Prenatal exposition to haloperidol: A preclinical narrative review

Pre-existing maternal mental disorders may affect the early interactions between mother and baby, impacting the child's psychoemotional development. The typical antipsychotic haloperidol can be used during pregnancy, even with some restrictions. Its prescription is not limited to psychotic disorders, but also to other psychiatric conditions of high incidence and prevalence in the woman's fertile period. The present review focused on the preclinical available data regarding the biological and behavioral implications of embryonic exposure to haloperidol. The understanding of the effects of psychotropic drugs during neurodevelopment is important for its clinical aspect since there is limited evidence regarding the risks of antipsychotic drug treatment in pregnant women and their children. Moreover, a better comprehension of the mechanistic events that can be affected by antipsychotic treatment during the critical period of neurodevelopment may offer insights into the pathophysiology of neurodevelopmental disorders. The findings presented in this review converge to the existence of several risks associated with prenatal exposure to such medication and emphasize the need for further studies regarding its dimensions.

Impact of adverse reactions to first-generation antipsychotics on treatment adherence in outpatients with schizophrenia: a cross-sectional study

BACKGROUND

Antipsychotics are well-known to cause potentially serious and life-threatening adverse drug reactions (ADRs) that have been reported to be also one of the major reasons for non-adherence. In Eritrea, shortage of psychiatrists and physicians, inadequacy of laboratory setups and unavailability of second-generation antipsychotics in the national list of medicines would seem to amplify the problem. This study's objective is to determine the impact of adverse effects of first-generation antipsychotics on treatment adherence in outpatients with schizophrenia at Saint Mary Neuro-Psychiatric National Referral Hospital.

METHODS

A cross-sectional study design was employed. All eligible adult patients with diagnosed schizophrenia (n = 242) who visited the hospital during the study period were enrolled. Data on ADRs, adherence and other variables were collected from patients using a self-administered questionnaire, interview and through medical cards review. The collected variables were analyzed using SPSS 22.0 with descriptive and multivariable logistic regression analysis. Statistical significance was tested at p value < 0.05.

RESULTS

Greater than one-third (35.5%) of the patients with schizophrenia were non-adherent to treatment. The odds of non-adherence increased 1.06 times for each unit increase in the total ADR score (AOR = 1.06, 95% CI 1.04, 1.09). Patients with extrapyramidal (AOR = 44.69, 95% CI 5.98, 334.30), psychic (AOR = 14.90, 95% CI 1.90, 116.86), hormonal (AOR = 2.60, 95% CI 1.41, 4.80), autonomic (AOR = 3.23, 95% CI 1.37, 7.57) and miscellaneous reactions (AOR = 2.16, 95% CI 1.13, 4.13) were more likely to be non-adherent compared to their counterparts.

CONCLUSION

Poor treatment adherence was found to be substantial which was attributed to total ADR score, extrapyramidal, hormonal, psychic, autonomic and miscellaneous categories of reactions of the LUNSERS. To improve treatment adherence, early detection and management of adverse effects and inclusion of second-generation antipsychotics are recommended.

Antipsychotics and severe hyponatremia: A Swedish population-based case-control study

BACKGROUND

Antipsychotics have been claimed to cause hyponatremia. The risk associated with individual antipsychotics, or groups (first-generation [FGAs] or second-generation [SGAs] antipsychotics), is not well-documented. The objective of this study was to investigate the association between antipsychotics and hospitalization due to hyponatremia.

METHODS

The general Swedish population was the base of this register-based case-control study. Comparisons were made between patients hospitalized with a principal diagnosis of hyponatremia (n = 14,359) and matched controls (n = 57,383). Multivariable logistic regression adjusting for concomitant drugs, medical conditions, previous hospitalizations and socioeconomic factors was performed to investigate the association between hyponatremia and antipsychotic use. In addition newly initiated (≤90 days) or ongoing use was analysed separately.

RESULTS

Compared to controls, the adjusted OR (95%CI) for hospitalization due to hyponatremia was for any antipsychotic 1.67(1.5-1.86). Individuals on FGA were more likely to experience severe hyponatremia (2.12[1.83-2.46]) than those on any SGA (1.32[1.15-1.51]). No increased risks, neither as newly initiated nor ongoing therapy, were found for risperidone (0.86[0.56-1.31] and 0.83[0.67-1.02]) and aripiprazole (1.16[0.30-4.46] and 0.62[0.27-1.34]), respectively.

CONCLUSIONS

There was an association between antipsychotic therapy and hospitalization due to hyponatremia. The association was stronger for FGAs than SGAs. Risperidone was not associated with an increased risk.

The Place of Antipsychotics in the Therapy of Anxiety Disorders and Obsessive-Compulsive Disorders

PURPOSE OF REVIEW

The purpose of this review was to assess and present the findings up to this date on the efficacy of antipsychotics in the treatment of generalized anxiety disorders (GAD), social anxiety disorders (SAD), panic disorders (PD), and obsessive-compulsive disorders (OCD), mostly based on published randomized controlled trials (RCTs) or on open-label studies when RCT were lacking.

RECENT FINDINGS

Quetiapine could be recommended in patients with GAD. The efficacy of aripiprazole in two open-label studies on patients with antidepressant-refractory GAD should be assessed in RCTs. Despite preliminary positive results in open studies, there are currently no strong evidence for the effectiveness of antipsychotics in refractory SAD and in refractory PD. Conversely, risperidone and aripiprazole can be used for the treatment of refractory OCD as augmentation agents to antidepressants. Contrary to SAD and PD, this review found evidence for the use of second-generation antipsychotics in GAD and OCD. Otherwise, first-generation antipsychotics cannot be recommended in anxiety disorders and OCD.

Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis

Our systematic review and meta-analysis of observational studies indicated that the use of antipsychotics was associated with a nearly 1.5-fold increase in the risk of fracture. First-generation antipsychotics (FGAs) appeared to carry a higher risk of fracture than second-generation antipsychotics (SGAs).

INTRODUCTION

The risk of fractures associated with the use of antipsychotic medications has inconsistent evidence between different drug classes. A systematic review and meta-analysis was conducted to evaluate whether there is an association between the use of antipsychotic drugs and fractures.

METHODS

Searches were conducted through the PubMed and EMBASE databases to identify observational studies that had reported a quantitative estimate of the association between use of antipsychotics and fractures. The summary risk was derived from random effects meta-analysis.

RESULTS

The search yielded 19 observational studies (n = 544,811 participants) with 80,835 fracture cases. Compared with nonuse, use of FGAs was associated with a significantly higher risk for hip fractures (OR 1.67, 95% CI, 1.45-1.93), and use of second generation antipsychotics (SGAs) was associated with an attenuated but still significant risk for hip fractures (OR 1.33, 95% CI, 1.11-1.58). The risk of fractures associated with individual classes of antipsychotic users was heterogeneous, and odds ratios ranged from 1.24 to 2.01. Chlorpromazine was associated with the highest risk (OR 2.01, 95% CI 1.43-2.83), while Risperidone was associated with the lowest risk of fracture (OR 1.24, 95% CI 0.95-1.83).

CONCLUSIONS

FGA users were at a higher risk of hip fracture than SGA users. Both FGAs and SGAs were associated with an increased risk of fractures, especially among the older population. Therefore, the benefit of the off-label use of antipsychotics in elderly patients should be weighed against any risks for fracture.

long-acting injectable first-generation antipsychotics in bipolar disorder

OBJECTIVE

The aim of this study was to compare the treatment effectiveness between long-acting injectable risperidone and long-acting injectable first-generation antipsychotics among patients with bipolar disorder.

METHOD

We conducted a retrospective cohort study using Taiwan's National Health Insurance Research Database. Patients with bipolar disorder aged 15 years or higher, who were newly administered long-acting injectable antipsychotics between June 1, 2004 and December 31, 2011 were included. The clinical outcome indexes were hospitalization for any mood, manic/mixed, or depressive episodes. In addition, the all-cause discontinuation of long-acting injectable antipsychotic treatment was also assessed.

RESULTS

A total of 3916 patients with bipolar disorder were extracted. Compared with risperidone, the use of first-generation antipsychotics was associated with a higher rate of hospitalization for any mood episode and major depressive episode. However, there was no statistically significant difference in treatment discontinuation rate between risperidone and first-generation antipsychotics.

LIMITATIONS

Information for the severity of mood symptoms, social support, life style, neurological and metabolic adverse effect was not available in this database. In addition, we only measured severe mood episodes with hospitalization as our outcome index. It may not be possible to generalize our findings to mild mood episodes.

CONCLUSIONS

Our findings suggested that patients treated with long-acting injectable risperidone might be superior to first-generation antipsychotics in the rate of psychiatric hospitalization.

Detecting and Managing Adverse Effects of Antipsychotic Medications: Current State of Play

Antipsychotics are some of the most frequently prescribed medications not only for psychotic disorders and symptoms but also for a wide range of on-label and off-label indications. Because second-generation antipsychotics have largely replaced first-generation antipsychotics as first-line options due to their substantially decreased risk of extrapyramidal side effects, attention has shifted to other clinically concerning adverse events associated with antipsychotic therapy. The focus of this article is to update the nonextrapyramidal side effects associated with second-generation antipsychotics. Issues surrounding diagnosis and monitoring as well as clinical management are addressed.