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Treatment-resistant Schizophrenia

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https://www.readbyqxmd.com/read/28097367/impaired-glucose-homeostasis-in-first-episode-schizophrenia-a-systematic-review-and-meta-analysis
#1
Toby Pillinger, Katherine Beck, Cristian Gobjila, Jacek G Donocik, Sameer Jauhar, Oliver D Howes
Importance: Schizophrenia is associated with an increased risk of type 2 diabetes. However, it is not clear whether schizophrenia confers an inherent risk for glucose dysregulation in the absence of the effects of chronic illness and long-term treatment. Objective: To conduct a meta-analysis examining whether individuals with first-episode schizophrenia already exhibit alterations in glucose homeostasis compared with controls. Data Sources: The EMBASE, MEDLINE, and PsycINFO databases were systematically searched for studies examining measures of glucose homeostasis in antipsychotic-naive individuals with first-episode schizophrenia compared with individuals serving as controls...
January 11, 2017: JAMA Psychiatry
https://www.readbyqxmd.com/read/28094812/putative-presynaptic-dopamine-dysregulation-in-schizophrenia-is-supported-by-molecular-evidence-from-post-mortem-human-midbrain
#2
T D Purves-Tyson, S J Owens, D A Rothmond, G M Halliday, K L Double, J Stevens, T McCrossin, C Shannon Weickert
The dopamine hypothesis of schizophrenia posits that increased subcortical dopamine underpins psychosis. In vivo imaging studies indicate an increased presynaptic dopamine synthesis capacity in striatal terminals and cell bodies in the midbrain in schizophrenia; however, measures of the dopamine-synthesising enzyme, tyrosine hydroxylase (TH), have not identified consistent changes. We hypothesise that dopamine dysregulation in schizophrenia could result from changes in expression of dopamine synthesis enzymes, receptors, transporters or catabolic enzymes...
January 17, 2017: Translational Psychiatry
https://www.readbyqxmd.com/read/28086761/is-treatment-resistant-schizophrenia-categorically-distinct-from-treatment-responsive-schizophrenia-a-systematic-review
#3
Amy L Gillespie, Ruta Samanaite, Jonathan Mill, Alice Egerton, James H MacCabe
BACKGROUND: Schizophrenia is a highly heterogeneous disorder, and around a third of patients are treatment-resistant. The only evidence-based treatment for these patients is clozapine, an atypical antipsychotic with relatively weak dopamine antagonism. It is plausible that varying degrees of response to antipsychotics reflect categorically distinct illness subtypes, which would have significant implications for research and clinical practice. If these subtypes could be distinguished at illness onset, this could represent a first step towards personalised medicine in psychiatry...
January 13, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28071142/erratum
#4
(no author information available yet)
Lee J, Takeuchi H, Fervaha G, Sin GL, Foussias G, Agid O, Farooq S, Remington G. Subtyping schizophrenia by treatment response: antipsychotic development and the central role of positive symptoms. Can J Psychiatry. 2015;60(11):515-522. Original DOI: 10.1177/070674371506001107. In Table 2 of the above article, in "Proposed criteria for clozapine resistance" for "Current illness severity," the CGI-SCH positive was stated as "> 4" but it should be "CGI-SCH positive ≥ 4." The corrected table is below. [Table: see text]...
March 2016: Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
https://www.readbyqxmd.com/read/28067751/efficacy-of-clozapine-on-dopamine-supersensitivity-psychosis-in-schizophrenia
#5
Yusuke Nakata, Nobuhisa Kanahara, Hiroshi Kimura, Hiroyuki Watanabe, Masaomi Iyo
Although the effectiveness of clozapine (CLZ) for patients with treatment-resistant schizophrenia (TRS) has been well established, its active mechanism has not been completely clarified. Several clinical studies showed that neuroleptic-induced dopamine supersensitivity psychosis (DSP) could be involved in the etiology of TRS. We preliminarily explored the possible beneficial effect of CLZ for dopamine supersensitivity schizophrenia. The present study is a case series. We followed 15 patients with DSP for about 2...
January 6, 2017: International Clinical Psychopharmacology
https://www.readbyqxmd.com/read/28064233/clozapine-associated-with-autoimmune-reaction-fever-and-low-level-cardiotoxicity-a-case-report
#6
Charilaos Gerasimou, Georgia Phaedra Vitali, George D Vavougios, Charalabos Papageorgiou, Athanasios Douzenis, Styliani I Kokoris, Ioannis Liappas, Emmanouil Rizos
BACKGROUND: Clozapine is a second-generation antipsychotic drug used in treatment-resistant schizophrenia. Fever induced by clozapine is a rather frequent side-effect which usually occurs in the first 4 weeks of treatment. Despite its effectiveness, there are potentially life-threatening adverse effects, such as cardiotoxicity. CASE REPORT: We present the case of a 31-year-old caucasian male with refractory schizophrenia who developed benign fever, increase of C-reactive protein and high troponin levels, without presenting any other signs to myocarditis, on the 13th day under clozapine treatment, which declined progressively upon discontinuation of the drug...
January 2017: In Vivo
https://www.readbyqxmd.com/read/28062471/pharmacological-guidelines-for-schizophrenia-a-systematic-review-and-comparison-of-recommendations-for-the-first-episode
#7
Dolores Keating, Stephen McWilliams, Ian Schneider, Caroline Hynes, Gráinne Cousins, Judith Strawbridge, Mary Clarke
OBJECTIVES: Clinical practice guidelines (CPGs) support the translation of research evidence into clinical practice. Key health questions in CPGs ensure that recommendations will be applicable to the clinical context in which the guideline is used. The objectives of this study were to identify CPGs for the pharmacological treatment of first-episode schizophrenia; assess the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument; and compare recommendations in relation to the key health questions that are relevant to the pharmacological treatment of first-episode schizophrenia...
January 6, 2017: BMJ Open
https://www.readbyqxmd.com/read/28017493/music-evoked-emotions-in-schizophrenia
#8
Daijyu Abe, Makoto Arai, Masanari Itokawa
BACKGROUND/OBJECTIVES: Previous studies have reported that people with schizophrenia have impaired musical abilities. Here we developed a simple music-based assay to assess patient's ability to associate a minor chord with sadness. We further characterize correlations between impaired musical responses and psychiatric symptoms. METHOD: We exposed participants sequentially to two sets of sound stimuli, first a C-major progression and chord, and second a C-minor progression and chord...
December 23, 2016: Schizophrenia Research
https://www.readbyqxmd.com/read/28011131/functional-brain-networks-in-treatment-resistant-schizophrenia
#9
Eleni P Ganella, Cali F Bartholomeusz, Caio Seguin, Sarah Whittle, Chad Bousman, Christina Phassouliotis, Ian Everall, Christos Pantelis, Andrew Zalesky
INTRODUCTION: Up to 20% of individuals with schizophrenia show minimal or no response to medication and are considered to have 'treatment-resistant' schizophrenia (TRS). Unlike early and established schizophrenia, few studies have investigated resting-state functional connectivity (rs-FC) in TRS. Here, we test for disruptions in FC and altered efficiency of functional brain networks in a well-characterized cohort of TRS patients. METHODS: Resting-state functional magnetic resonance imaging was used to investigate functional brain networks in 42 TRS participants prescribed clozapine (30 males, mean age=41...
December 20, 2016: Schizophrenia Research
https://www.readbyqxmd.com/read/27996317/cardiac-arrest-with-clozapine-and-olanzapine-revealing-long-qt-syndrome
#10
Edward Woloszyn, Nishant Whig, Eileen Trigoboff, Jeffery J Grace
The authors describe a rare case of "concealed" congenital Long QT Syndrome (LQTS) Type 3 in a patient with treatment resistant schizophrenia and no known personal or family history of cardiac disease. The patient in this Case Report had a hidden genetic condition revealed only following the essential administration of antipsychotics. As a result, this patient experienced an aborted cardiac arrest and a total of five episodes of ventricular tachycardia (VT) requiring cardioversion. Successful control of the VT occurred with an Automatic Internal Defibrillator (AID), judicious use of antipsychotic medications, and anti-arrhythmic medications...
December 20, 2016: Clinical Schizophrenia & related Psychoses
https://www.readbyqxmd.com/read/27995063/integrity-of-the-arcuate-fasciculus-in-patients-with-schizophrenia-with-auditory-verbal-hallucinations-a-dti-tractography-study
#11
Marion Psomiades, Clara Fonteneau, Marine Mondino, David Luck, Frederic Haesebaert, Marie-Françoise Suaud-Chagny, Jerome Brunelin
Auditory verbal hallucinations (AVH) of schizophrenia are associated with a disrupted connectivity between frontal and temporoparietal language areas. We hypothesized that this dysconnectivity is underpinned by white matter abnormalities in the left arcuate fasciculus, the main fiber bundle connecting speech production and perception areas. We therefore investigated the relationship between AVH severity and the integrity of the arcuate fasciculus measured by diffusion tensor imaging (DTI) tractography in patients with schizophrenia...
2016: NeuroImage: Clinical
https://www.readbyqxmd.com/read/27990037/dynamic-3-d-computer-graphics-for-designing-a-diagnostic-tool-for-patients-with-schizophrenia
#12
Attila Farkas, Thomas V Papathomas, Steven M Silverstein, Hristiyan Kourtev, John F Papayanopoulos
We introduce a novel procedure that uses dynamic 3-D computer graphics as a diagnostic tool for assessing disease severity in schizophrenia patients, based on their reduced influence of top-down cognitive processes in interpreting bottom-up sensory input. Our procedure uses the hollow-mask illusion, in which the concave side of the mask is misperceived as convex, because familiarity with convex faces dominates sensory cues signaling a concave mask. It is known that schizophrenia patients resist this illusion and their resistance increases with illness severity...
November 2016: Visual Computer
https://www.readbyqxmd.com/read/27987221/active-and-placebo-transcranial-magnetic-stimulation-effects-on-external-and-internal-auditory-hallucinations-of-schizophrenia
#13
M-L Paillère-Martinot, A Galinowski, M Plaze, J Andoh, D Bartrés-Faz, F Bellivier, J-P Lefaucheur, D Rivière, T Gallarda, J-L Martinot, E Artiges
OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) over the left temporo-parietal region has been proposed as a treatment for resistant auditory verbal hallucinations (AVH), but which patients are more likely to benefit from rTMS is still unclear. This study sought to assess the effects of rTMS on AVH, with a focus on hallucination phenomenology. METHOD: Twenty-seven patients with schizophrenia and medication-resistant AVH participated to a randomized, double-blind, placebo-controlled, add-on rTMS study...
December 16, 2016: Acta Psychiatrica Scandinavica
https://www.readbyqxmd.com/read/27960654/a-case-of-dose-escalation-of-quetiapine-in-persistent-insomnia-disorder
#14
Claudia Cornelis, Ann Van Gastel, Glenn Dumont, Violette Coppens, Bernard Sabbe, Manuel Morrens, Filip Van Den Eede
Quetiapine, an atypical antipsychotic drug, is recommended for the treatment of schizophrenia and mood disorders. In addition, given its sedative effects, a low dose of the agent is also widely used in the treatment of anxiety disorders, personality disorders, substance abuse, and sleep disturbances. In this case study, quetiapine was the first effective drug in reducing chronic insomnia in a male patient with a long treatment history. Because its effect declined over time, in the course of two years, a gradual dose increase led to a posology 50 times higher than the off-label dosage used to obtain sedation, i...
December 14, 2016: Acta Clinica Belgica
https://www.readbyqxmd.com/read/27955831/sedative-effect-of-clozapine-is-a-function-of-5-ht2a-and-environmental-novelty
#15
Radhika S Joshi, Rolen Quadros, Michael Drumm, Rupasri Ain, Mitradas M Panicker
Antipsychotic drugs are the mainstay in the treatment of schizophrenia and bipolar disorder. However, antipsychotics often exhibit sedation or activity suppression among many other side effects, and the factors that influence them remain poorly understood. We now show, using a 5-HT2A knockout (Htr2a(-/-)) mouse, that environmental circumstances can affect suppression of activity induced by the atypical antipsychotic- Clozapine. We observed that Htr2a(-/-) mice were more resistant to Clozapine-induced suppression of activity (CISA) and this behaviour was dependent on the environment being 'novel'...
December 7, 2016: European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/27934603/generation-and-characterization-of-an-induced-pluripotent-stem-cell-ipsc-line-from-a-patient-with-clozapine-resistant-schizophrenia
#16
Fabio Marsoner, Matteo Marcatili, Thodoris Karnavas, Daniele Bottai, Armando D'Agostino, Silvio Scarone, Luciano Conti
Peripheral Blood Mononuclear Cells (PBMCs) were collected from a patient with clozapine-resistant (also known as "super-refractory") Schizophrenia. iPSCs were established with a non-integrating Sendai virus-based reprogramming system. A footprint-free hiPSC line was characterized to express the main endogenous pluripotency markers and to retain a normal karyotype. Cells showed pluripotency competency by giving rise to progeny of differentiated cells belonging to the three germ layers. This hiPSC line represents a valuable tool to obtain mature, pathology-relevant neuronal populations in vitro that are suitable to investigate the molecular background of the schizophrenic disorder and the resultant patients' response to treatments...
November 10, 2016: Stem Cell Research
https://www.readbyqxmd.com/read/27931902/effectiveness-of-blonanserin-for-patients-with-drug-treatment-resistant-schizophrenia-and-dopamine-supersensitivity-a-retrospective-analysis
#17
Masumi Tachibana, Tomihisa Niitsu, Motoki Watanabe, Tasuku Hashimoto, Nobuhisa Kanahara, Masatomo Ishikawa, Masaomi Iyo
OBJECTIVE: Dopamine supersensitivity psychosis (DSP) is one of the key factors contributing to the development of antipsychotic treatment-resistant schizophrenia (TRS). We investigated the efficacy of blonanserin, an atypical antipsychotic, for patients with TRS and DSP. METHODS: In this 12-month retrospective follow-up study, we investigated the cases of eight consecutive patients with unstable TRS and DSP treated with blonanserin as an add-on therapy. We examined changes in scores for the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression-Severity of Illness (CGI-S) scale and the Global Assessment of Functioning scale (GAF) during the 12 months after the administration of blonanserin...
December 2016: Asian Journal of Psychiatry
https://www.readbyqxmd.com/read/27931201/probable-clozapine-induced-parenchymal-lung-disease-and-perimyocarditis-a-case-report
#18
Erlend Bugge, Trygve Nissen, Rolf Wynn
BACKGROUND: Clozapine is the archetypical atypical antipsychotic, its primary indication being treatment resistant schizophrenia. Severe side effects caused by clozapine, including leukopenia, agranulocytosis, and myocarditis, are well known. A rarely described side effect is concurrent perimyocarditis and parenchymal lung disease. CASE PRESENTATION: A previously physically healthy 23-year-old male Caucasian that suffered from schizophrenia presented with flu-like symptoms 1 week after starting clozapine treatment...
December 8, 2016: BMC Psychiatry
https://www.readbyqxmd.com/read/27923116/new-evidence-in-support-of-staging-approaches-in-schizophrenia-differences-in-clinical-profiles-between-first-episode-early-stage-and-late-stage
#19
Bruno Bertolucci Ortiz, Fernanda Dal Medico Eden, Aline Silva Rodrigues de Souza, Carla Agostinho Teciano, Daniela Malatesta de Lima, Cristiano Noto, Cinthia Hiroko Higuchi, Hugo Cogo-Moreira, Rodrigo Affonseca Bressan, Ary Gadelha
Few studies have examined the progression of symptom dimensions in schizophrenia patients over the course of the illness. The objective of this study was to investigate whether clinical and psychopathological differences exist between first-episode schizophrenia (FES) and multiple-episode patients in an inpatient setting. Patients (N=203) were evaluated using the Positive and Negative Syndrome Scale (PANSS) over time. Five different generalized estimating equations were built for the PANSS factors using the following as covariates: sex, patient's age, assessment time point (i...
November 18, 2016: Comprehensive Psychiatry
https://www.readbyqxmd.com/read/27922589/does-adding-a-second-antipsychotic-to-clozapine-improve-clinical-response-in-resistant-schizophrenia
#20
Magdalena Jiménez-Cornejo, Gonzalo Munizaga, David Aceituno
Clozapine constitutes the treatment of choice in patients with schizophrenia with persisting symptoms despite antipsychotics at adequate dose and treatment duration. However, an important proportion does not respond to optimal doses of clozapine, so the addition of a second antipsychotic might increase clinical response. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified 17 systematic reviews comprising 62 studies addressing the question of this article, including 26 randomized trials...
December 2, 2016: Medwave
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