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Treatment-resistant Schizophrenia

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https://www.readbyqxmd.com/read/29310360/achieving-stable-remission-with-maintenance-electroconvulsive-therapy-in-a-patient-with-treatment-resistant-schizophrenia-a-case-report
#1
Sebastian Moeller, Neele Kalkwarf, Caroline Lücke, Diana Ortiz, Sonja Jahn, Christiane Först, Niclas Braun, Alexandra Philipsen, Helge H O Müller
RATIONALE: Up to one third of all schizophrenic patients are classified as having treatment-resistant schizophrenia (TRS). This subgroup faces remarkable medical and psychosocial damages, and pharmacotherapy is often limited due to nonresponse and/or side effects. Maintenance electroconvulsive therapy (M-ECT) might be effective in TRS. PATIENT CONCERNS: We present a case of a 26-year-old male patient with a TRS. DIAGNOSES: He received a treatment series of ECT sessions and a course of 24 M-ECTs...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29298994/cost-effectiveness-of-hla-dqb1-hla-b-pharmacogenetic-guided-treatment-and-blood-monitoring-in-us-patients-taking-clozapine
#2
François R Girardin, Antoine Poncet, Arnaud Perrier, Nathalie Vernaz, Mark Pletscher, Caroline F Samer, Jeffrey A Lieberman, Jean Villard
Less than 1% of adult patients with schizophrenia taking clozapine develop agranulocytosis, and most of these cases occur within the first weeks of treatment. The human leukocyte antigen (HLA) region has been associated with genetic susceptibility to clozapine-induced agranulocytosis (single amino acid changes in HLA-DQB1 (126Q) and HLA-B (158T)). The current study aimed to evaluate the cost-effectiveness, from a healthcare provider's perspective, of an HLA genotype-guided approach in patients with treatment-resistant schizophrenia who were taking clozapine and to compare the results with the current absolute neutrophil count monitoring (ANCM) schemes used in the USA...
January 3, 2018: Pharmacogenomics Journal
https://www.readbyqxmd.com/read/29284810/efficacy-and-tolerability-of-clozapine-versus-quetiapine-in-treatment-resistant-schizophrenia
#3
Mitesh Kumar, B S Chavan, Ajeet Sidana, Subhash Das
Objectives: To compare the efficacy and tolerability of clozapine and quetiapine in patients with treatment-resistant schizophrenia (TRS). Patients and Methods: In this prospective, randomized, open label study of 14 weeks, 53 patients with schizophrenia diagnosed as per ICD-10 and fulfilling the modified version of Conley and Kelly's criteria of TRS were randomly assigned to receive clozapine or quetiapine as per a computer-generated random table. After 2-weeks of dose-titration phase, doses were fixed at minimum therapeutic dose and subsequently adjusted according to the clinical improvement...
November 2017: Indian Journal of Psychological Medicine
https://www.readbyqxmd.com/read/29274737/substantia-nigra-ultrastructural-pathology-in-schizophrenia
#4
Courtney K Walker, Joy K Roche, Vidushi Sinha, Rosalinda C Roberts
Schizophrenia is a severe mental illness affecting approximately 1% of the population worldwide. Despite its prevalence, the cause remains unknown, and treatment is not effective in all patients. Dopamine is thought to play a role in schizophrenia pathology, yet the substantia nigra (SN), the origin of dopaminergic pathways, has not been studied extensively in schizophrenia. In this study, electron microscopy was used to examine neurons, oligodendrocytes, and myelinated axons in the SN of normal controls (NCs, n=9) and schizophrenia subjects with varying response to antipsychotic drugs [SZ, n=14; treatment resistant (TR)=6, treatment responsive (RESP)=6, unknown=2]...
December 20, 2017: Schizophrenia Research
https://www.readbyqxmd.com/read/29259655/continuation-with-clozapine-after-eosinophilia-a-case-report
#5
Yen-Cheng Ho, Huang-Li Lin
Background: Clozapine-induced eosinophilia had been reported in several studies about blood dyscrasias in clozapine-treated patient. The largest study with 2404 patients in Italy found the incidence of 2.2% by criteria of more than 0.4 × 109/l. Associated cases of pancreatitis, hepatitis, colitis, nephritis, and myocarditis were reported. Interestingly, incidence of myocarditis is high in Australia, but low in the rest of the world. In the following, we will present a case of clozapine-induced eosinophilia which spontaneous resolution was noted under continuation of clozapine...
2017: Annals of General Psychiatry
https://www.readbyqxmd.com/read/29241148/obesity-exacerbates-the-acute-metabolic-side-effects-of-olanzapine
#6
Logan K Townsend, Willem T Peppler, Natasha D Bush, David C Wright
Olanzapine is a second-generation antipsychotic used in the management of schizophrenia and various off-label conditions. The acute metabolic responses of olanzapine recapitulate many of the side effects associated with obesity. Obesity rates are high in the schizophrenic population, but it is unknown whether pre-existing obesity-associated metabolic dysfunction augments the acute side effects of olanzapine. To address this question, we compared the responses to olanzapine in lean and high-fat diet-induced (HFD) obese mice...
December 8, 2017: Psychoneuroendocrinology
https://www.readbyqxmd.com/read/29230675/clozapine-and-gastrointestinal-hypomotility
#7
REVIEW
Dan Cohen
Gastrointestinal hypomotility (GIH) is an under-reported but highly prevalent and potentially dangerous side effect of clozapine. In a comprehensive meta-analysis of clozapine-treated patients, the prevalence of GIH was 32%. In general, GIH has consistently been reported to have a negative impact on quality of life, and there is no reason to believe this will be different in clozapine-treated patients with therapy-resistant schizophrenia. GIH is dangerous; in a comparative review of lethal side effects of clozapine, the mortality of agranulocytosis was 2...
December 11, 2017: CNS Drugs
https://www.readbyqxmd.com/read/29218779/association-between-global-functioning-at-first-schizophrenia-diagnosis-and-treatment-resistance
#8
Henriette T Horsdal, Theresa Wimberley, Ole Köhler-Forsberg, Lone Baandrup, Christiane Gasse
AIM: Several factors such as age, gender, urbanicity and clinical treatment setting have been associated with treatment-resistant schizophrenia (TRS). We examined the association between the Global Assessment of Functioning (social Functioning [GAF-F]) score at first schizophrenia diagnosis and TRS and explored whether level of functioning could partially explain the known associations. METHODS: A nationwide population-based cohort study among individuals, who had a GAF-F score at first schizophrenia diagnosis...
December 8, 2017: Early Intervention in Psychiatry
https://www.readbyqxmd.com/read/29200573/neural-effects-of-transcranial-direct-current-stimulation-in-schizophrenia-a-case-study-using-functional-near-infrared-spectroscopy
#9
S Trevor Taylor, Harleen Chhabra, Vanteemar S Sreeraj, Venkataram Shivakumar, Sunil V Kalmady, Ganesan Venkatasubramanian
Schizophrenia is a severe neuropsychiatric disorder characterized by delusions, hallucinations, behavioral symptoms, and cognitive deficits. Roughly, 70%-80% of schizophrenia patients experience auditory verbal hallucinations (AVHs), with 25%-30% demonstrating resistance to conventional antipsychotic medications. Studies suggest a promising role for add-on transcranial direct current stimulation (tDCS) in the treatment of medication-refractory AVHs. The mechanisms through which tDCS could be therapeutic in such cases are unclear, but possibly involve neuroplastic effects...
September 2017: Indian Journal of Psychological Medicine
https://www.readbyqxmd.com/read/29199762/m-resist-a-complete-m-health-solution-for-patients-with-treatmentresistant-schizophrenia-a-qualitative-study-of-user-needs-and-acceptability-in-the-barcelona-metropolitan-area
#10
Elena Huerta-Ramos, Silvia Marcó-García, Maria Soledad Escobar-Villegas, Elena Rubio-Abadal, Susana Ochoa, Eva M Grasa Bello, Anna Alonso Solís, Mireia Rabella, Jesús Berdun, Margarita Hospedales, Group M-Resist, Iluminada Corripio, Judith Usall
BACKGROUND: Despite the theoretical potential of m-health solutions in the treatment of patients with schizophrenia, there remains a lack of technological solutions in daily practice. The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to an integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment Resistant Schizophrenia (m-RESIST). METHODS: A qualitative study of the needs and acceptability of outpatients with treatment-resistant schizophrenia was carried out in Parc Sanitari Sant Joan de Déu (Barcelona)...
November 2017: Actas Españolas de Psiquiatría
https://www.readbyqxmd.com/read/29193710/effectiveness-of-the-repeated-administration-of-scopolamine-ointment-on-clozapine-induced-hypersalivation-in-patients-with-treatment-resistant-schizophrenia-a-preliminary-study
#11
Ippei Takeuchi, Manako Hanya, Junji Uno, Kiyoshi Fujita, Hiroyuki Kamei
INTRODUCTION: This study investigated the efficacy of scopolamine (an anticholinergic agent) ointment against clozapine-induced hypersalivation. METHODS: The patients enrolled in this study consisted of 10 clozapine-treated schizophrenia patients and 10 healthy adult men. A prospective, randomized, double-blind, crossover, placebo-controlled clinical trial was designed. RESULTS: A total of 10 patients and 10 healthy adult men completed the study...
December 2017: Asia-Pacific Psychiatry: Official Journal of the Pacific Rim College of Psychiatrists
https://www.readbyqxmd.com/read/29163244/peripheral-transcription-of-nrg-erbb-pathway-genes-are-upregulated-in-treatment-resistant-schizophrenia
#12
Md Shaki Mostaid, Ting Ting Lee, Gursharan Chana, Suresh Sundram, Cynthia Shannon Weickert, Christos Pantelis, Ian Everall, Chad Bousman
Investigation of peripheral gene expression patterns of transcripts within the NRG-ErbB signaling pathway, other than neuregulin-1 (NRG1), among patients with schizophrenia and more specifically treatment-resistant schizophrenia (TRS) is limited. The present study built on our previous work demonstrating elevated levels of NRG1 EGFα, EGFβ, and type I(Ig2) containing transcripts in TRS by investigating 11 NRG-ErbB signaling pathway mRNA transcripts (NRG2, ErbB1, ErbB2, ErbB3, ErbB4, PIK3CD, PIK3R3, AKT1, mTOR, P70S6K, eIF4EBP1) in whole blood of TRS patients (N = 71) and healthy controls (N = 57)...
2017: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/29117910/increased-resting-state-global-functional-connectivity-density-of-default-mode-network-in-schizophrenia-subjects-treated-with-electroconvulsive-therapy
#13
Huan Huang, Yuchao Jiang, Mengqing Xia, Yingying Tang, Tianhong Zhang, Huiru Cui, Junjie Wang, Yu Li, Lihua Xu, Adrian Curtin, Jianhua Sheng, Yuping Jia, Dezhong Yao, Chunbo Li, Cheng Luo, Jijun Wang
Modified electroconvulsive therapy (MECT) has been widely applied to help treat schizophrenia patients who are treatment-resistant to pharmaceutical therapy. Although the technique is increasingly prevalent, the underlying neural mechanisms have not been well clarified. We conducted a longitudinal study to investigate the alteration of global functional connectivity density (gFCD) in schizophrenia patients undergoing MECT using resting state fMRI (functional magnetic resonance imaging). Two groups of schizophrenia inpatients were recruited...
November 6, 2017: Schizophrenia Research
https://www.readbyqxmd.com/read/29116126/development-of-multivariable-models-to-predict-change-in-body-mass-index-within-a-clinical-trial-population-of-psychotic-individuals
#14
Rebecca N S Harrison, Fiona Gaughran, Robin M Murray, Sang Hyuck Lee, Jose Paya Cano, David Dempster, Charles J Curtis, Danai Dima, Hamel Patel, Simone de Jong, Gerome Breen
Many antipsychotics promote weight gain, which can lead to non-compliance and relapse of psychosis. By developing models that accurately identify individuals at greater risk of weight gain, clinicians can make informed treatment decisions and target intervention measures. We examined clinical, genetic and expression data for 284 individuals with psychosis derived from a previously published randomised controlled trial (IMPACT). These data were used to develop regression and classification models predicting change in Body Mass Index (BMI) over one year...
November 7, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29083297/in-male-rats-the-ability-of-central-insulin-to-suppress-glucose-production-is-impaired-by-olanzapine-whereas-glucose-uptake-is-left-intact
#15
Chantel Kowalchuk, Celine Teo, Virginia Wilson, Araba Chintoh, Loretta Lam, Sri Mahavir Agarwal, Adria Giacca, Gary J Remington, Margaret K Hahn
BACKGROUND: Insulin receptors are widely expressed in the brain and may represent a crossroad between metabolic and cognitive disorders. Although antipsychotics, such as olanzapine, are the cornerstone treatment for schizophrenia, they are associated with high rates of type 2 diabetes and lack efficacy for illness-related cognitive deficits. Historically, this risk of diabetes was attributed to the weight gain propensity of antipsychotics, but recent work suggests antipsychotics can have weight-independent diabetogenic effects involving unknown brain-mediated mechanisms...
November 2017: Journal of Psychiatry & Neuroscience: JPN
https://www.readbyqxmd.com/read/29077650/safety-and-efficacy-of-theta-burst-stimulation-in-the-treatment-of-psychiatric-disorders-a-review-of-the-literature
#16
REVIEW
Fady Rachid
Theta-burst stimulation (TBS) is a form of repetitive transcranial magnetic stimulation and is thought to induce more rapid and longer-lasting effects on synaptic plasticity than conventional repetitive transcranial magnetic stimulation protocols. TBS is being used as an investigational and more recently as a therapeutic tool. The purpose of this review is to describe and discuss the studies that have evaluated the safety and efficacy of this technique in the treatment of various psychiatric disorders such as depression, schizophrenia, obsessive-compulsive disorder, Tourette's disorder, nicotine and cocaine addiction, and pathological gambling...
November 2017: Journal of Nervous and Mental Disease
https://www.readbyqxmd.com/read/29072776/antipsychotic-plasma-levels-in-the-assessment-of-poor-treatment-response-in%C3%A2-schizophrenia
#17
R McCutcheon, K Beck, E D'Ambrosio, J Donocik, C Gobjila, S Jauhar, S Kaar, T Pillinger, T Reis Marques, M Rogdaki, O D Howes
OBJECTIVE: Treatment resistance is a challenge for the management of schizophrenia. It is not always clear whether inadequate response is secondary to medication ineffectiveness, as opposed to medication underexposure due to non-adherence or pharmacokinetic factors. We investigated the prevalence of subtherapeutic antipsychotic plasma levels in patients identified as treatment-resistant by their treating clinician. METHOD: Between January 2012 and April 2017, antipsychotic plasma levels were measured in 99 individuals provisionally diagnosed with treatment-resistant schizophrenia by their treating clinicians, but not prescribed clozapine...
October 26, 2017: Acta Psychiatrica Scandinavica
https://www.readbyqxmd.com/read/29057817/unresolved-issues-for-utilization-of-atypical-antipsychotics-in-schizophrenia-antipsychotic-polypharmacy-and-metabolic-syndrome
#18
REVIEW
Sang Won Jeon, Yong-Ku Kim
Atypical antipsychotics (AAP) are the prevailing form of schizophrenia treatment today due to their low side effects and superior efficacy. Nevertheless, some issues still need to be addressed. First, there are still a large number of patients with treatment-resistant schizophrenia (TRS), which has led to a growing trend to resort to AAP polypharmacy with few side effects. Most clinical treatment guidelines recommend clozapine monotherapy in TRS, but around one third of schizophrenic patients fail to respond to clozapine...
October 18, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29053485/the-effects-of-electroconvulsive-therapy-augmentation-of-antipsychotic-treatment-on-cognitive-functions-in-patients-with-treatment-resistant-schizophrenia
#19
Bjanka Vuksan Ćusa, Nataša Klepac, Nenad Jakšić, Zoran Bradaš, Marija Božičević, Natalia Palac, Marina Šagud
OBJECTIVES: Treatment-resistant schizophrenia (TRS) continues to be a challenge in modern psychiatry. Most of these patients have severe neurocognitive deficits. Electroconvulsive therapy (ECT) has proved effective and safe in the treatment of TRS, but because of potential neurocognitive adverse effects, it is associated with many controversies. The aim of this prospective, open study was to evaluate the effects of ECT augmentation of antipsychotics on cognitive functions in patients with TRS...
October 19, 2017: Journal of ECT
https://www.readbyqxmd.com/read/29050493/serum-bdnf-is-positively-associated-with-negative-symptoms-in-older-adults-with-schizophrenia
#20
Sasha S Binford, Erin M Hubbard, Elena Flowers, Bruce L Miller, Heather Leutwyler
OBJECTIVES: Older adults with chronic schizophrenia are at greater risk for functional disability and poorer health outcomes than those without serious mental illness. These individuals comprise 1-2% of the elderly population in the United States and are projected to number approximately 15 million by 2030. The symptoms of schizophrenia can be disabling for individuals, significantly reducing quality of life. Often, the negative symptoms (NS) are the most resistant to treatment and are considered a marker of illness severity, though they are challenging to measure objectively...
January 1, 2017: Biological Research for Nursing
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