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Treatment resistant schizophrenia

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https://www.readbyqxmd.com/read/27884042/valproate-for-schizophrenia
#1
REVIEW
Yijun Wang, Jun Xia, Bartosz Helfer, Chunbo Li, Stefan Leucht
BACKGROUND: Many people with schizophrenia do not achieve a satisfactory treatment response with ordinary antipsychotic drug treatment. In these cases, various add-on medications are used, and valproate is one of these. OBJECTIVES: To examine whether:1. valproate alone is an effective treatment for schizophrenia and schizoaffective psychoses; and2. valproate augmentation of antipsychotic medication is an effective treatment for the same illnesses. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (July 2002; February 2007; July 2012; March 04, 2016)...
November 24, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27882189/successful-treatment-of-resistant-hypertension-by-means-of-chronic-renal-artery-occlusion-revascularization-in-a-fragile-patient
#2
Laura Spezia, Simone Perandini, Raffaele Augelli, Giovanni Puppini, Stefania Montemezzi
BACKGROUND: Renal artery stenosis is a common cause of secondary hypertension refractory to medical therapy. Percutaneous angioplasty along with metallic stent placement has been described as an effective treatment for revascularization of the renal artery. CASE REPORT: A 54-year-old woman affected by paranoid schizophrenia with a history of hypertension and chronic renal failure due to renal artery occlusion was treated by endovascular recanalization and stent placement that resulted in improvement of renal function and control of hypertension...
2016: Polish Journal of Radiology
https://www.readbyqxmd.com/read/27879426/the-successful-concurrent-use-of-two-long-acting-depot-antipsychotics-in-a-patient-with-treatment-resistant-schizophrenia-and-history-of-serious-violence-a-case-report
#3
Anna Lenardon, Mona Ahmed, Katie-Lynn Harfield, Mrigendra Das
OBJECTIVE: This case report describes a forensic psychiatric patient presenting with treatment-resistant schizophrenia and serious interpersonal violence complicated by poor adherence to oral medication who was treated successfully with two concurrent long-acting depot antipsychotics. METHOD: Treatment response was measured for a 6-month period at 6-weekly intervals, post-initiation using the Positive and Negative Symptoms of Schizophrenia with Excited Component score (PANSS-EC), Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression Scale (CGI)...
November 22, 2016: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
https://www.readbyqxmd.com/read/27871302/glycopyrrolate-in-comparison-to-hyoscine-hydrobromide-and-placebo-in-the-treatment-of-hypersalivation-induced-by-clozapine-gothic1-study-protocol-for-a-randomised-controlled-feasibility-study
#4
Inti Qurashi, Simon Chu, Nusrat Husain, Richard J Drake, Imran Chaudhry, J F W Deakin
BACKGROUND: Clozapine is the only medication licensed for the treatment of resistant schizophrenia in the UK. Although efficacious, a common and unpopular side effect of clozapine treatment is clozapine-induced hypersalivation (CIH), which can contribute to non-adherence. The standard treatment for CIH in the UK is hyoscine hydrobromide but this may aggravate cognitive deficits in patients with schizophrenia while glycopyrrolate may be an effective alternative with a more tolerable side effect profile...
November 21, 2016: Trials
https://www.readbyqxmd.com/read/27866120/evidence-based-guidelines-on-the-therapeutic-use-of-transcranial-direct-current-stimulation-tdcs
#5
REVIEW
Jean-Pascal Lefaucheur, Andrea Antal, Samar S Ayache, David H Benninger, Jérôme Brunelin, Filippo Cogiamanian, Maria Cotelli, Dirk De Ridder, Roberta Ferrucci, Berthold Langguth, Paola Marangolo, Veit Mylius, Michael A Nitsche, Frank Padberg, Ulrich Palm, Emmanuel Poulet, Alberto Priori, Simone Rossi, Martin Schecklmann, Sven Vanneste, Ulf Ziemann, Luis Garcia-Larrea, Walter Paulus
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction...
October 29, 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/27857125/presynaptic-dopamine-capacity-in-patients-with-treatment-resistant-schizophrenia-taking-clozapine-an-18-f-dopa-pet-study
#6
Euitae Kim, Oliver D Howes, Mattia Veronese, Katherine Beck, Seongho Seo, Jin Woo Park, Jae Sung Lee, Yun-Sang Lee, Jun Soo Kwon
Some patients with schizophrenia show poor response to first-line antipsychotic treatments and this is termed treatment resistant schizophrenia. The differential response to first-line antipsychotic drugs may reflect a different underlying neurobiology. Indeed, a previous study found dopamine synthesis capacity was significantly lower in patients with treatment resistant schizophrenia. However, in this study, the treatment resistant patients were highly symptomatic whilst the responsive patients showed no or minimal symptoms...
November 18, 2016: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/27853387/treatment-resistant-schizophrenia-current-insights-on-the-pharmacogenomics-of-antipsychotics
#7
REVIEW
John Lally, Fiona Gaughran, Philip Timms, Sarah R Curran
Up to 30% of people with schizophrenia do not respond to two (or more) trials of dopaminergic antipsychotics. They are said to have treatment-resistant schizophrenia (TRS). Clozapine is still the only effective treatment for TRS, although it is underused in clinical practice. Initial use is delayed, it can be hard for patients to tolerate, and clinicians can be uncertain as to when to use it. What if, at the start of treatment, we could identify those patients likely to respond to clozapine - and those likely to suffer adverse effects? It is likely that clinicians would feel less inhibited about using it, allowing clozapine to be used earlier and more appropriately...
2016: Pharmacogenomics and Personalized Medicine
https://www.readbyqxmd.com/read/27848034/vagus-nerve-stimulation-in-psychiatry-a-systematic-review-of-the-available-evidence
#8
REVIEW
Camelia-Lucia Cimpianu, Wolfgang Strube, Peter Falkai, Ulrich Palm, Alkomiet Hasan
Invasive and non-invasive vagus nerve stimulation (VNS) is a promising add-on treatment for treatment-refractory depression, but is also increasingly evaluated for its application in other psychiatric disorders, such as dementia, schizophrenia, somatoform disorder, and others. We performed a systematic review aiming to give a detailed overview of the available evidence of the efficacy of VNS for the treatment of psychiatric disorders. Data derived from animal models, experimental trials without health-related outcomes, case reports, single-session studies, and reviews were excluded...
November 16, 2016: Journal of Neural Transmission
https://www.readbyqxmd.com/read/27833234/successful-management-of-patient-with-treatment-resistant-schizophrenia-and-swyer-james-macleod-syndrome-with-clozapine
#9
Arpit Parmar, Rajeev Ranjan, Rajesh Sagar
Swyer-James-Macleod syndrome (SJMS) is a rare disorder characterized by infective bronchiolitis. It typically presents with a history of recurrent chest infections during childhood. Cardinal sign of the disease includes the hyperlucency of the lung fields. Till date, only a few cases have been reported of this syndrome. We report a very unusual case of SJMS along with comorbid schizophrenia in a 20-year-old female and the successful management using clozapine.
September 2016: Indian Journal of Psychological Medicine
https://www.readbyqxmd.com/read/27826741/the-porirua-protocol-in-the-treatment-of-clozapine-induced-gastrointestinal-hypomotility-and-constipation-a-pre-and-post-treatment-study
#10
Susanna Every-Palmer, Pete M Ellis, Mike Nowitz, James Stanley, Eve Grant, Mark Huthwaite, Helen Dunn
BACKGROUND: Clozapine, an antipsychotic used in treatment-resistant schizophrenia, causes slow gastrointestinal transit in 50-80% of patients. Clozapine-induced gastrointestinal hypomotility is both common and serious, and potential complications include severe constipation, ileus, bowel obstruction and related complications, with a higher mortality rate than clozapine-related agranulocytosis. Little evidence exists on its prevention and management. METHOD: Using a well-validated radiopaque marker ('Metcalf') method, we compared colonic transit times (CTTs) of clozapine-treated inpatients not receiving laxatives with their transit times when receiving laxatives, with treatment prescribed according to the Porirua Protocol for clozapine-related constipation (docusate and senna augmented by macrogol 3350 in treatment-resistant cases)...
November 8, 2016: CNS Drugs
https://www.readbyqxmd.com/read/27821411/the-treatment-of-schizophrenia-can-we-raise-the-standard-of-care
#11
REVIEW
Stanley Victor Catts, Brian Ignatius O'Toole
OBJECTIVE: There is evidence that over time health outcomes of people with schizophrenia are deteriorating rather than improving both in terms of mortality rate and levels of morbidity, even in Australia where service resourcing is substantial. Our objective was to examine the evidence of whether poor outcomes reflect decreases in treatment effectiveness and, if so, what are the barriers to improving standards of care. This review will argue that the confidence of clinicians to diagnose schizophrenia early, and provide assertive and long-term care, may be being undermined by a series of controversies in the published literature and discrepancies in clinical practice guidelines...
November 7, 2016: Australian and New Zealand Journal of Psychiatry
https://www.readbyqxmd.com/read/27813505/is-electroconvulsive-therapy-effective-as-augmentation-in-clozapine-resistant-schizophrenia
#12
Lucas Kittsteiner Manubens, Diego Lobos Urbina, David Aceituno
Clozapine is considered to be the most effective antipsychotic drug for patients with treatment resistant schizophrenia, but up to a third of the patients do not respond to this treatment. Various strategies have been tried to augment the effect of clozapine in non-responders, one of these strategies being electroconvulsive therapy. However, its efficacy and safety are not yet clear. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified six systematic reviews including 55 studies, among them six randomized controlled trials addressing clozapine-resistant schizophrenia...
October 14, 2016: Medwave
https://www.readbyqxmd.com/read/27800285/remission-of-psychosis-in-treatment-resistant-schizophrenia-following-a-seizure-a-case-report
#13
Hena Jawaid, Sana Younus, Hanif Mesiya
The authors report a case of treatment-resistant schizophrenia in a 22-year-old woman, who, despite multiple trials of antipsychotics, did not respond to treatment. Clozapine treatment was initiated, but the patient's symptoms did not remit until after she had a clozapine-induced seizure. The authors discuss the importance in considering that electroconvulsive therapy may be effective in reducing positive and negative symptoms in patients suffering from treatment-resistant schizophrenia.
May 2016: Innovations in Clinical Neuroscience
https://www.readbyqxmd.com/read/27776383/clozapine-monitoring-in-clinical-practice-beyond-the-mandatory-requirement
#14
Nilamadhab Kar, Socorro Barreto, Rahul Chandavarkar
Clozapine is effective in treatment resistant schizophrenia; however, it is underutilised probably because of its side effects. The side effects are also the potential reasons for clozapine discontinuation. A mandatory requirement for its use is regular monitoring of white blood cell count and absolute neutrophil count. However there are many side effects that need monitoring in clinical practice considering their seriousness. This article tries to summarise the clinical concerns surrounding the serious side effects of clozapine some of which are associated with fatalities and presents a comprehensive way to monitor patients on clozapine in clinical practice...
November 30, 2016: Clinical Psychopharmacology and Neuroscience: the Official Scientific Journal of the Korean College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/27771104/-therapeutic-drug-monitoring-of-clozapine
#15
Zoubir Djerada, Françoise Daviet, Pierre-Michel Llorca, Alain Eschalier, Franck Saint-Marcoux, Danièle Bentué-Ferrer, Fréderic Libert
Clozapine is a prototypical atypical antipsychotic used to treat severe schizophrenia and for which a therapeutic drug monitoring (TDM) is quite commonly proposed. Clozapine is rapidly absorbed (maximum concentration reached within 1 to 4hours), and is extensively metabolized in the liver by CYP1A2 to an active metabolite (and to a lesser extent, to inactive metabolites via other enzymes). Its half-life is 8 to 16h. A therapeutic range has been proposed for clozapine as some studies have reported both a relationship between low plasmatic concentrations and resistance to treatment (threshold level is likely between 250 and 400μg/L), and a relationship between high plasmatic concentrations and an increase in the occurrence of toxicity (alert level=1000μg/L)...
August 24, 2016: Thérapie
https://www.readbyqxmd.com/read/27764052/a-case-of-resistant-schizophrenia-successfully-treated-with-clozapine-long-acting-injectable-aripiprazole-combination
#16
Gianna Sepede, Giuseppe Di Iorio, Maria Chiara Spano, Marco Lorusso, Fabiola Sarchione, Rita Santacroce, Rosa Maria Salerno, Massimo Di Giannantonio
BACKGROUND: Treatment-resistant schizophrenia (TRS) is a condition characterized by intense symptom severity and poor response to different antipsychotic agents. The first therapeutic option in TRS is clozapine, but often high/medium doses are not tolerated. Adding an oral antipsychotic to low doses of clozapine is a promising strategy in the management of TRS. On the contrary, there are few data on combined clozapine/long-acting injectable (LAI) medications, and none on clozapine/LAI-aripiprazole...
November 2016: Clinical Neuropharmacology
https://www.readbyqxmd.com/read/27753686/tolerability-of-effective-high-doses-of-paliperidone-palmitate-in-patients-with-severe-resistant-schizophrenia
#17
Juan J Fernández-Miranda, Silvia Díaz-Fernández
The aim of the study was to evaluate the effectiveness and tolerability of doses of paliperidone palmitate (PP) of 175 mgEq and over/28 days in patients with severe schizophrenia [Clinical Global Impression-Severity scale (CGI-S)≥5] and their retention in treatment. A 36-month prospective, observational study was carried out of patients with severe schizophrenia who were treated with 175 mg and over every 28 days of PP to achieve clinical stabilization (N=30). Assessment included CGI-S, WHO Disability Assessment Schedule, Camberwell Assessment of Need, and Medication Adherence Report Scale...
January 2017: International Clinical Psychopharmacology
https://www.readbyqxmd.com/read/27746054/measuring-common-responses-to-psychosis-assessing-the-psychometric-properties-of-a-new-measure
#18
Sarah Tully, Adrian Wells, Melissa Pyle, Jemma Hudson, Andrew Gumley, David Kingdon, Matthias Schwannauer, Douglas Turkington, Anthony P Morrison
Responses to psychotic experiences are central to cognitive models of psychosis. The current study aimed to develop and validate a self-report measure of common responses to the experience of psychosis. This measure is needed as cognitive and behavioural responses are implicated in the maintenance of psychosis, but there is currently no measure that comprehensively assesses these maintaining factors. The Measure of Common Responses to psychosis (MCR) was developed and utilised in a sample of 487 participants who met criteria for treatment-resistant schizophrenia...
October 13, 2016: Schizophrenia Research
https://www.readbyqxmd.com/read/27737473/time-to-initiation-of-clozapine-treatment-in-children-and-adolescents-with-early-onset-schizophrenia
#19
E Trinczek, M Heinzel-Gutenbrunner, M Haberhausen, C J Bachmann
Introduction: Early-onset schizophrenia (EOS) has a poor prognosis and is difficult to treat, which often leads to the initiation of clozapine treatment. Studies in adults have shown that the initiation of clozapine treatment is often delayed. There is a lack of studies concerning the initiation of clozapine in children and adolescents with EOS. The aim of this study was to investigate the time span from first EOS-related psychiatric hospitalization to clozapine initiation. Methods: We retrospectively studied a consecutive cohort of children and adolescents with EOS and first-time clozapine prescriptions from a tertiary care child and adolescent psychiatric center in Germany...
October 13, 2016: Pharmacopsychiatry
https://www.readbyqxmd.com/read/27732102/guide-to-the-management-of-clozapine-related-tolerability-and-safety-concerns
#20
Leslie Citrome, Joseph P McEvoy, Stephen R Saklad
Clozapine is a highly effective antipsychotic medication, which provides a range of significant benefits for patients with schizophrenia, and is the standard of care for treatment-resistant schizophrenia as well as for reducing the risk of suicidal behaviors in schizophrenia and schizoaffective disorder. However, clozapine is widely underutilized, largely because prescribing clinicians lack experience in prescribing it and managing its adverse events (AEs). Clozapine is associated with three uncommon but immediately dangerous AEs-agranulocytosis, myocarditis/cardiomyopathy, and seizures-as well as AEs that may become dangerous if neglected, including weight gain, metabolic syndrome and constipation, and others that are annoying or distressing such as sedation, nighttime enuresis and hypersalivation...
2016: Clinical Schizophrenia & related Psychoses
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