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Treatment-resistant Schizophrenia

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https://www.readbyqxmd.com/read/28812368/how-psychiatrists-recommend-treatment-and-its-relationship-with-patient-uptake
#1
Laura Thompson, Rose McCabe
Consultations for patients with chronic mental health conditions are conceived as meetings of experts: medical and experiential, respectively. Treatment decisions, in these terms, become a joint responsibility rather than handed down ex-cathedra. One resource for constituting decisions as 'shared' is the treatment recommendation - decisional authority can be invoked through its design. There is concern that people diagnosed with schizophrenia are infrequently involved in treatment decisions. However, the methods psychiatrists actually employ remain undefined...
August 16, 2017: Health Communication
https://www.readbyqxmd.com/read/28767928/trends-in-the-prescription-of-clozapine-in-a-psychiatric-hospital-a-5-year-observational-study
#2
Gabriela Danielski Niehues, Alexandre Balestieri Balan, Vinicius Brum Prá, Raphaela Santos Pellizzaro, Paulo Roberto Antunes da Silva, Manuela Danielski Niehues, Ana Paula Costa, Marcelo Liborio Schwarzbold, Alexandre Paim Diaz
Introduction: Clozapine is a well-recognized effective treatment for some patients with treatment-resistant schizophrenia (TRS). Although it has potential benefits and approximately 30% of patients have a clinical indication for clozapine use, prescription rates are low. Objective: To evaluate clozapine prescription trends over a 5-year period in a tertiary psychiatric hospital. Methods: In this observational study, data prospectively collected by the Medical and Statistical File Service (Serviço de Arquivo Médico e Estatístico) and the Pharmacy Division of Instituto de Psiquiatria de Santa Catarina between January 2010 and December 2014 were summarized and analyzed by investigators blinded to data collection...
July 31, 2017: Trends in Psychiatry and Psychotherapy
https://www.readbyqxmd.com/read/28763030/the-binding-effect-of-proteins-on-medications-and-its-impact-on-electrochemical-sensing-antipsychotic-clozapine-as-a-case-study
#3
George E Banis, Thomas Winkler, Patricia Barton, Sheryl E Chocron, Eunkyoung Kim, Deanna L Kelly, Gregory F Payne, Hadar Ben-Yoav, Reza Ghodssi
Clozapine (CLZ), a dibenzodiazepine, is demonstrated as the optimal antipsychotic for patients suffering from treatment-resistant schizophrenia. Like many other drugs, understanding the concentration of CLZ in a patient's blood is critical for managing the patients' symptoms, side effects, and overall treatment efficacy. To that end, various electrochemical techniques have been adapted due to their capabilities in concentration-dependent sensing. An open question associated with electrochemical CLZ monitoring is whether drug-protein complexes (i...
August 1, 2017: Pharmaceuticals
https://www.readbyqxmd.com/read/28754582/catatonia-in-children-and-adolescents-new-perspectives
#4
Xavier Benarous, Marie Raffin, Vladimir Ferrafiat, Angèle Consoli, David Cohen
INTRODUCTION: Catatonia is a rare and severe psychomotor condition in children and adolescents. In the current report, we aimed to review the recent literature. METHOD: Using a PRISMA approach, we searched MEDLINE between 1982 and 2017 using the keywords 'CATATONIA' and 'CHILD' or 'ADOLESCENT'. In total, we reviewed 130 reports (controlled study, N=4; clinical chart, N=23; case report, N=54; and editorial/review, N=42). RESULTS: Several aspects seem to be age specific: (1) although the clinical presentation resembles that in adults, some symptoms are important in children and adolescents (e...
July 25, 2017: Schizophrenia Research
https://www.readbyqxmd.com/read/28750580/mortality-and-self-harm-in-association-with-clozapine-in-treatment-resistant-schizophrenia
#5
Theresa Wimberley, James H MacCabe, Thomas M Laursen, Holger J Sørensen, Aske Astrup, Henriette T Horsdal, Christiane Gasse, Henrik Støvring
OBJECTIVE: This study evaluated rates of all-cause mortality and self-harm in association with clozapine treatment in individuals with treatment-resistant schizophrenia. METHOD: A population-based cohort of 2,370 individuals with treatment-resistant schizophrenia after Jan. 1, 1996, was followed until death, first episode of self-harm, emigration, or June 1, 2013. Time to all-cause death and time to first episode of self-harm were analyzed in Cox regression models with time-varying treatment, adjusted for clinical and sociodemographic covariates...
July 28, 2017: American Journal of Psychiatry
https://www.readbyqxmd.com/read/28748226/peripheral-kynurenine-3-monooxygenase-deficiency-as-a-potential-risk-factor-for-metabolic-syndrome-in-schizophrenia-patients
#6
Gregory Oxenkrug, Marieke van der Hart, Julien Roeser, Paul Summergrad
Increased predisposition of schizophrenia patients (SP) to development of obesity and insulin resistance suggested common signaling pathway between metabolic syndrome (MetS) and schizophrenia. Deficiency of kynurenine-3-monooxygenase (KMO), enzyme catalyzing formation of 3-hydroxykynurenine (3-HK) from kynurenine (Kyn), a tryptophan (Trp) metabolite, might contribute to development of MetS as suggested by non-expression of KMO genes in human fat tissue and elevated serum concentrations of Kyn and its metabolites, kynurenic (KYNA) and anthranilic (ANA) acids, in diabetic patients and Zucker fatty rats (ZFR)...
2017: Integr Clin Med
https://www.readbyqxmd.com/read/28742291/evaluating-the-effect-of-the-changes-in-fda-guidelines-for-clozapine-monitoring
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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 norclozapine (NCZ) levels, and clinical outcomes...
July 18, 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
#16
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
#17
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
#18
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
#19
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
#20
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...
August 2017: CNS Drugs
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