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Second-generation Antipsychotics (second-generation + antipsychotics)
Selected AbstractsSecondary delusional parasitosis treated with paliperidoneCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 3 2009R. W. Freudenmann Summary Second-generation antipsychotics (SGA) are increasingly used in primary and secondary delusional parasitosis (DP) because of their better overall tolerability compared with first-generation antipsychotics (FGA) such as pimozide. Controlled clinical trials with antipsychotics in DP are lacking, owing to difficulties in obtaining informed consent and in securing adherence to a study protocol by patients with DP. We present the case of an 88-year-old man with a 12-year history of DP secondary to leucoencephalopathy. After 9 days of an age-adapted dose of paliperidone, the patient no longer experienced the presence of vermin on his skin and stopped showering at night to get rid off of them. Paliperidone was well tolerated. At follow-up after 2 weeks, the DP was still remitted. Paliperidone appears to expand the therapeutic arsenal in treating DP with modern SGAs; however, this finding needs to be replicated. [source] Antipsychotic prescribing trends: a review of pharmaco-epidemiological studiesACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010H. Verdoux Objective:, To review findings from pharmaco-epidemiological studies exploring antipsychotic (AP) drugs prescribing trends. Method:, We retrieved original studies that explored AP prescribing trends in general population samples since 2000. For each study, we extracted information on sampling method, period, assessment of AP use and corresponding estimates (incidence rates, prevalence rates, pharmacy sales, prescription data) and diagnostic assessment. Results:, Nearly all studies meeting the inclusion criteria (n = 17) showed an increase in AP prescriptions, mainly because of a dramatic rise in second-generation antipsychotics (SGAP) prescriptions. APs are often prescribed for non-psychotic disorders in adults as well as in children and adolescents. Conclusion:, Considering the growing number of persons from the general population exposed to APs, population studies assessing the risk/benefit ratio of SGAP use in disorders other than psychosis are necessary, particularly in children and adolescents. [source] Treatment-resistant bipolar depression: towards a new definitionACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009I. Pacchiarotti Objective:, To summarize the conceptual and operational definitions of treatment-resistant bipolar depression and to review the evidence-based therapeutic options. Method:, Structured searches of PubMed, Index Medicus, Excerpta Medica and Psyclit conducted in December 2008. Results:, Criteria for treatment resistance in bipolar depression are commonly based on concepts stemming from treatment resistance as defined for unipolar depression, an approach that proved to be inadequate. In fact, the addition of an ad hoc criterion based on lithium and other mood stabilizer unresponsiveness after reaching adequate plasma levels appears to be a patch that attempts to take into account the uniqueness of bipolar depression but fails to become operational. Recent data from randomized clinical trials of new anticonvulsants and second-generation antipsychotics should lead to the development of a modern definition of treatment-resistant bipolar depression, and specific therapeutic algorithms. Conclusion:, We suggest a redefinition of resistant bipolar I and II depression. We propose different degrees of severity within bipolar depression in a stepwise manner. [source] Pharmacological treatment of negative symptoms of schizophrenia: therapeutic opportunity or Cul-de-sac?ACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2007P. F. Buckley Objective:, Negative symptoms of schizophrenia are debilitating and they contribute to poor outcome in schizophrenia. Initial enthusiasm that second-generation antipsychotics would prove to be powerful agents to improve negative symptoms has given way to relative pessimism that the effects of current pharmacological treatments are at best modest. Method:, A review of the current ,state-of-play' of pharmacological treatments for negative symptoms in schizophrenia. Results:, Treatment results to date have been largely disappointing. The evidence for efficacy of second-generation antipsychotics is reviewed. Conclusion:, The measurement and treatment trials methodology for the evaluation of negative symptoms need additional refinement before therapeutic optimism that better treatments for negative symptoms can be realized. [source] Early intervention with second-generation antipsychotics in first-episode psychosis: results of an 8-week naturalistic studyEARLY INTERVENTION IN PSYCHIATRY, Issue 1 2010Richard C. Josiassen Abstract Objective: The objective was to compare short-term effectiveness of aripiprazole with three other second-generation antipsychotics (SGAs) in the treatment of first-episode psychosis. Method: In a naturalistic, ,single-blind' design, 60 subjects experiencing their first psychotic episode were treated for 8 weeks with aripiprazole (n = 19), risperidone (n = 16), olanzapine (n = 14) or quetiapine (n = 11). Medication and dosing decisions were made by treating psychiatrists, constrained to once-a-day dosing, low initial doses and no clozapine. Weekly ratings were obtained using the Positive and Negative Syndrome Scale (PANSS), Simpson-Angus Rating Scale and Barnes Akathasia Rating Scale. Weight and vital signs were also collected weekly. Results: The group presented with severe psychotic symptoms (mean baseline PANSS total score of 105.2), which were reduced rapidly (P < 0.0005). The between-group and group by time interaction terms were non-significant. Similar reductions were seen across all PANSS sub-scales. At Week 1 the mean PANSS Activation Scale score was reduced more with olanzapine than in the other groups (P < 0.002). Few instances of extrapyramidal symptoms occurred; all were sporadic and did not require treatment. Group body weight increased by 7.3% over the study. Vital signs remained unchanged. Conclusions: Early intervention with low doses of four SGAs led to rapid symptom reduction in first-episode psychotic patients with severe psychopathology. Although no clear medication advantages were observed in the short term, longer duration studies with larger samples will be required for determining efficacy, rates of compliance, relapse prevention and diminished incidence of extrapyramidal signs and symptoms. [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] Iloperidone for schizophrenia: a review of the efficacy and safety profile for this newly commercialised second-generation antipsychoticINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2009L. Citrome Summary Objective:, The aim of the study was to describe the efficacy and safety of iloperidone for the treatment of schizophrenia. Data sources:, The pivotal registration trials were accessed by querying http://www.pubmed.gov, http://www.fda.gov and http://www.clinicaltrials.gov for the search term ,iloperidone'. Study selection:, Four published primary reports of phase III studies were identified as well as preclinical animal and receptor affinity studies that describe potential mechanisms of action and pharmacogenomic studies that identify potential genetic biomarkers for efficacy and tolerability. Product labelling provided additional data. Data extraction:, Descriptions of the principal results and calculation of number needed to treat (NNT) and number needed to harm (NNH) for relevant dichotomous outcomes were extracted from the study reports. Additional safety outcomes subject to NNH analysis were obtained from product labelling. Data synthesis:, Iloperidone is a second-generation antipsychotic agent indicated for the acute treatment of schizophrenia in adults. Iloperidone has been evaluated in several double-blind placebo-controlled clinical trials. The oral formulation has demonstrated efficacy in reducing the symptoms of acute schizophrenia at fixed daily doses ranging from 12 to 24 mg. Data reported for categorical definitions of response using the Positive and Negative Syndrome Scale were limited to one study and specifically to rates of achieving a , 20% decrease in the positive subscale from baseline; significantly more patients receiving iloperidone 24 mg/day (72%) than placebo (52%) met this criterion, yielding a NNT of five. Iloperidone should be titrated slowly to avoid orthostatic hypotension, potentially delaying the achievement of a therapeutic dose level. There appears to be a dose relationship for adverse events such as dizziness, somnolence and dry mouth; for example NNH vs. placebo for somnolence was 25 for iloperidone 10,16 mg/day and 10 for 20,24 mg/day. There is a possibility of a therapeutic dose response as well. Iloperidone is essentially free of extra-pyramidal side effects. Iloperidone is associated with weight gain comparable with risperidone. Long-term double-blind maintenance studies have demonstrated iloperidone's non-inferiority to haloperidol for relapse prevention. Product labelling includes a warning about the potential for QT interval prolongation. At present there are no efficacy studies available that are powered to directly compare iloperidone with other second-generation antipsychotics. The development of a depot formulation of iloperidone as well as efforts to identify genetic biomarkers for prediction of both efficacy and tolerability are in progress. Conclusions:, Aside from paliperidone, iloperidone is the first new second-generation antipsychotic to be commercialised in the USA since 2002. From the limited registration data, iloperidone appears to be relatively well tolerated once titrated to a therapeutic level and can be a useful option to consider. The development of a depot formulation and potential for genetic biomarkers may make this agent compelling. Further comparisons with other available agents among patients with schizophrenia in the ,real world' are needed. [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] Prescribing antipsychotic drugs for inpatients with schizophrenia in Asia: Comparison of REAP-2001 and REAP-2004 studiesASIA-PACIFIC PSYCHIATRY, Issue 2 2010Mian-Yoon Chong MD PhD FRCPsych Abstract Introduction: This international collaborative study aimed to investigate the trend and change in prescription patterns of antipsychotic drugs for inpatient schizophrenia in Asia by comparing two surveys in 2001 and 2004. Methods: Prescription patterns of inpatient schizophrenia in China, Hong Kong, Japan, Korea, Singapore and Taiwan were surveyed in July of 2001 and 2004 using a standardized protocol. Patients' social and clinical characteristics, psychiatric symptoms, course of illness and adverse effects of medications were systematically assessed and recorded. Prescription patterns of antipsychotic drugs were compared and analyzed. Results: Altogether, 4535 patients were surveyed. There were no significant differences in their demographic characteristics between 2001 and 2004. Compared with 2001, a significant increase in the use of second-generation antipsychotics (SGA) (from 45.5% to 64.7%) with reciprocal decreasing use of first-generation antipsychotics was found in 2004. The trend was unanimously seen across these Asian countries and among those prescribed with monotherapy or polypharmacy. The proportion using monotherapy significantly increased, from 52.7% in 2001 to 61.1% in 2004. There was a tendency of using a lower dosage of antipsychotic medications and a less concomitant use of anti-Parkinson drugs. Discussion: The present study showed a trend of increasing use of SGA among Asian countries. Except for Japan and Singapore, a relatively low use of antipsychotic polypharmacy was generally found. The increasing use of SGA and policy changes reduced the mean duration of admission days. With increasing awareness of consumers and continuing education for psychiatrists, the trend is expected to continue. [source] Antipsychotic and mood stabilizer efficacy and tolerability in pediatric and adult patients with bipolar I mania: a comparative analysis of acute, randomized, placebo-controlled trialsBIPOLAR DISORDERS, Issue 2 2010Christoph U Correll Correll CU, Sheridan EM, DelBello MP. Antipsychotic and mood stabilizer efficacy and tolerability in pediatric and adult patients with bipolar I mania: a comparative analysis of acute, randomized, placebo-controlled trials. Bipolar Disord 2010: 12: 116,141. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objective:, To compare antipsychotic and mood stabilizer (MS) efficacy and tolerability in youth and adults with bipolar mania. Methods:, Medline/PubMed search for studies including: (i) youth (< 18 years) or adults (, 18 years); (ii) bipolar I disorder; (iii) double-blind, randomized, placebo-controlled trial (DB-RPCT); (iv) , 12 weeks of treatment; and (v) calculable effect sizes (ES) and/or numbers needed to treat/harm (NNT/NNH) ± 95% confidence intervals (CI). Non-overlapping 95% CIs determined significant group differences. Results:, We identified nine DB-RPCTs in youth (n = 1,609), 5 evaluating second-generation antipsychotics (SGAs) (n = 1,140) and 4 evaluating MSs (n = 469). We also identified 23 DB-RPCTs in adults (n = 6,501), 14 including SGAs (n = 3,297), 5 using haloperidol as an active comparator (n = 580), and 11 including MSs (n = 2,581). Young Mania Rating Scale scores improved significantly more with SGAs than MSs in youth (ES = 0.65, CI: 0.53,0.78 versus 0.24, CI: 0.06,0.41) and adults (ES = 0.48, CI: 0.41,0.55 versus 0.24, CI: 0.17,0.31). After excluding topiramate studies, SGAs had larger ES than MSs only in youth (ES = 0.65, CI: 0.53,0.78 versus 0.20, CI: 0.02,0.39), but not adults (ES = 0.48, CI: 0.41,0.55 versus 0.46, CI: 0.37,0.55). However, in adults SGAs had significantly larger ES regarding Clinical Global Impressions scores than MSs, even without topiramate (ES = 0.75, CI: 0.68,0.82 versus 0.24, CI: 0.07,0.41). Rates of response, remission, and discontinuation due to any reason compared to placebo were similar between medication and age groups, except for more favorable NNTs for remission with SGAs than MSs in adults after excluding topiramate. SGAs caused more weight gain than MSs in youth (ES = 0.53, CI: 0.41,0.66 versus 0.10, CI: ,0.12,0.33), but not in adults (ES = 0.13, CI: 0.05,0.22 versus 0.00, CI: ,0.08,0.08). However, results were heterogeneous and not significant in either age group after excluding topiramate. Nevertheless, SGA-related weight gain was significantly greater in youth than adults. In youth, SGA-related somnolence was greater than with MSs (NNH = 4.7, CI: 3.9,6.0 versus 9.5, CI: 6.3,23.5), and more likely than in adults (NNH = 7.1, CI: 6.1,8.8). Conversely, youth experienced less akathisia with SGAs than adults (NNH = 20.4, CI: 14.1,36.5 versus 10.2, CI: 8.1,13.7), likely due to lower doses/slower titration. Conclusions:, In treating mania, potentially greater short-term efficacy compared to placebo with SGAs versus MS needs to be balanced against increased adverse events, especially in youth. [source] Delusional parasitosis: a new pathway for diagnosis and treatmentCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 2 2008P. Lepping Summary Delusional parasitosis is an uncommon disorder that presents particular challenges to the dermatologist. Patients often resist psychiatric referral. Evidence of efficacy of treatment options is generally weak, but some studies exist. By identifying whether the disorder is primary or secondary to another illness, by attempting to involve the liaison psychiatry team if possible and by treating the patient with a modern antipsychotic, remission is achievable. A pathway for diagnostics and therapy is presented. Treatments of choice are ,atypical' or second-generation antipsychotics such as amisulpride, risperidone or olanzapine in age-appropriate doses. Pimozide is no longer the treatment of choice, owing to a higher risk of adverse drug reactions and lower concordance. In some cases, depot antipsychotics can be considered. For diagnostics and treatment, close collaboration of dermatologists and psychiatrists is recommended. [source] | ||||||||||