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Kimura K, Narita H, Imai H, Akiyama H, Ishikawa S, Sawagashira R, Isoyama T, Nohara M, Kawamura M, Kono Y, Saito T, Kusumi I. Cardiovascular adverse reactions associated with escitalopram in patients with underlying cardiovascular diseases: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1248397. [PMID: 37810602 PMCID: PMC10556499 DOI: 10.3389/fpsyt.2023.1248397] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Background Despite the anticipated efficacy of escitalopram in treating depression and anxiety in individuals with preexisting cardiovascular conditions, persistent concerns regarding its adverse effects have emerged. In this systematic review, we aimed to evaluate the cardiovascular safety profile of escitalopram compared with that of placebo in patients with underlying cardiovascular disease. Methods We used a predefined search strategy in PubMed, Cochrane Central Register of Controlled Trials, Embase, International Clinical Trials Registry Platform, and ClinicalTrials.gov to identify studies evaluating adverse cardiovascular reactions to escitalopram in patients with underlying cardiovascular disease. Randomized controlled trials (RCTs) that provided results on cardiovascular safety outcomes were included. Two independent reviewers screened the abstracts and full texts of the individual studies. The risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results The primary outcomes were the frequency of major adverse cardiovascular events (MACE), QTc prolongation, and discontinuation of study medication. We identified 5 RCTs with 773 participants who met the inclusion criteria. Escitalopram was not associated with significantly increased risk of MACE (risk ratio [RR] = 1.85; 95% confidence interval [CI] 0.80 to 4.26; I2 0%; 5 RCTs; n = 773, moderate certainty of evidence), discontinuation of study medication (RR = 1.03; 95% CI 0.84-1.26; I2 0%; 5 RCTs; n = 773, low certainty of evidence), and QTc prolongation (RR = 1.20; 95% CI 0.76-1.90; I2 0%; 4 RCTs; n = 646, low certainty of evidence). Conclusion Escitalopram does not significantly increase the risk of cardiovascular adverse reactions compared with placebo in patients with underlying cardiovascular disease. However, the presence of wide CIs and the limited number of included studies highlight the need for further studies with larger sample sizes to enhance the precision and reliability of these findings.Systematic review registration: International Prospective Register of Systematic Reviews [CRD42022298181].
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Affiliation(s)
- Kenichi Kimura
- Department of Psychiatry and Neurology, Hokkaido University Hospital, Sapporo, Japan
| | - Hisashi Narita
- Department of Psychiatry and Neurology, Hokkaido University Hospital, Sapporo, Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Hisashi Akiyama
- Department of Psychiatry and Neurology, Hokkaido University Hospital, Sapporo, Japan
| | - Shuhei Ishikawa
- Department of Psychiatry and Neurology, Hokkaido University Hospital, Sapporo, Japan
| | - Ryo Sawagashira
- Department of Physiology, Hokkaido University School of Medicine, Sapporo, Japan
- Creative Research Institute, Hokkaido University, Sapporo, Japan
| | - Tomoyuki Isoyama
- Department of Psychiatry and Neurology, Hokkaido University Hospital, Sapporo, Japan
| | - Mariko Nohara
- Department of Psychiatry and Neurology, Hokkaido University Hospital, Sapporo, Japan
| | - Michiyo Kawamura
- Medical Sciences Group, Research Support Division, Hokkaido University Library, Sapporo, Japan
| | - Yukari Kono
- Medical Sciences Group, Research Support Division, Hokkaido University Library, Sapporo, Japan
| | - Takuya Saito
- Department of Child and Adolescent Psychiatry, Hokkaido University Hospital, Sapporo, Japan
| | - Ichiro Kusumi
- Department of Psychiatry and Neurology, Hokkaido University Hospital, Sapporo, Japan
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Sawagashira R, Tanaka M. Nicotine promotes the utility of short-term memory during visual search in macaque monkeys. Psychopharmacology (Berl) 2022; 239:3019-3029. [PMID: 35802143 DOI: 10.1007/s00213-022-06186-6] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
RATIONALE The central cholinergic system is a major therapeutic target for restoring cognitive functions. Although manipulation of cholinergic signaling is known to alter working memory (WM), the underlying mechanism remains unclear. It is widely accepted that WM consists of multiple functional modules, one storing short-term memory and the other manipulating and utilizing it. A recently developed visual search task and a relevant model can be used to assess multiple components of WM during administration of acetylcholine receptor (AChR)-related substances. OBJECTIVES The effects of systemic administration of AChR-related agents on WM and eye movements were examined during the oculomotor foraging task. METHODS Three monkeys performing the task received an intramuscular injection of saline or the following AChR-related agents: nicotine (24 or 56 μg/kg), mecamylamine (nicotinic AChR antagonist, 1.0 mg/kg), oxotremorine (muscarinic AChR agonist, 3.0 µg/kg), and scopolamine (muscarinic AChR antagonist, 20 μg/kg). The task was to find a target among 15 identical objects by making eye movements within 6 s. The data were analyzed according to the foraging model that incorporated three parameters. RESULTS Nicotine and mecamylamine significantly increased the utility but not the capacity of short-term memory, while muscarinic AChR-related agents did not alter any WM parameters. Further regression analyses with a mixed-effect model showed that the beneficial effect of nicotine on memory utility remained after considering eye movement variability, but the beneficial effect of mecamylamine disappeared. CONCLUSIONS Nicotine improves visual search, mainly by increasing the utility of short-term memory, with minimal changes in oculomotor parameters.
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Affiliation(s)
- Ryo Sawagashira
- Department of Physiology, Hokkaido University School of Medicine, Sapporo, 060-8638, Japan. .,Department of Psychiatry, Hokkaido University School of Medicine, Sapporo, 060-8638, Japan.
| | - Masaki Tanaka
- Department of Physiology, Hokkaido University School of Medicine, Sapporo, 060-8638, Japan.
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Yamada Y, Okubo R, Tachimori H, Uchino T, Kubota R, Okano H, Ishikawa S, Horinouchi T, Takanobu K, Sawagashira R, Hasegawa Y, Sasaki Y, Nishiuchi M, Kawashima T, Tomo Y, Hashimoto N, Ikezawa S, Nemoto T, Watanabe N, Sumiyoshi T. Pharmacological interventions for social cognitive impairments in schizophrenia: A protocol for a systematic review and network meta-analysis. Front Psychol 2022; 13:878829. [PMID: 35992452 PMCID: PMC9381750 DOI: 10.3389/fpsyg.2022.878829] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Social cognitive impairments adversely affect social functioning (e.g., employment status) in patients with schizophrenia. Although pharmacological interventions have been suggested to provide some benefits on social cognition, little information is available on the comparative efficacy of pharmacotherapy. Thus, the aim of this planned systematic review and network meta-analysis is to perform a quantitative comparison of the effects of various psychotropic drugs, including supplements, on social cognition disturbances of schizophrenia. Methods The literature search will be carried out using the PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, ClinicalTrials.gov, and International Clinical Trials Registry Platform databases from inception onward. Randomized controlled trials that examined the efficacy of drugs in social cognitive disturbances will be included, based on the most recent studies and the broader literature than previously searched. This protocol defines a priori the methods that will be used for study selection, data collection, quality assessment, and statistical syntheses. Discussion The findings this work are expected to help promote the development of better therapeutics of social cognitive impairments in schizophrenia and related psychiatric conditions. Systematic Review Registration [www.crd.york.ac.uk/prospero], identifier [CRD42021293224].
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Affiliation(s)
- Yuji Yamada
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ryo Okubo
- Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
- *Correspondence: Ryo Okubo,
| | - Hisateru Tachimori
- Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
- Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Uchino
- Department of Neuropsychiatry, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Ryotaro Kubota
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hiroki Okano
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shuhei Ishikawa
- Department of Psychiatry, Hokkaido University Hospital, Sapporo, Japan
| | - Toru Horinouchi
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keisuke Takanobu
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryo Sawagashira
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yumi Hasegawa
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yohei Sasaki
- Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Motohiro Nishiuchi
- Graduate School of Human and Social Sciences, Musashino University, Tokyo, Japan
| | - Takahiro Kawashima
- Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yui Tomo
- Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoru Ikezawa
- Endowed Institute for Empowering Gifted Minds, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Sawagashira R, Yamamura R, Okubo R, Hashimoto N, Ishikawa S, Ito YM, Sato N, Kusumi I. Subthreshold Change in Glycated Hemoglobin and Body Mass Index After the Initiation of Second-Generation Antipsychotics Among Patients With Schizophrenia or Bipolar Disorder: A Nationwide Prospective Cohort Study in Japan. J Clin Psychiatry 2022; 83. [PMID: 35377566 DOI: 10.4088/jcp.21m14099] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: The risk of diabetes development has been reported to differ among second-generation antipsychotics (SGAs). However, few studies have focused on the subthreshold change in glycated hemoglobin (HbA1c). Therefore, this study examined the subthreshold change in HbA1c and change in body mass index (BMI) 3 months after patients initiated one of 6 SGAs widely prescribed in Japan. Methods: This is a prospective cohort study of patients followed up based on the Japanese blood glucose monitoring guidelines for patients with schizophrenia. We collected eligible patients' demographic data, medication history, blood tests, and weight measurements both at baseline and 3 months after recruitment, between April 2013 and March 2015. In the 378 patients with schizophrenia, schizoaffective disorder, and bipolar disorder based on ICD-10, we compared the subthreshold change in HbA1c and the change in BMI 3 months after antipsychotic initiation by using multivariate regression analysis. Results: The subthreshold change in HbA1c 3 months after initiating blonanserin was significantly lower compared with olanzapine (B = -0.17, 95% CI = -0.31 to -0.04). In addition, the change in BMI 3 months after initiating blonanserin and aripiprazole was significantly lower compared with olanzapine (B = -0.93, 95% CI = -1.74 to -0.12; B = -0.71, 95% CI = -1.30 to -0.12, respectively). Conclusions: This is the first study to clarify the differences in the subthreshold change in HbA1c among SGAs. Our results suggest that blonanserin is likely to be a favorable treatment for patients with high risk of diabetes. Trial Registration: UMIN Clinical Trial Registry identifier: UMIN000009868.
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Affiliation(s)
- Ryo Sawagashira
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Physiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryodai Yamamura
- Division of Biomedical Oncology, Institute for Genetic Medicine, Hokkaido University, Sapporo, Japan
| | - Ryo Okubo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan.,Corresponding author: Ryo Okubo, PhD, MD, Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shuhei Ishikawa
- Department of Psychiatry, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M Ito
- Hokkaido University Hospital Clinical Research & Medical Innovation Center, Sapporo, Japan
| | - Norihiro Sato
- Hokkaido University Hospital Clinical Research & Medical Innovation Center, Sapporo, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Ishikawa S, Yamamura R, Hashimoto N, Okubo R, Sawagashira R, Ito YM, Sato N, Kusumi I. The type rather than the daily dose or number of antipsychotics affects the incidence of hyperglycemic progression. Prog Neuropsychopharmacol Biol Psychiatry 2022; 113:110453. [PMID: 34637872 DOI: 10.1016/j.pnpbp.2021.110453] [Citation(s) in RCA: 2] [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: 04/28/2021] [Revised: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 12/25/2022]
Abstract
There have been concerns that antipsychotics increase the incidence of hyperglycemic progression. Many factors have been suggested to contribute to the risk of antipsychotic-induced hyperglycemic progression, including the type, daily dose, and number of antipsychotics; however, few studies have examined these relationships. This study aimed to examine the affect of antipsychotic treatment-associated factors on hyperglycemic progression, after adjustment for the affect of background factors suggested to be associated with hyperglycemic progression. This was a nationwide, multicenter, prospective cohort study examining the incidence of hyperglycemic progression during a 12 mo period following the initiation of newly prescribed antipsychotic medication. Demographic data, medication history, and blood test values were collected from 631 study participants with normal blood glucose levels at baseline for 12 mo. The primary endpoint (incidence of hyperglycemic progression) was defined as progression from normal to prediabetic or probable diabetic status, and was evaluated based on the Japanese monitoring guidance in patients with schizophrenia. To further examine the affect of antipsychotics on glucose metabolism over time, we examined changes in HbA1c levels 3, 6, and 12 mo after the initiation of treatment with each antipsychotic. We found that treatment with zotepine and clozapine was associated with a significantly high incidence of hyperglycemic progression. Furthermore, changes in HbA1c levels 6 mo after the initiation of zotepine treatment were significantly higher than those following blonanserin and haloperidol treatments. In contrast, there was no significant difference in the change in total cholesterol, triglycerides, HDL cholesterol, and BMI during the same period. Moreover, the "daily dose" and "number" of antipsychotics did not show an association with the incidence of hyperglycemic progression. However, in a post hoc analysis in which the antipsychotics were divided into two groups according to the strength of blockade of H1, M1, M3, and 5-HT2C receptors, the incidence of hyperglycemic progression was higher in the medium- and high-daily dose groups than in the low-daily dose group in the antipsychotic group with strong blockade of these receptors. Our study indicated that the type of antipsychotic had a greater affect on the incidence of hyperglycemic progression than the daily dose of antipsychotics or their number. Among these, zotepine was most likely to increase the incidence of hyperglycemic progression, suggesting the need for caution when these antipsychotics are prescribed.
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Affiliation(s)
- Shuhei Ishikawa
- Department of Psychiatry, Hokkaido University Hospital, North 14, West 5, Sapporo 060-8648, Japan.
| | - Ryodai Yamamura
- Division of Biomedical Oncology, Institute for Genetic Medicine, Hokkaido University, North 15, West 7, Sapporo 060-8638, Japan.
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Sapporo 060-8638, Japan.
| | - Ryo Okubo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan.
| | - Ryo Sawagashira
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Sapporo 060-8638, Japan; Department of Physiology, Hokkaido University Graduate School of Medicine, North 15, West 7, Sapporo 060-8638, Japan.
| | - Yoichi M Ito
- Hokkaido University Hospital Clinical Research & Medical Innovation Center, North 14, West 5, Sapporo 060-8648, Japan.
| | - Norihiro Sato
- Hokkaido University Hospital Clinical Research & Medical Innovation Center, North 14, West 5, Sapporo 060-8648, Japan.
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Sapporo 060-8638, Japan.
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Sawagashira R, Sasagawa Y, Matsukura M, Takamaru Y. Sick Sinus Syndrome Mimicking Autonomic Dysfunction of Dementia With Lewy Bodies. Cureus 2021; 13:e14667. [PMID: 34079668 PMCID: PMC8159329 DOI: 10.7759/cureus.14667] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dementia with Lewy bodies (DLB) is recognized as the second most common form of dementia in aged people. It is well known that patients with DLB often develop various autonomic symptoms. Here, we present a case in which there was sick sinus syndrome mimicking the DLB-related autonomic dysfunctions. After the pacemaker implantation, the patient's symptom perfectly extinguished. It is essential for psychiatrists or other professionals who are mainly seeing dementia patients to rule out critical causes that may mimic autonomic symptoms in patients with DLB.
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Affiliation(s)
- Ryo Sawagashira
- Physiology, Hokkaido University, Sapporo, JPN.,Psychiatry, Hokkaido University, Sapporo, JPN
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Sawagashira R, Sasagawa Y, Matsukura M, Takamaru Y. Case of myxedema coma induced by lithium carbonate in a patient with schizophrenia. Psychiatry Clin Neurosci 2018; 72:131. [PMID: 29232051 DOI: 10.1111/pcn.12626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/20/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ryo Sawagashira
- Department of Psychiatry, Otaru General Hospital, Hokkaido, Japan
| | | | - Mayumi Matsukura
- Department of Psychiatry, Otaru General Hospital, Hokkaido, Japan
| | - Yuji Takamaru
- Department of Psychiatry, Otaru General Hospital, Hokkaido, Japan
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Sawagashira R, Fujii Y, Kusumi I. Clinical pharmacokinetic interactions between lamotrigine and hormonal contraceptives in bipolar I disorder. Psychiatry Clin Neurosci 2017; 71:290. [PMID: 28191687 DOI: 10.1111/pcn.12512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/23/2016] [Revised: 11/27/2016] [Accepted: 02/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ryo Sawagashira
- Department of Psychiatry, Otaru General Hospital, Otaru, Japan
| | - Yutaka Fujii
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Sawagashira R, Watari T, Tokuda Y. Rapidly Progressive Tetraparesis with Ossification of the Posterior Longitudinal Ligament (OPLL). J Gen Fam Med 2016. [DOI: 10.14442/jgfm.17.2_158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Sawagashira R, Nakayama T, Yoshikawa H, Kimikawa C, Kurogi N. [Case Report; A case of lipoid pneumonia mimicking lung cancer]. ACTA ACUST UNITED AC 2016; 105:281-4. [PMID: 27228725 DOI: 10.2169/naika.105.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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