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Treatment-resistant Schizophrenia

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https://www.readbyqxmd.com/read/27931902/effectiveness-of-blonanserin-for-patients-with-drug-treatment-resistant-schizophrenia-and-dopamine-supersensitivity-a-retrospective-analysis
#1
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
#2
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
#3
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
#4
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
https://www.readbyqxmd.com/read/27919182/treatment-resistant-schizophrenia-treatment-response-and-resistance-in-psychosis-trrip-working-group-consensus-guidelines-on-diagnosis-and-terminology
#5
Oliver D Howes, Rob McCutcheon, Ofer Agid, Andrea de Bartolomeis, Nico J M van Beveren, Michael L Birnbaum, Michael A P Bloomfield, Rodrigo A Bressan, Robert W Buchanan, William T Carpenter, David J Castle, Leslie Citrome, Zafiris J Daskalakis, Michael Davidson, Richard J Drake, Serdar Dursun, Bjørn H Ebdrup, Helio Elkis, Peter Falkai, W Wolfgang Fleischacker, Ary Gadelha, Fiona Gaughran, Birte Y Glenthøj, Ariel Graff-Guerrero, Jaime E C Hallak, William G Honer, James Kennedy, Bruce J Kinon, Stephen M Lawrie, Jimmy Lee, F Markus Leweke, James H MacCabe, Carolyn B McNabb, Herbert Meltzer, Hans-Jürgen Möller, Shinchiro Nakajima, Christos Pantelis, Tiago Reis Marques, Gary Remington, Susan L Rossell, Bruce R Russell, Cynthia O Siu, Takefumi Suzuki, Iris E Sommer, David Taylor, Neil Thomas, Alp Üçok, Daniel Umbricht, James T R Walters, John Kane, Christoph U Correll
OBJECTIVE: Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines. METHOD: A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus...
December 6, 2016: American Journal of Psychiatry
https://www.readbyqxmd.com/read/27884042/valproate-for-schizophrenia
#6
REVIEW
Yijun Wang, Jun Xia, Bartosz Helfer, Chunbo Li, Stefan Leucht
BACKGROUND: Many people with schizophrenia do not achieve a satisfactory treatment response with ordinary antipsychotic drug treatment. In these cases, various add-on medications are used, and valproate is one of these. OBJECTIVES: To examine whether:1. valproate alone is an effective treatment for schizophrenia and schizoaffective psychoses; and2. valproate augmentation of antipsychotic medication is an effective treatment for the same illnesses. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (July 2002; February 2007; July 2012; March 04, 2016)...
November 24, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27882189/successful-treatment-of-resistant-hypertension-by-means-of-chronic-renal-artery-occlusion-revascularization-in-a-fragile-patient
#7
Laura Spezia, Simone Perandini, Raffaele Augelli, Giovanni Puppini, Stefania Montemezzi
BACKGROUND: Renal artery stenosis is a common cause of secondary hypertension refractory to medical therapy. Percutaneous angioplasty along with metallic stent placement has been described as an effective treatment for revascularization of the renal artery. CASE REPORT: A 54-year-old woman affected by paranoid schizophrenia with a history of hypertension and chronic renal failure due to renal artery occlusion was treated by endovascular recanalization and stent placement that resulted in improvement of renal function and control of hypertension...
2016: Polish Journal of Radiology
https://www.readbyqxmd.com/read/27879426/the-successful-concurrent-use-of-two-long-acting-depot-antipsychotics-in-a-patient-with-treatment-resistant-schizophrenia-and-history-of-serious-violence-a-case-report
#8
Anna Lenardon, Mona Ahmed, Katie-Lynn Harfield, Mrigendra Das
OBJECTIVE: This case report describes a forensic psychiatric patient presenting with treatment-resistant schizophrenia and serious interpersonal violence complicated by poor adherence to oral medication who was treated successfully with two concurrent long-acting depot antipsychotics. METHOD: Treatment response was measured for a 6-month period at 6-weekly intervals, post-initiation using the Positive and Negative Symptoms of Schizophrenia with Excited Component score (PANSS-EC), Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression Scale (CGI)...
November 22, 2016: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
https://www.readbyqxmd.com/read/27871302/glycopyrrolate-in-comparison-to-hyoscine-hydrobromide-and-placebo-in-the-treatment-of-hypersalivation-induced-by-clozapine-gothic1-study-protocol-for-a-randomised-controlled-feasibility-study
#9
Inti Qurashi, Simon Chu, Nusrat Husain, Richard J Drake, Imran Chaudhry, J F W Deakin
BACKGROUND: Clozapine is the only medication licensed for the treatment of resistant schizophrenia in the UK. Although efficacious, a common and unpopular side effect of clozapine treatment is clozapine-induced hypersalivation (CIH), which can contribute to non-adherence. The standard treatment for CIH in the UK is hyoscine hydrobromide but this may aggravate cognitive deficits in patients with schizophrenia while glycopyrrolate may be an effective alternative with a more tolerable side effect profile...
November 21, 2016: Trials
https://www.readbyqxmd.com/read/27866120/evidence-based-guidelines-on-the-therapeutic-use-of-transcranial-direct-current-stimulation-tdcs
#10
REVIEW
Jean-Pascal Lefaucheur, Andrea Antal, Samar S Ayache, David H Benninger, Jérôme Brunelin, Filippo Cogiamanian, Maria Cotelli, Dirk De Ridder, Roberta Ferrucci, Berthold Langguth, Paola Marangolo, Veit Mylius, Michael A Nitsche, Frank Padberg, Ulrich Palm, Emmanuel Poulet, Alberto Priori, Simone Rossi, Martin Schecklmann, Sven Vanneste, Ulf Ziemann, Luis Garcia-Larrea, Walter Paulus
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction...
October 29, 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/27857125/presynaptic-dopamine-capacity-in-patients-with-treatment-resistant-schizophrenia-taking-clozapine-an-18-f-dopa-pet-study
#11
Euitae Kim, Oliver D Howes, Mattia Veronese, Katherine Beck, Seongho Seo, Jin Woo Park, Jae Sung Lee, Yun-Sang Lee, Jun Soo Kwon
Some patients with schizophrenia show poor response to first-line antipsychotic treatments and this is termed treatment resistant schizophrenia. The differential response to first-line antipsychotic drugs may reflect a different underlying neurobiology. Indeed, a previous study found dopamine synthesis capacity was significantly lower in patients with treatment resistant schizophrenia. However, in this study, the treatment resistant patients were highly symptomatic whilst the responsive patients showed no or minimal symptoms...
November 18, 2016: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/27853387/treatment-resistant-schizophrenia-current-insights-on-the-pharmacogenomics-of-antipsychotics
#12
REVIEW
John Lally, Fiona Gaughran, Philip Timms, Sarah R Curran
Up to 30% of people with schizophrenia do not respond to two (or more) trials of dopaminergic antipsychotics. They are said to have treatment-resistant schizophrenia (TRS). Clozapine is still the only effective treatment for TRS, although it is underused in clinical practice. Initial use is delayed, it can be hard for patients to tolerate, and clinicians can be uncertain as to when to use it. What if, at the start of treatment, we could identify those patients likely to respond to clozapine - and those likely to suffer adverse effects? It is likely that clinicians would feel less inhibited about using it, allowing clozapine to be used earlier and more appropriately...
2016: Pharmacogenomics and Personalized Medicine
https://www.readbyqxmd.com/read/27848034/vagus-nerve-stimulation-in-psychiatry-a-systematic-review-of-the-available-evidence
#13
REVIEW
Camelia-Lucia Cimpianu, Wolfgang Strube, Peter Falkai, Ulrich Palm, Alkomiet Hasan
Invasive and non-invasive vagus nerve stimulation (VNS) is a promising add-on treatment for treatment-refractory depression, but is also increasingly evaluated for its application in other psychiatric disorders, such as dementia, schizophrenia, somatoform disorder, and others. We performed a systematic review aiming to give a detailed overview of the available evidence of the efficacy of VNS for the treatment of psychiatric disorders. Data derived from animal models, experimental trials without health-related outcomes, case reports, single-session studies, and reviews were excluded...
November 16, 2016: Journal of Neural Transmission
https://www.readbyqxmd.com/read/27833234/successful-management-of-patient-with-treatment-resistant-schizophrenia-and-swyer-james-macleod-syndrome-with-clozapine
#14
Arpit Parmar, Rajeev Ranjan, Rajesh Sagar
Swyer-James-Macleod syndrome (SJMS) is a rare disorder characterized by infective bronchiolitis. It typically presents with a history of recurrent chest infections during childhood. Cardinal sign of the disease includes the hyperlucency of the lung fields. Till date, only a few cases have been reported of this syndrome. We report a very unusual case of SJMS along with comorbid schizophrenia in a 20-year-old female and the successful management using clozapine.
September 2016: Indian Journal of Psychological Medicine
https://www.readbyqxmd.com/read/27826741/the-porirua-protocol-in-the-treatment-of-clozapine-induced-gastrointestinal-hypomotility-and-constipation-a-pre-and-post-treatment-study
#15
Susanna Every-Palmer, Pete M Ellis, Mike Nowitz, James Stanley, Eve Grant, Mark Huthwaite, Helen Dunn
BACKGROUND: Clozapine, an antipsychotic used in treatment-resistant schizophrenia, causes slow gastrointestinal transit in 50-80% of patients. Clozapine-induced gastrointestinal hypomotility is both common and serious, and potential complications include severe constipation, ileus, bowel obstruction and related complications, with a higher mortality rate than clozapine-related agranulocytosis. Little evidence exists on its prevention and management. METHOD: Using a well-validated radiopaque marker ('Metcalf') method, we compared colonic transit times (CTTs) of clozapine-treated inpatients not receiving laxatives with their transit times when receiving laxatives, with treatment prescribed according to the Porirua Protocol for clozapine-related constipation (docusate and senna augmented by macrogol 3350 in treatment-resistant cases)...
November 8, 2016: CNS Drugs
https://www.readbyqxmd.com/read/27821411/the-treatment-of-schizophrenia-can-we-raise-the-standard-of-care
#16
REVIEW
Stanley Victor Catts, Brian Ignatius O'Toole
OBJECTIVE: There is evidence that over time health outcomes of people with schizophrenia are deteriorating rather than improving both in terms of mortality rate and levels of morbidity, even in Australia where service resourcing is substantial. Our objective was to examine the evidence of whether poor outcomes reflect decreases in treatment effectiveness and, if so, what are the barriers to improving standards of care. This review will argue that the confidence of clinicians to diagnose schizophrenia early, and provide assertive and long-term care, may be being undermined by a series of controversies in the published literature and discrepancies in clinical practice guidelines...
November 7, 2016: Australian and New Zealand Journal of Psychiatry
https://www.readbyqxmd.com/read/27813505/is-electroconvulsive-therapy-effective-as-augmentation-in-clozapine-resistant-schizophrenia
#17
Lucas Kittsteiner Manubens, Diego Lobos Urbina, David Aceituno
Clozapine is considered to be the most effective antipsychotic drug for patients with treatment resistant schizophrenia, but up to a third of the patients do not respond to this treatment. Various strategies have been tried to augment the effect of clozapine in non-responders, one of these strategies being electroconvulsive therapy. However, its efficacy and safety are not yet clear. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified six systematic reviews including 55 studies, among them six randomized controlled trials addressing clozapine-resistant schizophrenia...
October 14, 2016: Medwave
https://www.readbyqxmd.com/read/27800285/remission-of-psychosis-in-treatment-resistant-schizophrenia-following-a-seizure-a-case-report
#18
Hena Jawaid, Sana Younus, Hanif Mesiya
The authors report a case of treatment-resistant schizophrenia in a 22-year-old woman, who, despite multiple trials of antipsychotics, did not respond to treatment. Clozapine treatment was initiated, but the patient's symptoms did not remit until after she had a clozapine-induced seizure. The authors discuss the importance in considering that electroconvulsive therapy may be effective in reducing positive and negative symptoms in patients suffering from treatment-resistant schizophrenia.
May 2016: Innovations in Clinical Neuroscience
https://www.readbyqxmd.com/read/27776383/clozapine-monitoring-in-clinical-practice-beyond-the-mandatory-requirement
#19
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
https://www.readbyqxmd.com/read/27771104/-therapeutic-drug-monitoring-of-clozapine
#20
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
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