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Nomura N, Siafis S, Schneider-Thoma J, Brandt L, Park J, Efthimiou O, Priller J, Davis JM, Takeuchi H, Leucht S. The trajectory of sedative adverse events caused by antipsychotics: a meta-analysis of individual participant data from randomised, placebo-controlled, clinical trials in acute phase schizophrenia. Lancet Psychiatry 2025; 12:266-275. [PMID: 40113354 DOI: 10.1016/s2215-0366(25)00025-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 12/23/2024] [Accepted: 01/14/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND Sedative adverse events are common in patients with schizophrenia undergoing antipsychotic treatment, which affects treatment adherence and the patients' quality of life. Although tolerance to sedation is believed to develop, robust evidence documenting the timing of sedation onset and resolution remains elusive. To address this gap, we aimed to assess the dynamics of onset and resolution of sedation across various antipsychotics in patients with schizophrenia. METHODS In this meta-analysis, we included placebo-controlled, randomised controlled trials (RCTs) of antipsychotic monotherapy for the acute phase of schizophrenia and schizoaffective disorder. We searched PubMed for RCTs from inception until May 6, 2021 and obtained individual participant data of included trials through the Yale University Open Data Access project. We created Kaplan-Meier curves to assess the probability of onset of sedation and resolution from the incidence of sedation across time after treatment initiation. People with lived experience were not involved in this study. This study is registered with PROSPERO, CRD42022351647. FINDINGS We included a total of 6791 participants (4549 [67·0%] men and 2242 [33·0%] women, with a mean age of 38·0 years [SD 12·4, range 13-81], 1172 [17·3%] were Asian, 1626 [23·9%] were Black, 3654 [53·8%] were White, and 339 [5·0%] were other ethnicities) from 19 RCTs. Sedative adverse events were observed in 582 (8·6%) of 6791 participants and typically occurred shortly after treatment initiation. Among participants receiving antipsychotics, 418 (83%) of 505 sedation events occurred within the first 2 weeks of treatment. Following the onset of sedation, 50% of symptoms were resolved within 1 week. After 4 weeks of treatment, 24% (95% CI 19·7-29·3) continued to have sedation with oral agents and 22·3% (15·3-32·3) with long-acting injectables. INTERPRETATION The high incidence of sedation within the first 2 weeks of treatment with antipsychotics emphasises the importance of early monitoring. Half of the sedation resolved within 1 week and 75% within 1 month, suggesting that tolerance to sedation is acquired quickly. If sedation is sustained, contributing factors should be evaluated. FUNDING German Federal Ministry of Education and Research.
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Affiliation(s)
- Nobuyuki Nomura
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany; Deutsches Zentrum für Psychische Gesundheit, München-Augsburg, Germany; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Spyridon Siafis
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany; Deutsches Zentrum für Psychische Gesundheit, München-Augsburg, Germany
| | - Johannes Schneider-Thoma
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Lasse Brandt
- Department of Psychiatry and Neurosciences, Charité-Universitaätsmedizin Berlin, Berlin, Germany; Deutsches Zentrum für Psychische Gesundheit, Berlin-Potsdam, Germany
| | - Jinyoung Park
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Orestis Efthimiou
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Josef Priller
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany; Deutsches Zentrum für Psychische Gesundheit, München-Augsburg, Germany; Neuropsychiatry and Laboratory of Molecular Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany; DZNE, Berlin, Germany; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, Edinburgh, UK
| | - John M Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA; Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Stefan Leucht
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany; Deutsches Zentrum für Psychische Gesundheit, München-Augsburg, Germany.
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De R, Smith ECC, Navagnanavel J, Au E, Maksyutynska K, Papoulias M, Singh R, Panganiban KJ, Humber B, Mohr GH, Nielsen MØ, Ebdrup BH, Remington G, Agarwal SM, Hahn MK. The impact of weight gain on antipsychotic nonadherence or discontinuation: A systematic review and meta-analysis. Acta Psychiatr Scand 2025; 151:109-126. [PMID: 39285800 DOI: 10.1111/acps.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 08/15/2024] [Accepted: 08/31/2024] [Indexed: 01/04/2025]
Abstract
BACKGROUND Nonadherence/discontinuation of antipsychotic (AP) medications represents an important clinical issue in patients across psychiatric disorders, including schizophrenia spectrum disorders (SSDs). While antipsychotic-induced weight gain (AIWG) is a reported contributor to nonadherence, a systematic review of the association between AIWG and medication nonadherence/discontinuation has not been explored previously. METHOD A systematic search was conducted in MEDLINE, EMBASE, PsychINFO, CINAHL, and CENTRAL databases, among others, to help identify all studies which explored adherence, study dropouts, AP switching and/or discontinuations attributable to AIWG among individuals with severe mental illness. A meta-analysis was also completed where applicable. RESULTS We identified two categories of studies for the meta-analysis. Category 1 included three studies, which compared measures of AP adherence or discontinuation across BMI classes/degrees of self-reported weight gain. When compared to normal weight individuals receiving APs or those who did not report AIWG, individuals who were either overweight or obese or reported weight gain in relation to AP use had an increased odds of AP nonadherence (OR 2.37; 95% CI 1.51-3.73; p = 0.0002). Category 2 had 14 studies which compared measures of discontinuation related to weight gain reported as an adverse effect across different APs. Olanzapine was associated with a 3.32 times (95% CI 2.32-4.74; p < 0.00001) increased likelihood of nonadherence or discontinuation when compared to other APs with lower weight gain liabilities. Similarly, APs with moderate weight gain liability (paliperidone, risperidone, and quetiapine) increased the odds of nonadherence or discontinuation by 2.25 (95% CI 1.31-3.87; p = 0.003) when compared to APs considered to have lower weight gain liability (i.e. haloperidol and aripiprazole). The qualitative summary also confirmed these findings. CONCLUSION This review and meta-analysis suggests that AIWG influences medication nonadherence/discontinuation, whereby APs with higher weight gain liability are associated with nonadherence/discontinuation. Additional studies are needed to confirm these findings.
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Affiliation(s)
- Riddhita De
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Emily C C Smith
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Janani Navagnanavel
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Emily Au
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Kateryna Maksyutynska
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Maria Papoulias
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Raghunath Singh
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Kristoffer J Panganiban
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Bailey Humber
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Grimur Høgnason Mohr
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Mette Ødegaard Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Unit for Complicated Schizophrenia, Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada
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Yeh D, Penaud S, Gaston-Bellegarde A, Scoriels L, Krebs MO, Piolino P. Impact of minimal self disorders on naturalistic episodic memory in first-episode psychosis and parallels in healthy individuals with schizotypal traits. Front Psychiatry 2024; 15:1469390. [PMID: 39605999 PMCID: PMC11598521 DOI: 10.3389/fpsyt.2024.1469390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 10/14/2024] [Indexed: 11/29/2024] Open
Abstract
Background Self-disorders constitute a core feature of the schizophrenia spectrum, including early stages such as first-episode psychosis (FEP). These disorders impact the minimal Self, or bodily self-consciousness, which refers to the basic, pre-reflective sense of embodied experience. The minimal Self is intrinsically linked to episodic memory, which captures specific past experiences of the Self. However, research on this relationship in the schizophrenia spectrum remains scarce. This pilot study aimed to investigate how the minimal Self modulated episodic memory of naturalistic events in FEP, using immersive virtual reality. A secondary objective was to examine the relationships between sense of Self, embodiment, episodic memory, schizotypal personality traits in healthy participants (CTL), and psychopathology in FEP. Methods A full-body illusion was induced in 10 FEP and 35 matched CTL, using a first-person avatar, with synchronous or asynchronous visuomotor stimulation (strong or weak embodiment conditions, respectively). Following embodiment induction, participants navigated a virtual city and encountered naturalistic daily life events, which were incidentally encoded. Episodic memory of these events was assessed through a comprehensive recognition task (factual and contextual information, retrieval phenomenology). Sense of Self, schizotypal personality traits, and psychopathology were assessed via self-reported questionnaires or clinical assessments. Results Synchronous visuomotor stimulation successfully induced a stronger sense of embodiment in both FEP and CTL. The strong embodiment condition was associated with reduced perceived virtual space occupation by the body in FEP. Under strong embodiment, FEP performed significantly worse than CTL in contextual information recognition, but their ratings for retrieval phenomenology were comparable to CTL. Conversely, under weak embodiment, FEP performed similarly to CTL in contextual information recognition, but they rated retrieval phenomenology significantly lower. For CTL, we observed a slight, though non-significant, enhancement in recognition memory under strong compared to weak embodiment. Additionally, higher schizotypy in CTL correlated with a diminished sense of Self and poorer episodic memory. Conclusions Disturbances in the minimal Self in FEP are associated with episodic memory impairments. These findings emphasise the importance of targeting minimal Self-disorders in schizophrenia spectrum disorders, since episodic memory impairments may negatively affect patients' quality of life and psychosocial outcomes. Additionally, they support a fully dimensional model of schizotypy.
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Affiliation(s)
- Delphine Yeh
- Université Paris Cité, Laboratoire Mémoire, Cerveau et Cognition, Boulogne-Billancourt, France
| | - Sylvain Penaud
- Université Paris Cité, Laboratoire Mémoire, Cerveau et Cognition, Boulogne-Billancourt, France
| | | | - Linda Scoriels
- Université Paris Cité, Laboratoire de Psychologie du Développement et de l’Éducation de l’Enfant, CNRS, Paris, France
- GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Marie-Odile Krebs
- GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris Cité, INSERM, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Pascale Piolino
- Université Paris Cité, Laboratoire Mémoire, Cerveau et Cognition, Boulogne-Billancourt, France
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Meola TR, Kamath S, Elz AS, Prestidge CA, Wignall A, Joyce P. Contrasting the pharmacokinetic performance and gut microbiota effects of an amorphous solid dispersion and lipid nanoemulsion for a poorly water-soluble anti-psychotic. Eur J Pharm Biopharm 2024; 203:114453. [PMID: 39134099 DOI: 10.1016/j.ejpb.2024.114453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/18/2024] [Accepted: 08/09/2024] [Indexed: 09/14/2024]
Abstract
Increasing attention is being afforded to understanding the bidirectional relationship that exists between oral drugs and the gut microbiota. Often overlooked, however, is the impact that pharmaceutical excipients exert on the gut microbiota. Subsequently, in this study, we contrasted the pharmacokinetic performance and gut microbiota interactions between two commonly employed formulations for poorly soluble compounds, namely 1) an amorphous solid dispersion (ASD) stabilised by poly(vinyl pyrrolidone) K-30, and 2) a lipid nanoemulsion (LNE) comprised of medium chain glycerides and lecithin. The poorly soluble antipsychotic, lurasidone, was formulated with ASD and LNE due to its rate-limiting dissolution, poor oral bioavailability, and significant food effect. Both the ASD and LNE were shown to facilitate lurasidone supersaturation within in vitro dissolution studies simulating the gastrointestinal environment. This translated into profound improvements in oral pharmacokinetics in rats, with the ASD and LNE exerting comparable ∼ 2.5-fold improvements in lurasidone bioavailability, compared to the pure drug. The oral formulations imparted contrasting effects on the gut microbiota, with the LNE depleting the richness and abundance of the microbial ecosystem, as evidenced through reductions in alpha diversity (Chao1 index) and operational taxonomical units (OTUs). In contrast, the ASD exerted a 'gut neutral' effect, whereby a mild enrichment of alpha diversity and OTUs was observed. Importantly, this suggests that ASDs are effective solubility-enhancing formulations that can be used without comprising the integrity of the gut microbiota - an integral consideration in the treatment of mental health disorders, such as schizophrenia, due to the role of the gut microbiota in regulating mood and cognition.
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Affiliation(s)
- Tahlia R Meola
- UniSA Clinical & Health Sciences, University of South Australia, South Australia 5000, Australia
| | - Srinivas Kamath
- Centre for Pharmaceutical Innovation (CPI), UniSA Clinical & Health Sciences, University of South Australia, South Australia 5000, Australia
| | - Aurelia S Elz
- Centre for Pharmaceutical Innovation (CPI), UniSA Clinical & Health Sciences, University of South Australia, South Australia 5000, Australia; Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia 5000, Australia
| | - Clive A Prestidge
- Centre for Pharmaceutical Innovation (CPI), UniSA Clinical & Health Sciences, University of South Australia, South Australia 5000, Australia
| | - Anthony Wignall
- Centre for Pharmaceutical Innovation (CPI), UniSA Clinical & Health Sciences, University of South Australia, South Australia 5000, Australia
| | - Paul Joyce
- Centre for Pharmaceutical Innovation (CPI), UniSA Clinical & Health Sciences, University of South Australia, South Australia 5000, Australia.
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Paul T, See JW, Vijayakumar V, Njideaka-Kevin T, Loh H, Lee VJQ, Dogrul BN. Neurostructural changes in schizophrenia and treatment-resistance: a narrative review. PSYCHORADIOLOGY 2024; 4:kkae015. [PMID: 39399446 PMCID: PMC11467815 DOI: 10.1093/psyrad/kkae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/11/2024] [Accepted: 09/05/2024] [Indexed: 10/15/2024]
Abstract
Schizophrenia is a complex disorder characterized by multiple neurochemical abnormalities and structural changes in the brain. These abnormalities may begin before recognizable clinical symptoms appear and continue as a dynamic process throughout the illness. Recent advances in imaging techniques have significantly enriched our comprehension of these structural alterations, particularly focusing on gray and white matter irregularities and prefrontal, temporal, and cingulate cortex alterations. Some of the changes suggest treatment resistance to antipsychotic medications, while treatment nonadherence and relapses may further exacerbate structural abnormalities. This narrative review aims to discuss the literature about alterations and deficits within the brain, which could improve the understanding of schizophrenia and how to interpret neurostructural changes.
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Affiliation(s)
- Tanya Paul
- Department of Medicine, Avalon University School of Medicine, World Trade Center, Willemstad, Curaçao
| | - Jia Whei See
- General Medicine, Universitas Sriwijaya, Palembang City 30114, Indonesia
| | - Vetrivel Vijayakumar
- Department of Psychiatry, United Health Services Hospitals, Johnson City, New York 13790, USA
| | - Temiloluwa Njideaka-Kevin
- Department of Medicine, Avalon University School of Medicine, World Trade Center, Willemstad, Curaçao
| | - Hanyou Loh
- Department of Medicine, Avalon University School of Medicine, World Trade Center, Willemstad, Curaçao
| | - Vivian Jia Qi Lee
- Department of Medicine, Avalon University School of Medicine, World Trade Center, Willemstad, Curaçao
| | - Bekir Nihat Dogrul
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York 14642, USA
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Salihi I, Attouche N, Bakana GT, Nani S, Agoub M, Alami KM. Schizophrenia and medication adherence among the population in Morocco: a cross-sectional study at the University Psychiatric Center of Casablanca. Pan Afr Med J 2024; 48:123. [PMID: 39525536 PMCID: PMC11549242 DOI: 10.11604/pamj.2024.48.123.39645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/01/2024] [Indexed: 11/16/2024] Open
Abstract
Introduction schizophrenia is a chronic, disabling, and serious disease. It represents a challenge because of its prevalence and its consequences in terms of morbidity and mortality for patients, but also for their families and society. Patients often fail to adhere to their treatment, and this has a severe negative effect on the prognosis of the disease. Thus, the identification of the predictive factors influencing this compliance is very important for adequate management and a favorable evolution. The aim of the study is to assess the predictive factors of non-adherence in patients with schizophrenia. Methods a cross-sectional study of 320 patients diagnosed with schizophrenia according to the DSM-5 criteria, was conducted at the University Psychiatric Centre of Casablanca, Morocco. Epidemiological, clinical, and therapeutic data were collected using a hetero-questionnaire, while medication adherence was assessed using the Medication Adherence Rating Scale (MARS). The positive and negative symptoms scale (PANSS) was used to assess the severity of symptoms in patients with schizophrenia. Results in our study, the total sample comprised 320 (100%) patients, classified into two groups: 82 (25.62%) were categorized as adherent, while 238 (74.38%) were non-adherent, and 72% were male. The non-adherent group was young (p=0.003), and a significant proportion had no educational background (p=0.015), lived alone (p=0,001), in urban areas (p=0.031), non-regular follow-up (p=0.045) and had a toxic history (p=0.0001), early age of onset of the disease (p=0.002). Moreover, this group exhibited more severe schizophrenic symptoms (p=0.02), lacked insight into their condition (p=0.046), and predominantly used typical antipsychotics (p=0.019) with a high frequency of intake (p=0.0001). Sedation emerged as a predominant side effect (p=0.036) of treatment. Notably, a high frequency of hospitalizations (p=0.005) exhibited a strong association with medication non-adherence. The mean age of the sample was 32.9 years (standard deviation: 10.8), with a mean age of disease onset reported at 25.5 years (standard deviation=4.9). Conclusion this study highlights the prevalence of non-adherence among patients with schizophrenia, with significant associations observed with demographic factors, the severity of symptoms, treatment patterns, and hospitalization frequency, emphasizing the urgent need for tailored interventions to enhance medication adherence and improve patient outcomes in managing schizophrenia.
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Affiliation(s)
- Imane Salihi
- Laboratory of Clinical Neurosciences and Mental Health, Hassan II University, Casablanca, Morocco
| | - Nadia Attouche
- Laboratory of Clinical Neurosciences and Mental Health, Hassan II University, Casablanca, Morocco
| | | | - Samira Nani
- Laboratory of Community Medicine, Hassan II University, Casablanca, Morocco
| | - Mohamed Agoub
- Laboratory of Clinical Neurosciences and Mental Health, Hassan II University, Casablanca, Morocco
| | - Khadija Mchichi Alami
- Laboratory of Clinical Neurosciences and Mental Health, Hassan II University, Casablanca, Morocco
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Vgontzas AN, Paschalidou A, Simos PG, Anastasaki M, Zografaki A, Volikos E, Koutra K, Basta M. Impact of long-acting injectable antipsychotics vs. oral medication on relapses of patients with psychosis and bipolar disorder. Psychiatry Res 2024; 332:115676. [PMID: 38176166 DOI: 10.1016/j.psychres.2023.115676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
Relapse associated with multiple hospital readmissions of patients with chronic and severe mental disorders, such as psychosis and bipolar disorder, is frequently associated with non-adherence to treatment. The primary aim of the study was to compare the effectiveness of long-acting injectable (LAI) treatment, vs. oral medication in reducing readmissions of patients with psychotic or bipolar disorder in a community sample of 164 patients with psychosis and 29 patients with bipolar disorder (n = 193), with poor adherence to oral medication. The mean follow up period was 5.6 years and the number of readmissions were compared for an equal-length period of oral treatment preceding the onset of LAI administration. We observed a significant decrease of 45.2 % in total hospital readmissions after receiving LAIs treatment. The effect was significant both for patients with a pre-LAI treatment history of predominantly voluntary hospitalizations and with predominantly involuntary admissions. In addition, we observed equal effectiveness of first- vs. second-generation LAIs in reducing total hospital readmissions regardless of type of pre-treatment admission history (voluntary vs. involuntary). LAIs appear to be effective in reducing both voluntary and involuntary hospital readmissions in patients with psychosis and bipolar disorder with a history of poor adherence to treatment.
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Affiliation(s)
- Alexandros N Vgontzas
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Sleep Research and Treatment Center Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | - Anna Paschalidou
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece
| | - Panagiotis G Simos
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete 71110, Greece; Institute of Computer Science, Foundation of Research and Technology, Heraklion, Greece
| | - Maria Anastasaki
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece
| | - Avgi Zografaki
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece
| | - Emmanouil Volikos
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete 71110, Greece
| | - Katerina Koutra
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus, Rethymnon, Crete 74100, Greece
| | - Maria Basta
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete 71110, Greece
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Lee DY, Kim C, Yu DH, Park RW. Safety outcomes of antipsychotics classes in drug-naïve patients with first-episode schizophrenia: A nationwide cohort study in South Korea. Asian J Psychiatr 2024; 91:103857. [PMID: 38128353 DOI: 10.1016/j.ajp.2023.103857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Given the similar efficacies across antipsychotic medications for schizophrenia, understanding their safety profiles, particularly concerning receptor-binding differences, is crucial for optimal drug selection, especially for patients with first episode schizophrenia. We aimed to compare the safety outcomes of second-generation antipsychotics. METHODS We conducted a retrospective cohort study with new user active comparator design using a nationwide claims database in South Korea. Participants were drug-naïve adult patients with first-episode schizophrenia. Three representative drugs with different pharmacologic profiles were compared: risperidone, olanzapine, and aripiprazole. Propensity scores were used to match the study groups, and the Cox proportional hazard model was used to calculate hazard ratios. Sensitivity analyses were performed in various epidemiological settings. Seventeen safety outcomes, including neuropsychiatric, cardiometabolic and gastrointestinal events, were assessed, with upper-respiratory-tract infection as a negative control outcome. RESULTS A total of 1044, 2078, and 3634 participants were matched for olanzapine vs. risperidone, olanzapine vs. aripiprazole, and risperidone vs. aripiprazole comparisons, respectively. For parkinsonism, there was a significant difference in outcomes between the risperidone and aripiprazole groups (HR 1.80 [95% CI 1.13-2.91]), with consistent sensitivity analysis results. There were no significant differences in other neuropsychiatry outcomes or in the risk of cardiometabolic and gastrointestinal outcomes between any of the comparative group pairs. CONCLUSIONS The risk of drug-induced parkinsonism was significantly higher with risperidone than with aripiprazole. Although olanzapine is known for its metabolic risk, there were no significant differences in risk between the other pairs.
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Affiliation(s)
- Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
| | - Dong Han Yu
- Big Data Department, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea; Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea.
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Witkowski G, Januszko P, Skalski M, Mach A, Wawrzyniak ZM, Poleszak E, Ciszek B, Radziwoń-Zaleska M. Factors Contributing to Risk of Persistence of Positive and Negative Symptoms in Schizophrenia during Hospitalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4592. [PMID: 36901603 PMCID: PMC10001938 DOI: 10.3390/ijerph20054592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
The aim of the study was to evaluate factors that may contribute to the persistence of positive, negative and other psychopathological symptoms of schizophrenia. All patients were treated in general psychiatric wards between January 2006 and December 2017. The initial study sample comprised of the medical reports of 600 patients. The main, specified inclusion criterion for the study was schizophrenia as a discharge diagnosis. Medical reports of 262 patients were excluded from the study due to no neuroimaging scans being available. The symptoms were categorised into three groups: positive, negative, and other psychopathological symptoms. The statistical analysis comprised modalities such as demographic data, clinical symptoms, as well as neuroimaging scans linking them to a potential impact of sustaining the mentioned groups of symptoms during the period of hospitalization. The analysis revealed that statistically significant risk factors of persistence of the three groups of symptoms are the elderly age, the increasing toll of hospitalizations, suicidal attempts in medical history, a family history of alcohol abuse, the presence of positive, negative and other psychopathological symptoms on admission to the hospital, as well as the absence of cavum septi pellucidi (CSP). The study showed that addiction to psychotropic drugs and a family history of schizophrenia were more frequent in patients with persistent CSP.
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Affiliation(s)
- Grzegorz Witkowski
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, 02-004 Warsaw, Poland
| | - Piotr Januszko
- Department of Psychiatry, Medical University of Warsaw, 00-665 Warsaw, Poland
| | - Michał Skalski
- Department of Psychiatry, Medical University of Warsaw, 00-665 Warsaw, Poland
| | - Anna Mach
- Department of Psychiatry, Medical University of Warsaw, 00-665 Warsaw, Poland
| | - Zbigniew Maciej Wawrzyniak
- Faculty of Electronics and Information Technology, Warsaw University of Technology, 00-665 Warsaw, Poland
| | - Ewa Poleszak
- Laboratory of Preclinical Testing, Chair and Department of Applied and Social Pharmacy, Medical University of Lublin, 20-093 Lublin, Poland
| | - Bogdan Ciszek
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, 02-004 Warsaw, Poland
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10
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Daniels JT, Busby D, Chase-Topping M, Brown SM. I wish he’d listen: Client centered interviewing approaches are associated with higher compliance with behavioral modification advice in pet dog owners. J Vet Behav 2023. [DOI: 10.1016/j.jveb.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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11
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Burschinski A, Schneider‐Thoma J, Chiocchia V, Schestag K, Wang D, Siafis S, Bighelli I, Wu H, Hansen W, Priller J, Davis JM, Salanti G, Leucht S. Metabolic side effects in persons with schizophrenia during mid- to long-term treatment with antipsychotics: a network meta-analysis of randomized controlled trials. World Psychiatry 2023; 22:116-128. [PMID: 36640396 PMCID: PMC9840505 DOI: 10.1002/wps.21036] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 01/15/2023] Open
Abstract
Metabolic side effects of antipsychotic drugs can have serious health consequences and may increase mortality. Although persons with schizophrenia often take these drugs for a long time, their mid- to long-term metabolic effects have been studied little so far. This study aimed to evaluate the mid- to long-term metabolic side effects of 31 antipsychotics in persons with schizophrenia by applying a random-effects Bayesian network meta-analysis. We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (up to April 27, 2020) and PubMed (up to June 14, 2021). We included published and unpublished, open and blinded randomized controlled trials with a study duration >13 weeks which compared any antipsychotic in any form of administration with another antipsychotic or with placebo in participants diagnosed with schizophrenia. The primary outcome was weight gain measured in kilograms. Secondary outcomes included "number of participants with weight gain", fasting glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. We identified 137 eligible trials (with 35,007 participants) on 31 antipsychotics, with a median follow-up of 45 weeks. Chlorpromazine produced the most weight gain (mean difference to placebo: 5.13 kg, 95% credible interval, CrI: 1.98 to 8.30), followed by clozapine (4.21 kg, 95% CrI: 3.03 to 5.42), olanzapine (3.82 kg, 95% CrI: 3.15 to 4.50), and zotepine (3.87 kg, 95% CrI: 2.14 to 5.58). The findings did not substantially change in sensitivity and network meta-regression analyses, although enriched design, drug company sponsorship, and the use of observed case instead of intention-to-treat data modified the mean difference in weight gain to some extent. Antipsychotics with more weight gain were often also among the drugs with worse outcome in fasting glucose and lipid parameters. The confidence in the evidence ranged from low to moderate. In conclusion, antipsychotic drugs differ in their propensity to induce metabolic side effects in mid- to long-term treatment. Given that schizophrenia is often a chronic disorder, these findings should be given more consideration than short-term data in drug choice.
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Affiliation(s)
- Angelika Burschinski
- Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany
| | - Johannes Schneider‐Thoma
- Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany
| | - Virginia Chiocchia
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Graduate School for Health SciencesUniversity of BernBernSwitzerland
| | - Kristina Schestag
- Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany
| | - Dongfang Wang
- Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany
| | - Hui Wu
- Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany
| | | | - Josef Priller
- Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany,University of Edinburgh and UK Dementia Research InstituteEdinburghUK,Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Neuropsychiatrie, Charité Universitätsmedizin Berlin and German Center for Neurodegenerative DiseasesBerlinGermany
| | - John M. Davis
- Psychiatric Institute, University of Illinois at ChicagoChicagoILUSA,Maryland Psychiatric Research CenterBaltimoreMDUSA
| | - Georgia Salanti
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of MedicineTechnical University of MunichMunichGermany
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12
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Matloka M, Janowska S, Pankiewicz P, Kokhanovska S, Kos T, Hołuj M, Rutkowska-Wlodarczyk I, Abramski K, Janicka M, Jakubowski P, Świątkiewicz M, Welniak-Kaminska M, Hucz-Kalitowska J, Dera P, Bojarski L, Grieb P, Popik P, Wieczorek M, Pieczykolan J. A PDE10A inhibitor CPL500036 is a novel agent modulating striatal function devoid of most neuroleptic side-effects. Front Pharmacol 2022; 13:999685. [PMID: 36438799 PMCID: PMC9681820 DOI: 10.3389/fphar.2022.999685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/24/2022] [Indexed: 01/04/2024] Open
Abstract
Background: Phosphodiesterase 10A (PDE10A) is expressed almost exclusively in the striatum and its inhibition is suggested to offer potential treatment in disorders associated with basal ganglia. We evaluated the selectivity, cytotoxicity, genotoxicity, pharmacokinetics and potential adverse effects of a novel PDE10A inhibitor, CPL500036, in vivo. Methods: The potency of CPL500036 was demonstrated by microfluidic technology, and selectivity was investigated in a radioligand binding assay against 44 targets. Cardiotoxicity in vitro was evaluated in human ether-a-go-go related gene (hERG)-potassium channel-overexpressing cells by the patch-clamp method and by assessing key parameters in 3D cardiac spheroids. Cytotoxicity was determined in H1299, HepG2 and SH-SY5Y cell lines. The Ames test was used for genotoxicity analyses. During in vivo studies, CPL500036 was administered by oral gavage. CPL500036 exposure were determined by liquid chromatography-tandem mass spectrometry and plasma protein binding was assessed. The bar test was employed to assess catalepsy. Prolactin and glucose levels in rat blood were measured by ELISAs and glucometers, respectively. Cardiovascular safety in vivo was investigated in dogs using a telemetry method. Results: CPL500036 inhibited PDE10A at an IC50 of 1 nM, and interacted only with the muscarinic M2 receptor as a negative allosteric modulator with an IC50 of 9.2 µM. Despite inhibiting hERG tail current at an IC25 of 3.2 μM, cardiovascular adverse effects were not observed in human cardiac 3D spheroids or in vivo. Cytotoxicity in vitro was observed only at > 60 μM and genotoxicity was not recorded during the Ames test. CPL500036 presented good bioavailability and penetration into the brain. CPL500036 elicited catalepsy at 0.6 mg/kg, but hyperprolactinemia or hyperglycemic effects were not observed in doses up to 3 mg/kg. Conclusion: CPL500036 is a potent, selective and orally bioavailable PDE10A inhibitor with a good safety profile distinct from marketed antipsychotics. CPL500036 may be a compelling drug candidate.
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Affiliation(s)
| | | | | | | | - Tomasz Kos
- Department of Behavioral Neuroscience and Drug Development, Maj Institute of Pharmacology, Polish Academy of Sciences, Kraków, Poland
| | - Małgorzata Hołuj
- Department of Behavioral Neuroscience and Drug Development, Maj Institute of Pharmacology, Polish Academy of Sciences, Kraków, Poland
| | | | | | | | | | - Maciej Świątkiewicz
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | | | | | | | | | - Paweł Grieb
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Popik
- Department of Behavioral Neuroscience and Drug Development, Maj Institute of Pharmacology, Polish Academy of Sciences, Kraków, Poland
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13
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Aguglia A, Fusar-Poli L, Natale A, Amerio A, Espa I, Villa V, Martinotti G, Carrà G, Bartoli F, D'Agostino A, Serafini G, Amore M, Aguglia E, Ostuzzi G, Barbui C. Factors Associated with Medication Adherence to Long-Acting Injectable Antipsychotics: Results from the STAR Network Depot Study. PHARMACOPSYCHIATRY 2022; 55:281-289. [PMID: 35468642 DOI: 10.1055/a-1804-6211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Long-acting injectable (LAI) antipsychotics are prescribed to people with severe psychiatric disorders who show poor adherence to oral medication. The present paper examined factors potentially associated with medication adherence to LAI treatment. METHODS The STAR (Servizi Territoriali Associati per la Ricerca) Network Depot Study was a multicenter, observational, prospective study that enrolled 461 subjects initiating a LAI from 32 Italian centers. After 6 and 12 months of treatment, we evaluated differences between participants with high (≥5 points) and low (<5 points) medication adherence using Kemp's 7-point scale in sociodemographic, clinical, psychopathological, and drug-related variables. Factors that differed significantly between the two groups were entered for multivariate logistic regression. RESULTS Six months after enrollment, participants with high medication adherence were younger, living with other people, had lower Brief Psychiatric Rating Scale (BPRS) total scores, lower adverse events, and a more positive attitude toward medication than participants with low adherence. Multivariate regression confirmed lower BPRS resistance and activation scores, absence of adverse events, and positive attitude toward medication as factors significantly associated with good adherence. After 12 months, all BPRS subscales were significantly lower in the high adherence group, which also showed a more positive attitude toward medication. BPRS resistance and attitude toward medication were confirmed as factors associated with medication adherence. DISCUSSION Our findings suggest that adherence to LAI is principally related to attitude toward medication and traits of suspiciousness/hostility. Quality of patient-clinician relationship and tailored psychoeducational strategies may positively affect adherence in people undergoing psychopharmacological treatment, including LAI.
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Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Via Santa Sofia, Catania, Italy
| | - Antimo Natale
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Via Santa Sofia, Catania, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Irene Espa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Veronica Villa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore, Monza, Italy
- Division of Psychiatry, University College London, Tottenham Court Rd, Bloomsbury, London, United Kingdom
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, via Cadore, Monza, Italy
| | - Armando D'Agostino
- Department of Health Sciences, University of Milan, Ospedale San Paolo, Blocco A, Via Antonio di Rudinì, Milan, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Via Santa Sofia, Catania, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation; Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation; Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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14
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Valencia M, Medina R, Calixto E, Rodríguez N. Cerebral, Psychosocial, Family Functioning and Disability of Persons with Schizophrenia. Neuropsychiatr Dis Treat 2022; 18:2069-2082. [PMID: 36133029 PMCID: PMC9484561 DOI: 10.2147/ndt.s370449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/30/2022] [Indexed: 11/23/2022] Open
Abstract
The human brain is the most cognitively capable of mammalian brains, endowed as it is with an overdeveloped cerebral cortex that, in parallel, renders it vulnerable to mental disorders. Schizophrenia is the expression of the dysregulation of the neuronal activity of cortical and subcortical regions due to modifications in the levels of the various neurotransmitters, especially of dopamine, with a reciprocal, intimate relationship among genes with environmental and psychosocial factors. If the dopaminergic system increases the function prefrontal cortex will be reduced: this is the main reason of social, occupational and familiar disruption. The present article describes the function of the brain in schizophrenia and its relation with anatomical, physiological, and genetic changes, in addition to identifying, psychosocial and family factors that can be determinant in the functionality of the patient. A review of national and international bibliography was conducted bearing in mind the following variables: functioning at the cerebral level; psychosocial functioning, familial functioning, disability, and functionality in persons with schizophrenia. Due to the variety of the issues included in this review, it can be concluded that schizophrenia is the product of a complex array of symptoms, deficits and disabilities. It was identified that there is a reciprocal confluence of diverse genetic, psychosocial, familial, environmental, educative, and social factors which affect the functionality of persons with this disorder. The latter makes it necessary to study the patient taking into consideration all of these components in an integral manner.
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Affiliation(s)
- Marcelo Valencia
- Department of Innovation and Global Health, Epidemiologic and Psychosocial Research Direction; National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Rafael Medina
- Institute Jaliscience of Mental Health, Guadalajara, Jalisco, Mexico
| | - Eduardo Calixto
- Neurobiology Department, Neurosciences Direction, National Institute of Psychiatry Ramon de la Fuente, Mexico City, Mexico
| | - Noemí Rodríguez
- Institute Jaliscience of Mental Health, Guadalajara, Jalisco, Mexico
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15
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Stressors and coping mechanisms of people with mental disorders in the community. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background
People with mental disorders often experience human rights violations, discrimination, exclusion, and stigma.
Objective
To determine the stressors and coping mechanisms of people with mental disorders in society.
Methods
This research is a qualitative phenomenological research. We wanted to explore and describe the experiences of mentally ill patients in the community at the rehabilitation stage in stress management, including the stressors in people with a mental health condition and the coping mechanisms used. Data collection was carried out using in-depth interviews with 15 participants.
Results
The results of this study show that the stressors of mental illness patients are a less-accepting environment, feeling of shame, fear of being excluded, having no income, and side effects of drugs.
Conclusions
The coping mechanisms used include carrying out activities, telling stories to others, and diverting emotions.
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16
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Youn H, Lee MS, Jeong HG, Kim SH. Evaluation of factors associated with medication adherence in patients with bipolar disorder using a medication event monitoring system: a 6-month follow-up prospective study. Ann Gen Psychiatry 2022; 21:33. [PMID: 35999628 PMCID: PMC9400298 DOI: 10.1186/s12991-022-00411-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/07/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Non-adherence in patients with bipolar disorder (BD) results in symptoms, such as aggravation, BD recurrence, emergency room visits, re-hospitalization, and poor psychosocial outcomes. Though non-adherence rates have been reported to range between 30-50% in patients with BD, the problem of adherence is often either overlooked by the physician or denied by the patient. An essential first step to enhancing medication adherence is to objectively estimate adherence. The Medication Event Monitoring System (MEMS), which is a pill bottle cap with a microprocessor, is an accurate device for assessing medication adherence. Using the MEMS, we aimed to measure medication adherence in patients with BD and evaluate the factors associated with and 6-month changes in medication adherence. METHODS Participants with BD were recruited from the psychiatric outpatient clinic of the Korea University Guro Hospital. The medication adherence of each participant was assessed using the MEMS, a self-report, pill count, and clinician rating. MEMS-measured adherence was reassessed after 6 months. Patient demographics were recorded and clinical assessments were conducted. Data were analyzed using Kappa statistics and Pearson's correlation analysis. RESULTS Of the 59 participants, 50 records were included in the analysis. Patient adherence and adherence rate assessed by the MEMS were lower than those assessed by the other measures. MEMS-measured adherence was correlated more closely with pill counts than with self-reports or clinician ratings. MEMS-measured adherence was negatively associated with prescription duration and the Brief Psychiatric Rating Scale-Affect Subscale Score. Six-month changes in MEMS-measured adherence were positively associated with attitude toward drugs and negatively associated with weight gain assessed by the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale. CONCLUSIONS Clinicians may have to consider the limited accuracy of self-reporting and clinician rating methods and exercise caution when assessing the medication adherence of patients with BD using these methods. Our findings may assist clinicians in the assessment and improvement of medication adherence in patients with BD and, consequently, may be useful for the treatment and prevention of BD recurrence.
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Affiliation(s)
- HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Moon-Soo Lee
- Department of Child and Adolescent Psychiatry, Korea University Guro Hospital, Seoul, Republic of Korea.,Korea University Research Institute of Mental Health, Seoul, Republic of Korea
| | - Hyun-Ghang Jeong
- Korea University Research Institute of Mental Health, Seoul, Republic of Korea.,Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Seung-Hyun Kim
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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17
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Jin L, Chen Y, Zhu J, Huang Q, Li B, Xu Y, Xi R, Lu W. The Willingness of Community Psychiatric Management Physicians to Preferentially Recommend Long-Acting Injections in Beijing. Front Public Health 2021; 9:779563. [PMID: 34869192 PMCID: PMC8639574 DOI: 10.3389/fpubh.2021.779563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Severe mental disorders (SMD) impose a heavy burden on individuals, society, and the country. Under the background of deinstitutionalization, more and more patients return to the community, and the community psychiatric management physicians (CPMP) play an essential role in this process. Long-acting injection (LAI) is an important way to improve compliance and reduce re-hospitalization. Some districts in Beijing have implemented the policy of free LAI. This article aims to find out the willingness of CPMP to preferentially recommend LAI and provide suggestions for follow-up promotion. Methods: All CPMP in 16 districts of Beijing were surveyed. A self-made electronic questionnaire was used to investigate the willingness to recommend LAI in priority. Descriptive statistics, Chi-square test, and logistic regression were used to analyze the data. Results: The willingness of CPMP to preferentially recommend LAI is up to 80%. Participants aged 40–49, female, with higher self-evaluation of psychiatric management knowledge, managing patients who have used LAI in the past, and working in communities with the free LAI policy have higher willingness to recommend LAI in priority. Conclusion: CPMP in Beijing have a positive attitude toward LAI, and most of them have the willingness to recommend LAI to the patients in priority. The recommendation willingness is the basis of prescription decision-making. Therefore, the coverage of free LAI policy should be further expanded in the future to improve the recommendation willingness and thus improve the injection rate of LAI.
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Affiliation(s)
- Lefan Jin
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
| | - Yun Chen
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Policy Research Office, Beijing Institute of Mental Health, Beijing, China
| | - Junli Zhu
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
| | - Qingzhi Huang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Policy Research Office, Beijing Institute of Mental Health, Beijing, China
| | - Bin Li
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Policy Research Office, Beijing Institute of Mental Health, Beijing, China
| | - Ying Xu
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Policy Research Office, Beijing Institute of Mental Health, Beijing, China
| | - Rui Xi
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Policy Research Office, Beijing Institute of Mental Health, Beijing, China
| | - Wei Lu
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
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18
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Suen YN, Yeung ETW, Chan SKW, Hui CLM, Lee EHM, Chang WC, Chan CYH, Chen CEYH. Integration of biological and psychological illness attributional belief in association with medication adherence behaviour: A path analysis. Early Interv Psychiatry 2021; 15:1686-1695. [PMID: 33461243 DOI: 10.1111/eip.13114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/14/2020] [Accepted: 01/04/2021] [Indexed: 01/18/2023]
Abstract
AIM This study aimed to determine the association of biological (BAB) and psychological illness attributional beliefs (PAB) with medication adherence behaviour in patients with psychosis in Hong Kong. METHODS A cross-sectional survey of 301 outpatients with psychosis in Hong Kong was conducted from August to October 2016. The survey included a set of questionnaires examining patient medication adherence behaviours (using five behavioural items from the Medication Adherence Rating Scale), illness attributional belief, insight into the illness, and attitudes towards antipsychotics and medical professionals. The associations between these variables were analysed using path analysis and adjusted for covariates of perceived social support, experience of side-effects, and gender. RESULTS The data fit a model in which medication adherence behaviour was associated with illness attributional belief, insight, and attitudes (chi-square = 32.33, p = .26; RMSEA = 0.02; SRMR = 0.04; and CFI = 0.97). BAB was positively and directly associated with medication adherence behaviour. PAB was positively and indirectly associated with medication adherence behaviour through insight into the illness and attitude towards medical professionals. PAB can strengthen the relationship between BAB and insight, and only the high PAB group exhibited a positive relationship between BAB and attitude towards medical professionals. CONCLUSIONS An integration of biological and psychological attributional beliefs in patients with psychosis is essential for better medication adherence behaviour. Future interventions should aim to modify patients' illness attributional beliefs by integrating both biological and psychological illness attribution to improve medication adherence.
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Affiliation(s)
- Yi Nam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, PokfuLam, Hong Kong
| | - Emily Tsz Wa Yeung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, PokfuLam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, PokfuLam, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, PokfuLam, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, PokfuLam, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, PokfuLam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, PokfuLam, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, PokfuLam, Hong Kong
| | - Candice Yu Hay Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, PokfuLam, Hong Kong
| | - Chan Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, PokfuLam, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, PokfuLam, Hong Kong
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Meola TR, Joyce P, Wignall A, Bremmell KE, Prestidge CA. Harnessing the potential of nanostructured formulations to mimic the food effect of lurasidone. Int J Pharm 2021; 608:121098. [PMID: 34534629 DOI: 10.1016/j.ijpharm.2021.121098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 02/07/2023]
Abstract
Lurasidone is an important antipsychotic drug indicated for the treatment of schizophrenia and bipolar disorder, with an oral bioavailability of 9-19% owing to its poor aqueous solubility. Additionally, lurasidone exhibits a 2-fold positive food effect, such that patients must administer their medication with a meal, leading to significant non-compliance. The aim of this research was to evaluate the in vitro and in vivo performance of lurasidone when engineered as nanostructured systems. Specifically, a nanosuspension, nano-emulsion and silica-lipid hybrid (SLH) microparticles were formulated and the influence of composition and nanostructure on the mechanism of solubilisation was compared. Formulations were shown to enhance fasted state solubilisation levels in vitro by up to 5.9-fold, compared to pure drug. Fed- and fasted-state solubilisation profiles revealed that in contrast to the nanosuspension and nano-emulsion, lurasidone SLH mitigated the positive pharmaceutical effect of lurasidone. In vivo pharmacokinetic evaluations revealed that the nanosuspension, nano-emulsion and SLH enhanced the bioavailability of lurasidone by 3-fold, 2.4-fold and 8.8-fold, respectively, compared to pure drug after oral administration. For lurasidone, the combination of lipid-based nanostructure and porous silica nanostructure (SLH) led to optimal fasted state bioavailability which can ultimately result in enhanced treatment efficacy, easier dosing regimens and improved patient outcomes.
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Affiliation(s)
- Tahlia R Meola
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia 5000, Australia; ARC Centre for Excellence in Bio-Nano Science and Technology, Adelaide, South Australia 5000, Australia
| | - Paul Joyce
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia 5000, Australia; ARC Centre for Excellence in Bio-Nano Science and Technology, Adelaide, South Australia 5000, Australia
| | - Anthony Wignall
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia 5000, Australia; ARC Centre for Excellence in Bio-Nano Science and Technology, Adelaide, South Australia 5000, Australia
| | - Kristen E Bremmell
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia 5000, Australia; ARC Centre for Excellence in Bio-Nano Science and Technology, Adelaide, South Australia 5000, Australia
| | - Clive A Prestidge
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia 5000, Australia; ARC Centre for Excellence in Bio-Nano Science and Technology, Adelaide, South Australia 5000, Australia.
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20
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Schneider-Thoma J, Kapfhammer A, Wang D, Bighelli I, Siafis S, Wu H, Hansen WP, Davis JM, Salanti G, Leucht S. Metabolic side effects of antipsychotic drugs in individuals with schizophrenia during medium- to long-term treatment: protocol for a systematic review and network meta-analysis of randomized controlled trials. Syst Rev 2021; 10:214. [PMID: 34340713 PMCID: PMC8330017 DOI: 10.1186/s13643-021-01760-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/09/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Antipsychotic drugs and especially the newer compounds are known to cause metabolic side effects. However, a comprehensive comparison of the different substances regarding their propensity to cause metabolic side effects in medium- to long-term treatment of schizophrenia is lacking. METHODS We will conduct a systematic review and network meta-analysis (NMA). We will include randomized controlled trials (RCTs) in which participants received either placebo or an antipsychotic (i.e. placebo-controlled trials and head-to-head comparisons of drugs). We will include studies in individuals with schizophrenia or related disorders (such as schizophreniform or schizoaffective disorders) at any stage of the disease (acute episode; maintenance phase). We will include studies with a duration of more than 3 months (medium- to long-term treatment). The primary outcome will be the change in body weight. Secondary outcomes will be the further metabolic parameters: fastening glucose, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides. We will search for eligible studies (independent of the publication status) in Cochrane Schizophrenia Group's Study-Based Register of Trials, which is compiled by regular searches in trial registries and multiple electronic databases from their inception onwards including MEDLINE, EMBASE and PsycINFO. Additionally, we will search previously published systematic reviews and websites of pharmaceutical companies for eligible studies. At least two reviewers will independently conduct the process of study selection and data extraction. We will use the Cochrane Risk of Bias 2 tool to evaluate the risk of bias in studies. We will conduct random-effects NMA within a Bayesian framework to synthesize all evidence for each outcome. We will conduct sensitivity and subgroup analyses to assess the robustness of the findings and to explore heterogeneity. The confidence in the results will be evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework. DISCUSSION This systematic review and network meta-analysis will provide a synthesis of the existing evidence from RCTs how antipsychotic drugs differ in terms of metabolic side effects during medium- to long-term treatment. The findings have the potential to influence the choice of antipsychotic medication made by individuals with schizophrenia and their physicians. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020175414.
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Affiliation(s)
- Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Angelika Kapfhammer
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Dongfang Wang
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Hui Wu
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wulf-Peter Hansen
- BASTA - das Bündnis für psychisch erkrankte Menschen , Munich, Germany
| | - John M Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA
- Department of Psychiatry, Johns Hopkins University , Baltimore, Maryland, USA
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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21
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Kavak Budak F, Gültekin A, Özdemir AA. The Association Between Religious Belief and Treatment Adherence Among Those with Mental Illnesses. JOURNAL OF RELIGION AND HEALTH 2021; 60:2428-2437. [PMID: 33830402 DOI: 10.1007/s10943-021-01251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
This study was conducted to determine the association between religious belief and treatment adherence among those with mental illness. The sample size of this cross-sectional study was determined to be 255 patients diagnosed with mental illness via power analysis. A descriptive characteristics form prepared by the researcher, the Systems of Belief Inventory, and the Morisky Medication Adherence Scale were used to collect data. Patients were listed and chosen by using a simple random sampling method. This study found no significant correlation between religious belief and treatment adherence (p > .05). It was determined that treatment adherence was moderate in patients with high religious beliefs and that treatment adherence was low in patients with low religious beliefs. Religious belief was not a factor influencing treatment adherence among those with mental illness.
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Affiliation(s)
- Funda Kavak Budak
- Department of Psychiatric Nursing, Inonu Unıversıty, Malatya, Turkey
| | | | - Aysel A Özdemir
- Department of Psychiatric Nursing, Malatya Turgut Ozal Unıversıty, Malatya, Turkey.
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22
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Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. Lancet Psychiatry 2021; 8:387-404. [PMID: 33862018 DOI: 10.1016/s2215-0366(21)00039-0] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence of comparative benefits of long-acting injectable antipsychotics (LAIs) versus oral antipsychotics for schizophrenia has been inconsistent across study designs. The aim of this study was to evaluate the comparative benefits of LAIs versus oral antipsychotics in three study designs to inform clinical decision making. METHODS We did a comprehensive systematic review and meta-analysis comparing LAIs versus oral antipsychotics for schizophrenia covering three study designs: randomised controlled trials (RCTs), cohort studies, and pre-post studies. Our literature search was without language restrictions, in MEDLINE and PubMed, the Cochrane Library, Scopus, and Embase, for studies published from database inception up to a last search on March 13, 2020. We also searched for unpublished studies and ClinicalTrials.gov. We included studies lasting at least 6 months that targeted adults with schizophrenia and related disorders (>80% of participants). Studies on penfluridol (neither an LAI or daily oral antipsychotic), case reports, and case series with fewer than 20 patients were excluded. Two investigators independently extracted study-level data and resolved disagreement by consensus, or via a third investigator. Study authors were contacted to obtain additional information as needed. For our primary outcome we meta-analysed the risk ratio (RR) for hospitalisation or relapse with LAIs versus oral antipsychotics by a random-effects model, with hospitalisation used preferentially over relapse. As secondary analyses, we reversed the preferential order to relapse over hospitalisation, and assessed hospitalisation risk and relapse risk individually. Other secondary outcomes included all meta-analysable data, classed by relevance to effectiveness, efficacy, safety, quality of life, cognitive function, and other outcomes, and analysed by study design. Dichotomous outcomes were expressed as pooled RR and continuous outcomes as standardised mean difference (SMD). The protocol is registered with PROSPERO (CRD42019142094). FINDINGS We identified 14 687 records, of which 137 studies (397 319 patients) met the inclusion criteria (32 RCTs [23·4%; 8577 patients], 65 cohort studies [47·4%; 377 447 patients], and 40 pre-post studies [29·2%; 11 295 patients]) and were analysed. The quality of studies in terms of risk of bias varied across study designs and within each study design from low to high. LAIs were associated with a lower risk of hospitalisation or relapse than oral antipsychotics in each of the three study designs (RCTs: 29 studies, 7833 patients, RR 0·88 [95% CI 0·79-0·99], p=0·033; cohort studies: 44 studies, 106 136 patients, RR 0·92 [0·88-0·98], p=0·0044; pre-post studies: 28 studies, 17 876 patients, RR 0·44 [0·39-0·51], p<0·0001). This association was maintained across the study designs when we reversed the preferential order to risk of relapse over hospitalisation, and in individual analysis of hospitalisation risk. The association was maintained only in pre-post studies for relapse risk alone. In all other outcomes related to effectiveness, efficacy, safety, quality of life, cognitive function, and other outcomes, LAIs were more beneficial than oral antipsychotics in 60 (18·3%) of 328 comparisons, not different in 252 (76·8%) comparisons, and less beneficial in 16 (4·9%) comparisons when analysed by study design. Significant heterogeneity was observed across all three study designs. Publication biases were apparent in cohort and pre-post studies, but effect sizes were similar after trim-and-fill analyses. INTERPRETATION Although study designs have strengths and weaknesses, including potential low quality of observational studies, we consistently identified significant benefit with LAIs versus oral antipsychotics in preventing hospitalisation or relapse, in settings ranging from restricted research (RCTs) to real-word application (cohort and pre-post studies). Our findings suggest that increased clinical use of LAIs could improve outcomes in schizophrenia. FUNDING None. TRANSLATIONS For the Chinese, French, German, Italian, Japanese, Portugese and Spanish translations of the abstract see Supplementary Materials section.
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23
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Besag FMC, Vasey MJ, Salim I. Is Adjunct Aripiprazole Effective in Treating Hyperprolactinemia Induced by Psychotropic Medication? A Narrative Review. CNS Drugs 2021; 35:507-526. [PMID: 33880739 DOI: 10.1007/s40263-021-00812-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/10/2023]
Abstract
Psychotropic medication treatment can cause elevated serum prolactin levels and hyperprolactinaemia (HPRL). Reports have suggested that aripiprazole may decrease elevated prolactin. The aim of this review was to assess evidence for the efficacy of adjunct aripiprazole in the treatment of psychotropic-induced HPRL. PubMed and Google Scholar were searched to identify randomised placebo-controlled trials (RCTs) of adjunct aripiprazole in patients with HPRL attributed to primary psychotropic medications. Data for individual patients from case studies, chart reviews and open-label studies were also identified and assessed. Six RCTs, with a total of 609 patients, met inclusion criteria. Primary psychotropics included risperidone, haloperidol, paliperidone, fluphenazine and loxapine. Reductions in prolactin from baseline, before the introduction of aripiprazole, were significantly greater for adjunct aripiprazole than for adjunct placebo in all the studies (p = 0.04 to p < 0.0001). Normalisation of serum prolactin levels was significantly more likely with adjunct aripiprazole than adjunct placebo (p = 0.028 to p < 0.001, data from three studies). Improvement or resolution of HPRL-related symptoms (galactorrhoea, oligomenorrhoea, amenorrhoea and sexual dysfunction) were reported in three studies. Prolactin levels decreased in all case reports and in both of two open-label studies; they normalised in 30/41 patients (73.2%) in case studies and 12/29 (41.4%) in the open-label studies. Adjunct aripiprazole was statistically significantly effective in treating elevated serum prolactin levels in six RCTs. Evidence from case reports and open-label studies suggests a degree of effectiveness in most patients.
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Affiliation(s)
- Frank M C Besag
- East London Foundation NHS Trust, 9 Rush Court, Bedford, MK40 3JT, UK. .,University College London, London, UK. .,King's College London, London, UK.
| | | | - Iffah Salim
- East London Foundation NHS Trust, Glen Road, Cherry Tree Way, Newham, London, E13 8SP, UK
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24
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Farmer AD, Strzelczyk A, Finisguerra A, Gourine AV, Gharabaghi A, Hasan A, Burger AM, Jaramillo AM, Mertens A, Majid A, Verkuil B, Badran BW, Ventura-Bort C, Gaul C, Beste C, Warren CM, Quintana DS, Hämmerer D, Freri E, Frangos E, Tobaldini E, Kaniusas E, Rosenow F, Capone F, Panetsos F, Ackland GL, Kaithwas G, O'Leary GH, Genheimer H, Jacobs HIL, Van Diest I, Schoenen J, Redgrave J, Fang J, Deuchars J, Széles JC, Thayer JF, More K, Vonck K, Steenbergen L, Vianna LC, McTeague LM, Ludwig M, Veldhuizen MG, De Couck M, Casazza M, Keute M, Bikson M, Andreatta M, D'Agostini M, Weymar M, Betts M, Prigge M, Kaess M, Roden M, Thai M, Schuster NM, Montano N, Hansen N, Kroemer NB, Rong P, Fischer R, Howland RH, Sclocco R, Sellaro R, Garcia RG, Bauer S, Gancheva S, Stavrakis S, Kampusch S, Deuchars SA, Wehner S, Laborde S, Usichenko T, Polak T, Zaehle T, Borges U, Teckentrup V, Jandackova VK, Napadow V, Koenig J. International Consensus Based Review and Recommendations for Minimum Reporting Standards in Research on Transcutaneous Vagus Nerve Stimulation (Version 2020). Front Hum Neurosci 2021; 14:568051. [PMID: 33854421 PMCID: PMC8040977 DOI: 10.3389/fnhum.2020.568051] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/01/2020] [Indexed: 12/18/2022] Open
Abstract
Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation (tVNS) across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation(VNS) and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice.
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Affiliation(s)
- Adam D. Farmer
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke on Trent, United Kingdom
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Alexander V. Gourine
- Department of Neuroscience, Physiology and Pharmacology, Centre for Cardiovascular and Metabolic Neuroscience, University College London, London, United Kingdom
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Andreas M. Burger
- Laboratory for Biological Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | | | - Ann Mertens
- Department of Neurology, Institute for Neuroscience, 4Brain, Ghent University Hospital, Gent, Belgium
| | - Arshad Majid
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Bart Verkuil
- Clinical Psychology and the Leiden Institute of Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Bashar W. Badran
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Carlos Ventura-Bort
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Charly Gaul
- Migraine and Headache Clinic Koenigstein, Königstein im Taunus, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | | | - Daniel S. Quintana
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Dorothea Hämmerer
- Medical Faculty, Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- Center for Behavioral Brain Sciences Magdeburg (CBBS), Otto-von-Guericke University, Magdeburg, Germany
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Eleni Frangos
- Pain and Integrative Neuroscience Branch, National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States
| | - Eleonora Tobaldini
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eugenijus Kaniusas
- Institute of Electrodynamics, Microwave and Circuit Engineering, TU Wien, Vienna, Austria
- SzeleSTIM GmbH, Vienna, Austria
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Fivos Panetsos
- Faculty of Biology and Faculty of Optics, Complutense University of Madrid and Institute for Health Research, San Carlos Clinical Hospital (IdISSC), Madrid, Spain
| | - Gareth L. Ackland
- Translational Medicine and Therapeutics, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Gaurav Kaithwas
- Department of Pharmaceutical Sciences, School of Biosciences and Biotechnology, Babasaheb Bhimrao Ambedkar University (A Central University), Lucknow, India
| | - Georgia H. O'Leary
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Hannah Genheimer
- Department of Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Heidi I. L. Jacobs
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, Netherlands
| | - Ilse Van Diest
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology-Citadelle Hospital, University of Liège, Liège, Belgium
| | - Jessica Redgrave
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Jiliang Fang
- Functional Imaging Lab, Department of Radiology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jim Deuchars
- School of Biomedical Science, Faculty of Biological Science, University of Leeds, Leeds, United Kingdom
| | - Jozsef C. Széles
- Division for Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Julian F. Thayer
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Kaushik More
- Institute for Cognitive Neurology and Dementia Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Neuromodulatory Networks, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Kristl Vonck
- Department of Neurology, Institute for Neuroscience, 4Brain, Ghent University Hospital, Gent, Belgium
| | - Laura Steenbergen
- Clinical and Cognitive Psychology and the Leiden Institute of Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Lauro C. Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasilia, Brasilia, Brazil
| | - Lisa M. McTeague
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Mareike Ludwig
- Department of Anatomy, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Maria G. Veldhuizen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marijke De Couck
- Faculty of Health Care, University College Odisee, Aalst, Belgium
- Division of Epileptology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marina Casazza
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Marius Keute
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, New York, NY, United States
| | - Marta Andreatta
- Department of Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Martina D'Agostini
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
- Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Matthew Betts
- Department of Anatomy, Faculty of Medicine, Mersin University, Mersin, Turkey
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany
| | - Matthias Prigge
- Neuromodulatory Networks, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Roden
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Munich, Germany
| | - Michelle Thai
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, United States
| | - Nathaniel M. Schuster
- Department of Anesthesiology, Center for Pain Medicine, University of California, San Diego Health System, La Jolla, CA, United States
| | - Nicola Montano
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Niels Hansen
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIPLab), University of Göttingen, Göttingen, Germany
| | - Nils B. Kroemer
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Rico Fischer
- Department of Psychology, University of Greifswald, Greifswald, Germany
| | - Robert H. Howland
- Department of Psychiatry, University of Pittsburgh School of Medicine, UPMC Western Psychiatric Hospital, Pittsburgh, PA, United States
| | - Roberta Sclocco
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Radiology, Logan University, Chesterfield, MO, United States
| | - Roberta Sellaro
- Cognitive Psychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden, Netherlands
- Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy
| | - Ronald G. Garcia
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sebastian Bauer
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Sofiya Gancheva
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Stavros Stavrakis
- Faculty of Biological Science, School of Biomedical Science, University of Leeds, Leeds, United Kingdom
| | - Stefan Kampusch
- Institute of Electrodynamics, Microwave and Circuit Engineering, TU Wien, Vienna, Austria
- SzeleSTIM GmbH, Vienna, Austria
| | - Susan A. Deuchars
- School of Biomedical Science, Faculty of Biological Science, University of Leeds, Leeds, United Kingdom
| | - Sven Wehner
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - Sylvain Laborde
- Department of Performance Psychology, Institute of Psychology, Deutsche Sporthochschule, Köln, Germany
| | - Taras Usichenko
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Thomas Polak
- Laboratory of Functional Neurovascular Diagnostics, AG Early Diagnosis of Dementia, Department of Psychiatry, Psychosomatics and Psychotherapy, University Clinic Würzburg, Würzburg, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Uirassu Borges
- Department of Performance Psychology, Institute of Psychology, Deutsche Sporthochschule, Köln, Germany
- Department of Social and Health Psychology, Institute of Psychology, Deutsche Sporthochschule, Köln, Germany
| | - Vanessa Teckentrup
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Vera K. Jandackova
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
- Department of Human Movement Studies, Faculty of Education, University of Ostrava, Ostrava, Czechia
| | - Vitaly Napadow
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Radiology, Logan University, Chesterfield, MO, United States
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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25
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Towards personalized pharmacology: Antipsychotics and schizophrenia. Therapie 2021; 76:137-147. [PMID: 33423786 DOI: 10.1016/j.therap.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022]
Abstract
Since the discovery of the first antipsychotic in 1952, many antipsychotic drugs have been developed, each with different pharmacokinetic and pharmacodynamic properties. The pharmacological heterogeneity of antipsychotic drugs should allow a personalized drug prescription adapted to the different clinical picture of schizophrenia. Schizophrenia is a chronic disease, during which 3 stages of pharmacological intervention can be identified: the first episode psychotic (FEP), the phase of therapeutic stabilization that can progress to situations of resistance, and the question of long-term prescription. During FEP, the choice of the first antipsychotic treatment seems to be underpinned by its safety profile in relation to the patient for whom it is prescribed, according to the adage start low and go-slow. The therapeutic stabilization phase is based on treatment optimization through a rigorous evaluation of the benefits-harm balance, with the use of tools such as personalized therapeutic drug monitoring and pharmacogenetics. Generally speaking, while some antipsychotic drugs seem to present a more favorable efficacy profile in certain situations, the differences are small, whereas the differences in safety are more important and should be considered in the first line. Individual factors such as the presence of co-morbidities, as well as previously experienced treatments must also be taken into account. Finally, the question of maintaining the prescription of antipsychotic drugs over the long term arises in view of the iatrogenic risk with controversial current data. Overall, the personalized prescription of antipsychotic drugs in schizophrenia remains limited by a lack of data in the literature, justifying the development of clinical studies in this field. But at present, the dogma remains that of primum non nocere.
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Alisauskiene R, Johnsen E, Gjestad R, Kroken RA, Jørgensen HA, Løberg EM. The Influence of Substance Use on Side Effects of Olanzapine, Quetiapine, Risperidone, and Ziprasidone in Psychosis. Subst Use Misuse 2021; 56:1880-1891. [PMID: 34369263 DOI: 10.1080/10826084.2021.1958858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Side effects restrict the optimal use of antipsychotics. Little is known about the influence of substance use on side effects. The aim of this study was to compare antipsychotic side effects in patients with psychosis with and without substance use, while also taking medication history and diagnosis into consideration. METHODS All patients (n = 226, mean age 34, females 33%) diagnosed with schizophrenia spectrum disorders (SSD; F20-F29) or other psychosis (F30-F32; F10-F19), were treated with olanzapine, quetiapine, risperidone or ziprasidone, and were assessed at baseline, 4-weeks, 14-weeks, and 27-weeks. The UKU-Side Effects Self-Rating Scale version was used to evaluate the side effect profiles, and the information on substance use was based on the Clinician Drug Use Scale. RESULTS At baseline, 30% of the patients used substances, 54% were diagnosed with SSD, and 47% were antipsychotic naïve. The occurrence of side effects in total was not different in patients with substance use compared to without after 4-weeks of treatment, nor in the follow-up period. At 4-weeks there were some group differences in relation to substance use, diagnosis, and medication history for single side effects. Patients with substance use showed more increased dream activity, less reduced salivation, and more gynecomastia. Patients with SSD showed less neurological side effects, orgasm dysfunction, and tension/inner unrest. The medication naïve patients showed increased hypokinesia/akinesia. CONCLUSION Substance use alone does not influence the general magnitude of side effects of antipsychotic medication and does not indicate a different prescription practice in patients with psychosis and substance use.
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Affiliation(s)
- Renata Alisauskiene
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rune A Kroken
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hugo A Jørgensen
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Else-Marie Løberg
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
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Kargin M, Ersöğütçü F, Aslanoğlu E. Medication adherence and hopelessness in male individuals with substance use disorder. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1851412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Maral Kargin
- Faculty of Health Science Nursing Department, Firat University, Elazığ, Turkey
| | - Filiz Ersöğütçü
- Faculty of Health Science Nursing Department, Firat University, Elazığ, Turkey
| | - Eren Aslanoğlu
- Kovancılar Vocational School Department of Medical Services and Techniques, Firat University, Elazığ, Turkey
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Alasmee N, Hasan AA. Primary caregivers experience of anti-psychotic medication: A qualitative study. Arch Psychiatr Nurs 2020; 34:520-528. [PMID: 33280675 DOI: 10.1016/j.apnu.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 08/08/2020] [Accepted: 09/05/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Management of schizophrenia is now shifted to the community setting and family caregivers are the primary caregivers. Managing medications is a complex responsibility of family caregivers caring for patients with mental illness. Medication compliance contributes to improve health outcomes and reduced hospitalization for the care service users; however, little is known about attitudes and perception of family caregivers. AIMS AND OBJECTIVES To explore family caregivers experience towards antipsychotic medications. METHODS A purposeful sampling of 21 family caregivers was included in the study. Semi-structured interview was employed to collect data from the participants between May and October 2015. Thematic analysis approach was used to identify the common pattern in the data. RESULTS Four main themes emerged from the study: insight into illness (poor understanding of illness), treatment factor (thinking about medication, poor guidance for medication compliance), resources and support (availability of medication and cost of medication), health care provider factors (communication gap and poor assessment with follow-up, social dysfunction (social isolation, disruption in life routine) of the primary caregivers. CONCLUSIONS Responsibility for providing care for patients with mental illness are taken place in the community setting and cared by family caregivers. More information resources are required for this role, which requires specific medication management skills and knowledge.
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Affiliation(s)
- Nofaa Alasmee
- Fakeeh College for Medical Sciences, Alhamra District, Palestine Street, Jeddah, Saudi Arabia
| | - Abd Alhadi Hasan
- Fakeeh College for Medical Sciences, Alhamra District, Palestine Street, Jeddah, Saudi Arabia.
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29
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Raghavan V, Cherubal AG, John S, Padmavati R. Comparison of cost-effectiveness of long-acting depot injection antipsychotics and oral antipsychotics in patients with schizophrenia in a rural community in South India. Indian J Psychiatry 2020; 62:747-748. [PMID: 33896993 PMCID: PMC8052869 DOI: 10.4103/psychiatry.indianjpsychiatry_670_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/09/2020] [Accepted: 04/18/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Vijaya Raghavan
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India. E-mail:
| | | | - Sujit John
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India. E-mail:
| | - R Padmavati
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India. E-mail:
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30
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Dai M, Wu Y, Tang Y, Yue W, Yan H, Zhang Y, Tan L, Deng W, Chen Q, Yang G, Lu T, Wang L, Yang F, Zhang F, Yang J, Li K, Lv L, Tan Q, Zhang H, Ma X, Li L, Wang C, Ma X, Zhang D, Yu H, Zhao L, Ren H, Wang Y, Hu X, Zhang G, Du X, Wang Q, Li T. Longitudinal trajectory analysis of antipsychotic response in patients with schizophrenia: 6-week, randomised, open-label, multicentre clinical trial. BJPsych Open 2020; 6:e126. [PMID: 33090091 PMCID: PMC7745240 DOI: 10.1192/bjo.2020.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Understanding the patterns of treatment response is critical for the treatment of patients with schizophrenia; one way to achieve this is through using a longitudinal dynamic process study design. AIMS This study aims to explore the response trajectory of antipsychotics and compare the treatment responses of seven different antipsychotics over 6 weeks in patients with schizoprenia (trial registration: Chinese Clinical Trials Registry Identifier: ChiCTR-TRC-10000934). METHOD Data were collected from a multicentre, randomised open-label clinical trial. Patients were evaluated with the Positive and Negative Syndrome Scale (PANSS) at baseline and follow-up at weeks 2, 4 and 6. Trajectory groups were classified by the method of k-means cluster modelling for longitudinal data. Trajectory analyses were also employed for the seven antipsychotic groups. RESULTS The early treatment response trajectories were classified into a high-trajectory group of better responders and a low-trajectory group of worse responders. The results of trajectory analysis showed differences compared with the classification method characterised by a 50% reduction in PANSS scores at week 6. A total of 349 patients were inconsistently grouped by the two methods, with a significant difference in the composition ratio of treatment response groups using these two methods (χ2 = 43.37, P < 0.001). There was no differential contribution of high- and low trajectories to different drugs (χ2 = 12.52, P = 0.051); olanzapine and risperidone, which had a larger proportion in the >50% reduction at week 6, performed better than aripiprazole, quetiapine, ziprasidone and perphenazine. CONCLUSIONS The trajectory analysis of treatment response to schizophrenia revealed two distinct trajectories. Comparing the treatment responses to different antipsychotics through longitudinal analysis may offer a new perspective for evaluating antipsychotics.
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Affiliation(s)
- Minhan Dai
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, China; and West China Brain Research Center, West China Hospital of Sichuan University, China
| | - Yulu Wu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, China; and West China Brain Research Center, West China Hospital of Sichuan University, China
| | - Yiguo Tang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, China; and West China Brain Research Center, West China Hospital of Sichuan University, China
| | - Weihua Yue
- Peking University Sixth Hospital (Institute of Mental Health), China; and National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), China
| | - Hao Yan
- Peking University Sixth Hospital (Institute of Mental Health), China; and National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), China
| | - Yamin Zhang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, China; West China Brain Research Center, West China Hospital of Sichuan University, China
| | - Liwen Tan
- Second Xiangya Hospital, Central South University, China
| | - Wei Deng
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, China; and West China Brain Research Center, West China Hospital of Sichuan University, China
| | - Qi Chen
- Second Xiangya Hospital, Central South University, China
| | - Guigang Yang
- Beijing Anding Hospital, Institute for Brain Disorders, Capital Medical University, China
| | - Tianlan Lu
- Peking University Sixth Hospital (Institute of Mental Health), China; and National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), China
| | - Lifang Wang
- Peking University Sixth Hospital (Institute of Mental Health), China; and National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), China
| | | | - Fuquan Zhang
- Wuxi Mental Health Center, Nanjing Medical University, China
| | - Jianli Yang
- Institute of Mental Health, Tianjin Anding Hospital, China; and Tianjin Medical University General Hospital, Tianjin Medical University, China
| | | | - Luxian Lv
- Second Affiliated Hospital of Xinxiang Medical University, China
| | - Qingrong Tan
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, China
| | - Hongyan Zhang
- Wuxi Mental Health Center, Nanjing Medical University, China
| | - Xin Ma
- Beijing Anding Hospital, Institute for Brain Disorders, Capital Medical University, China
| | - Lingjiang Li
- Second Xiangya Hospital, Central South University, China
| | - Chuanyue Wang
- Beijing Anding Hospital, Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Xiaohong Ma
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, China; and West China Brain Research Center, West China Hospital of Sichuan University, China
| | - Dai Zhang
- Peking University Sixth Hospital (Institute of Mental Health), China; and National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), China
| | - Hao Yu
- Department of Psychiatry, Jining Medical University, China
| | - Liansheng Zhao
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, China; and West China Brain Research Center, West China Hospital of Sichuan University, China
| | - Hongyan Ren
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, China; West China Brain Research Center, West China Hospital of Sichuan University, China
| | - Yingcheng Wang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, China; and West China Brain Research Center, West China Hospital of Sichuan University, China
| | - Xun Hu
- West China Brain Research Center, West China Hospital of Sichuan University, China; and Biobank, West China Hospital of Sichuan University, China
| | - Guangya Zhang
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, China
| | - Xiaodong Du
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, China
| | - Qiang Wang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, China; and West China Brain Research Center, West China Hospital of Sichuan University, China
| | - Tao Li
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, China; and West China Brain Research Center, West China Hospital of Sichuan University, China
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Buchman-Wildbaum T, Váradi E, Schmelowszky Á, Griffiths MD, Demetrovics Z, Urbán R. Targeting the problem of treatment non-adherence among mentally ill patients: The impact of loss, grief and stigma. Psychiatry Res 2020; 290:113140. [PMID: 32512354 DOI: 10.1016/j.psychres.2020.113140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
The present study examined the factor structure of the Hungarian version of the Medication Adherence Rating Scale (MARS) and analyzed its association with socio-demographics, insight, internalized stigma, and the experience of loss and grief as a result of the mental illness diagnosis, using confirmatory factor analysis (CFA) with a series of one covariates at a time. Mentally ill patients (N=200) completed self-report questionnaires. CFA supported the original three-factor structure although one item was moved from its original factor to another. Lower insight, higher internalized stigma, loss, and grief were significant predictors of lower treatment adherence. Lower adherence was found to be significantly associated with lower quality of life. No difference in adherence was found between different diagnostic groups, which stresses the need to examine non-adherence in the wider spectrum of mental diagnosis. The study also stresses the importance of patients' subjective experience in promoting better adherence, and raises the need to address the experience of stigma but also of less studied experiences, such as patients' feelings of loss and grief. Integrating these experiences in intervention programs might have meaningful implications for the improvement of treatment adherence and patients' quality of life.
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Affiliation(s)
- Tzipi Buchman-Wildbaum
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Enikő Váradi
- XVI District Center for Mental Health Care, Budapest, Hungary; Integrated Day care Center for Psychiatric Patients, Cogito Foundation, Budapest, Hungary
| | | | - Mark D Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Róbert Urbán
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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32
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Meola TR, Paxton K, Joyce P, Schultz HB, Prestidge CA. The effect of drug ionization on lipid-based formulations for the oral delivery of anti-psychotics. ADMET AND DMPK 2020; 8:437-451. [PMID: 35300191 PMCID: PMC8915591 DOI: 10.5599/admet.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/15/2020] [Indexed: 11/18/2022] Open
Abstract
Lipid-based formulations (LBFs) are well-known to improve the oral bioavailability of poorly water-soluble drugs (PWSDs) by presenting the drug to the gastrointestinal environment in a molecularly dispersed state, thus avoiding the rate-limiting dissolution step. Risperidone and lurasidone are antipsychotics drugs which experience erratic and variable absorption, leading to a low oral bioavailability. The aim of this research was to develop and investigate the performance of risperidone and lurasidone when formulated as an emulsion and silica-lipid hybrid (SLH). Lurasidone and risperidone were dissolved in Capmul® MCM at 100% and 80% their equilibrium solubility, respectively, prior to forming a sub-micron emulsion. SLH microparticles were fabricated by spray-drying a silica stabilised sub-micron emulsion to form a solid powder. The performances of the formulations were evaluated in simulated intestinal media under digesting conditions, where the emulsion and SLH provided a 17-fold and 23-fold increase in LUR solubilisation, respectively. However, the performance of RIS was reduced by 2.2-fold when encapsulated within SLH compared to pure drug. Owing to its pKa, RIS adsorbed to the silica and thus, dissolution was significantly hindered. The results reveal that LBFs may not overcome the challenges of all PWSDs and physiochemical properties must be carefully considered when predicting drug performance.
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Affiliation(s)
- Tahlia R Meola
- UniSA: Clinical and Health Sciences, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia.,ARC Centre of Excellence in Convergent Bio-Nano Science & Technology, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia
| | - Kara Paxton
- UniSA: Clinical and Health Sciences, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia.,ARC Centre of Excellence in Convergent Bio-Nano Science & Technology, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia
| | - Paul Joyce
- UniSA: Clinical and Health Sciences, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia.,ARC Centre of Excellence in Convergent Bio-Nano Science & Technology, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia
| | - Hayley B Schultz
- UniSA: Clinical and Health Sciences, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia.,ARC Centre of Excellence in Convergent Bio-Nano Science & Technology, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia
| | - Clive A Prestidge
- UniSA: Clinical and Health Sciences, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia.,ARC Centre of Excellence in Convergent Bio-Nano Science & Technology, University of South Australia, City West Campus, Adelaide, South Australia 5000, Australia
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33
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Tan W, Lin H, Lei B, Ou A, He Z, Yang N, Jia F, Weng H, Hao T. The psychosis analysis in real-world on a cohort of large-scale patients with schizophrenia. BMC Med Inform Decis Mak 2020; 20:132. [PMID: 32646484 PMCID: PMC7477870 DOI: 10.1186/s12911-020-1125-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background With China experiencing unprecedented economic development and social change over the past three decades, Chinese policy makers and health care professionals have come to view mental health as an important outcome to monitor. Our study conducted an epidemiological study of psychosis in Guangdong province, with 20 million real-world follow-up records in the last decade. Methods Data was collected from Guangdong mental health information platform from 2010 to 2019, which had standardized disease registration and follow-up management for nearly 600,000 patients with six categories of mental diseases and 400,000 patients with schizophrenia. We conducted clinical staging for the disease course of the patients and divided the data with various factors into different stages of disease. Quantitative analysis was utilized to investigate the high relevant indicators to the disease. The results were projected on geography map for regional distribution analysis. Results The majority cases of mental disease incidence were between the age of 15 and 29, while the peak age for both male and female was between 20 to 24 years old. The disease course with the largest number of patients’ cases was between 5 to 10 years. The therapeutic effect of patients gradually decreased with the development of disease course, while the risk increased with the disease course. The analysis of influencing factors showed that poor economic conditions incurred higher risk scores, and good medication adherence was effective in improving treatment outcomes. In addition, receiving good education contributed to the reduction of the risk of schizophrenia and the improvement of the efficiency of early treatment. Through the analysis of regional distribution of schizophrenia disease, developed economic conditions and favorable resource conditions could promote the reduction of disease risk, while in economically backward regions, it often accompanied with lower therapeutic effect and higher disease risk. Conclusions Certain demographic factors had a relatively prominent impact on the therapeutic effect and risk of schizophrenia, such as high-quality medication adherence. Therapeutic effect and risk were highly correlated. Backward economic conditions often associated with poor efficacy and higher risk assessment, and the developed economy and better medical resource are beneficial for the treatment of psychotic.
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Affiliation(s)
- Wenyan Tan
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Haicheng Lin
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Baoxin Lei
- School of Computer Science, South China Normal University, Guangzhou, China
| | - Aihua Ou
- Department of Big Data Research of Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zehui He
- Department of Big Data Research of Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ning Yang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Fujun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
| | - Heng Weng
- Department of Big Data Research of Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Tianyong Hao
- School of Computer Science, South China Normal University, Guangzhou, China.
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Haro JM, Novick D, Belger M, Jones PB. Antipsychotic type and correlates of antipsychotic treatment discontinuation in the outpatient treatment of schizophrenia. Eur Psychiatry 2020; 21:41-7. [PMID: 16414249 DOI: 10.1016/j.eurpsy.2005.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AbstractAntipsychotic medication maintenance and the factors influencing it were analyzed using data from the SOHO study, a large observational study of the outcomes of antipsychotic treatment for schizophrenia in Europe. A total of 7186 adult patients in the outpatient setting who were initiating or changing their antipsychotic medication and who were prescribed only one antipsychotic after the baseline visit were analyzed. Medication maintenance at 12 months varied with the type of antipsychotic prescribed, being highest with clozapine (79.5%) and olanzapine (77.0%), and lowest with quetiapine (51.4%) and amisulpride (58.2%). Multiple logistic regression analysis demonstrated that the type of antipsychotic prescribed at baseline was the most important predictor of medication maintenance. Alcohol dependency, taking mood stabilizers, compulsory admission or arrest in the previous 6 months, greater clinical severity, and changing antipsychotic medication due to lack of effectiveness at baseline predicted a higher frequency of medication discontinuation in the subsequent 12 months. In contrast, medication maintenance was higher among patients who were treatment naïve at baseline, socially active or who had loss of libido at baseline. The findings from this study should be interpreted conservatively because of its non-randomized observational design.
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Affiliation(s)
- Josep Maria Haro
- Research and Development Unit, Sant Joan de Déu-Serveis de Salut Mental, Dr. Antoni Pujades 42, 08030 Sant Boi, Barcelona, Spain.
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Uçok A, Incesu C, Aker T, Erkoç S. Sexual dysfunction in patients with schizophrenia on antipsychotic medication. Eur Psychiatry 2020; 22:328-33. [PMID: 17344032 DOI: 10.1016/j.eurpsy.2007.01.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Revised: 01/02/2007] [Accepted: 01/03/2007] [Indexed: 11/30/2022] Open
Abstract
AbstractObjectiveThe objective of this study was to determine the prevalence of sexual dysfunction in patients with schizophrenia under antipsychotic therapy and to investigate the effect of various parameters on sexual dysfunction.MethodA total of 827 stabilized outpatients who met DSM-IV criteria for schizophrenia, were recruited in the study. Arizona Sexual Experience Scale (ASEX) and the subscale on sexual function of the UKU Side Effects Rating Scale were applied at a single interview.ResultsIn total, 52.6% of the patients had sexual dysfunction, 54.2% reported a low sexual desire and 41.7% reported problems in having an orgasm. Erectile dysfunction and ejaculation problems were seen in 48.1% and 64.2% of the men, respectively; amenorrhea was seen in 24.9% of the women. ASEX score and severity of disease were found to be correlated (p = 0.02). Higher ASEX scores were observed in patients who smoked (p = 0.01). Men receiving atypical monotherapy had lower ASEX scores than those receiving a combination of atypical and conventional antipsychotics (p = 0.017). Patients on combination therapy had more ejaculation problems than the atypical group (p = 0.001). Low sexual desire was more prevalent among women using conventional drugs than those on atypical drugs (p = 0.004). In linear regression analyses, ASEX was affected significantly and independently by the severity of the disease only in men (p = 0.005).ConclusionOur results show that sexual dysfunction is widespread among patients with schizophrenia on antipsychotic medications.
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Affiliation(s)
- Alp Uçok
- Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Millet Street, Capa 34390, Istanbul, Turkey.
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Dossenbach M, Dyachkova Y, Pirildar S, Anders M, Khalil A, Araszkiewicz A, Shakhnovich T, Akram A, Pecenak J, McBride M, Treuer T. Effects of atypical and typical antipsychotic treatments on sexual function in patients with schizophrenia: 12-month results from the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study. Eur Psychiatry 2020; 21:251-8. [PMID: 16530390 DOI: 10.1016/j.eurpsy.2005.12.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AbstractPurposeSexual dysfunction in patients with schizophrenia can reduce quality of life and treatment compliance. This report will compare the effects of selected atypical and typical antipsychotics on sexual function in a large, international population of outpatients with schizophrenia who were treated over 1 year.Subjects and methodsOutpatients with schizophrenia, who initiated or changed antipsychotic treatment, and entered this 3-year, prospective, observational study were classified according to the monotherapy prescribed at baseline: olanzapine (N = 2638), risperidone (N = 860), quetiapine (N = 142) or haloperidol (N = 188).ResultsBased on patient perception, the odds of experiencing sexual dysfunction during 1 year of therapy was significantly lower for patients treated with olanzapine and quetiapine when compared to patients who received risperidone or haloperidol (all P ≤ 0.001). Females on olanzapine (14%) or quetiapine (8%) experienced a lower rate of menstrual irregularities, compared to females on risperidone (23%) or haloperidol (29%). Significant discordance was evident between patient reports and psychiatrist perception of sexual dysfunction, with psychiatrists underestimating sexual dysfunction (P ≤ 0.001).ConclusionsThese findings indicate clinically relevant differences exist in the sexual side effect profiles of these selected antipsychotics. These factors should be considered when selecting the most appropriate treatment for outpatients with schizophrenia.
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Affiliation(s)
- Martin Dossenbach
- Eli Lilly and Company, Ges.m.b.H, Kölblgasse 8-10, 1030 Vienna, Austria. d.m.@lilly.com
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García-Blanco A, García-Portilla MP, Fuente-Tomás LDL, Batalla M, Sánchez-Autet M, Arranz B, Safont G, Arqués S, Livianos L, Sierra P. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. J Sex Med 2020; 17:930-940. [PMID: 32139195 DOI: 10.1016/j.jsxm.2020.01.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In addition to factors intrinsic to bipolar disorder (BD), sexual functioning (SF) can be affected by extrinsic causes, such as psychotropic drugs. However, the effect of mood stabilizers on SF and quality of life (QoL) is an underexplored research area. AIM To analyze SF in BD outpatients in euthymia for at least 6 months treated only with mood stabilizers and the association between SF and QoL. METHODS A multicenter cross-sectional study was conducted in 114 BD outpatients treated with (i) lithium alone (L group); (ii) anticonvulsants alone (valproate or lamotrigine; A group); (iii) lithium plus anticonvulsants (L+A group); or (iv) lithium plus benzodiazepines (L+B group). The Changes in Sexual Functioning Questionnaire Short Form (CSFQ-14) was used. Statistical analyses were performed to compare CSFQ-14 scores among the pharmacological groups. An adaptive lasso was used to identify potential confounding variables, and linear regression models were used to study the association of the CSFQ-14 with QoL. MAIN OUTCOME MEASURES Self-reports on phases of the sexual response cycle (ie, desire, arousal, and orgasm) and QoL were assessed. RESULTS The A group had better total SF scores than the L group and the L+B group. Relative to the A group, the L and L+B groups had worse sexual desire; the L group had worse sexual arousal; and the L+A group and the L+B group had worse sexual orgasm. Regarding sociodemographic factors, being female and older age were associated with worse total SF and all subscale scores. Among all subscales scores, higher sexual arousal scores were associated with better QoL. CLINICAL IMPLICATIONS Potential modified extrinsic factors such as psychotropic medication that can affect SF can be addressed and adjusted to lessen side effects on SF. STRENGTHS & LIMITATIONS Sample of patients with euthymic BD in treatment with mood stabilizers and no antipsychotics or antidepressants, substance use as an exclusion criterion, and use of a validated, gender-specific scale to evaluate SF. Major limitations were cross-sectional design, sample size, and lack of information about stability of relationship with partner. CONCLUSIONS Lithium in monotherapy or in combination with benzodiazepines is related to worse total SF and worse sexual desire than anticonvulsants in monotherapy. While the addition of benzodiazepines or anticonvulsants to lithium negatively affects sexual orgasm, sexual arousal (which plays a significant role in QoL) improves when benzodiazepines are added to lithium. Anticonvulsants in monotherapy have the least negative effects on SF in patients with BD. García-Blanco A, García-Portilla MP, Fuente-Tomás L de la, et al. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. J Sex Med 2020;17:930-940.
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Affiliation(s)
| | - María P García-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain
| | - Lorena de la Fuente-Tomás
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain
| | - María Batalla
- La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Belén Arranz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Gemma Safont
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, University Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain
| | | | - Lorenzo Livianos
- La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; CIBERESP-17, Valencia, Spain
| | - Pilar Sierra
- La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain.
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Dumontaud M, Korchia T, Khouani J, Lancon C, Auquier P, Boyer L, Fond G. Sexual dysfunctions in schizophrenia: Beyond antipsychotics. A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109804. [PMID: 31711954 DOI: 10.1016/j.pnpbp.2019.109804] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/10/2019] [Accepted: 11/05/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sexual dysfunctions (SD) in schizophrenia are frequent with strong impact on adherence and quality of life. Current recommendations stipulate to switch to prolactin-sparing antipsychotic in case of SD. OBJECTIVES To synthetize in a systematic review data on the SD prevalence and the associated risk factors in schizophrenia (SZ). METHODS Medline, Google Scholar, PsychInfo, and Cochrane were explored, without any year or language restriction. RESULTS Overall, 89 studies and 25,490 participants were included in the present review. SZ subjects aged 18-70 reported high SD frequency [30%-82%] (men [33%- 85%]; women [25%- 85%]). For SZ men erectile dysfunction [31%-95%] was the most frequent SD vs. loss of libido for women [31%-100%]. The following risk factors were associated with increased SD: 1. Illness severity (including psychotic symptomatology, early age at SZ onset, negative symptomatology, and continuous illness course), 2. Depressive symptomatology 3. Antipsychotics (especially first generation antipsychotics, risperidone and antipsychotic polytherapy). Switching to prolactin-sparing antipsychotics has shown effectiveness in some studies (especially aripiprazole). Antidepressants were not found to be associated with SD in SZ subjects. CONCLUSION The prevalence of SD is high in SZ subjects. In addition to the current guidelines, the present review suggests that treating depressive symptoms may be a major intervention to improve SD in SZ subjects. Sociodemographic variables, physical illnesses, metabolic syndrome and peripheral inflammation have been poorly or never explored and should be included in future studies.
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Affiliation(s)
- Marion Dumontaud
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France
| | - Théo Korchia
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France
| | - Jérémy Khouani
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France
| | - Christophe Lancon
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Sainte-Marguerite Hospital, Marseille, France
| | - Pascal Auquier
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France
| | - Laurent Boyer
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France
| | - Guillaume Fond
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France.
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Read J, Williams J. Positive and Negative Effects of Antipsychotic Medication: An International Online Survey of 832 Recipients. Curr Drug Saf 2020; 14:173-181. [PMID: 30827259 PMCID: PMC6864560 DOI: 10.2174/1574886314666190301152734] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/16/2019] [Accepted: 02/22/2019] [Indexed: 12/22/2022]
Abstract
Background: Antipsychotic medication is currently the treatment of choice for psychosis, but few studies directly survey the first-hand experience of recipients. Objective: To ascertain the experiences and opinions of an international sample of users of antipsychotic drugs, regarding positive and negative effects. Methods: An online direct-to-consumer questionnaire was completed by 832 users of antipsychotics, from 30 countries – predominantly USA, UK and Australia. This is the largest such sample to date. Results: Over half (56%) thought, the drugs reduced the problems they were prescribed for, but 27% thought they made them worse. Slightly less people found the drugs generally ‘helpful’ (41%) than found them ‘unhelpful’ (43%). While 35% reported that their ‘quality of life’ was ‘improved’, 54% reported that it was made ‘worse’. The average number of adverse effects reported was 11, with an average of five at the ‘severe’ level. Fourteen effects were reported by 57% or more participants, most commonly: ‘Drowsiness, feeling tired, sedation’ (92%), ‘Loss of motivation’ (86%), ‘Slowed thoughts’ (86%), and ‘Emotional numbing’ (85%). Suicidality was reported to be a side effect by 58%. Older people reported particularly poor outcomes and high levels of adverse effects. Duration of treatment was unrelated to positive outcomes but significantly related to negative outcomes. Most respondents (70%) had tried to stop taking the drugs. The most common reasons people wanted to stop were the side effects (64%) and worries about long-term physical health (52%). Most (70%) did not recall being told anything at all about side effects. Conclusion: Clinical implications are discussed, with a particular focus on the principles of informed consent, and involving patients in decision making about their own lives.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, United Kingdom
| | - James Williams
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
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Liu W, Wang S, Lu W, Cheng Z, Jiang N. Sustained Release Ziprasidone Microparticles Prepared by Spray Drying with Soluplus® and Ethyl Cellulose to Eliminate Food Effect and Enhance Bioavailability. AAPS PharmSciTech 2019; 21:27. [PMID: 31858315 DOI: 10.1208/s12249-019-1592-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to develop and evaluate a new formulation of ziprasidone (ZIP) for improved fasted state absorption and sustained drug release. ZIP solid dispersions were produced via spray drying using Soluplus®, an amphiphilic polymer, as the solubility enhancer. Physicochemical analysis proved that ZIP presented at amorphous state in the spray-dried microparticles and the dissolution rate of ZIP from the Soluplus®-ZIP composite microparticles was significantly increased compared with that of the physical mixtures. Commonly used encapsulation materials including Eudragit® RL, Eudragit® S100 and Ethyl Cellulose were incorporated into the solid dispersions to regulate the drug release kinetics. The formulation containing ethyl cellulose provided the most sustained release behaviors. Pharmacokinetic studies in beagle dogs confirmed that there was no significant difference in oral bioavailability of the microparticles under fasted and fed states, and a prolonged Tmax value was simultaneously achieved compared with the commercial ZIP capsules.
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Kavak Budak F, Yilmaz E. The effect of yoga on clinical insight and medication adherence in patients with schizophrenia - A randomized controlled trial. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.100949] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
UNLABELLED IntroductionDespite consistently high discontinuation rates due to withdrawal of consent (WOC) and insufficient therapeutic effect (ITE) in schizophrenia trials, insight into the underlying factors contributing to poor satisfaction with treatment and dropout is limited. A better understanding of these factors could help to improve trial design and completion rates. METHODS Using data from 1,136 trial participants with schizophrenia or schizoaffective disorder, we explored associations between predictor variables with (1) dropout due to WOC and ITE and (2) satisfaction with treatment among patients and investigators by means of hierarchic multiple regression analyses. RESULTS ITE was associated with poor clinical improvement, poor investigator satisfaction with treatment, and poor patient insight into their own disease, whereas WOC only showed a meaningful association with poor patient satisfaction with treatment. Investigator satisfaction with treatment appeared most strongly associated with Positive and Negative Syndrome Scale (PANSS) positive factor endpoint scores, whereas patient satisfaction with treatment was best predicted by the endpoint score on the PANSS emotional distress factor. The occurrence of severe side effects showed no meaningful association to satisfaction with treatment among investigators and patients, and neither did a patient's experienced psychopathology, nor their self-rating of functional impairment. CONCLUSIONS Whereas trial discontinuation due to ITE is associated with poor treatment effectiveness, a patient's decision to withdraw from an antipsychotic trial remains unpredictable and may occur even when the investigator observes a global clinical improvement and is satisfied with the treatment.
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Switching stable patients with schizophrenia from their oral antipsychotics to aripiprazole lauroxil: a post hoc safety analysis of the initial 12-week crossover period. CNS Spectr 2019; 24:419-425. [PMID: 29941057 DOI: 10.1017/s1092852918000986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Switching antipsychotic medications is common in patients with schizophrenia who are experiencing persistent symptoms or tolerability issues associated with their current drug regimen. This analysis assessed the safety of switching from an oral antipsychotic to the long-acting injectable antipsychotic aripiprazole lauroxil (AL). METHODS This was a post hoc analysis of outpatients with schizophrenia who were prescribed an oral antipsychotic and who enrolled in an international, open-label, long-term (52-week) safety study of AL. The analysis focused on the first 3 injections of AL 882 mg over 12 weeks, divided into the immediate 4-week crossover period between the first and second AL injections (initiation phase) and the subsequent 8 weeks (stabilization phase). Patients were grouped by preswitch oral antipsychotic medication, and safety and clinical symptoms were assessed. RESULTS In total, 190 patients had switched from one of the following oral antipsychotic medications: aripiprazole, conventional antipsychotics, risperidone/paliperidone, olanzapine, or quetiapine. The 12-week completion rate was high (92.1%) and similar across the different preswitch oral antipsychotic groups. Overall, adverse event (AE) rates experienced over 12 weeks were modest; no AEs were considered serious. The most common AEs in the initiation phase were injection site pain (5.8%), insomnia (5.8%), and akathisia (3.2%). No apparent relationship was observed between preswitch medication and early-onset AEs. Mean Positive and Negative Syndrome Scale total scores remained stable during this period across preswitch antipsychotic groups. CONCLUSION Switching from an oral antipsychotic to AL was feasible in an outpatient setting for patients with schizophrenia, and the 12-week retention rate was favorable.
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Asman AG, Hoogendoorn CJ, McKee MD, Gonzalez JS. Assessing the association of depression and anxiety with symptom reporting among individuals with type 2 diabetes. J Behav Med 2019; 43:57-68. [PMID: 31111355 DOI: 10.1007/s10865-019-00056-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/09/2019] [Indexed: 12/27/2022]
Abstract
Depression and anxiety have been linked to increased somatic symptoms among individuals with type 2 diabetes (T2D), but their independent effects and role in symptom attributions remain unclear. This study examined depression and anxiety in relation to total symptoms and symptom attributions in a diverse sample of 120 adults with T2D. Multiple linear regression tested associations after controlling for medical comorbidities and insulin use. Clinician-rated depression (β = .53, p < .001), self-reported depression (β = .59, p < .001) and self-reported anxiety (β = .62, p < .001) were positively associated with total somatic symptoms. Models adjusting for depression and anxiety revealed significant independent effects for each, regardless of measurement method. In attribution models, only self-reported depression (β = .27, p = .003) was significantly associated with greater attribution to diabetes, whereas clinician-rated depression (β = .19, p = .047), self-reported depression (β = .38, p < .001) and anxiety (β = .28, p = .004) were associated with increased attribution to medications. In models adjusting for depression and anxiety, self-reported depression was a significant independent predictor of diabetes (β = .29, p = .023) and medication (β = .38, p = .004) attribution; anxiety was a significant predictor of medication attribution (β = .25, p = .039). Findings suggest depression and anxiety are implicated in overall increases in somatic symptom complaints and an increased tendency to attribute these symptoms to diabetes and side-effects of diabetes medications among adults with T2D.
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Affiliation(s)
- Arielle G Asman
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Rousso Building, Bronx, NY, 10461, USA
| | - Claire J Hoogendoorn
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Rousso Building, Bronx, NY, 10461, USA
| | - M Diane McKee
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Health System, Bronx, NY, USA.,New York Regional Center for Diabetes Translation Research, Bronx, NY, USA
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Rousso Building, Bronx, NY, 10461, USA. .,Albert Einstein College of Medicine, Bronx, NY, USA. .,Montefiore Health System, Bronx, NY, USA. .,New York Regional Center for Diabetes Translation Research, Bronx, NY, USA. .,The Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, NY, USA.
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Souaiby L, Kazour F, Zoghbi M, Bou Khalil R, Richa S. Sexual dysfunction in patients with schizophrenia and schizoaffective disorder and its association with adherence to antipsychotic medication. J Ment Health 2019; 29:623-630. [PMID: 30862199 DOI: 10.1080/09638237.2019.1581333] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Antipsychotic-induced sexual dysfunction is a common complaint among patients with psychotic disorders. However, few papers have discussed its impact on treatment adherence.Aims: The aim of the study was to determine the prevalence of antipsychotic induced sexual dysfunction in patients with schizophrenia and schizoaffective disorder and assess its impact on treatment adherence.Methods: Nighty-five outpatients treated with antipsychotics for at least four weeks were recruited. Sexual dysfunction was assessed using a questionnaire inspired from the Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale and the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ). An Arabic version of the Medication Adherence Rating Scale (MARS) was used to assess treatment adherence.Results: The prevalence of sexual dysfunction was 57.9%, of which 65.5% attributed it to treatment. Reduced desire was the mostly reported sexual dysfunction in males and females. Number, dose and duration of antipsychotics were not associated with sexual dysfunction. MARS score was associated with the presence of sexual dysfunction (p = 0.0001) and its attribution to antipsychotic medication (p = 0.0003), the latter being an independent associated variable (p = 0.001).Conclusion: Sexual dysfunction is prevalent in patients with schizophrenia and schizoaffective disorder treated with antipsychotic drugs. Clinicians should ask about sexual dysfunction and discuss its different causes with patients in order to improve adherence.
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Affiliation(s)
- Lama Souaiby
- Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon.,Hotel-Dieu de France, Beirut, Lebanon
| | - François Kazour
- Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon.,Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Marouan Zoghbi
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Department of Family Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Rami Bou Khalil
- Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon.,Hotel-Dieu de France, Beirut, Lebanon
| | - Sami Richa
- Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon.,Hotel-Dieu de France, Beirut, Lebanon
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Comparison of Paliperidone Palmitate and Second-Generation Oral Antipsychotics in Terms of Medication Adherence, Side Effects, and Quality of Life. J Clin Psychopharmacol 2019; 39:57-62. [PMID: 30566417 DOI: 10.1097/jcp.0000000000000993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Although schizophrenia can be treated effectively, acute aggravations and relapses occur often. Antipsychotic drug therapies are fairly effective for decreasing the rate of relapses in patients with schizophrenia. This study aimed to compare paliperidone palmitate and the second-generation oral antipsychotic drugs used to treat patients with schizophrenia in terms of medication adherence, side effects, and quality of life. METHODS The study included 33 patients diagnosed with schizophrenia who were treated with paliperidone palmitate and 51 patients who were treated with second-generation oral antipsychotics. All the patients were administered the Positive and Negative Syndrome Scale, the Clinical Global Impression, the Extrapyramidal Symptom Rating Scale, the UKU (Ugvalg for Kliniske Undersgelser) Side Effect Rating Scale, the Short Form 36, the Morisky Medication Adherence Scale, and the Schedule for Assessing the Three Components of Insight. RESULTS The medication adherence and perceived general health scores of the patients treated with paliperidone palmitate were significantly higher than those of the patients treated with second-generation antipsychotics, and the side effects of the medication on the patients' daily performance were significantly lower. CONCLUSIONS This study demonstrated that long-acting paliperidone palmitate therapy was associated with more favorable results in terms of medication adherence, drug side effects, and quality of life compared with second-generation oral antipsychotics. However, there is a need for further, more specific, and larger-scale studies in this field.
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Schöttle D, Ruppelt F, Schimmelmann BG, Karow A, Bussopulos A, Gallinat J, Wiedemann K, Luedecke D, Rohenkohl AC, Huber CG, Bock T, Lambert M. Reduction of Involuntary Admissions in Patients With Severe Psychotic Disorders Treated in the ACCESS Integrated Care Model Including Therapeutic Assertive Community Treatment. Front Psychiatry 2019; 10:736. [PMID: 31708810 PMCID: PMC6822062 DOI: 10.3389/fpsyt.2019.00736] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/13/2019] [Indexed: 01/12/2023] Open
Abstract
Objective: The ACCESS treatment model offers assertive community treatment (ACT) embedded in an integrated care program to patients with severe psychotic disorders. Compared to standard care, it proved to be more effective in terms of service disengagement and other outcomes in patients with psychotic disorders over 12, 24, and 48 months. Many patients with severe mental disorders experience involuntary admissions which can be potentially traumatic. In this study, we assessed the effect of ACT on reducing involuntary admissions over an observation period of 4 years. Method: One hundred seventy-one patients treated in ACCESS were included in this study. The primary outcome was rate of involuntary admissions during 48 months. Secondary outcomes were differences between those with and without involuntary admissions in the 2 years prior to ACCESS regarding change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication non-adherence, and service-disengagement. Results: Of 171 patients, 58 patients (33.9%) were involuntarily admitted to hospital in the past 2 years before entry. During the 4 years of treatment, 16 patients (9.4%) were involuntarily admitted to hospital which was a significantly lower rate compared to the 2 years before inclusion in ACCESS (p < .001). Comparing the two groups, larger improvements in severity of illness (p = .004) and functional status (p = .043) were detected in the group with no history of involuntary admissions. At 4-year follow-up, of the remaining patients, 69.2% (n = 81) were full adherent (p < .001), compared to 18.9% (n = 31) at baseline with no differences between the two groups over the study period (p = .25). Over 4 years, only 13 patients (13.2%) were service-disengaged due to non-practical reasons. Conclusions: In this long-term study, we were able to demonstrate a reduction in involuntary admissions in four treatment years compared to the 2 years prior to admission to the ACCESS model in patients with severe and mostly multiphase schizophrenia spectrum disorders and affective disorders with psychotic features. This may help prevent patients from suffering from a potentially traumatic experience during treatment in the psychiatric system. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT01888627.
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Affiliation(s)
- Daniel Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Bussopulos
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken Basel (UPK), University of Basel, Basel, Switzerland
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Christine Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian G Huber
- Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken Basel (UPK), University of Basel, Basel, Switzerland
| | - Thomas Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Citrome L, McEvoy JP, Todtenkopf MS, McDonnell D, Weiden PJ. A commentary on the efficacy of olanzapine for the treatment of schizophrenia: the past, present, and future. Neuropsychiatr Dis Treat 2019; 15:2559-2569. [PMID: 31564881 PMCID: PMC6733343 DOI: 10.2147/ndt.s209284] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/20/2019] [Indexed: 01/29/2023] Open
Abstract
Olanzapine is a second-generation atypical antipsychotic with proven efficacy for the treatment of schizophrenia. Approved in 1996, olanzapine is one of the most studied antipsychotics, resulting in a considerable amount of clinical data across diverse patient populations. Despite the fact that olanzapine is associated with a known risk of metabolic side effects, including weight gain, many clinicians continue to prescribe olanzapine for the treatment of schizophrenia with the expectation of additional therapeutic antipsychotic efficacy relative to other first-line atypical antipsychotics. The goal of this narrative is to revisit the role of oral olanzapine in the management of patients with schizophrenia, including those with recently diagnosed schizophrenia ("first-episode"), those with an established schizophrenia diagnosis who experience acute exacerbations, those receiving long-term antipsychotic treatment as a maintenance intervention, and those with suboptimal response to antipsychotic treatment, including treatment resistance. Collectively, data from published literature support the favorable efficacy of olanzapine compared with other first- and second-generation antipsychotics, including lower rates of treatment discontinuation and clinically meaningful improvements in the symptoms of schizophrenia. The development of antipsychotic medications with the favorable efficacy of olanzapine, but with reduced weight gain, could address a major unmet need in the treatment of schizophrenia.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
| | - Joseph P McEvoy
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Characteristics of Patients Experiencing Extrapyramidal Symptoms or Other Movement Disorders Related to Dopamine Receptor Blocking Agent Therapy. J Clin Psychopharmacol 2019; 39:336-343. [PMID: 31205194 PMCID: PMC6594730 DOI: 10.1097/jcp.0000000000001061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE/BACKGROUND Dopamine receptor blocking agents (DRBAs), also known as antipsychotics, are medications widely used to treat a growing number of mental health diagnoses. However, their utility is limited by the potential to cause serious adverse movement reactions. Akathisia, dystonia, parkinsonism, and tardive dyskinesia (collectively known as extrapyramidal symptoms or EPSs) are associated with reduced social and occupational functioning, negative patient attitudes toward treatment, and nonadherence to pharmacotherapy. Neuroleptic malignant syndrome is a life-threatening reaction that can result from DRBA use and cause musculoskeletal dysfunction. The aim of this study is to profile patients who have developed DRBA-related movement adverse effects and identify risk factors significantly associated with each subtype of EPSs or other movement disorders (OMDs) such as neuroleptic malignant syndrome. METHODS/PROCEDURES A report of all potential DRBA-related EPSs or OMDs occurrences within a large community hospital network was generated using International Classification of Diseases, Ninth Revision (ICD-9) and 10th Revision (ICD-10) billing codes. Each patient encounter was manually reviewed to confirm that a documented case of DRBA-related EPSs or OMDs had indeed occurred and subsequently determine the likely causative agent(s). FINDINGS/RESULTS The resultant cohort of 148 patients experiencing unique DRBA-related EPS or OMD events was analyzed. The average patient was female, middle-aged, and overweight. The most common DRBAs precipitating EPSs or OMDs were haloperidol and quetiapine. In the population studied, age was significantly associated with the subtype of EPSs experienced such that those patients with akathisia and dystonia tended to be younger, whereas those with tardive dyskinesia tended to be older. Body mass index (BMI) category was also negatively correlated with the incidence of dystonia. In addition, it was observed that exposure to specific DRBAs, classes, and routes of administration significantly affected the risk of developing different subtypes of EPSs or OMDs in the study population. IMPLICATIONS/CONCLUSIONS To our knowledge, this is the first study to describe an association between age and BMI with the risk of akathisia and dystonia, respectively, in patients taking DRBAs. Other trends observed with age and BMI in patients developing DRBA-related EPSs support previously reported findings. Expanding the knowledge base of individual characteristics associated with the risk of developing different subtypes of EPSs or OMDs can help providers and patients anticipate and attempt to mitigate these reactions, and may ultimately improve adherence to DRBA therapy.
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Greene M, Burudpakdee C, Seetasith A, Behling M, Krasa H. Evaluation of patient support program and adherence to long-acting injectable aripiprazole for patients utilizing injection local care centers. Curr Med Res Opin 2019; 35:97-103. [PMID: 30322282 DOI: 10.1080/03007995.2018.1536651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Patient support programs, such as the ASSURE Program for long-acting injectable aripiprazole, are designed to help support access to medications, including long-acting injectable (LAI) antipsychotics for patients with schizophrenia. This study was conducted to evaluate adherence to long-acting injectable aripiprazole among patients utilizing the program local care centers (LCC). METHODS Data collected from participating LCC between October 2014 and February 2018 were utilized. Characteristics of patients receiving injections at LCC and participating in additional support services of the program, types of program offering utilized and patient cost share for long-acting injectable aripiprazole were described. Adherence, measured as the proportion of days covered (PDC) during follow-up, was estimated in patients utilizing the LCC for 6 months and 9 months. Patients with PDC ≥80% were considered adherent to treatment. RESULTS Two hundred and thirty-four patients received at least one injection at participating LCC and enrolled in the patient support program. Mean (SD) age was 37.3 (13.5) years; 60.7% were male; 32.5% were covered by Medicare. In total, 157 and 87 patients were actively utilizing the LCC for at least 6 months and 9 months, respectively. PDC of 97% and 98% were reported among patients with 6 months and 9 months of follow-up, respectively, and patients were considered adherent to long-acting injectable aripiprazole during follow-up. CONCLUSION Patients utilizing the LCC demonstrated high medication adherence, suggesting that injection services provided by the centers may reduce barriers to treatment and help patients with schizophrenia remain on LAI antipsychotic treatment.
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Affiliation(s)
- Mallik Greene
- a Otsuka Pharmaceutical Development & Commercialization, Inc. , Princeton , NJ , USA
| | | | | | | | - Holly Krasa
- a Otsuka Pharmaceutical Development & Commercialization, Inc. , Princeton , NJ , USA
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