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Antipsychotic augmentation

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https://www.readbyqxmd.com/read/28318897/efficacy-of-off-label-augmentation-in-unipolar-depression-a-systematic-review-of-the-evidence
#1
REVIEW
Julia Kleeblatt, Felix Betzler, Laura L Kilarski, Tom Bschor, Stephan Köhler
Treatment of unipolar depression with currently available antidepressants is still unsatisfactory. Augmentation with lithium or second generation antipsychotics is an established practice in non-responders to antidepressant monotherapy, but is also associated with a substantial non-response rate and with non-tolerance. Based on a systematic review of the literature, including meta-analyses, randomized controlled trials (RCTs), non-randomized comparative studies and case studies, off-label augmentation agents (administered in addition to an antidepressant, without FDA approval for treatment of MDD) were identified and evaluated regarding their efficacy using levels of evidence...
March 16, 2017: European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/28302501/pharmacokinetic-considerations-in-antipsychotic-augmentation-strategies-how-to-combine-risperidone-with-low-potency-antipsychotics
#2
Michael Paulzen, Georgios Schoretsanitis, Benedikt Stegmann, Christoph Hiemke, Gerhard Gründer, Koen R J Schruers, Sebastian Walther, Sarah E Lammertz, Ekkehard Haen
OBJECTIVES: To investigate in vivo the effect of low-potency antipsychotics on metabolism of risperidone (RIS). METHODS: A therapeutic drug monitoring database containing plasma concentrations of RIS and its metabolite 9-OH-RIS of 1584 patients was analyzed. Five groups were compared; a risperidone group (n=842) and four co- medication groups; a group co-medicated with chlorprothixene (n=67), a group with levomepromazine (n=32), a group with melperone (n=46), a group with pipamperone (n=63) and a group with prothipendyl (n=24)...
March 14, 2017: Progress in Neuro-psychopharmacology & Biological Psychiatry
https://www.readbyqxmd.com/read/28294084/continuous-circular-cycling-as-a-predictor-of-treatment-response-in-bipolar-disorders-a-comprehensive-review-of-the-current-literature
#3
Antonio Tundo, Paola Cavalieri
Evidence from the literature suggests that, on average, 27% of patients with a bipolar disorder (BD) experience a continuous cycling course (CCC) and that this subgroup differs significantly from patients with a noncontinuous cycling course (N-CCC) with respect to sociodemographic characteristics and clinical presentation. The aim of the present paper is to review the studies that evaluated short- and long-term treatment responses in BD patients with CCC. The retrieved studies indicate that CCC is a significant predictor of poor response to long-term treatment with lithium (the odds of a response in the CCC group were 57% less than in the N-CCC group; p<0...
March 15, 2017: CNS Spectrums
https://www.readbyqxmd.com/read/28288438/epidemiology-of-pharmaceutically-treated-depression-and-treatment-resistant-depression-in-taiwan
#4
Daniel Fife, Yu Feng, Michael Yao-Hsien Wang, Chee-Jen Chang, Chia-Yih Liu, Hsiao-Ting Juang, Wesley Furnback, Jaskaran Singh, Bruce Wang
Epidemiologic data on treatment resistant depression (TRD) in Asia-Pacific countries are limited. We estimated the incidence of TRD in Taiwan using a cohort of 704,265 adults randomly sampled from Taiwan's National Health Insurance Research database for 2005. TRD was defined as a patient having pharmaceutically treated depression (PTD) not adequately responding to 2 antidepressant (AD) regimens, i.e., AD regimens that were followed by other AD regimens. Among 2751 PTD subjects, 576 (20.94%, 95% CI: 19.46, 22...
March 6, 2017: Psychiatry Research
https://www.readbyqxmd.com/read/28280892/antidepressant-pharmacotherapy-in-old-age-depression-a-review-and-clinical-approach
#5
REVIEW
Nathalie Pruckner, Vjera Holthoff-Detto
PURPOSE: Depression in old age is a disabling disease associated with functional and cognitive decline severely affecting quality of life. Studies specifically investigating antidepressant treatment for this special cohort of patients remain scarce and results are often conflicting. A narrative literature review was undertaken, synthesizing findings from published studies, systematic reviews, and treatment guidelines specifically conducted in elderly depressed patients to summarize implications and current recommendations as well as gaps in evidence for old-age pharmacologic treatment...
March 10, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28182008/thioridazine-enhances-sensitivity-to-carboplatin-in-human-head-and-neck-cancer-cells-through-downregulation-of-c-flip-and-mcl-1-expression
#6
Seung Un Seo, Hyuk Ki Cho, Kyoung-Jin Min, Seon Min Woo, Shin Kim, Jong-Wook Park, Sang Hyun Kim, Yung Hyun Choi, Young Sam Keum, Jin Won Hyun, Hyun Ho Park, Sang-Han Lee, Dong Eun Kim, Taeg Kyu Kwon
Carboplatin is a less toxic analog of cisplatin, but carboplatin also has side effects, including bone marrow suppression. Therefore, to improve the capacity of the anticancer activity of carboplatin, we investigated whether combined treatment with carboplatin and thioridazine, which has antipsychotic and anticancer activities, has a synergistic effect on apoptosis. Combined treatment with carboplatin and thioridazine markedly induced caspase-mediated apoptosis in head and neck squamous cell carcinoma (AMC-HN4) cells...
February 9, 2017: Cell Death & Disease
https://www.readbyqxmd.com/read/28127934/antipsychotic-augmentation-vs-monotherapy-in-schizophrenia-systematic-review-meta-analysis-and-meta-regression-analysis
#7
Britta Galling, Alexandra Roldán, Katsuhiko Hagi, Liz Rietschel, Frozan Walyzada, Wei Zheng, Xiao-Lan Cao, Yu-Tao Xiang, Mathias Zink, John M Kane, Jimmi Nielsen, Stefan Leucht, Christoph U Correll
Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safety. We conducted a systematic literature search and a random effects meta-analysis of randomized trials comparing augmentation with a second antipsychotic vs. continued antipsychotic monotherapy in schizophrenia. Co-primary outcomes were total symptom reduction and study-defined response. Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction (16 studies, N=694, standardized mean difference, SMD=-0...
February 2017: World Psychiatry: Official Journal of the World Psychiatric Association (WPA)
https://www.readbyqxmd.com/read/28062203/semi-mechanistic-computer-simulation-of-psychotic-symptoms-in-schizophrenia-with-a-model-of-a-humanized-cortico-striatal-thalamocortical-loop
#8
Athan Spiros, Patrick Roberts, Hugo Geerts
Despite new insights into the pathophysiology of schizophrenia and clinical trials with highly selective drugs, no new therapeutic breakthroughs have been identified. We present a semi-mechanistic Quantitative Systems Pharmacology (QSP) computer model of a biophysically realistic cortical-striatal-thalamo-cortical loop. The model incorporates the direct, indirect and hyperdirect pathway of the basal ganglia and CNS drug targets that modulate neuronal firing, based on preclinical data about their localization and coupling to voltage-gated ion channels...
February 2017: European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology
https://www.readbyqxmd.com/read/28008259/efficacy-and-tolerability-of-topiramate-augmentation-therapy-for-schizophrenia-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#9
Yuji Okuyama, Kazuto Oya, Shinji Matsunaga, Taro Kishi, Nakao Iwata
This study aimed to perform a comprehensive meta-analysis of topiramate-augmentation therapy in patients with schizophrenia receiving antipsychotic agents. Data published up to June 20, 2016 were obtained from the PubMed, PsycINFO, and Cochrane Library databases. Twelve randomized controlled trials comparing topiramate to placebo or antipsychotic only were included (n=676 patients). The primary outcome was change in overall symptoms. Relative risk (RR) and standardized mean difference (SMD), along with 95% confidence intervals, were calculated using random effects model for each outcome...
2016: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/28004621/augmentation-of-phenelzine-with-aripiprazole-and-quetiapine-in-a-treatment-resistant-patient-with-psychotic-unipolar-depression-case-report-and-literature-review
#10
Jonathan M Meyer, Michael A Cummings, George Proctor
Irreversible monoamine oxidase inhibitor (MAOI) antidepressants have significant efficacy in treatment-resistant unipolar depression, but in some instances patients may not achieve remission. Among the adjunctive and augmentation strategies, certain second-generation antipsychotics (SGAs) have approval for inadequate responders to antidepressant therapy, including aripiprazole, brexpiprazole, and quetiapine, with lurasidone and the olanzapine/fluoxetine combination indicated for bipolar depression. Clinicians may eschew SGA options in part due to the limited literature on SGA-MAOI combinations, with only one published case involving aripiprazole, and none for olanzapine, lurasidone, or brexpiprazole...
December 22, 2016: CNS Spectrums
https://www.readbyqxmd.com/read/27977041/risperidone-versus-placebo-for-schizophrenia
#11
REVIEW
Ranganath D Rattehalli, Sai Zhao, Bao Guo Li, Mahesh B Jayaram, Jun Xia, Stephanie Sampson
BACKGROUND: Risperidone is the first new-generation antipsychotic drug made available in the market in its generic form. OBJECTIVES: To determine the clinical effects, safety and cost-effectiveness of risperidone compared with placebo for treating schizophrenia. SEARCH METHODS: On 19th October 2015, we searched the Cochrane Schizophrenia Group Trials Register, which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials...
December 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27919104/dual-health-care-system-use-and-high-risk-prescribing-in-patients-with-dementia-a-national-cohort-study
#12
Joshua M Thorpe, Carolyn T Thorpe, Walid F Gellad, Chester B Good, Joseph T Hanlon, Maria K Mor, John R Pleis, Loren J Schleiden, Courtney Harold Van Houtven
Background: Recent federal policy changes attempt to expand veterans' access to providers outside the Department of Veterans Affairs (VA). Receipt of prescription medications across unconnected systems of care may increase the risk for unsafe prescribing, particularly in persons with dementia. Objective: To investigate the association between dual health care system use and potentially unsafe medication (PUM) prescribing. Design: Retrospective cohort study...
February 7, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27884042/valproate-for-schizophrenia
#13
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/27852961/effect-of-antipsychotic-pharmacotherapy-on-clinical-outcomes-of-intermittent-theta-burst-stimulation-for-refractory-depression
#14
Laura Schulze, Gary Remington, Peter Giacobbe, Sidney H Kennedy, Daniel M Blumberger, Zafiris J Daskalakis, Jonathan Downar
Theta-burst stimulation is an emerging protocol for repetitive transcranial magnetic stimulation that takes 1-3 min to administer, yet offers equal/superior potency to conventional protocols lasting 30-60 min. However, preclinical evidence suggests that D2 receptor blockade may abolish the acute effects of theta-burst stimulation on synaptic facilitation or inhibition. As many patients presenting for repetitive transcranial magnetic stimulation are taking antipsychotic medications as augmentation for treatment-resistant depression, this finding is potentially concerning for the implementation of theta-burst stimulation in clinical settings...
November 9, 2016: Journal of Psychopharmacology
https://www.readbyqxmd.com/read/27848269/evidence-based-pharmacotherapy-of-treatment-resistant-unipolar-depression
#15
Markus Dold, Siegfried Kasper
Treatment resistance to the antidepressive pharmacotherapy represents one of the most important clinical challenges in the pharmacological management of unipolar depression. In this review, we aimed to summarise the evidence for various pharmacological treatment options in therapy-resistant unipolar depression derived from clinical trials, systematic reviews, meta-analyses and treatment guidelines. The first measure in case of insufficient response to the initial antidepressant monotherapy contains the debarment of 'pseudo-resistance', potentially caused by inadequate dose and treatment duration of the antidepressant, insufficient plasma levels, non-compliance of the patient regarding medication intake or relevant psychiatric and/or somatic comorbidities...
March 2017: International Journal of Psychiatry in Clinical Practice
https://www.readbyqxmd.com/read/27844095/antidepressant-effects-of-combination-of-brexpiprazole-and-fluoxetine-on-depression-like-behavior-and-dendritic-changes-in-mice-after-inflammation
#16
Min Ma, Qian Ren, Chun Yang, Ji-Chun Zhang, Wei Yao, Chao Dong, Yuta Ohgi, Takashi Futamura, Kenji Hashimoto
RATIONALE: Addition of low doses of atypical antipsychotic drugs with selective serotonin reuptake inhibitors (SSRIs) could promote a rapid antidepressant effect in treatment-resistant patients with major depression. Brexpiprazole, a new atypical antipsychotic drug, has been used as adjunctive therapy for the treatment of major depression. OBJECTIVES: The present study was undertaken to examine whether brexpiprazole could augment antidepressant effects of the SSRI fluoxetine in an inflammation model of depression...
February 2017: Psychopharmacology
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
#17
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)...
January 2017: CNS Drugs
https://www.readbyqxmd.com/read/27813505/is-electroconvulsive-therapy-effective-as-augmentation-in-clozapine-resistant-schizophrenia
#18
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/27788337/adjunctive-brexpiprazole-for-the-treatment-of-major-depressive-disorder
#19
John L Beyer, Richard H Weisler
The lifetime prevalence of major depressive episodes in the United States is nearly 17%. Clinical trials and clinical effectiveness studies have demonstrated that many patients will fail to achieve remission using traditional monotherapy, contributing to significant morbidity and suffering. Because of this, augmentation strategies have been proposed to improve both treatment response and remission. Areas covered: Brexpiprazole is a second generation antipsychotic (SGA) approved by the US FDA in 2015 as an add-on treatment to an antidepressant medication for the treatment of adults with MDD, based on the results of two large-scale, randomized, placebo-controlled trials...
December 2016: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/27783545/estimating-the-value-of-new-technologies-that-provide-more-accurate-drug-adherence-information-to-providers-for-their-patients-with-schizophrenia
#20
Jason Shafrin, Taylor T Schwartz, Darius N Lakdawalla, Felicia M Forma
BACKGROUND: Nonadherence to antipsychotic medication among patients with schizophrenia results in poor symptom management and increased health care and other costs. Despite its health impact, medication adherence remains difficult to accurately assess. New technologies offer the possibility of real-time patient monitoring data on adherence, which may in turn improve clinical decision making. However, the economic benefit of accurate patient drug adherence information (PDAI) has yet to be evaluated...
November 2016: Journal of Managed Care & Specialty Pharmacy
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