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Antipsychotic Medication (antipsychotic + medication)
Kinds of Antipsychotic Medication Selected AbstractsQTc-interval abnormalities in a forensic populationCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2007Sobhi Girgis Background,Antipsychotic drugs have been linked to sudden death among psychiatric patients, with a suggestion that prolongation of the QT-interval detectable on a standard electrocardiogram may be linked to fatal cardiac arrhythmias in these circumstances. Patients in secure forensic psychiatric facilities may be particularly likely to be on high-dose antipsychotic medication, and yet, as far as the authors are aware, no study of QT-intervals among such patients has been reported. Aim,To investigate the prevalence of QT-interval abnormalities and associated known risk factors for fatal cardiac arrhythmias in a sample of forensic patients. Method,Participants had a 12-lead electrocardiogram taken at 50 mm/s. Information was collected on their age, gender, psychiatric diagnosis, history of cardiovascular, liver and kidney diseases, and smoking, on all medications and on history of seclusion over the previous 12 months. Analysis was carried out using binary logistic regression. Results,Lower rates of QT-interval abnormalities than might be expected for this population were found. It was also found that a high dose of antipsychotics was associated with QTc prolongation (Adjusted OR = 9.5, 95% CI 2.6,34.2), a result consistent with previous literature. Conclusion,Forensic patients need not be at increased risk of QTc abnormality provided risk factors are properly managed. A high dose of antipsychotic medication increases the risk of QTc prolongation. Copyright © 2007 John Wiley & Sons, Ltd. [source] The subjective experience of taking antipsychotic medication: a content analysis of Internet dataACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009J. Moncrieff Objective:, We explored the subjective effects associated with olanzapine, risperidone and older antipsychotics. Method:, We conducted a content analysis of an Internet database of comments about prescribed medications. Results:, We analysed 223 comments on risperidone, 170 on olanzapine and 46 relating to three older antipsychotics. The predominant subjective effects produced by all drugs consisted of sedation, cognitive impairment and emotional flattening or indifference. Connections appeared between these effects and Parkinsonian-like symptoms with the older drugs, sexual impairment with risperidone and metabolic effects with olanzapine. The experience of akathisia was frequently linked to suicidal thoughts. Some respondents described how the drugs' subjective effects helped to reduce symptoms of mania, psychosis and anxiety. Conclusion:, The generalisability of Internet data is uncertain. However, the data suggest that adverse subjective effects play a central role in the experience of taking antipsychotic drugs and may be related to the drugs' desired benefits. [source] Early intervention in patients at ultra high risk of psychosis: benefits and risksACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009M. B. De Koning Objective:, Prediction of transition to psychosis in the prodromal phase of schizophrenia has raised interest in intervention prior to the onset of frank psychosis. The aim of this review was to examine whether interventions in the prodromal phase have a favourable benefit/risk ratio. Method:, A literature search in PubMed, EMBASE and PsycINFO was performed. Results:, Three randomized clinical trials with antipsychotic medication and/or cognitive behavioural therapy as clinical intervention suggested a positive effect at the end of treatment, but no significant differences were found at the end of follow-up periods from 1 to 4 years. Naturalistic studies present a hypothesis about a possible preventive effect of antidepressive medication. The results of eight other studies are more difficult to interpret. Side-effects of antipsychotic medication and non-adherence with medication are essential problems. Conclusion:, At the present time, the data concerning the benefits and risks do not justify prodromal intervention as standard clinical practice. [source] Neurocognitive functions in euthymic bipolar patientsACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2009K. Jamrozinski Objective:, Meta-analytic findings support the hypothesis of specific neurocognitive deficits for bipolar patients in the domains of attention, processing speed, memory and executive functions. This study aims to show neurocognitive impairment in euthymic patients with bipolar I disorder compared with healthy controls while detailing the impact of medication side-effects or illness characteristics on neuropsychological test performance. Method:, Forty euthymic patients with bipolar I disorder were compared with 40 healthy controls in a cross-sectional design. Clinical features and neuropsychological measures of IQ, psychomotor speed, verbal fluency, learning and memory, executive functions and attention were assessed. Results:, Patients without antipsychotic drug use did not differ significantly from healthy controls in any neuropsychological measure. Yet patients treated with antipsychotics showed significant underperformance in the domains of semantic fluency, verbal learning and recognition memory as well as executive functions related to planning abilities, even when clinical features were controlled for. Conclusion:, The impact of antipsychotic medication needs to be further clarified for euthymic bipolar patients and should be considered when neuropsychological test performance is interpreted. [source] Side-effects of antipsychotic medication and health-related quality of life in schizophreniaACTA PSYCHIATRICA SCANDINAVICA, Issue 2009P. E. Bebbington Objective:, This analysis used data from the large (n = 1208) European Schizophrenia Cohort to examine the association between subjective side-effects of antipsychotic medication and the Mental and Physical Composite Scores (MCS; PCS) of the SF-36 scale. Method:, Relationships between the subjective evaluation of side-effects identified from the Subjective Side-Effects Scale and the adjusted mean score on the PCS and MCS were examined. Where appropriate, these associations of subjective side-effects were compared with those of the same side-effects measured objectively. Results:, In this study, subjective side-effects of antipsychotic medication were linked either to both the PCS and the MCS or, in a few instances, to neither. Subjective evaluations of sexual side-effects were associated only with the MCS, those of sialorrhoea only with the PCS. Objective ratings of extrapyramidal side-effects were related neither to PCS nor to MCS. Conclusion:, These data suggest that side-effects, whether subjective or objective, may need to be considered individually in relation to their impact on quality of life. [source] Does antipsychotic withdrawal provoke psychosis?ACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2006Review of the literature on rapid onset psychosis (supersensitivity psychosis), withdrawal-related relapse Objective:, To examine the evidence that discontinuation of long-term antipsychotic medication, including clozapine, may provoke a psychotic episode. Method:, Databases were searched and citations scrutinised. Results:, Evidence for a rapid onset psychosis (supersensitivity psychosis) following clozapine withdrawal was found and weaker evidence that this might occur with some other antipsychotic drugs. Some cases were reported in people without a psychiatric history. It appears that the psychosis may be a feature of drug withdrawal rather than the re-emergence of an underlying illness, at least in some patients. Meta-analyses of withdrawal studies have suggested that antipsychotic discontinuation may also increase the risk of relapse over and above the risk because of the underlying disorder, but not all individual studies show this effect. Mechanisms may relate to brain adaptations to long-term drug use but data are sparse. Conclusion:, These effects require further urgent research. Interventions to reduce morbidity after drug withdrawal need to be developed. [source] Obesity, serious mental illness and antipsychotic drugsDIABETES OBESITY & METABOLISM, Issue 7 2009Richard I. G. Holt The prevalence of overweight and obesity is higher in people with mental illness than in the general population. Body weight is tightly regulated by a complex system involving the cortex and limbic system, the hypothalamus and the gastrointestinal tract. While there are justifiable concerns about the weight gain associated with antipsychotic medication, it is too simplistic to ascribe all obesity in people with serious mental illness (SMI) to their drug treatment. The development of obesity in SMI results from the complex interaction of the genotype and environment of the person with mental illness, the mental illness itself and antipsychotic medication. There are dysfunctional reward mechanisms in SMI that may contribute to poor food choices and overeating. While it is clear that antipsychotics have profound effects to stimulate appetite, no one receptor interaction provides an adequate explanation for this effect, and many mechanisms are likely to be involved. The complexity of the system regulating body weight allows us to start to understand why some individuals appear much more prone to weight gain and obesity than others. [source] Association between antipsychotic drugs and diabetesDIABETES OBESITY & METABOLISM, Issue 2 2006Richard I. G. Holt The link between atypical antipsychotic drugs and the development of diabetes has been hotly debated in the literature. In this review, we attempt to classify the various types of data published and presented in a hierarchical basis. Case reports and retrospective pharmacoepidemiological studies suggest that both conventional and atypical antipsychotic medications are associated with an increased risk of glucose abnormalities or diabetes. Prospective data examining the relationship between atypical antipsychotic drugs and diabetes began to emerge in 2003 and are much less conclusive. Estimates of the attributable risk associated with atypical antipsychotic drugs are low. The few studies that have included a placebo group suggest that we cannot necessarily blame antipsychotic medication when diabetes develops in an individual with schizophrenia. [source] Schizophrenia and weight management: a systematic review of interventions to control weightACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2003G. Faulkner Objective: Weight gain is a frequent side effect of antipsychotic medication which has serious implications for a patient's health and well being. This study systematically reviews the literature on the effectiveness of interventions designed to control weight gain in schizophrenia. Method: A systematic search strategy was conducted of major databases in addition to citation searches. Study quality was rated. Results: Sixteen studies met the inclusion criteria. Five of eight pharmacological intervention studies reported small reductions in weight (<5% baseline body weight). All behavioural (including diet and/or exercise) interventions reported small reductions in, or maintenance of, weight. Conclusion: Weight loss may be difficult but it is not impossible. Given the inconsistent results, the widespread use of pharmacological interventions cannot be recommended. Both dietary and exercise counselling set within a behavioural modification programme is necessary for sustained weight control. [source] Behavioural management of antipsychotic-induced weight gain: a reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2003U Werneke Objective: Although psychiatrists are aware of weight gain induced by atypical antipsychotics, only few studies on behavioural interventions in this patient group are published. This review aims to summarize the evidence on effectiveness of behavioural interventions for weight gain in the general population and in-patients treated with atypical antipsychotics. Method: Medline and Cochrane databases search for evidence on effectiveness of behavioural interventions. Results: In general, behavioural approaches including, diet, exercise and drug treatments may be effective. There were only 13 studies of behavioural interventions for patients taking antipsychotic medication. No study met the criteria for a RCT. Calorie restriction in a controlled ward environment, structured counselling combined with cognitive behavioural therapy and counselling on life style and provision of rewards may potentially lead to weight loss. Conclusion: Currently only limited, methodologically flawed, evidence is available that behavioural interventions in overweight patients treated with antipsychotics, although intuitively appealing, actually work. [source] Stability of medication in early psychosis: a comparison between second-generation and low-dose first-generation antipsychoticsEARLY INTERVENTION IN PSYCHIATRY, Issue 1 2009Stein Opjordsmoen Abstract Aim: This naturalistic study aims to compare discontinuation rates for low-dose first-generation versus second-generation antipsychotics in first-episode psychotic patients. Methods: The prescription of antipsychotic medication in 301 consecutively admitted patients with first-episode psychosis from four catchment areas is described. For the first year of inclusion a first-generation antipsychotic in low dose was recommended as the first medication. From the second year a second-generation antipsychotic was recommended as first choice. Switching was allowed when any drug was judged to be ineffective or to have serious side-effects. Switching during the first 2 years after inclusion is described. Results: Switching from a low-dose first-generation antipsychotic was more frequent than from a second-generation antipsychotic (90.7 vs. 58.4%). Lack of therapeutic effect and side-effects were the more frequently recorded reasons for changing in the first-generation group. Akathisia, parkinsonism, dyskinesias, dystonia and dysphoria were more often reported in patients on first-generation drugs. Weight gain and sedation were more often reported in patients on second-generation drugs. Conclusion: The findings suggest a better adherence to and tolerability for second-generation antipsychotics than for low-dose first-generation antipsychotics in first-episode psychosis. [source] Interictal Psychoses in Comparison with Schizophrenia,A Prospective StudyEPILEPSIA, Issue 12 2007Yukari Tadokoro Summary Purpose: To prospectively investigate the incidence of interictal psychoses of epilepsy patients, and make a comparison between those with interictal psychoses and patients with schizophrenia in respect to their responses to antipsychotic drugs, as well as psychotic states. Methods: We undertook a two-part prospective investigation. In Part I, the psychotic episodes of 619 epilepsy patients were investigated, while 182 patients with psychotic syndromes were followed in Part II, of whom 59 were diagnosed with schizophrenia and 13 with epilepsy with interictal psychoses. The Positive and Negative Syndrome Scale was used for efficacy assessment. Results: The average annual incidence of interictal psychosis was 0.42% during the 56-month study period. A significant difference was found between patients with schizophrenia and epilepsy patients with interictal psychoses in respect to results on the negative subscale of the PANSS at the initial examination (mean scores of 18.1 and 13.2, respectively, p = 0.004). The response rates one year later for these groups were 27.1% and 53.8%, respectively, which showed a trend of better response to the antipsychotic medication by the epilepsy group (p = 0.098). Initial and maximum doses of antipsychotic drugs used for epilepsy patients with interictal psychoses were significantly lower than those used for patients with schizophrenia (p = 0.008 and p = 0.006, respectively). Conclusions: Schizophrenia and epileptic psychosis showed different symptom profiles. On average, epilepsy patients with interictal psychoses achieved higher remission rates with lower doses of antipsychotic drugs as compared to patients with schizophrenia in the present 1-year follow-up study. [source] Relative association of treatment-emergent adverse events with quality of life of patients with schizophrenia: post hoc analysis from a 3-year observational studyHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 6 2010Cecilia Adrianzén Abstract Objective To explore the relative association of adverse events with health-related quality of life (HRQL) in patients (N,=,16,091) with schizophrenia, treated with antipsychotic medication. Methods In this post hoc analysis of data from two 3-year observational studies, a mixed effects model with repeated measures was used to evaluate the association between HRQL (EuroQoL visual analogue scale (EQ-VAS)) and pre-specified covariates including: severity of illness, extrapyramidal symptoms, tardive dyskinesia, sexual dysfunction, and clinically significant weight gain (>,7% increase from baseline after ,,3 months of treatment). Results Mean EQ-VAS increased from 47.8,±,21.7 at baseline to 72.4,±,18.4 after 36 months. The rank order of the negative association of adverse events with HRQL was: sexual dysfunction (effect estimate ,4.04; 95% CI ,4.30 to ,3.79), extrapyramidal symptoms (effect estimate ,2.09; 95% CI ,2.43 to ,1.75), and tardive dyskinesia (effect estimate ,0.89; 95% CI ,1.46 to ,0.32). Conclusions Differences were observed in the direction and magnitude of the association between each adverse event and HRQL. Recognition of the relative association of adverse events with HRQL may contribute to improved adherence of patients with schizophrenia to antipsychotic therapy. Copyright © 2010 John Wiley & Sons, Ltd. [source] The effect of dopamine partial agonists on the nicotine dependency in patients with schizophreniaHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 2 2010Se Hee Kim Abstract Objective We compared the effects of haloperidol and three atypical antipsychotics (risperidone, olanzapine, and aripiprazole) on nicotine dependence in schizophrenic patients. Methods One hundred and thirty nine schizophrenic patients, who began using antipsychotic medication, were assessed for severity of nicotine dependence and for cigarette craving at baseline and following 8 weeks of treatment using the Fagerström Tolerance Questionnaire (FTQ) and a Likert-style, seven point, visual-analogue rating scale. Results Nicotine dependence increased in the haloperidol group, but not in atypical antipsychotics groups. Patients treated with aripiprazole showed a reduction both in nicotine dependence and cigarette craving. Conclusions The effects of aripiprazole, a partial agonist of the dopamine D2 receptor, may reduce the severity of nicotine dependence in schizophrenic patients. Copyright © 2009 John Wiley & Sons, Ltd. [source] Celecoxib as an adjunct in the treatment of depressive or mixed episodes of bipolar disorder: a double-blind, randomized, placebo-controlled study,,HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 2 2008Fabiano G. Nery Abstract Objective To investigate whether the cox-2 inhibitor celecoxib has antidepressant effects in bipolar disorder (BD) patients during depressive or mixed phases. Methods We studied 28 DSM-IV BD patients who were experiencing a depressive or mixed episode and were on a stable dose of a mood stabilizer or atypical antipsychotic medication. Subjects were randomized to receive 6 weeks of double-blind placebo or celecoxib (400,mg/day) treatment. Current mood stabilizer or antipsychotic medication remained at the same doses during the trial. Results Intention-to-treat analysis showed that the patients receiving celecoxib had lower Hamilton Depression Rating Scale (HamD) scores after 1 week of treatment compared to the patients receiving placebo, but this difference was not statistically significant (p,=,0.09). The improvement in the first week of treatment was statistically significant when the analysis included only the subjects who completed the full 6-week trial (p,=,0.03). The two groups did not differ significantly on depressive or manic symptoms from the second week until the end of the trial. Celecoxib was well tolerated with the exception of two subjects who dropped out of the study due to rash. Conclusions Our findings suggest that adjunctive treatment with celecoxib may produce a rapid-onset antidepressant effect in BD patients experiencing depressive or mixed episodes. Copyright © 2008 John Wiley & Sons, Ltd. [source] Catechol-O-methyltransferase val108/158met genotype and response to antipsychotic medication in schizophreniaHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 4 2007Ari Illi Abstract Catechol-O-methyltransferase (COMT) gene has been investigated as a possible candidate gene in schizophrenia. The most studied polymorphism has been the functional val108/158met polymorphism of this COMT gene. There is also some evidence that this polymorphism could be related to drug response to antipsychotics in schizophrenia. COMT enzyme inactivates dopamine and noradrenaline. Based mainly on the original dopamine theory of schizophrenia, our primary hypothesis was that the maintenance dose of antipsychotics would be higher in patients with the low activity COMT genotype. In this study we evaluated the current daily dosage of antipsychotics in 180 patients with schizophrenia in connection with the COMT genotype. We could not demonstrate any clearly significant effect of this particular COMT genotype in relation to the daily maintenance dosages of antipsychotics in patients with schizophrenia. Copyright © 2007 John Wiley & Sons, Ltd. [source] The prevention of deep venous thrombosis in physically restrained patients with schizophreniaINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2010M. De Hert Summary Background:, Physical restraint and seclusion are associated with several risks. Antipsychotic drug use increases this risk. Objective:, To evaluate whether the risk of thromboembolism in physical restraint and seclusion of patients with psychosis, treated with antipsychotic medication, was considered by taking preventive measures. Method:, Anonymous data on all consecutively admitted patients with schizophrenia, treated with antipsychotic medication, between 2002 and 2009, were analysed. Diagnostic information and data about seclusion procedures and medication were collected. Preventive measures of thromboembolism in patients in physical restraint were assessed by reviewing case notes and the medication prescribed at the time of seclusion. Results:, Seclusion of patients with psychosis is common. Out of 679 identified patients, 170 had been secluded (472 events). Physical restraint use was not a rare event (N seclusions with restraint use 296, 62.7%). Pharmacological preventive measures (use of heparine dugs) were taken frequently to prevent deep vein thrombosis (DVT) by physical restraint or isolation. Sixty-five (38.2%) out of 170 secluded patients, including a majority of patients who had been under physical restraint, had been administered anticoagulants at the time of seclusion. No cases of DVT occurred. Conclusions:, Preventive measures were routinely administered in clinical practice and were effective in the prevention of DVT. For a clinical setting, it is important to establish a clear and detailed management plan on seclusion and fixation taken into account in all possible risks of physical restraint. [source] Paliperidone palmitate , review of the efficacy, safety and cost of a new second-generation depot antipsychotic medicationINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2010L. Citrome Summary Objective:, To describe the efficacy, safety and cost of paliperidone palmitate, a depot antipsychotic medication recently approved for the treatment of schizophrenia. Data sources:, A literature search was conducted by querying the websites http://www.pubmed.gov, http://www.fda.gov, http://www.accessdata.fda.gov/scripts/cder/drugsatfda and http://www.clinicaltrials.gov for the search term ,paliperidone palmitate'. Cost information was obtained from the pharmaceutical vendor servicing a local state-operated psychiatric facility. Study selection:, All available reports of studies were identified. Product labelling provided additional information. Data extraction:, Descriptions of the principal results and calculation of the number needed to treat (NNT) and number needed to harm (NNH) for relevant dichotomous outcomes were extracted from the study reports and synopses. Additional safety outcomes subject to NNH analysis were obtained from product labelling. Data synthesis:, Paliperidone palmitate is a newly available depot formulation of paliperidone (the 9-OH metabolite of risperidone). Upon injection into the deltoid or gluteal muscle, the release of the drug starts as early as day 1, reaches maximum plasma concentrations at 13 days and lasts for as long as 126 days. Maximum concentration following deltoid injection is approximately 28% higher compared with injection into the gluteal muscle, and thus paliperidone palmitate requires initiation by two initial deltoid injections spread 1 week apart to achieve therapeutic concentrations rapidly. Subsequent injections are at 4-week intervals. Acute efficacy was evidenced by four short-term double-blind, randomised, placebo-controlled, fixed-dose studies of acutely relapsed adult inpatients who met DSM-IV criteria for schizophrenia. NNT for a 30% or greater decrease in the Positive and Negative Syndrome Scale total score compared with placebo was consistently lower for the higher dose strengths of 156 and 234 mg, suggesting a therapeutic dose,response. Treatment with paliperidone palmitate at doses between 39 and 156 mg significantly delayed the time to recurrence of symptoms of schizophrenia after 24 weeks of maintained symptom stability. The NNT vs. placebo to avoid a recurrence of symptoms was 5 (95% CI 4,7). Overall, paliperidone palmitate was reasonably well tolerated, with low rates of extrapyramidal symptoms or body weight gain; however, these may be more common at higher doses. Injection site reactions occurred at a rate ranging from 4% to 10%, depending on the dose regimen, compared with 2% for the pooled placebo arms. The acquisition cost of a maintenance dose of paliperidone palmitate calculated on a per day basis is similar to that for risperidone microspheres, but about double the cost for oral paliperidone and approximately 19 times the cost of oral generic risperidone. Conclusions:, Paliperidone palmitate is efficacious for the acute and maintenance treatment of schizophrenia and is reasonably well tolerated. It offers several advantages over other available second-generation depot antipsychotics: it comes in prefilled syringes in a number of different dosage strengths; it does not require refrigeration; it does not require supplementation with oral antipsychotics; it can be administered once monthly; it can be administered with a very small bore needle; the injection volume is small; the injection site can be either the deltoid or gluteal muscles; it does not require an additional precautionary observation period after the injection. For patients for whom oral risperidone or paliperidone is otherwise effective, paliperidone palmitate offers a guaranteed delivery system that enhances adherence. However, the high acquisition cost of paliperidone palmitate will likely be an important obstacle to its routine use. [source] Worldwide-Schizophrenia Outpatient Health Outcomes (W-SOHO): baseline characteristics of pan-regional observational data from more than 17,000 patients,INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2009J. Karagianis Summary Objective:, To describe the Worldwide-Schizophrenia Outpatient Health Outcomes (W-SOHO) patient population at study entry, focusing on illness burden and prescribing practices across regions. Methods:, The SOHO study was a 3-year, prospective, observational study designed to assess costs and outcomes associated with antipsychotic use in outpatients initiating or changing antipsychotic (with an emphasis on olanzapine compared with other antipsychotics). SOHO was conducted in 10 European countries and 27 other countries as Intercontinental SOHO (IC-SOHO). Data from all countries have been pooled to produce the W-SOHO dataset. Main outcomes measures:, Clinical Global Impression-Schizophrenia (CGI-SCH) severity scores, psychotropic medication use, adverse events, social interaction, housing and employment status, self-perceived health state (EuroQoL EQ-5D scale and Visual Analogue Scale, EQ-VAS), and reasons for initiation/change of antipsychotic. Results:, The W-SOHO database comprises 17,384 patients from six regions; East Asia (n = 1223), Central and Eastern Europe (n = 2175), Northern Europe (n = 4291), Southern Europe (n = 5788), Latin America (n = 2566), North Africa and the Middle East (n = 1341). Overall, patients were 38 ± 13 years old (mean ± SD), moderately ill (mean CGI-SCH overall score of 4.4 ± 1.0) with a median duration of illness of 7 years (interquartile range 1,16 years); 43% were female, 10% were receiving antipsychotic medication for the first time. Adverse events were prevalent across all regions; on average, 50% (range 41,59%) of patients taking antipsychotics exhibited extrapyramidal symptoms at baseline, and 62% (34,67%) of patients reported sexual dysfunction in the previous month. On average, only 19% (16,23%) of patients were in paid employment and as many as 69% were living in dependent housing. Conclusions:, Despite inherent diversity in these patients and the health care systems supporting them, there are striking cross-regional similarities in baseline characteristics for most measures. Not all countries are represented; regional comparisons may not be valid outside of the countries studied. [source] Metabolic side effects of antipsychotic medicationINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2007A. Tschoner Summary The use of second-generation antipsychotics (SGAs) is associated with metabolic side effects including weight gain, diabetes mellitus and an atherogenic lipid profile. These adverse effects are not only the risk factors for cardiovascular disease, insulin resistance and diabetes mellitus leading to increased morbidity and mortality but may also impair the patient's adherence to treatment. SGAs in particular are associated with significant weight gain with clozapine and olanzapine carrying the highest risk, whereas newer agents, such as risperidone and aripiprazole, are considered to be less prone to cause weight gain. Consequently, a consensus development conference convened issuing recommendations on patient monitoring when treated with SGAs. The metabolic effects of antipsychotic drugs should be of concern when planning a patient's treatment strategy. Baseline screening and regular follow-up monitoring whose intervals should depend on the individual predisposition are advised. Possible therapeutical strategies for the management of drug-induced obesity include therapeutic approaches, such as life style change and pharmaceutical intervention. Drugs with a weight reducing effect become more important because of the lack of compliance with behavioural intervention. Topiramate, histamine-antagonists, dopaminergic- and serotoninergic agents have shown positive results in the management of psychotropic medication induced weight gain. However, further trials are required to support a specific therapeutical approach as well as studies to investigate the underlying mechanisms for future drug development. [source] Determinants of antipsychotic medication use among older people living in aged care homes in AustraliaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2010Prasad S. Nishtala Abstract Objective To investigate determinants of antipsychotic medication use among older people living in aged care homes in Australia. Design Retrospective study of a random sample of de-identified medication reports using cross-sectional data gathered between 1 January 2008 and 30 June 2008 in Australia. Subjects The mean (SD) age of the residents was 84.0 (9.0) years. Seventy-five per cent were females. Measures Resident demographics, clinical characteristics, medical diagnoses and prescribed medication were systematically recorded. Logistic regression (LR) models were used to determine predictors for any antipsychotic, atypical and conventional antipsychotic use. Results Twenty-three per cent of the residents were prescribed one or more antipsychotics. In the LR model, factors for predicting the odds ratio and 95% confidence interval (CI) for any antipsychotic medication use were agitation (7.11, 95% CI 3.15,16.03), challenging behaviours (7.47, 95% CI 2.53,22.10), dementia (2.35, 95% CI 1.36,4.06), dementia with mood disorder (0.39, 95% CI 0.16,0.92), paranoia (6.70, 95% CI 1.08,41.55), psychosis (14.79, 95% CI 3.64,60.00) and any psychiatric diagnosis (3.30, 95% CI 1.82,6.00). Use of atypical antipsychotic medication was significant for agitation (4.58, 95% CI 2.05,10.23), aggression (2.25, 95% CI 1.05,4.78), challenging behaviours (8.01, 95% CI 2.76,23.24), dementia (3.64, 95% CI 1.99,6.67), dementia with mood disorder (0.16, 95% CI 0.06,0.43), psychosis (16.51, 95% CI 4.28,63.66) and any psychiatric diagnosis (4.44, 95% CI 2.33,8.46). Conclusions Psychiatric diagnosis, psychosis and dementia were associated with significantly greater odds for the use of antipsychotic medications. Older people suffering from dementia and comorbid mood disorders treated with antidepressants were less likely to be prescribed atypical antipsychotics. Copyright © 2009 John Wiley & Sons, Ltd. [source] Blinding in clozapine trials: a problem and a potential solutionINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2009Tamar Wohlfarth Abstract Background:,A methodological problem arises when efficacy of clozapine is compared with other antipsychotic medication in double blind randomized studies. Due to the risk of leucopenia and agranulocytosis, patients in the clozapine condition need to have regular blood testing. The problem is that in order to maintain blinding, patients in the comparison conditions need to undergo blood testing as well and this can lead to underestimation of treatment acceptability and efficacy of the comparators. Methods:,A thought experiment considering all possible solutions for the methodological problem. Results:,We propose a special study design that preserves randomization and blinding while at the same time prevents underestimation of the effect in the comparator treatments. In addition, the necessity for blood testing is limited to only a small number of patients who receive comparative treatments. The design involves initial randomization to a sub-study including clozapine and a small comparator arm or to a sub-study that includes only comparator arms. Blood testing is only necessary in the first sub-study. Discussion:,Limitations of the proposed design are discussed. It is noted that this study design may offer a solution to similar situations where blood testing or other types of monitoring (e.g. as with lithium) is required in one but not in all of the treatment arms of a double blind randomized study. Copyright © 2009 John Wiley & Sons, Ltd. [source] A best-evidence synthesis review of the administration of psychotropic pro re nata (PRN) medication in in-patient mental health settingsJOURNAL OF CLINICAL NURSING, Issue 9 2008John A Baker BNurs, MPhil Aims and objectives., This paper aims to synthesise published literature of drug use/administration studies of pro re nata psychotropic medications in mental health wards. Design., The study employed a best-evidence synthesis review design. Background., The administration of psychotropic pro re nata medications is a frequently used clinical intervention in mental health wards. Pro re nata contributes to exposing patients to high doses of antipsychotic medication. Despite the frequent use of pro re nata, there is limited evidence of their effectiveness. Methods., A best-evidence synthesis review. Results., Six major themes emerged from the literature: (i) frequency of administration; (ii) administration during the 24-hour day; (iii) administration associated with length and stage of admission; (iv) rationales for administration; (v) medicines administered (including route of administration); and (vi) effects and side effects of the medicines administered. Conclusions., Overall findings indicate that the administration of psychotropic pro re nata varies radically and appears to be influenced by many variables. Relevance to clinical practice., Patients are most likely to receive a benzodiazepine or typical antipsychotic as pro re nata. Pro re nata is an important and under-researched clinical intervention used in mental health wards. [source] The effectiveness of antipsychotic medication in the management of behaviour problems in adults with intellectual disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2007S. Deb Abstract Background Psychopharmacological intervention in the management of behaviour problems in adults with intellectual disabilities (ID) has become a common treatment strategy. This has become a cause for concern, given that the evidence for its effectiveness is uncertain and most drugs are not licensed for this use. Methods A comprehensive systematic review of empirical research on the effectiveness of antipsychotic medication was conducted. Electronic and manual searches of literature were conducted. Stringent scientific methodology determined those primary trials that were worthy of inclusion. Results This review revealed one randomized controlled trial (RCT), one controlled, four uncontrolled prospective and three retrospective case series studies in adults. Additionally, two studies in both adults and children , one crossover RCT and one prospective controlled trial , were found. Conclusion Presently, there is RCT-based evidence for risperidone to be effective in both adults and children; however, this treatment carries a certain amount of risk associated with adverse effects. There is also evidence to support the use of other antipsychotics, primarily atypicals, but the evidence is based on noncontrolled case studies. There is currently not enough evidence available to recommend specific medication for specific behaviour problems. Before prescribing medication, clinicians should carry out a thorough assessment of behaviour, including its causes and consequences, and draw up a formulation providing the rationale for the prescribed intervention after considering all medication- and nonmedication-based management options. [source] Effects of antipsychotic medication on muscarinic M1 receptor mRNA expression in the rat brainJOURNAL OF NEUROSCIENCE RESEARCH, Issue 2 2008Mei Han Abstract Alterations in muscarinic M1 receptor protein and mRNA expression have been revealed in post-mortem brains of schizophrenia patients. Most patients had been treated with antipsychotics, so medication effects cannot be excluded as a possible explanation for these results. With in situ hybridization, this study investigated M1 receptor mRNA expression in rats treated with the typical antipsychotic haloperidol (0.3 mg/kg/day) and the atypical antipsychotics olanzapine (1.5 mg/kg/day) and aripiprazole (2.25 mg/kg/day) for 1 or 12 weeks. Compared with the control group, haloperidol significantly increased (,13,21%, P < 0.05) M1 mRNA expression in the CA1, CA2, and CA3 regions of the hippocampus after both 1 and 12 weeks of treatment, and it also increased (,17%, P < 0.01) M1 mRNA expression in the substantia nigra compacta after 1 week of treatment. Olanzapine significantly increased (14,22%, P < 0.05) M1 mRNA expression in the hippocampus (CA1, CA2, and CA3) and substantia nigra compacta after 12 weeks of treatment, but not after 1 week. Aripiprazole significantly increased (17%, P < 0.01) M1 mRNA expression in the hippocampus (CA1) after both 1 and 12 week treatments and increased (12%, P < 0.05) M1 mRNA expression in the nucleus accumbens after 1 week of treatment. Despite their different affinities for muscarinic M1 receptors, all three antipsychotic medications induced a similar trend of change in M1 mRNA expression in selected brain regions. These data suggest that the decreased M1 receptor protein and mRNA expression observed in schizophrenia patients is unlikely to be a consequence of drug treatments and implicates muscarinic M1 receptors in the pharmacotherapy of the disease. © 2007 Wiley-Liss, Inc. [source] Risk profiles for non-adherence to antipsychotic medicationsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 8 2008T. V. MCCANN rmn rgn phd ma ba dipnurs (lond) rnt rcnt Poor adherence to medications is common in individuals with schizophrenia, and can lead to relapse and re-hospitalization. This paper presents the findings of an Australian study of the factors affecting antipsychotic medication taking in individuals with schizophrenia. The Factors Influencing Neuroleptic Medication Taking Scale was used with a non-probability sample of mental health service users. Ethics approval was obtained from a university and a hospital ethics committee. Data were analysed using spss version 15. Most participants had insight into their illness and were aware of the stigma of mental illness. Around 70% experienced annoying side effects, while nearly half admitted alcohol consumption. About one-fifth admitted they had missed taking medications during the previous week. Significant others played a variable role in medication taking. Over 80% were satisfied with their relationships with health professionals, but were less satisfied with access to these professionals, especially psychiatrists. Logistic regression analysis showed that age, impact of medication side effects, and access to psychiatrists were independent predictors of medication omission. It is argued that medication taking is a complex issue, which needs to be taken into consideration in health professional training and measures to promote adherence. [source] Anticipatory Pleasure Skills Training: A New Intervention to Reduce Anhedonia in SchizophreniaPERSPECTIVES IN PSYCHIATRIC CARE, Issue 3 2010Jérôme Favrod RN PURPOSE., Anhedonia is a challenging symptom of schizophrenia and remains largely recalcitrant to current pharmacological treatments. The goal of this exploratory pilot study was to assess if a cognitive,sensory intervention could improve anticipatory pleasure. DESIGN AND METHODS., Five participants meeting the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) criteria for schizophrenia, presenting severe anhedonia and stabilized on atypical antipsychotic medication, received between 10 hours and 25 hours of training. FINDINGS., Results show that the patients improved on the anticipatory scale of the Temporal Experience of Pleasure Scale. Daily activities of the patients were also increased. PRACTICE IMPLICATIONS., These preliminary data need to be interpreted with caution given the small sample of the study, but they offer promising paths to develop new interventions to alleviate anhedonia in schizophrenia. [source] COMT genotypes and use of antipsychotic medication: linking population-based prescription database to the HUNT study,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008Dr Knut Hagen Abstract Purpose The aim of this prospective study was to evaluate the impact of codon 158 polymorphism at the catechol- O -methyltransferase (COMT) gene on prescription of antipsychotic medication in a general population. Methods The sample comprised 2623 non-diabetic individuals who participated in the Nord-Trřndelag Health Study (HUNT) in the period 1995,97 and who were alive 1 January 2004. The subjects were followed up with respect to prescription of antipsychotic medication based on data obtained from the Norwegian prescription database. Results Among the group of 76 individuals who had been prescribed antipsychotic medication the distribution did not differ between genotypes and alleles when compared to a control group. For 47 individuals with at least three prescriptions a correlation between median total defined daily doses (DDDs) and genotype groups was found (Spearman's rho, ,0.40, p,=,0.01), being highest for the Met/Met genotype (250), intermediate for the Met/Val genotype (126) and lowest for the Val/Val genotype (47) (p,=,0.03). Conclusion In this population-based cohort of 2623 adults, the Val158Met polymorphism at the COMT gene had no major impact on number of individuals who had been prescribed antipsychotic medication. However, linkage to the prescription database may in an indirect way indicate an association between the COMT Val158Met polymorphism and treatment response or dose requirements of antipsychotic medication. Copyright © 2008 John Wiley & Sons, Ltd. [source] Effects of a 10-week weight control program on obese patients with schizophrenia or schizoaffective disorder: A 12-month follow upPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 1 2009Chih-Ken Chen md Aims:, Weight gain secondary to antipsychotic medication is associated with many serious conditions, including type II diabetes mellitus, hypertension, and coronary heart disease, and also with poor medication compliance. Weight control programs may be of benefit to outpatients with schizophrenia, but also raise an issue of cost-effectiveness. We aimed to evaluate the effectiveness of a 10-week weight control program for outpatients taking atypical antipsychotics for treatment of schizophrenia, and to follow up the effects of this weight control program in controlling weight gain after termination of the program. Methods:, A total of 33 patients with schizophrenia and antipsychotic-related obesity were enrolled in a 10-week multimodal weight control program. The patients' weights were recorded at baseline, week 4, week 8, week 10 (end of the intervention), week 12, week 24, and week 48. Secondary measures included blood sugar levels, cholesterol levels, triglyceride levels, quality of life and mental health. Results:, For those who completed the weight control program, there was a mean weight loss of 2.1 kg by the end of the intervention, 3.7 kg over 6 months, and 2.7 kg over 12 months. The mean body mass index decreased by 0.8, 1.5 and 1.1 at week 10, week 24 and week 48, respectively, all with statistical significance. Conclusions:, The 10-week weight control program was effective in terms of weight reduction among obese patients with schizophrenia or schizoaffective disorder, and the weight reduction effect lasted for up to 6 months, and up to 12 months in some cases. [source] Lifetime prognosis of schizophrenia: extended observation (more than 40 years) of 129 patients with typical schizophreniaPSYCHOGERIATRICS, Issue 2 2005Yosuke ICHIMIYA Abstract Background:, The excess mortality among patients with schizophrenia has been documented by epidemiological studies. These studies have shown that suicide accounts for most of this mortality. In contrast, the natural deaths of patients with schizophrenia have been commonly related to cardiovascular disease in these studies. Methods:, In this study, the clinical features of 129 patients with typical schizophrenia were examined in order to study the lifetime prognosis of patients with schizophrenia in Japan. These patients had their first visit to Kawagoe Dojinkai Hospital in 1963 and had been continuously observed for over 40 years. Results:, As at January 2003, the status of these 129 patients was categorized as follows: 27 patients were inpatients (mean age was 72.9 years), 20 patients were outpatients (mean age was 68.8 years), 2 patients were outpatients of another hospital, 20 patients had been admitted into nursing homes, 53 patients had passed away and 7 patients were missing. Clinical features were recorded for 44 (23 male patients with a mean age of 68.6 years and 21 female patients with a mean age of 64.2 years) out of the 53 patients who had passed away. The causes of death consisted of malignancy (13 cases), pneumonia (eight cases), heart failure (five cases), cerebral infarction (three cases), diabetes mellitus (three cases), cardiac infarction (two cases), ileus (two cases), asphyxia (one case), liver cirrhosis (one case), gastric ulcer (one case), heat stroke (one case), homicide (one case) and suicide (three cases). Two patients were discovered to have passed away alone at home. Conclusion:, The mean age of death was found to be lower than the life expectancy. However, only three patients committed suicide. These findings suggest that patients with schizophrenia may possess some biological vulnerability. Further study is needed to evaluate the effects of long-term antipsychotic medication. Clinically, medical checks for malignancy and care services for elderly patients are needed. Furthermore, in order to prevent future occurrences of patients dying alone in their own home, a social support system should be established. [source] | |||||||||||||||||||||||||||||||