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Treatment resistant schizophrenia

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
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
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...
October 18, 2016: Clinical Neuropharmacology
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...
October 6, 2016: International Clinical Psychopharmacology
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
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
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
Tongeji E Tungaraza
It has been repeatedly shown that clozapine is more efficacious than other antipsychotics in the management of treatment-resistant schizophrenia. However, clozapine is associated with a number of side effects including weight gain. Antipsychotic-induced weight gain has been linked with a number of untoward events including psychological factors such as stigma and low self-esteem, and physical factors such as metabolic syndromes and untimely death. The mechanism underlying antipsychotic (including clozapine)-induced weight gain is not clearly understood, although it is said to involve several brain areas, several neurotransmitters, neuropeptides and genetic factors...
October 2016: Therapeutic Advances in Psychopharmacology
John Kasinathan, Gillian Sharp, Anthony Barker
OBJECTIVES: Olanzapine is a well established treatment for schizophrenia. The olanzapine pamoate depot (long-acting injectable) formulation improves compliance and clinical trials have shown it to be effective. However, there are no previously published reports evaluating olanzapine depot in violent patients with schizophrenia in the community. We evaluated the clinical efficacy of olanzapine depot, its effect on violence, hospitalization and incarceration in community patients with schizophrenia and prior history of serious violence...
October 2016: Therapeutic Advances in Psychopharmacology
Amy McKeever, SueEllen Alderman, Stephanie Luff, Brian DeJesus
Severe and persistent mental illness (SPMI) refers to complex mood disorders that include major depressive disorder with or without psychosis; severe anxiety disorders resistant to treatment; affective psychotic disorders including bipolar affective disorder, schizophrenia, and schizoaffective disorder; and other nonaffective subtypes of schizophrenia. SPMIs affect 1 in 17 people and are among the leading causes of disability and impaired health-related quality of life in the United States. Caring for childbearing women with preexisting SPMI can be challenging for maternal-child health clinicians...
October 2016: Nursing for Women's Health
Varuni Asanka de Silva, Chathurie Suraweera, Suhashini S Ratnatunga, Madhubashinee Dayabandara, Nimali Wanniarachchi, Raveen Hanwella
BACKGROUND: Most antipsychotics are associated with weight gain and other metabolic complications. Several randomized trials have shown metformin to be effective, but this still hasn't been included in clinical guidelines on managing antipsychotic induced weight gain. METHODS: All double blind placebo controlled trials assessing the efficacy of metformin in the treatment of antipsychotic induced weight gain were included. Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE were searched for the period January 2000-December 2015...
October 3, 2016: BMC Psychiatry
Şükrü Kartalcı, Lale Gönenir Erbay, Esra Porgalı Zayman, Önder Otlu, Aysun Bay Karabulut, Gülşen Kartalcı
OBJECTIVE: Schizophrenia is a chronic psychotic disorder in which genetics and environmental factors such as infection and the corresponding immune response play a role in the etiopathogenesis. The aim of this study was to compare some immune factors such as nuclear factor-B (NF-B) activation, myeloperoxidase (MPO), the anti-inflammatory cytokine interleukin-4 (IL-4), and regulatory cytokine transforming growth factor- (TGF-) in schizophrenia patients and an age- and gender-matched control group...
2016: Türk Psikiyatri Dergisi, Turkish Journal of Psychiatry
Morgane Besson, Benoît Forget
Although smoking prevalence has declined in recent years, certain subpopulations continue to smoke at disproportionately high rates and show resistance to cessation treatments. Individuals showing cognitive and affective impairments, including emotional distress and deficits in attention, memory, and inhibitory control, particularly in the context of psychiatric conditions, such as attention-deficit hyperactivity disorder, schizophrenia, and mood disorders, are at higher risk for tobacco addiction. Nicotine has been shown to improve cognitive and emotional processing in some conditions, including during tobacco abstinence...
2016: Frontiers in Psychiatry
Taylor M Mehta, Ryan J Van Lieshout
Clozapine is an antipsychotic used in the management of treatment-resistant schizophrenia. However, little is known about clozapine use during pregnancy and lactation, or its impact on the mother, foetus, and infant. This review aims to summarize the available literature on the safety of clozapine use during the perinatal period. EMBASE, PsycINFO, and MEDLINE were searched from their inceptions through June 2016. The review encompasses 21 studies that have examined clozapine use during pregnancy and lactation...
October 4, 2016: Archives of Women's Mental Health
Patrick Davey, Siobhan Gee, Sukhi S Shergill
SUMMARY: A case is presented of a 25-year-old man with treatment-resistant paranoid schizophrenia whose only previous trial of clozapine had been stopped following a suspected clozapine-induced myocarditis. Due to the failure of his psychosis to respond to a number of antipsychotic treatments and augmentation strategies, clozapine was restarted on admission. His rechallenge was marked by intermittent pyrexia, tachycardia and elevated C-reactive protein (CRP), but eosinophilia was absent...
May 2016: BJPsych Open
S E Holmes, R Hinz, R J Drake, C J Gregory, S Conen, J C Matthews, J M Anton-Rodriguez, A Gerhard, P S Talbot
Positron emission tomography (PET) imaging of the 18 kDa translocator protein (TSPO) has been used to investigate whether microglial activation, an indication of neuroinflammation, is evident in the brain of adults with schizophrenia. Interpretation of these studies is confounded by potential modulatory effects of antipsychotic medication on microglial activity. In the first such study in antipsychotic-free schizophrenia, we have used [(11)C](R)-PK11195 PET to compare TSPO availability in a predominantly antipsychotic-naive group of moderate-to-severely symptomatic unmedicated patients (n=8), similarly symptomatic medicated patients with schizophrenia taking risperidone or paliperidone by regular intramuscular injection (n=8), and healthy comparison subjects (n=16)...
October 4, 2016: Molecular Psychiatry
Diane Grillault Laroche, Adeline Gaillard
The prevalence of OCS and OCD is higher in schizophrenic patients than in the general population. These disorders are sometimes induced by AAPs. There is higher frequency of OCS and greater severity in patients treated with antipsychotics with predominant anti-serotoninergic profiles opposed to those with predominant dopaminergic blockade. Induced OCS may be due to complex neuromodulation involving many serotonin, dopamine and glutamate receptors and several subtypes. Concerning connectivity, AAPs differentially influence the BOLD signal, depending on the intensity of D2 receptor blockade...
September 21, 2016: Psychiatry Research
Elena Huerta-Ramos, Maria Soledad Escobar-Villegas, Katya Rubinstein, Zsolt Szabolcs Unoka, Eva Grasa, Margarita Hospedales, Erika Jääskeläinen, Elena Rubio-Abadal, Asaf Caspi, István Bitter, Jesus Berdun, Jussi Seppälä, Susana Ochoa, Kata Fazekas, Iluminada Corripio, Judith Usall
BACKGROUND: Despite the theoretical potential of mHealth solutions in the treatment of patients with schizophrenia, there remains a lack of technological tools in clinical practice. OBJECTIVE: The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to a European integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST)...
2016: JMIR MHealth and UHealth
Maria Pontillo, Franco De Crescenzo, Stefano Vicari, Maria Laura Pucciarini, Roberto Averna, Ornella Santonastaso, Marco Armando
AIM: To provide an updated of recent findings about efficacy of cognitive-behavior therapy (CBT) in reduction of command hallucinations. METHODS: PubMed/MEDLINE, Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, searches were performed using the keywords "hallucinations", "behavioural therapy" and " cognitive therapy" in order to identify relevant articles published during the years of 2011 to 2016. No language limits were used...
September 22, 2016: World Journal of Psychiatry
Mihriban Dalkıran, Akif Tasdemir, Tamer Salihoglu, Murat Emul, Alaattin Duran, Mufit Ugur, Ruhi Yavuz
People with schizophrenia have impairments in emotion recognition along with other social cognitive deficits. In the current study, we aimed to investigate the immediate benefits of ECT on facial emotion recognition ability. Thirty-two treatment resistant patients with schizophrenia who have been indicated for ECT enrolled in the study. Facial emotion stimuli were a set of 56 photographs that depicted seven basic emotions: sadness, anger, happiness, disgust, surprise, fear, and neutral faces. The average age of the participants was 33...
September 23, 2016: Psychiatric Quarterly
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