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Treatment resistant schizophrenia

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https://www.readbyqxmd.com/read/28742291/evaluating-the-effect-of-the-changes-in-fda-guidelines-for-clozapine-monitoring
#1
Ryan S Sultan, Mark Olfson, Christoph U Correll, Erica J Duncan
BACKGROUND: Concerns exist that clozapine is underutilized in the management of treatment-resistant schizophrenia. Although a 2015 change in the US Food and Drug Administration (FDA) monitoring recommendations lowered the threshold of the absolute neutrophil count for treatment interruption from 1,500/μL to 1,000/μL and removed white blood cell count thresholds from the monitoring algorithm, the implications of this policy change on clozapine interruptions remain unknown. METHODS: We analyzed outpatient prescribing records for antipsychotic medications in the Veterans Integrated Service Network 7 (VISN 7) database between 1999 and 2012 to assess the potential impact of the recent changes in FDA neutropenia monitoring recommendations on clozapine treatment discontinuation...
July 18, 2017: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/28735641/risk-and-resilience-brain-networks-in-treatment-resistant-schizophrenia
#2
Eleni P Ganella, Caio Seguin, Cali F Bartholomeusz, Sarah Whittle, Chad Bousman, Cassandra M J Wannan, Maria A Di Biase, Christina Phassouliotis, Ian Everall, Christos Pantelis, Andrew Zalesky
BACKGROUND: Genes, molecules and neural circuits that are associated with, or confer risk to developing schizophrenia have been studied and mapped. It is hypothesized that certain neural systems may counterbalance familial risk of schizophrenia, and thus confer resilience to developing the disorder. This study sought to identify resting-state functional brain connectivity (rs-FC) representing putative risk or resilience endophenotypes in schizophrenia. METHODS: Resting-state functional magnetic resonance imaging (rs-fMRI) was performed in 42 individuals with treatment resistant schizophrenia (TRS), 16 unaffected first-degree family members (UFM) and 42 healthy controls...
July 20, 2017: Schizophrenia Research
https://www.readbyqxmd.com/read/28734239/stigma-resistance-and-its-association-with-internalised-stigma-and-psychosocial-outcomes-among-psychiatric-outpatients
#3
Ying Wen Lau, Louisa Picco, Shirlene Pang, Anitha Jeyagurunathan, Pratika Satghare, Siow Ann Chong, Mythily Subramaniam
Studies have suggested that stigma resistance plays an important role in the recovery from mental illness. However, there has been limited research in Asian countries that has examined the benefits of stigma resistance among the mentally ill in Asian populations. Hence, this study aimed to assess the prevalence of stigma resistance and establish the socio-demographic correlates of stigma resistance, as well as its association with internalised stigma and psychosocial outcomes among a multi-ethnic population of 280 outpatients with obsessive compulsive disorder (OCD), schizophrenia, depressive disorders and anxiety disorders in Singapore...
July 14, 2017: Psychiatry Research
https://www.readbyqxmd.com/read/28721020/access-to-credible-information-on-schizophrenia-patients-medication-adherence-by-prescribers-can-change-their-treatment-strategies-evidence-from-an-online-survey-of-providers
#4
Jason Shafrin, Suepattra G May, Anshu Shrestha, Charles Ruetsch, Nicole Gerlanc, Felicia Forma, Ainslie Hatch, Darius N Lakdawalla, Jean-Pierre Lindenmayer
OBJECTIVE: Overestimating patients' medication adherence diminishes the ability of psychiatric care providers to prescribe the most effective treatment and to identify the root causes of treatment resistance in schizophrenia. This study was conducted to determine how credible patient drug adherence information (PDAI) might change prescribers' treatment decisions. METHODS: In an online survey containing 8 clinical case vignettes describing patients with schizophrenia, health care practitioners who prescribe antipsychotics to patients with schizophrenia were instructed to choose a preferred treatment recommendation from a set of predefined pharmacologic and non-pharmacologic options...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28710677/cerebellar-contributions-to-persistent-auditory-verbal-hallucinations-in-patients-with-schizophrenia
#5
Maximilian Cierpka, Nadine D Wolf, Katharina M Kubera, Mike M Schmitgen, Nenad Vasic, Karel Frasch, Robert Christian Wolf
There is growing evidence that the cerebellum plays a crucial role in the pathophysiology of schizophrenia symptoms. Despite increasing evidence for cerebellar involvement in affective, attentive, and cognitive functions including language processing and perception, investigations of cerebellar contributions to auditory verbal hallucinations (AVH) in schizophrenia are lacking. Using structural magnetic resonance imaging at 3T, we investigated the data of 20 patients with schizophrenia and 14 matched healthy controls...
July 14, 2017: Cerebellum
https://www.readbyqxmd.com/read/28703015/guidelines-for-the-pharmacotherapy-of-schizophrenia-in-adults
#6
Gary Remington, Donald Addington, William Honer, Zahinoor Ismail, Thomas Raedler, Michael Teehan
OBJECTIVE: The present guidelines address the pharmacotherapy of schizophrenia in adults across different stages, phases, and symptom domains. METHOD: Guidelines were developed using the ADAPTE process, which takes advantage of existing guidelines. Six guidelines were identified for adaptation, with recommendations extracted from each. For those specific to the pharmacotherapy of schizophrenia in adults, a working group selected between guidelines and recommendations to create an adapted guideline...
January 1, 2017: Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
https://www.readbyqxmd.com/read/28688742/effects-of-adjunctive-fluvoxamine-on-metabolic-parameters-and-psychopathology-in-clozapine-treated-patients-with-schizophrenia-a-12-week-randomized-double-blind-placebo-controlled-study
#7
Mong-Liang Lu, Tzu-Ting Chen, Po-Hsiu Kuo, Ching-Chi Hsu, Chun-Hsin Chen
OBJECTIVE: Numerous studies have demonstrated that fluvoxamine has considerable pharmacokinetic and pharmacodynamic interactions with clozapine. We conducted a 12-week, randomized, double-blind, placebo-controlled study to evaluate the effects of fluvoxamine on metabolic parameters and psychopathology in clozapine-treated patients with schizophrenia. METHODS: We recruited 85 patients who received a DSM-IV diagnosis of schizophrenia. Eligible patients were randomized to receive fluvoxamine 50mg/day plus clozapine 100mg/day or clozapine 300mg/day...
July 5, 2017: Schizophrenia Research
https://www.readbyqxmd.com/read/28667666/translating-advances-in-the-molecular-basis-of-schizophrenia-into-novel-cognitive-treatment-strategies
#8
REVIEW
Colm M P Oapos Tuathaigh, Paula M Moran, Xuechu C Zhen, John L Waddington
The presence and severity of cognitive symptoms, including working memory, executive dysfunction and attentional impairment, contributes materially to functional impairment in schizophrenia. Cognitive symptoms have proven resistant to both first- and second-generation antipsychotic drugs. Efforts to develop a consensus set of cognitive domains that are both disrupted in schizophrenia and are amenable to cross-species validation (e.g. the NIMH CNTRICS and RDoC initiatives) are an important step towards standardisation of outcome measures that can used in preclinical testing of new drugs...
June 30, 2017: British Journal of Pharmacology
https://www.readbyqxmd.com/read/28664816/cyp2c19-17-protects-against-metabolic-complications-of-clozapine-treatment
#9
Irina Piatkov, Dorgival Caetano, Yolinda Assur, Sue Lynn Lau, Micheline Coelho, Trudi Jones, Tristan Nguyen, Steven Boyages, Mark McLean
OBJECTIVES: Clozapine (CZ) is the most effective drug for managing treatment-resistant schizophrenic disorders. Its use has been limited due to adverse effects, which include weight gain and new-onset diabetes, but the incidence of these varies between patients. METHODS: We investigated 187 Clozapine Clinic patients (of whom 137 consented for genotyping) for the presence of CYP2C19*17 and its association with CZ and NCZ levels, and clinical outcomes. RESULTS: Thirty-nine percent of genotyped patients were carriers of the CYP2C 19*17 polymorphism...
June 30, 2017: World Journal of Biological Psychiatry
https://www.readbyqxmd.com/read/28655284/clozapine-response-rates-among-people-with-treatment-resistant-schizophrenia-data-from-a-systematic-review-and-meta-analysis
#10
Dan Siskind, Victor Siskind, Steve Kisely
Clozapine is the most effective antipsychotic for the 25% to 33% of people with schizophrenia who are treatment resistant, but not all people achieve response. Using data from a previously published clozapine systematic review and meta-analysis, we explored the proportion of people who achieved response and examined the absolute and percentage change in Positive and Negative Syndrome Scale (PANSS) scores. Overall, 40.1% (95% confidence interval [CI], 36.8%-43.4%) responded, with a mean reduction in PANSS of 22...
January 1, 2017: Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
https://www.readbyqxmd.com/read/28650930/clozapine-use-in-a-cohort-of-first-episode-psychosis
#11
Roisin Doyle, Caragh Behan, Donal OʼKeeffe, Sarah Masterson, Anthony Kinsella, Aine Kelly, Ann Sheridan, Dolores Keating, Caroline Hynes, Kevin Madigan, Elizabeth Lawlor, Mary Clarke
PURPOSE/BACKGROUND: For approximately one third of individuals treated for psychosis or schizophrenia, antipsychotic medications will have little or no therapeutic benefit. Clozapine remains the sole medication approved for treatment-resistant schizophrenia, and studies have demonstrated its superior efficacy in reducing psychotic symptoms. METHODS/PROCEDURES: Data were collected from the medical records of people who originally presented with a first-episode psychosis between 1995 and 1999 (N = 171)...
June 23, 2017: Journal of Clinical Psychopharmacology
https://www.readbyqxmd.com/read/28647739/antipsychotic-induced-dopamine-supersensitivity-psychosis-pharmacology-criteria-and-therapy
#12
Guy Chouinard, Anne-Noël Samaha, Virginie-Anne Chouinard, Charles-Siegfried Peretti, Nobuhisa Kanahara, Masayuki Takase, Masaomi Iyo
The first-line treatment for psychotic disorders remains antipsychotic drugs with receptor antagonist properties at D2-like dopamine receptors. However, long-term administration of antipsychotics can upregulate D2 receptors and produce receptor supersensitivity manifested by behavioral supersensitivity to dopamine stimulation in animals, and movement disorders and supersensitivity psychosis (SP) in patients. Antipsychotic-induced SP was first described as the emergence of psychotic symptoms with tardive dyskinesia (TD) and a fall in prolactin levels following drug discontinuation...
2017: Psychotherapy and Psychosomatics
https://www.readbyqxmd.com/read/28626273/combined-antipsychotics-and-electroconvulsive-therapy-in-an-acutely-psychotic-patient-with-treatment-resistant-schizophrenia
#13
Ruth Rayikanti, Iga Lentowicz, Badari Birur, Li Li
Treatment of patients with Treatment-resistant Schizophrenia (TRS), who fail to respond to multiple antipsychotic trials, including clozapine (CLZ), is challenging. Several alternative strategies are reported in studies, one of which includes augmenting antipsychotics (AP) with Electroconvulsive therapy (ECT). We discuss a case of an acutely psychotic patient with TRS who responded effectively and sustained remission to this strategy which was ECT combined with two AP, CLZ and aripiprazole. Notable improvement in clinical and cognitive outcomes was seen with just five right unilateral ECT sessions, CLZ titrated up to 62...
May 15, 2017: Psychopharmacology Bulletin
https://www.readbyqxmd.com/read/28623627/clozapine-induced-gastrointestinal-hypomotility-a-22-year-bi-national-pharmacovigilance-study-of-serious-or-fatal-slow-gut-reactions-and-comparison-with-international-drug-safety-advice
#14
Susanna Every-Palmer, Pete M Ellis
INTRODUCTION: Clozapine is the preferred antipsychotic for treatment-resistant schizophrenia, but has significant adverse effects, including gastrointestinal hypomotility or 'slow gut', which may result in severe constipation, ileus, bowel obstruction, and even death. These gastrointestinal effects remain inadequately recognized. METHODS: We reviewed all reports of serious clozapine-induced gastrointestinal hypomotility (CIGH) submitted to the Australian Therapeutic Goods Administration and New Zealand Pharmacovigilance Centre between 1992 and 2013...
June 16, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28620812/case-study-of-first-episode-schizophrenia-in-pregnancy-and-postpartum
#15
Kristopher A Kast, Smita Agarkar
Patients with first-episode psychosis of peripartum onset commonly prove to have a mood-disorder diathesis; however, a proportion of cases represent first-episode schizophrenia. We present such a case and discuss the clinical relevance of recognizing this small but important population of new mothers. These patients are at considerable risk of misdiagnosis, resulting in ineffective maintenance therapy, poorer recovery of function, and development of treatment resistance. Accurate diagnosis in the peripartum period will impact treatment decisions and long-term therapy...
August 2017: Archives of Women's Mental Health
https://www.readbyqxmd.com/read/28599949/quetiapine-extended-release-versus-aripiprazole-in-children-and-adolescents-with-first-episode-psychosis-the-multicentre-double-blind-randomised-tolerability-and-efficacy-of-antipsychotics-tea-trial
#16
Anne Katrine Pagsberg, Pia Jeppesen, Dea Gowers Klauber, Karsten Gjessing Jensen, Ditte Rudå, Marie Stentebjerg-Olesen, Peter Jantzen, Simone Rasmussen, Eva Ann-Sofie Saldeen, Maj-Britt Glenn Lauritsen, Niels Bilenberg, Anne Dorte Stenstrøm, Louise Nyvang, Sarah Madsen, Thomas M Werge, Theis Lange, Christian Gluud, Maria Skoog, Per Winkel, Jens Richardt M Jepsen, Birgitte Fagerlund, Christoph U Correll, Anders Fink-Jensen
BACKGROUND: Head-to-head trials to guide antipsychotic treatment choices for paediatric psychosis are urgently needed because extrapolations from adult studies might not be implementable. In this superiority trial with two-sided significance testing, we aimed to compare the efficacy and safety of quetiapine-extended release (quetiapine-ER) versus aripiprazole in children and adolescents with first-episode psychosis, to determine whether differences between the two treatments were sufficient to guide clinicians in their choice of one drug over the other...
June 6, 2017: Lancet Psychiatry
https://www.readbyqxmd.com/read/28597291/multiple-drug-transporters-mediate-the-placental-transport-of-sulpiride
#17
Mengru Bai, Zhiyuan Ma, Dongli Sun, Caihong Zheng, Yayun Weng, Xi Yang, Ting Jiang, Huidi Jiang
Sulpiride is a typical antipsychotic drug for the treatment of schizophrenia, depression and other psychological disorders. It has been proven that a small amount of sulpiride could cross the human placenta using an ex vivo placental perfusion model. However, the placental transfer mechanism has not been elucidated. Considering the structure of sulpiride, we speculated that the transporters expressed in placenta might be involved in sulpiride uptake across the blood-placenta barrier. The aim of our study was to determine which transporters contributed to the placental transfer of sulpiride...
June 9, 2017: Archives of Toxicology
https://www.readbyqxmd.com/read/28578741/antipsychotic-combinations-in-schizophrenia
#18
C Gastaldon, D Papola, G Ostuzzi
In the treatment of resistant schizophrenia, a number of meta-analyses attempted to quantify the efficacy and tolerability of antipsychotic (AP) polypharmacy v. monotherapy with contradictory results. Recently, a systematic review and meta-analysis of randomised controlled trials investigated the efficacy and tolerability of AP combination v. monotherapy in schizophrenia. It included 31 studies: 21 double-blind (considered high-quality studies) and 10 open-label (considered low-quality studies). The meta-analysis showed that, overall, the combination of two APs was more effective than monotherapy in terms of symptom reduction (standardised mean difference (SMD) = -0...
June 5, 2017: Epidemiology and Psychiatric Sciences
https://www.readbyqxmd.com/read/28574288/chronotype-and-its-relationship-with-sleep-disorders-in-children-with-attention-deficit-hyperactivity-disorder
#19
Fatma Benk Durmuş, Ayşe Rodopman Arman, Ayşe Burcu Ayaz
Chronotype can be classified as morningness types, people who prefer morning hours for their physical and mental activities; eveningness types, people who prefer the afternoon or evening hours; and intermediate types, those who show characteristics of both morningness and eveningness types. Attention deficit hyperactivity disorder (ADHD) has been linked with disturbances in chronotype, particularly increased eveningness. Despite the possibility of an association between chronotypes, sleep disturbances and ADHD symptoms, there is little evidence of this association considering the child population...
June 2, 2017: Chronobiology International
https://www.readbyqxmd.com/read/28573760/oral-glucose-tolerance-test-performance-in-olanzapine-treated-schizophrenia-spectrum-patients-is-predicted-by-bmi-and-triglycerides-but-not-olanzapine-dose-or-duration
#20
Jeffrey Guina, Sayon Roy, Ankur Gupta, Daniel D Langleben, Igor Elman
OBJECTIVE: Olanzapine, an atypical antipsychotic, is associated with glucoregulatory abnormalities, but the nature of this link is not fully elucidated. This is the first olanzapine oral glucose tolerance test (oGTT) study to consider treatment dose and duration, and to compare complementary indices respectively assessing insulin sensitivity (Matsuda index) and resistance (homeostasis model assessment). METHODS: Body mass index (BMI), body composition, plasma lipids, and oGTT were measured in olanzapine-treated nondiabetic patients with DSM-IV-TR diagnosis of schizophrenia or schizoaffective disorder (n = 35)...
June 1, 2017: Human Psychopharmacology
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