPS). Trials 2019; 20:395. [PMID: 31272477 PMCID: PMC6611021 DOI: 10.1186/s13063-019-3506-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 06/10/2019] [Indexed: 01/03/2023] Open
Abstract
Background Adolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and family intervention (FI). The evidence for APs in treating psychosis is limited in adolescents compared to adults. Nevertheless, it indicates that APs can reduce overall symptoms in adolescents but may cause more severe side effects, including cardiovascular and metabolic effects, than in adults. CBT and FI can improve outcomes in adults, but there are no studies of psychological interventions (PI) in patients under 18 years old. Given this limited evidence base, NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP. Methods/design The current study aimed to establish the feasibility and acceptability of conducting such a trial by recruiting 14–18-year-olds with a first episode of psychosis into a feasibility prospective randomised open blinded evaluation (PROBE) design, three-arm, randomised controlled trial of APs alone versus PI alone versus a combination of both treatments. We aimed to recruit 90 participants from Early Intervention and Child and Adolescent Mental Health Teams in seven UK sites. APs were prescribed by participants’ usual psychiatrists. PI comprised standardised cognitive behavioural therapy and family intervention sessions. Discussion This is the first study to compare APs to PI in an adolescent population with FEP. Recruitment finished on 31 October 2018. The study faced difficulties with recruitment across most sites due to factors including clinician and service-user treatment preferences. Trial registration Current controlled trial with ISRCTN, ISRCTN80567433. Registered on 27 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3506-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melissa Pyle
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
| | - Matthew R Broome
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK. .,Centre for Human Brain Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX4 7JX, UK.
| | - Emmeline Joyce
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, 3rd Floor Health Sciences Building, Aberdeen, AB25 2ZD, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Centre for Population Health Sciences, Usher Institute, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | - Daniel Freeman
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX4 7JX, UK
| | - David Fowler
- School of Psychology, Pevensey Building, University of Sussex, Falmer, BN1 9QH, UK
| | - Peter M Haddad
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Department of Psychiatry, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - David Shiers
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
| | - Chris Hollis
- NIHR MindTech MedTech Co-operative, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Jo Smith
- School of Allied Health and Community, Bredon Building, University of Worcester, Worcester, WR2 6AJ, UK
| | - Ashley Liew
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, CV4 7AL, UK.,Forward Thinking Birmingham, Birmingham Women's and Children's NHS Foundation Trust, Finch Road, Lozells, B19 1HS, UK
| | - Rory E Byrne
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
| | - Paul French
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool, L69 3BX, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, 3rd Floor Health Sciences Building, Aberdeen, AB25 2ZD, UK
| | - Linda Davies
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Jean MacFarlane Building, Manchester, M13 9PL, UK
| | - Richard Emsley
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, SE5 8AZ, UK
| | - Alison Yung
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK.,Centre for Youth Mental Health, Faculty of Medicine, University of Melbourne, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
| | - Max Birchwood
- Warwick Medical School-Mental Health and Wellbeing, University of Warwick, Coventry, CV4 7AL, UK
| | - Eleanor Longden
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
| | - Anthony P Morrison
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
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26
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Affiliation(s)
- Christoph U Correll
- .,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, and Department of Psychiatry, The Zucker Hillside Hospital, New Hyde Park, New York, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | | | - John Lauriello
- Department of Psychiatry, University of Missouri, Columbia, Missouri, USA
| | - Mark Olfson
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - John M Kane
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, and Department of Psychiatry, The Zucker Hillside Hospital, New Hyde Park, New York, USA
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27
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Jawad I, Watson S, Haddad PM, Talbot PS, McAllister-Williams RH. Medication nonadherence in bipolar disorder: a narrative review. Ther Adv Psychopharmacol 2018; 8:349-363. [PMID: 30524703 PMCID: PMC6278745 DOI: 10.1177/2045125318804364] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/01/2018] [Indexed: 12/14/2022] Open
Abstract
A number of effective maintenance medication options exist for bipolar disorder (BD) and these are regarded as the foundation of long-term treatment in BD. However, nonadherence to medication is common in BD. For example, a large data base study in the United States of America (USA) showed that approximately half of patients with BD were nonadherent with lithium and maintenance medications over a 12 month period. Such nonadherence carries a high risk of relapse due to the recurrent nature of the illness and the fact that abrupt cessation of treatment, particularly lithium, may cause rebound depression and mania. Indeed, medication nonadherence in BD is associated with significantly increased risks of relapse, recurrence, hospitalization and suicide attempts and a decreased likelihood of achieving remission and recovery, as well as with higher overall treatment costs. Factors associated with nonadherence include adverse effects of medication, complex medication regimens, negative patient attitudes to medication, poor insight, rapid-cycling BD, comorbid substance misuse and a poor therapeutic alliance. Clinicians should routinely enquire about nonadherence in a nonjudgmental fashion. Potential steps to improve adherence include simple pragmatic strategies related to prescribing including shared decision-making, psychoeducation with a clear focus on adherence, reminders (traditional and digital), potentially using a depot rather than an oral antipsychotic, managing comorbid substance misuse and improving therapeutic alliance. Financial incentives have been shown to improve adherence to depot antipsychotics, but this approach raises ethical issues and its long-term effectiveness is unknown. Often a combination of approaches will be required. The strategies that are adopted need to be patient specific, reflecting that nonadherence has no single cause, and chosen by the patient and clinician working together.
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Affiliation(s)
- Ibrahim Jawad
- Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Stuart Watson
- Northern Centre for Mood Disorders and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter M Haddad
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter S Talbot
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic, Health Science Centre, Manchester, UK
| | - R Hamish McAllister-Williams
- Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Northern Centre for Mood Disorders and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
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28
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Haddad PM, Correll CU. The acute efficacy of antipsychotics in schizophrenia: a review of recent meta-analyses. Ther Adv Psychopharmacol 2018; 8:303-318. [PMID: 30344997 PMCID: PMC6180374 DOI: 10.1177/2045125318781475] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/04/2018] [Indexed: 12/19/2022] Open
Abstract
Schizophrenia is the eighth leading cause of disability worldwide in people aged 15-44 years. Before antidopaminergic antipsychotics were introduced in the 1950s, no effective medications existed for the treatment of schizophrenia. This review summarizes key meta-analytic findings regarding antipsychotic efficacy in the acute treatment of schizophrenia, including clozapine in treatment-resistant patients. In the most comprehensive meta-analysis of randomized controlled trials conducted in multi-episode schizophrenia, antipsychotics outperformed placebo regarding total symptoms, positive symptoms, negative symptoms, depressive symptoms, quality of life and social functioning. Amongst these outcomes, the standardized mean difference for overall symptoms was largest, that is, 0.47 (95% credible interval = 0.42-0.51), approaching a medium effect size, being reduced to 0.38 when publication bias and small-trial effects were accounted for. A comparison of two meta-analyses indicated that first-episode patients, compared with multi-episode patients, were more likely to have at least minimal treatment response [⩾20% Positive and Negative Syndrome Scale (PANSS)/Brief Psychiatric Rating Scale (BPRS) score reduction: 81% versus 51%] and good response (⩾50% PANSS/BPRS score reduction: 52% versus 23%). In multi-episode schizophrenia, no response or worsening after 2 weeks of a therapeutic antipsychotic dose was highly predictive of not achieving a good response at endpoint (median treatment = 6 weeks: specificity = 86%; positive predictive value = 90%), suggesting a change in treatment should be considered in such cases. In first-episode psychosis, adequately dosed antipsychotic treatment trials for more than 2 weeks are recommended before using no response or worsening as a decision point for aborting a given antipsychotic. In clearly defined treatment-resistant schizophrenia, clozapine generally outperformed other antipsychotics, especially when dosed appropriately (target = 3-6 months' duration; trough clozapine level ⩾350-400 μg/L) with a response rate (⩾20% PANSS/BPRS) of 33% by 3 months of treatment. High antipsychotic doses and psychotropic combinations are unlikely to be superior to standard doses of antipsychotic monotherapy. Acute antipsychotic efficacy in schizophrenia depends on the targeted symptom domain (greater efficacy: total and positive symptoms, lesser efficacy: negative symptoms, depressive symptoms, social functioning and quality of life). Greater antipsychotic efficacy is associated with higher total baseline symptom severity, treatment-naïveté/first-episode status, shorter illness duration, and trials that are nonindustry sponsored and that have a lower placebo effect. The heterogeneity of antipsychotic response across individuals and key symptom domains, the considerable degree of nonresponse/treatment resistance in multi-episode patients, and the adverse effect potential of antipsychotics are major limitations, underscoring the need to develop new medications for the treatment of schizophrenia. Drug development should include matching patient subgroups, which are identified by means of clinical and biomarker variables, to mechanisms of action of novel medications, targeting specific symptom domains, and investigating mechanisms of action other than dopaminergic blockade.
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Affiliation(s)
- Peter M Haddad
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar. Neuroscience and Psychiatry Unit, University of Manchester, Stopford Building, Oxford Road, Manchester, UK
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Abstract
OBJECTIVES The purpose of this study was to investigate the association of antipsychotic exposure to the incidence and mortality of pneumonia. METHODS The design of this study involved meta-analysis of observational studies identified from electronic databases. RESULTS In total, 19 studies were included in the systematic review and 14 in the meta-analysis. Risk of pneumonia was increased by first-generation antipsychotics (risk ratio 1.69, 95% confidence interval 1.34-2.15; five studies), second-generation antipsychotics (risk ratio 1.93, 95% confidence interval 1.55-2.41; six studies) and all antipsychotics (risk ratio 1.83, 95% confidence interval 1.60-2.10; seven studies) compared with no antipsychotic use. Pneumonia risk did not differ in seven studies comparing first-generation antipsychotics with second-generation antipsychotics (risk ratio 1.07, 95% confidence interval 0.85-1.35). Case fatality rate was not different in pneumonia cases associated with antipsychotic exposure versus cases without exposure (risk ratio 1.50; 95% confidence interval 0.76-2.96; two studies). All antipsychotics with data from ⩾2 studies allowing meta-analysis, were associated with a significantly increased pneumonia risk (i.e. haloperidol, olanzapine, clozapine, risperidone, quetiapine, zotepine). CONCLUSION Exposure to both first-generation antipsychotics and second-generation antipsychotics is associated with an increased pneumonia risk. Clinicians need to be vigilant for the occurrence of pneumonia in patients commencing antipsychotics, especially those with other risk factors for pneumonia including older age, chronic respiratory disease, cerebrovascular disease, dysphagia and smoking.
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Affiliation(s)
- O Dzahini
- 1 Institute of Pharmaceutical Science, King's College London, London, UK.,2 South London and Maudsley NHS Foundation Trust, London, UK
| | - N Singh
- 3 Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - D Taylor
- 1 Institute of Pharmaceutical Science, King's College London, London, UK.,2 South London and Maudsley NHS Foundation Trust, London, UK
| | - P M Haddad
- 3 Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar.,4 University of Manchester, Manchester, UK
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Green AR, Aronson JK, Haddad PM. Examining the 'psychopharmacology revolution' (1950-1980) through the advertising of psychoactive drugs in the British Medical Journal. J Psychopharmacol 2018; 32:1056-1066. [PMID: 30251594 DOI: 10.1177/0269881118796810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Many modern pharmaceutical products were launched during 1950-1980, as reflected in advertisements in the British Medical Journal ( BMJ). One of the first therapeutic areas to benefit from novel effective medications was psychiatry. METHODS We examined BMJ advertising material between 1950 and 1980, including every other issue over six-month periods (October-March) in 1950/1951, 1955/1956, 1957/1958, 1960/1961, 1962/1963, 1965/1966, 1967/1968, 1970/1971, 1972/1973, 1975/1976, 1980/1981. We recorded numbers of adverts for all pharmaceutical products and for psychiatric drugs; we also recorded trade names, generic names and marketing company. RESULTS Advertising in BMJ peaked in the 1960s and declined markedly in the 1970s. Adverts for psychiatric drugs as a percentage of total pharmaceutical product advertising was broadly similar during 1955-1980, but with peaks in 1960/1961, 1970/1971 and 1975/1976, reflecting the entry of several novel compounds into the market. The peak marketing of antipsychotic drugs, sedatives and anxiolytic drugs was in 1960 and of antidepressants 1970. The time course of the rise of tricyclics and the switch from barbiturates to benzodiazepines can be seen. Drugs for psychiatry rose from ninth (1955/1956) to fourth (1975/1976) in terms of the number of products in the top 10 therapeutic areas. There is no evidence that they were advertised more aggressively (number of adverts/number of products). CONCLUSIONS The birth of modern psychopharmacology is reflected in th e advertising of psychiatric drugs in BMJ. Many drugs currently used, or their closely related successors, were launched in the early to mid-1960s. This rise in modern pharmaceuticals preceded several other major therapeutic areas.
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Affiliation(s)
- A Richard Green
- 1 School of Life Sciences, Queen's Medical Centre, University of Nottingham, UK
| | - Jeffrey K Aronson
- 2 Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Peter M Haddad
- 3 Neuroscience and Psychiatry Unit, University of Manchester, UK
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31
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Barnes TR, Leeson V, Paton C, Marston L, Osborn DP, Kumar R, Keown P, Zafar R, Iqbal K, Singh V, Fridrich P, Fitzgerald Z, Bagalkote H, Haddad PM, Husni M, Amos T. Amisulpride augmentation of clozapine for treatment-refractory schizophrenia: a double-blind, placebo-controlled trial. Ther Adv Psychopharmacol 2018; 8:185-197. [PMID: 29977519 PMCID: PMC6022882 DOI: 10.1177/2045125318762365] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/01/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A second antipsychotic is commonly added to clozapine to treat refractory schizophrenia, notwithstanding the limited evidence to support such practice. METHODS The efficacy and adverse effects of this pharmacological strategy were examined in a double-blind, placebo-controlled, 12-week randomized trial of clozapine augmentation with amisulpride, involving 68 adults with treatment-resistant schizophrenia and persistent symptoms despite a predefined trial of clozapine. RESULTS There were no statistically significant differences between the amisulpride and placebo groups on the primary outcome measure (clinical response defined as a 20% reduction in total Positive and Negative Syndrome Scale score) or other mental state measures. However, the trial under recruited and was therefore underpowered to detect differences in the primary outcome, meaning that acceptance of the null hypothesis carries an increased risk of type II error. The findings suggested that amisulpride-treated participants were more likely to fulfil the clinical response criterion, odds ratio 1.17 (95% confidence interval 0.40-3.42) and have a greater reduction in negative symptoms, but these numerical differences were not statistically significant and only evident at 12 weeks. A significantly higher proportion of participants in the amisulpride group had at least one adverse event compared with the control group (p = 0.014), and these were more likely to be cardiac symptoms. CONCLUSIONS Treatment for more than 6 weeks may be required for an adequate trial of clozapine augmentation with amisulpride. The greater side-effect burden associated with this treatment strategy highlights the need for safety and tolerability monitoring, including vigilance for indicators of cardiac abnormalities, when it is used in either a clinical or research setting.
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Affiliation(s)
- Thomas R.E. Barnes
- Centre for Psychiatry, Hammersmith Hospital Campus, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London W12 0NN, UK
| | | | - Carol Paton
- Centre for Psychiatry, Imperial College London, UK
- Oxleas NHS Foundation Trust, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, UK
- PRIMENT Clinical Trials Unit, University College London, UK
| | - David P. Osborn
- Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Raj Kumar
- Tees, Esk and Wear Valley NHS Foundation Trust, Billingham, UK
| | - Patrick Keown
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- Newcastle University, Newcastle-upon-Tyne, UK
| | - Rameez Zafar
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | | | - Vineet Singh
- Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Pavel Fridrich
- North Essex Partnership University NHS Foundation Trust, Harlow, UK
| | | | | | - Peter M. Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Mariwan Husni
- Central and North West London NHS Foundation Trust, London, UK
- Northern Ontario School of Medicine, Ontario, Canada
| | - Tim Amos
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Morrison AP, Law H, Shiers D, Yung AR, Haddad PM. Stand-alone cognitive behavioural therapy is not in clinical equipoise with antipsychotic treatment - Author's reply. Lancet Psychiatry 2018; 5:540-541. [PMID: 29941130 DOI: 10.1016/s2215-0366(18)30218-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Anthony P Morrison
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| | - Heather Law
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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33
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Barnes TR, Leeson VC, Paton C, Marston L, Davies L, Whittaker W, Osborn D, Kumar R, Keown P, Zafar R, Iqbal K, Singh V, Fridrich P, Fitzgerald Z, Bagalkote H, Haddad PM, Husni M, Amos T. Amisulpride augmentation in clozapine-unresponsive schizophrenia (AMICUS): a double-blind, placebo-controlled, randomised trial of clinical effectiveness and cost-effectiveness. Health Technol Assess 2018; 21:1-56. [PMID: 28869006 DOI: 10.3310/hta21490] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND When treatment-refractory schizophrenia shows an insufficient response to a trial of clozapine, clinicians commonly add a second antipsychotic, despite the lack of robust evidence to justify this practice. OBJECTIVES The main objectives of the study were to establish the clinical effectiveness and cost-effectiveness of augmentation of clozapine medication with a second antipsychotic, amisulpride, for the management of treatment-resistant schizophrenia. DESIGN The study was a multicentre, double-blind, individually randomised, placebo-controlled trial with follow-up at 12 weeks. SETTINGS The study was set in NHS multidisciplinary teams in adult psychiatry. PARTICIPANTS Eligible participants were people aged 18-65 years with treatment-resistant schizophrenia unresponsive, at a criterion level of persistent symptom severity and impaired social function, to an adequate trial of clozapine monotherapy. INTERVENTIONS Interventions comprised clozapine augmentation over 12 weeks with amisulpride or placebo. Participants received 400 mg of amisulpride or two matching placebo capsules for the first 4 weeks, after which there was a clinical option to titrate the dosage of amisulpride up to 800 mg or four matching placebo capsules for the remaining 8 weeks. MAIN OUTCOME MEASURES The primary outcome measure was the proportion of 'responders', using a criterion response threshold of a 20% reduction in total score on the Positive and Negative Syndrome Scale. RESULTS A total of 68 participants were randomised. Compared with the participants assigned to placebo, those receiving amisulpride had a greater chance of being a responder by the 12-week follow-up (odds ratio 1.17, 95% confidence interval 0.40 to 3.42) and a greater improvement in negative symptoms, although neither finding had been present at 6-week follow-up and neither was statistically significant. Amisulpride was associated with a greater side effect burden, including cardiac side effects. Economic analyses indicated that amisulpride augmentation has the potential to be cost-effective in the short term [net saving of between £329 and £2011; no difference in quality-adjusted life-years (QALYs)] and possibly in the longer term. LIMITATIONS The trial under-recruited and, therefore, the power of statistical analysis to detect significant differences between the active and placebo groups was limited. The economic analyses indicated high uncertainty because of the short duration and relatively small number of participants. CONCLUSIONS The risk-benefit of amisulpride augmentation of clozapine for schizophrenia that has shown an insufficient response to a trial of clozapine monotherapy is worthy of further investigation in larger studies. The size and extent of the side effect burden identified for the amisulpride-clozapine combination may partly reflect the comprehensive assessment of side effects in this study. The design of future trials of such a treatment strategy should take into account that a clinical response may be not be evident within the 4- to 6-week follow-up period usually considered adequate in studies of antipsychotic treatment of acute psychotic episodes. Economic evaluation indicated the need for larger, longer-term studies to address uncertainty about the extent of savings because of amisulpride and impact on QALYs. The extent and nature of the side effect burden identified for the amisulpride-clozapine combination has implications for the nature and frequency of safety and tolerability monitoring of clozapine augmentation with a second antipsychotic in both clinical and research settings. TRIAL REGISTRATION EudraCT number 2010-018963-40 and Current Controlled Trials ISRCTN68824876. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 49. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Thomas Re Barnes
- Centre for Mental Health, Imperial College London, London, UK.,West London Mental Health NHS Trust, London, UK
| | - Verity C Leeson
- Centre for Mental Health, Imperial College London, London, UK
| | - Carol Paton
- Centre for Mental Health, Imperial College London, London, UK.,Oxleas NHS Foundation Trust, London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK.,PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Linda Davies
- Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | - William Whittaker
- Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | - David Osborn
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Raj Kumar
- Tees, Esk and Wear Valley NHS Foundation Trust, Billingham, UK
| | - Patrick Keown
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Rameez Zafar
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | | | - Vineet Singh
- Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Pavel Fridrich
- North Essex Partnership University NHS Foundation Trust, Chelmsford, UK
| | | | | | - Peter M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.,Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Mariwan Husni
- Central and North West London NHS Foundation Trust, London, UK.,Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Tim Amos
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Bristol, UK
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McIntyre RS, Young AH, Haddad PM. Rethinking the spectrum of mood disorders: implications for diagnosis and management - Proceedings of a symposium presented at the 30th Annual European College of Neuropsychopharmacology Congress, 4 September 2017, Paris, France. Ther Adv Psychopharmacol 2018; 8:1-16. [PMID: 29977518 PMCID: PMC6022880 DOI: 10.1177/2045125318762911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/09/2018] [Indexed: 12/17/2022] Open
Abstract
The simultaneous occurrence of manic and depressive features has been recognized since classical times, but the term 'mixed state' was first used by Kraepelin at the end of the 19th century. From the 1980s, until the advent of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), psychiatric disorders were classified using a categorical approach. However, it was recognized that such an approach was too rigid to encompass the range of symptomatology encountered in clinical practice. Therefore, a dimensional approach was adopted in DSM-5, in which affective states are considered to be distributed across a continuum ranging from pure mania to pure depression. In addition, the copresence of symptoms of the opposite pole are captured using a 'with mixed features' specifier, applied when three or more nonoverlapping subthreshold symptoms of the opposite pole are present. Mixed features are common in patients with mood episodes, complicating the course of illness, reducing treatment response and worsening outcomes. However, research in this area is scarce and treatment options are limited. Current evidence indicates that antidepressants should be avoided for the treatment of bipolar mixed states. Evidence for bipolar mixed states supports the use of several second-generation antipsychotics, valproate and electroconvulsive therapy. One randomized controlled trial has demonstrated the efficacy of lurasidone, compared with placebo, in patients with major depressive disorder with mixed features, and there is limited evidence supporting the use of ziprasidone in such patients. Further research is required to determine whether other antipsychotic agents, or additional therapeutic approaches, might also be effective in this setting.
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Affiliation(s)
- Roger S McIntyre
- UHN-Toronto Western Hospital, Mood Disorders Psychopharmacology Unit, University of Toronto, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada
| | - Allan H Young
- Department of Psychological Medicine, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter M Haddad
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
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Morrison AP, Law H, Carter L, Sellers R, Emsley R, Pyle M, French P, Shiers D, Yung AR, Murphy EK, Holden N, Steele A, Bowe SE, Palmier-Claus J, Brooks V, Byrne R, Davies L, Haddad PM. Antipsychotic drugs versus cognitive behavioural therapy versus a combination of both in people with psychosis: a randomised controlled pilot and feasibility study. Lancet Psychiatry 2018; 5:411-423. [PMID: 29605187 PMCID: PMC6048761 DOI: 10.1016/s2215-0366(18)30096-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/14/2018] [Accepted: 02/20/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Little evidence is available for head-to-head comparisons of psychosocial interventions and pharmacological interventions in psychosis. We aimed to establish whether a randomised controlled trial of cognitive behavioural therapy (CBT) versus antipsychotic drugs versus a combination of both would be feasible in people with psychosis. METHODS We did a single-site, single-blind pilot randomised controlled trial in people with psychosis who used services in National Health Service trusts across Greater Manchester, UK. Eligible participants were aged 16 years or older; met ICD-10 criteria for schizophrenia, schizoaffective disorder, or delusional disorder, or met the entry criteria for an early intervention for psychosis service; were in contact with mental health services, under the care of a consultant psychiatrist; scored at least 4 on delusions or hallucinations items, or at least 5 on suspiciousness, persecution, or grandiosity items on the Positive and Negative Syndrome Scale (PANSS); had capacity to consent; and were help-seeking. Participants were assigned (1:1:1) to antipsychotics, CBT, or antipsychotics plus CBT. Randomisation was done via a secure web-based randomisation system (Sealed Envelope), with randomised permuted blocks of 4 and 6, stratified by gender and first episode status. CBT incorporated up to 26 sessions over 6 months plus up to four booster sessions. Choice and dose of antipsychotic were at the discretion of the treating consultant. Participants were followed up for 1 year. The primary outcome was feasibility (ie, data about recruitment, retention, and acceptability), and the primary efficacy outcome was the PANSS total score (assessed at baseline, 6, 12, 24, and 52 weeks). Non-neurological side-effects were assessed systemically with the Antipsychotic Non-neurological Side Effects Rating Scale. Primary analyses were done by intention to treat; safety analyses were done on an as-treated basis. The study was prospectively registered with ISRCTN, number ISRCTN06022197. FINDINGS Of 138 patients referred to the study, 75 were recruited and randomly assigned-26 to CBT, 24 to antipsychotics, and 25 to antipsychotics plus CBT. Attrition was low, and retention high, with only four withdrawals across all groups. 40 (78%) of 51 participants allocated to CBT attended six or more sessions. Of the 49 participants randomised to antipsychotics, 11 (22%) were not prescribed a regular antipsychotic. Median duration of total antipsychotic treatment was 44·5 weeks (IQR 26-51). PANSS total score was significantly reduced in the combined intervention group compared with the CBT group (-5·65 [95% CI -10·37 to -0·93]; p=0·019). PANSS total scores did not differ significantly between the combined group and the antipsychotics group (-4·52 [95% CI -9·30 to 0·26]; p=0·064) or between the antipsychotics and CBT groups (-1·13 [95% CI -5·81 to 3·55]; p=0·637). Significantly fewer side-effects, as measured with the Antipsychotic Non-neurological Side Effects Rating Scale, were noted in the CBT group than in the antipsychotics (3·22 [95% CI 0·58 to 5·87]; p=0·017) or antipsychotics plus CBT (3·99 [95% CI 1·36 to 6·64]; p=0·003) groups. Only one serious adverse event was thought to be related to the trial (an overdose of three paracetamol tablets in the CBT group). INTERPRETATION A head-to-head clinical trial of CBT versus antipsychotics versus the combination of the two is feasible and safe in people with first-episode psychosis. FUNDING National Institute for Health Research.
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Affiliation(s)
- Anthony P Morrison
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| | - Heather Law
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lucy Carter
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Sellers
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard Emsley
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Manchester Academic Health Science Centre Clinical Trials Unit, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Melissa Pyle
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul French
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Natasha Holden
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ann Steele
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Samantha E Bowe
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jasper Palmier-Claus
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Victoria Brooks
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rory Byrne
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Peter M Haddad
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Green AR, Haddad PM, Aronson JK. Marketing medicines: charting the rise of modern therapeutics through a systematic review of adverts in UK medical journals (1950-1980). Br J Clin Pharmacol 2018; 84:1668-1685. [PMID: 29442380 DOI: 10.1111/bcp.13549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/09/2018] [Accepted: 02/01/2018] [Indexed: 11/27/2022] Open
Abstract
AIMS To examine how pharmaceutical products that were first marketed between 1950 and 1980 were promoted to physicians through advertisements and briefly review advertising regulations and accuracy of the advertisements in the light of modern knowledge. METHODS We systematically reviewed advertisements promoting drugs for specific therapeutic areas, namely central nervous system disorders (anxiety and sleep disorders, depression, psychoses, and Parkinson's disease), respiratory disorders, cardiovascular disorders, and gastrointestinal disorders. We examined about 800 issues of the British Medical Journal (1950-1980) and about 150 issues of World Medicine (1965-1984). RESULTS Advertising material was minimally regulated until the mid-1970s. Many drugs were marketed with little preclinical or clinical knowledge and some with the expectation that prescribers would obtain further data. The peak of advertising occurred in parallel with the surge in the release of novel drugs during the 1960s, but declined markedly after the mid-1970s. Advertisements generally contained little useful prescribing information. The period we investigated saw the release of many novel pharmaceuticals in the therapeutic areas we examined, and many (or their class successors) still play important therapeutic roles, including benzodiazepines, tricyclic antidepressants, phenothiazines, levodopa, selective and non-selective β-adrenoceptor antagonists, thiazide diuretics, β-adrenoceptor agonists, and histamine H2 receptor antagonists. CONCLUSIONS Advertising pharmaceuticals in the BMJ and World Medicine in 1950-1980 was poorly regulated and often lacked rigour. However, advertisements were gradually modified in the light of increasing clinical pharmacological knowledge, and they reflect an exciting period for the introduction of many drugs that continue to be of benefit today.
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Affiliation(s)
- A Richard Green
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Peter M Haddad
- Neuroscience and Psychiatry Unit, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - Jeffrey K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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Abstract
BackgroundMuch of the existing data regarding the relationship between antipsychotic medications and diabetes mellitus are non-prospective.AimsTo review critically non-prospective studies examining antipsychotic medications as risk factors for diabetes mellitus.MethodDatabase and manual searches.ResultsAnecdotal reports indicate that conventional and atypical antipsychotics can cause diabetes mellitus. However, retrospective studies cannot reliably quantify this association, as they do not adequately control for confounding risk factors for diabetes, or for variation in detection and diagnosis of this illness. Most studies report a higher rate of diabetes in patients who use antipsychotic medication than in non-users, and in patients taking atypical v. conventional antipsychotics. Studies assessing the relative risks of diabetes between individual atypical antipsychotics are contradictory.ConclusionsRetrospective data are of limited value. Well-designed prospective studies, which account for potential confounders, are needed to investigate the true association between antipsychotic medications and diabetes.
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Affiliation(s)
- Peter M Haddad
- Cromwell House, Bolton, Salford and Trafford Mental Health NHS Trust, Cromwell Road, Eccles, Salford M30 0GT, UK
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Abstract
The Merck Essay Prize was inaugurated in 1993. All trainee psychiatrists (senior house officers, registrars or senior registrars) in the United Kingdom and Republic of Ireland were eligible to submit an essay on the topic: ‘Depression: Counting the Costs’. The winning essay by Dr Peter Haddad is printed here. The runners-up in Joint second place were Dr J. Bray, Lecturer, University of Leicester (Leicester General Hospital) and Dr R. Bullock, Senior Registrar, St Mary Abbots Hospital, London.Depressive illness is the commonest form of mental disorder in the community. Its effects are far-reaching and include psychological suffering and social disruption for affected individuals and their families, increased mortality, and direct and indirect financial costs for society. Only about half of all cases of depression are recognised by doctors and not all of these receive effective treatment. The costs of depression could be reduced if detection and treatment were improved. Addressing this is a major challenge for psychiatric services.
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Abstract
Antidepressant discontinuation symptoms occur with all classes of antidepressant. A well-described discontinuation syndrome occurs with the selective serotonin reuptake inhibitors, common symptoms including dizziness, headache, nausea and lethargy. Rare antidepressant discontinuation syndromes include extrapyramidal syndromes and mania/hypomania. All these syndromes, even isolated discontinuation symptoms, share three common features that facilitate diagnosis; abrupt onset within days of stopping the antidepressant, a short duration when untreated and rapid resolution when the antidepressant is reinstated. Clinicians need to be familiar with strategies for the prevention and management of such symptoms. Preventive strategies include warning patients about the possibility of discontinuation symptoms, encouraging good antidepressant adherence and tapering antidepressants at the end of treatment. Most symptoms are mild and short-lived. Consequently symptoms that follow planned termination of an antidepressant can often be managed by providing an explanation and reassurance. More severe symptoms should be treated symptomatically or the antidepressant restarted, in which case symptoms usually resolve within 24 h. More cautious tapering can then follow.
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Correll CU, Citrome L, Haddad PM, Lauriello J, Olfson M, Calloway SM, Kane JM. The Use of Long-Acting Injectable Antipsychotics in Schizophrenia: Evaluating the Evidence. J Clin Psychiatry 2017; 77:1-24. [PMID: 27732772 DOI: 10.4088/jcp.15032su1] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Long-acting injectable antipsychotics (LAIs) are among the most effective treatments in psychiatry, yet they remain underutilized in clinical practice. Although LAIs are typically used to maintain treatment adherence in patients with chronic schizophrenia, recent research has suggested that they may also provide an effective treatment strategy for patients with early-phase or first-episode disease. In October 2015, a group of 8 experts on the management of schizophrenia and LAIs met to evaluate the evidence surrounding the efficacy, safety, and cost-effectiveness of LAIs and to develop practical recommendations regarding the clinical use, education, and unmet needs related to LAIs. Participants were also asked to rate the importance of several patient characteristics when choosing an LAI versus an oral antipsychotic, from the perspectives of 4 different stakeholder groups: patients, health care professionals, families, and payers. The evidence review demonstrated that LAIs are superior to placebo for acute and maintenance treatment of schizophrenia and, in general, appear to be similar to one another in terms of schizophrenia relapse prevention. Study design impacts the demonstrated efficacy of LAIs versus oral antipsychotics, but recent database and randomized controlled studies favor the use of LAIs in early-phase schizophrenia patients. LAIs vary considerably in their propensity to cause certain adverse effects, including weight gain, metabolic effects, extrapyramidal symptoms, and prolactin elevation, and these differences can be used to help guide LAI selection. Some studies, but not all, have demonstrated significant reductions in health care utilization or overall costs with LAIs. The expert panel identified several barriers to LAI use in current practice, including clinician lack of knowledge, negative attitudes about LAIs, and resource and cost issues. The participants also identified a number of additional factors that should be considered when weighing the use of LAI therapy, including medication adherence, relapse risk and severity, cognitive impairment, ease of use, substance misuse, access and cost, stigma, social support, patient autonomy, control over medication dosing, fear of needles, and the potential for patient harm due to relapses and associated loss of functioning. This evidence review, discussion, and summary recommendations may help clinicians, patients, families, payers, and other stakeholders to better characterize the role of LAIs in the treatment of schizophrenia.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA.,Recognition and Prevention (RAP) Program, The Zucker Hillside Hospital, Glen Oaks, New York, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | | | - John Lauriello
- Department of Psychiatry, University of Missouri, Columbia, Missouri, USA
| | - Mark Olfson
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Stephen M Calloway
- MO HealthNet Division, Department of Social Services, Jefferson City, Missouri, USA
| | - John M Kane
- Department of Behavioral Health Services, North Shore-Long Island Jewish Health System, New York, New York, USA.,Department of Psychiatry, The Zucker Hillside Hospital, New Hyde Park, New York, USA
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Husain MI, Chaudhry IB, Rahman RR, Hamirani MM, Mehmood N, Haddad PM, Hodsoll J, Young AH, Naeem F, Husain N. Pilot study of a culturally adapted psychoeducation (CaPE) intervention for bipolar disorder in Pakistan. Int J Bipolar Disord 2017; 5:3. [PMID: 28155203 PMCID: PMC5307423 DOI: 10.1186/s40345-017-0074-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/11/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan. AIM The purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan. METHODS Thirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients. RESULTS Retention in the study was good, 80% of patients in the TAU follow-up assessment and 100% of patients in the CaPE group attended all 12 sessions. Patient satisfaction was higher in the CaPE group relative to control (ES = 1.41). Further, there were large effect sizes shown for CaPE versus TAU for medication adherence (MMAS-4: ES = 0.81), knowledge and attitudes towards bipolar (BKAQ: ES = 0.68), mania (YMRS: ES = 1.18), depression (BDI: ES = 1.17) and quality of life measures (EQ-5D: ES ⇒ 0.88). CONCLUSIONS Culturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU. Larger scale studies are needed to confirm our findings. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02210390.
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Affiliation(s)
- Muhammad Ishrat Husain
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
| | - Imran B Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - Raza R Rahman
- Department of Psychiatry, Dow University of Health Sciences, Karachi, Pakistan
| | - Munir M Hamirani
- Department of Psychiatry, Abbasi Shaheed Hospital, Karachi, Pakistan
| | - Nasir Mehmood
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | | | - John Hodsoll
- Centre for Affective Disorders, Institute of PsychiatryPsychology and Neuroscience, King's College London, London, UK
| | - Allan H Young
- Centre for Affective Disorders, Institute of PsychiatryPsychology and Neuroscience, King's College London, London, UK
| | - Farooq Naeem
- Department of Psychiatry, Queens' University, Kingston, ON, Canada
| | - Nusrat Husain
- University of Manchester, Oxford Road, Manchester, UK
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Husain MI, Chaudhry IB, Hamirani MM, Minhas FA, Kazmi A, Hodsoll J, Haddad PM, Deakin JF, Husain N, Young AH. Minocycline and celecoxib as adjunctive treatments for bipolar depression: a study protocol for a multicenter factorial design randomized controlled trial. Neuropsychiatr Dis Treat 2017; 13:1-8. [PMID: 28031712 PMCID: PMC5182039 DOI: 10.2147/ndt.s115002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Evidence suggests that the use of anti-inflammatory agents may improve depressive symptoms in patients with bipolar affective disorder. However, there are few well-designed clinical trials demonstrating the efficacy of these newer treatment strategies. PATIENTS AND METHODS This is a multicenter, 3-month, randomized, placebo-controlled, double-blind, factorial design trial of minocycline and/or celecoxib added to TAU for the treatment of depressive symptoms in patients experiencing a DSM-5 bipolar I or II disorder and a current major depressive episode. A total of 240 participants will undergo screening and randomization followed by four assessment visits. The primary outcome measure will be mean change from baseline to week 12 on the Hamilton Depression Scale scores. Clinical assessments using the Clinical Global Impression scale, Patient Health Questionnaire-9, and the Generalized Anxiety Disorder 7-item scale will be carried out at every visit as secondary outcomes. Side-effect checklists will be used to monitor the adverse events at each visit. Complete blood count and plasma C-reactive protein will be measured at baseline and at the end of the treatment. Minocycline will be started at 100 mg once daily and increased to 200 mg at 2 weeks. Celecoxib will be started at 200 mg once daily and increased to 400 mg at 2 weeks. DISCUSSION Anti-inflammatory agents have been shown to be potentially efficacious in the treatment of depressive symptoms. The aim of this study is to determine whether the addition of minocycline and/or celecoxib to TAU improves depressive symptoms in patients with bipolar affective disorder.
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Affiliation(s)
- Muhammad I Husain
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | | | | | - Fareed A Minhas
- Institute of Psychiatry, Rawalpindi Medical College, Rawalpindi
| | - Ajmal Kazmi
- Department of Psychiatry, Karwan-e-Hayat Hospital, Karachi, Pakistan
| | - John Hodsoll
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
| | - Peter M Haddad
- Division of Psychology and Mental Health, University of Manchester, Manchester
| | - John Fw Deakin
- Division of Psychology and Mental Health, University of Manchester, Manchester
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Reeder FD, Husain N, Rhouma A, Haddad PM, Munshi T, Naeem F, Khachatryan D, Chaudhry IB. The relationship between childhood trauma and adult psychosis in a UK Early Intervention Service: results of a retrospective case note study. Neuropsychiatr Dis Treat 2017; 13:269-273. [PMID: 28223807 PMCID: PMC5308563 DOI: 10.2147/ndt.s98605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
AIM There is evidence that childhood trauma is a risk factor for the development of psychosis and it is recommended that childhood trauma is inquired about in all patients presenting with psychosis. This study aimed to determine the prevalence of childhood trauma in patients in the UK Early Intervention Service based on a case note review. METHODS This is a retrospective case note study of 296 patients in an UK Early Intervention Service. Trauma history obtained on service entry was reviewed and trauma experienced categorized. Results were analyzed using crosstab and frequency analysis. RESULTS The mean age of the sample was 24 years, 70% were male, 66% were White, and 23% Asian (ethnicity not documented in 11% of the sample). Approximately 60% of patients reported childhood trauma, 21% reported no childhood trauma, and data were not recorded for the remaining 19%. Among those reporting trauma, the prevalence of most frequently reported traumas were: severe or repeated disruption (21%), parental mental illness (19%), bullying (18%), absence of a parent (13%), and 'other' trauma (24%) - the majority of which were victimization events. Sixty-six percent of those reporting trauma had experienced multiple forms of trauma. CONCLUSION A high prevalence of childhood trauma (particularly trauma related to the home environment or family unit) was reported. This is consistent with other studies reporting on trauma and psychosis. The main weakness of the study is a lack of a control group reporting experience of childhood trauma in those without psychosis. Guidelines recommend that all patients with psychosis are asked about childhood trauma; but in 19% of our sample there was no documentation that this had been done indicating the need for improvement in assessment.
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Affiliation(s)
| | - Nusrat Husain
- Neurosciences and Psychiatry Unit, University of Manchester, Manchester
| | - Abdul Rhouma
- Early Intervention Service, Lancashire Care NHS Foundation Trust, Preston, UK
| | - Peter M Haddad
- Neurosciences and Psychiatry Unit, University of Manchester, Manchester
| | | | | | | | - Imran B Chaudhry
- Neurosciences and Psychiatry Unit, University of Manchester, Manchester
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Cooper SJ, Reynolds GP, Barnes T, England E, Haddad PM, Heald A, Holt R, Lingford-Hughes A, Osborn D, McGowan O, Patel MX, Paton C, Reid P, Shiers D, Smith J. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment. J Psychopharmacol 2016; 30:717-48. [PMID: 27147592 DOI: 10.1177/0269881116645254] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users' negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance ('pre-diabetes'), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines.These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these.
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Affiliation(s)
- Stephen J Cooper
- Professor of Psychiatry (Emeritus), Queen's University Belfast, UK Clinical Lead for the National Audit of Schizophrenia, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Gavin P Reynolds
- Professor (Emeritus), Queen's University Belfast, UK Honorary Professor of Neuroscience, Sheffield Hallam University, Sheffield, UK
| | | | - Tre Barnes
- Professor of Psychiatry, The Centre for Mental Health, Imperial College London, London, UK
| | - E England
- General Practitioner, Laurie Pike Health Centre, Birmingham, UK
| | - P M Haddad
- Honorary Clinical Professor of Psychiatry, University of Manchester, Manchester, UK Consultant Psychiatrist, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - A Heald
- Consultant Physician, Leighton and Macclesfield Hospitals, Cheshire, UK Research Fellow, University of Manchester, Manchester, UK
| | - Rig Holt
- Professor in Diabetes and Endocrinology, Human Development and Health Academic Unit, University of Southampton, Southampton, UK
| | - A Lingford-Hughes
- Professor of Addiction Biology, Imperial College, London, UK Consultant Psychiatrist, CNWL NHS Foundation Trust, London, UK
| | - D Osborn
- Professor of Psychiatric Epidemiology and Honorary Consultant Psychiatrist, Division of Psychiatry UCL, London, UK
| | - O McGowan
- Trainee in Psychiatry, Hairmyres Hospital, Glasgow, UK
| | - M X Patel
- Honorary Senior Lecturer, King's College London, IOPPN, Department of Psychosis Studies PO68, London, UK
| | - C Paton
- Chief Pharmacist, Oxleas NHS Foundation Trust, Dartford, UK Joint-Head, Prescribing Observatory for Mental Health, CCQI, Royal College of Psychiatrists, London, UK
| | - P Reid
- Policy Manager, Rethink Mental Illness, London, UK
| | - D Shiers
- Primary Care Lead for the National Audit of Schizophrenia, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - J Smith
- Professor of Early Intervention and Psychosis, University of Worcester, Worcester, UK
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Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 443] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
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Affiliation(s)
- G M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK
| | - I N Ferrier
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - J K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Trh Barnes
- The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK
| | - A Cipriani
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D R Coghill
- MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J R Geddes
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - H Grunze
- Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria
| | - E A Holmes
- MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - O Howes
- Institute of Psychiatry (Box 67), London, UK
| | | | - N Hunt
- Fulbourn Hospital, Cambridge, UK
| | - I Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - I C Macmillan
- Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - H McAllister-Williams
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - D R Miklowitz
- UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - M Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - C Paton
- Oxleas NHS Foundation Trust, Dartford, UK
| | - B J Saharkian
- Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kea Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jma Sinclair
- University Department of Psychiatry, Southampton, UK
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK
| | - E Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
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Singh SM, Haddad PM, Husain N, Heaney E, Tomenson B, Chaudhry IB. Cross-sectional comparison of first-generation antipsychotic long-acting injections vs risperidone long-acting injection: patient-rated attitudes, satisfaction and tolerability. Ther Adv Psychopharmacol 2016; 6:162-71. [PMID: 27354904 PMCID: PMC4910399 DOI: 10.1177/2045125316632458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES The objective of this study was to compare patients' attitudes and satisfaction with medication and patient-rated tolerability between those prescribed a first-generation antipsychotic long-acting injection (FGA-LAI) and those prescribed risperidone long-acting injection (RLAI). METHOD A cross-sectional study of a representative sample of outpatients prescribed an FGA-LAI or RLAI for a minimum of 6 months and attending a depot clinic. Attitudes to medication were assessed by the Drug Attitude Inventory (DAI-30), tolerability was measured by the Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) and satisfaction with antipsychotic medication was assessed by the Satisfaction with Antipsychotic Medication (SWAM) scale. RESULTS The RLAI (n = 28) and FGA-LAI (n = 39) groups did not differ in terms of mean age, sex, diagnosis and ethnicity. All individual LAIs were prescribed within British National Formulary limits. The most commonly prescribed FGA-LAI was flupentixol decanoate (n = 22). There was no significant difference between the RLAI and FGA-LAI groups in terms of mean total scores on the DAI-30, LUNSERS and SWAM or the tolerability subscales of the LUNSERS or the two subscales (treatment acceptability and medication insight) of the SWAM. In both LAI groups there was a low level of side effects (LUNSERS) and a generally positive attitude (DAI-30) and reasonable satisfaction (SWAM) with medication. CONCLUSIONS Patients treated with FGA-LAI and RLAI for at least 6 months did not differ in terms of patient-rated tolerability, attitudes and satisfaction with medication. The current design cannot determine whether differences would have been evident earlier on during treatment. These results should be regarded as preliminary and are subject to prescribing bias. Randomized studies avoid prescribing bias and are a superior way to compare specific LAIs. Ideally randomized studies should include patient-rated outcome measures including medication tolerability; assessment of side effects, efficacy and quality of life made by blinded raters; and additional objective side-effect data including changes in weight and key blood parameters.
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Affiliation(s)
| | | | | | | | | | - Imran B Chaudhry
- Lead Consultant Psychiatrist, Lancashire Care Early Intervention Service & Honorary Professor of Adult Psychiatry, University of Manchester, The Mount, Whalley Road, Accrington BB5 5DE, UK
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McAllister-Williams RH, Anderson IM, Finkelmeyer A, Gallagher P, Grunze HCR, Haddad PM, Hughes T, Lloyd AJ, Mamasoula C, McColl E, Pearce S, Siddiqi N, Sinha BNP, Steen N, Wainwright J, Winter FH, Ferrier IN, Watson S. Antidepressant augmentation with metyrapone for treatment-resistant depression (the ADD study): a double-blind, randomised, placebo-controlled trial. Lancet Psychiatry 2016; 3:117-27. [PMID: 26727041 DOI: 10.1016/s2215-0366(15)00436-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/11/2015] [Accepted: 09/11/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Many patients with major depressive disorder have treatment-resistant depression, defined as no adequate response to two consecutive courses of antidepressants. Some evidence suggests that antiglucocorticoid augmentation of antidepressants might be efficacious in patients with major depressive disorder. We aimed to test the proof of concept of metyrapone for the augmentation of serotonergic antidepressants in the clinically relevant population of patients with treatment-resistant depression. METHODS This double-blind, randomised, placebo-controlled trial recruited patients from seven UK National Health Service (NHS) Mental Health Trusts from three areas (northeast England, northwest England, and the Leeds and Bradford area). Eligible patients were aged 18-65 years with treatment-resistant depression (Hamilton Depression Rating Scale 17-item score of ≥18 and a Massachusetts General Hospital Treatment-Resistant Depression staging score of 2-10) and taking a single-agent or combination antidepressant treatment that included a serotonergic drug. Patients were randomly assigned (1:1) through a centralised web-based system to metyrapone (500 mg twice daily) or placebo, in addition to their existing antidepressant regimen, for 21 days. Permuted block randomisation was done with a block size of two or four, stratified by centre and primary or secondary care setting. The primary outcome was improvement in Montgomery-Åsberg Depression Rating Scale (MADRS) score 5 weeks after randomisation, analysed in the modified intention-to-treat population of all randomly assigned patients that completed the MADRS assessment at week 5. The study has an International Standard Randomised Controlled Trial Number (ISRCTN45338259) and is registered with the EU Clinical Trial register, number 2009-015165-31. FINDINGS Between Feb 8, 2011, and Dec 10, 2012, 165 patients were recruited and randomly assigned (83 to metyrapone and 82 to placebo), with 143 (87%) completing the primary outcome assessment (69 [83%] in the metyrapone and 74 [90%] in the placebo group). At 5 weeks, MADRS score did not significantly differ between groups (21·7 points [95% CI 19·2-24·4] in the metyrapone group vs 22·6 points [20·1-24·8] in the placebo group; adjusted mean difference of -0·51 points [95% CI -3·48 to 2·46]; p=0·74). 12 serious adverse events were reported in four (5%) of 83 patients in the metyrapone group and six (7%) of 82 patients in the placebo group, none of which were related to study treatment. 134 adverse events occurred in 58 (70%) patients in the metyrapone group compared with 95 events in 45 (55%) patients in the placebo group, of which 11 (8%) events in the metyrapone group and four (4%) in the placebo group were judged by principle investigators at the time of occurrence to be probably related to the study drug. INTERPRETATION Metyrapone augmentation of antidepressants is not efficacious in a broadly representative population of patients with treatment-resistant depression within the NHS and therefore is not an option for patients with treatment-resistant depression in routine clinical practice at this time. Further research is needed to clarify if such augmentation might benefit subpopulations with demonstrable hypothalamic-pituitary-adrenal axis abnormalities. FUNDING Efficacy and Mechanism Evaluation (EME) programme, a UK Medical Research Council and National Institute for Health Research partnership.
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Affiliation(s)
- R Hamish McAllister-Williams
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Ian M Anderson
- Neuroscience and Psychiatry Unit, Manchester University, Manchester, UK
| | - Andreas Finkelmeyer
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Heinz C R Grunze
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK; Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
| | - Peter M Haddad
- Neuroscience and Psychiatry Unit, Manchester University, Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Tom Hughes
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Adrian J Lloyd
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Elaine McColl
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Pearce
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Najma Siddiqi
- Bradford District Care NHS Foundation Trust, Bradford, UK; Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Baxi N P Sinha
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Nick Steen
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - June Wainwright
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona H Winter
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - I Nicol Ferrier
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stuart Watson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Emsley R, Alptekin K, Azorin JM, Cañas F, Dubois V, Gorwood P, Haddad PM, Naber D, Olivares JM, Papageorgiou G, Roca M, Thomas P, Hargarter L, Schreiner A. Nurses' perceptions of medication adherence in schizophrenia: results of the ADHES cross-sectional questionnaire survey. Ther Adv Psychopharmacol 2015; 5:339-50. [PMID: 26834967 PMCID: PMC4722504 DOI: 10.1177/2045125315612013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Poor adherence to antipsychotic treatment is a widespread problem within schizophrenia therapy with serious consequences including increased risks of relapse and rehospitalization. Mounting evidence supports the key roles that nurses play in monitoring patient progress and facilitating long-term treatment adherence. The Adherencia Terapéutica en la Esquizofrenia (ADHES) nurses' survey was designed to assess the opinions of nurses on the causes and management of partial/nonadherence to antipsychotic medication. METHODS A questionnaire-based cross-sectional survey of 4120 nurses from Europe, the Middle East and Africa. Interpretation of results was based on a descriptive comparison of responses. RESULTS Nurses perceived 54% of patients seen in the preceding month to be partially/nonadherent to treatment. Most nurses (90%) reported some level of experience with administration of long-acting injectable (LAI) antipsychotics, with 24% of nurses administering >10 injections per month. The majority (85%) of nurses surveyed believed that improving adherence would improve patient outcomes. Nearly half (49%) reported that most of their patients depend on a family member or other nonprofessional carer to remind them to take their medication as prescribed. A similar proportion of nurses (43%) reported that most of their patients relied on a professional to remind them to take medication. Most nurses (92%) felt that ensuring continuous medication with LAI antipsychotics would yield long-term benefits for patients, but their opinion was that over a third of patients were unaware of LAI antipsychotic treatments. In a series of forced options, the strategy used most often by respondents (89%) to promote medication adherence was to build trusting relationships with patients while listening to and interpreting their needs and concerns. Respondents also rated this as the most effective strategy that they used (48%). CONCLUSION Nurses are highly aware of adherence issues faced by their patients; further patient education on treatment options is needed.
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Affiliation(s)
- Robin Emsley
- Department of Psychiatry, University of Stellenbosch, Tygerberg 7505, Cape Town, South Africa
| | - Koksal Alptekin
- Department of Psychiatry, Dokuz Eylül University School of Medicine, Izmir, Turkey
| | | | - Fernando Cañas
- Department of Psychiatry, Hospital Dr R Lafora, Cra de Colmenar Viejo, Madrid, Spain
| | - Vincent Dubois
- Service de psychiatrie adulte, Cliniques universitaires St-Luc, Bruxelles, Belgium
| | - Philip Gorwood
- CMME, Hôpital Sainte-Anne (Paris Descartes), Paris, France
| | - Peter M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust and Department of Psychiatry, University of Manchester, Manchester, UK
| | - Dieter Naber
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - José Manuel Olivares
- Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - Miguel Roca
- Unidad de Psiquiatría, Hospital Juan March, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - Pierre Thomas
- Service de Psychiatrie, Hôpital M. Fontan, Lille, France
| | - Ludger Hargarter
- Department of Medical and Scientific Affairs, Janssen EMEA, Neuss, Germany
| | - Andreas Schreiner
- Department of Medical and Scientific Affairs, Janssen EMEA, Neuss, Germany
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Hynes C, Keating D, McWilliams S, Madigan K, Kinsella A, Maidment I, Feetam C, Drake RJ, Haddad PM, Gaughran F, Taylor M, Clarke M. Glasgow Antipsychotic Side-effects Scale for Clozapine - Development and validation of a clozapine-specific side-effects scale. Schizophr Res 2015; 168:505-13. [PMID: 26276305 DOI: 10.1016/j.schres.2015.07.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The authors developed and validated a clozapine-specific side-effects scale capable of eliciting the subjectively unpleasant side-effects of clozapine. METHODS Questions from the original Glasgow Antipsychotic Side-effects Scale (GASS) were compared to a list of the most commonly reported clozapine side-effects and those with a significant subjective burden were included in the GASS for Clozapine (GASS-C). The original authors of the GASS and a group of mental health professionals from the UK and Ireland were enlisted to comment on the questions in the GASS-C based on their clinical experience. 110 clozapine outpatients from two sites completed the GASS-C, the original GASS and a repeat GASS-C. Statistical analyses were performed using SPSS for Windows version 19. RESULTS The GASS-C was shown to have construct validity, in that Spearman's correlation coefficient was 0.816 (p<0.001) with the original GASS, whilst Cohen's kappa coefficient was >0.77 (p<0.001) for one question and >0.81 (p<0.001) for remaining relevant questions. GASS-C was also shown to have strong test-retest reliability, in that Cronbach's alpha coefficient was >0.907 (p<0.001), whilst Cohen's kappa coefficient was >0.81 (p<0.001) for 12 questions and >0.61 (p<0.001) for the remaining four questions. CONCLUSION The GASS-C is a valid and reliable clinical tool to enable a systematic assessment of the subjectively unpleasant side-effects of clozapine. Future research should focus on how the scale can be utilised as a clinical tool to improve real-world outcomes such as adherence to clozapine therapy and quality of life.
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Affiliation(s)
- Caroline Hynes
- Saint John of God Hospital, Stillorgan, Co. Dublin, Ireland.
| | - Dolores Keating
- Saint John of God Hospital, Stillorgan, Co. Dublin, Ireland.
| | | | - Kevin Madigan
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland.
| | - Anthony Kinsella
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland.
| | - Ian Maidment
- Aston University, School of Life and Health Sciences, Birmingham, United Kingdom.
| | - Celia Feetam
- Aston University, School of Life and Health Sciences, Birmingham, United Kingdom.
| | - Richard J Drake
- University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
| | - Peter M Haddad
- Greater Manchester Health NHS Foundation Trust, Manchester, United Kingdom.
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, National Psychosis Unit, London, United Kingdom.
| | | | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland.
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Abstract
INTRODUCTION OR BACKGROUND Depression frequently fails to respond to initial treatment. SOURCES OF DATA Predominantly meta-analyses and RCTs but supplemented where necessary by additional data and the authors' clinical experience. AREAS OF AGREEMENT A systematic assessment to identify remedial causes of poor response should be followed by planned sequential treatment trials. Joint decision making by the patient and clinician is essential. Strategies with the strongest support are antidepressant augmentation with lithium or second generation antipsychotics and adding cognitive behavioural treatment. Electroconvulsive therapy is highly effective in resistant depression but there is a high relapse rate when treatment ends. AREAS OF CONTROVERSY Some pharmacological strategies have inconsistent data (e.g. antidepressant combinations, T3 augmentation) or limited preliminary data (e.g. ketamine, antidepressant augmentation with pramipexole). The efficacy of vagus nerve stimulation, deep brain stimulation and repetitive transcranial magnetic stimulation is unclear. GROWING POINTS A greater understanding of the causes of depression may assist the development of more effective treatments. AREAS TIMELY FOR DEVELOPING RESEARCH Role of glutamate antagonists and psychological treatments, other than cognitive behavioural therapy, as adjunctive treatments.
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Affiliation(s)
- Peter M Haddad
- Neuroscience and Psychiatry Unit, University of Manchester, Stopford Building, Oxford Rd, Manchester M13 9PT, UK Greater Manchester West Mental Health NHS Foundation Trust, Cromwell House, Eccles, Salford M30 0GT, UK
| | - Peter S Talbot
- Wolfson Molecular Imaging Centre, University of Manchester, 27 Palatine Road, Manchester M20 3LJ, UK
| | - Ian M Anderson
- Neuroscience and Psychiatry Unit, University of Manchester, Stopford Building, Oxford Rd, Manchester M13 9PT, UK
| | - R Hamish McAllister-Williams
- Institute of Neuroscience, Newcastle University, Wolfson Research Centre, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne NE4 5PL, UK Northumberland, Tyne and Wear NHS Foundation Trust, Regional Affective Disorders Service, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne NE4 5PR, UK
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