P.0471 Relationship between antipsychotic therapy and the severity of negative symptoms in inpatients with schizophrenia

2021 ◽  
Vol 53 ◽  
pp. S346-S347
Author(s):  
V. Gerasimova ◽  
E. Kornetova ◽  
O. Fedorenko ◽  
S. Ivanova
Keyword(s):  
Negative Symptoms ◽  
Antipsychotic Therapy

scholarly journals Recycling N-acetylcysteine: A review of evidence for adjunctive therapy in schizophrenia

2019 ◽  
Vol 9 (3) ◽  
pp. 116-123 ◽  
Author(s):  
Robert J. Willborn ◽  
Colleen P. Hall ◽  
Matthew A. Fuller
Keyword(s):  
Negative Symptoms ◽  
Current Evidence ◽  
Positive Symptoms ◽  
Cognitive Symptoms ◽  
Antipsychotic Therapy ◽  
Assessment Development ◽  
Cognitive Symptom ◽  
Symptom Domains ◽  
Medication Intervention

AbstractIntroductionAll symptoms in schizophrenia may impact functioning. Although Food and Drug Administration-approved medications typically benefit positive symptoms, negative symptoms are generally refractory to medication interventions. N-acetylcysteine's (NAC) influence on glutamatergic neurotransmission has been established. An emerging body of research has attempted to correlate this action with reduction in symptom severity, evaluating response in positive, negative, and cognitive symptom domains.MethodsA literature review was performed to analyze available data on NAC intervention and improvement in the positive, negative, and cognitive symptom domains in patients with schizophrenia. Quality of evidence was systematically assessed to determine level of certainty in results.ResultsThree randomized controlled trials were identified. Across studies, negative symptoms decreased more with NAC compared to placebo; ranging between 11.9% and 24.1%. The assessment determined a low level of certainty regarding benefit of NAC on negative and cognitive symptoms and moderate certainty for NAC regarding findings of side effects and lack of benefit on positive symptoms.DiscussionConsistent reporting of benefit in negative symptoms is found across studies of NAC intervention. These improvements are notable for symptoms that have generally remained refractory to medication intervention. Inconsistent benefit was reported in positive and cognitive symptoms. GRADE (grading of recommendations assessment, development and evaluation) assessment of current evidence indicates a low certainty of benefit for negative symptoms with standard use of NAC in patients with schizophrenia. However, a trial of this low-risk intervention may be warranted in patients with resistant negative symptoms and subsequent impaired functioning despite appropriate antipsychotic therapy as they may experience additional benefit in this symptom domain.

scholarly journals Clinical and Therapeutic Factors Affecting the Social Adaptation of Patients with Schizophrenia

Psychiatry ◽  
2021 ◽  
Vol 19 (4) ◽  
pp. 26-33
Author(s):  
N. N. Petrova ◽  
K. A. Tsyrenova
Keyword(s):  
Social Functioning ◽  
Negative Symptoms ◽  
Social Adaptation ◽  
Neurocognitive Deficits ◽  
Information Processing Speed ◽  
Antipsychotic Therapy ◽  
Factors Affecting ◽  
Psychometric Scales ◽  
The Social ◽  
Problem Solving Behavior

Background: сurrently, the question remains open about the factors that affect the social functioning of patients with schizophrenia, including the role of negative symptoms and neurocognitive deficits. The aim: to study factors that affect the social functioning of patients with schizophrenia. Patients and methods: 64 in-patient with schizophrenia (mean age 35.9 ± 10.9 years) were examined at the stage of remission. The disease duration was 9.71 ± 6.0 years. The majority of patients suffered from paranoid and hallucinatory-paranoid attacs (43 and 23%, respectively). The study used follow-up, clinical and psychopathological methods as well as psychometric scales: PANSS, SANS, ВАСS, Calgary scales and UKU scales. An integrative indicator was introduced to assess the social adaptation of patients. Results: it is shown that as the duration of the disease increases, the indicator of social adaptation decreases. The presence of side effects of antipsychotic therapy is associated with restrictions on the social functioning of patients, but the use of second-generation antipsychotics contributes to an increase in the level of social functioning of patients. Patients with more pronounced apathetic-abulic disorders, flattened affect, anhedonia-asociality and social isolation are characterized by a lower level of social functioning. Adapted patients differ from maladapted patients by better indicators of auditory-speech memory, motor skills, information processing speed, ability to plan and problem solving behavior. Conclusion: the integrative indicator of social adaptation of patients with schizophrenia is associated with a number of cognitive and negative symptoms, features of antipsychotic therapy and the duration of the disease.

scholarly journals ANTIPSYCHOTICS: FROM THE FIRST TO THE THIRD GENERATION

2020 ◽  
Author(s):  
Nataliia N. Petrova ◽  
Alexander G. Sofronov
Keyword(s):  
Comparative Analysis ◽  
Negative Symptoms ◽  
Third Generation ◽  
Antipsychotic Therapy ◽  
Persistent Symptoms ◽  
D3 Receptors ◽  
The Third ◽  
Personalized Approach

The review is devoted to comparative analysis of antipsychotics of three generations. When writing the review, a systematic search in the databases PubMed, Medline, Elsevier was carried out, a simple filter for keywords was used. Pharmacological and clinical issues of antipsychotic therapy were considered, the mechanisms of action of antipsychotics of different generations were revealed. Current trends in the development of approaches to the therapy of schizophrenia and the concept of atypicality of antipsychotics were discussed. A comparative analysis of indications for use, tolerance (safety of use) and efficacy of various antipsychotic drugs with an emphasis on the effect on negative (primary, persistent) symptoms has been conducted. The hypothesis underlying new approaches to the therapy of schizophrenia, based on the effect on dopamine autoreceptors, consisting of a high density of D2 and low density of D3 receptors, has been presented. It has been shown that antipsychotics of the third generation open up new possibilities in the therapy of psychosis within the framework of a personalized approach in psychiatry with the achievement of functional recovery of patients. The characteristics of the drugs representatives of the third generation of antipsychotics aripiprazole and cariprazine were given. The uniqueness of cariprazine as the only drug that inhibits D3 receptors in vitro, as well as in vivo in patients with schizophrenia was emphasized. The data of evidence-based studies of the effectiveness of cariprazine in the treatment of negative, including predominant negative symptoms were presented.

scholarly journals Pathway-Phenotypes of Non-responders and Partial Responders to Treatment With Antipsychotics in Schizophrenia: A Machine Learning Study

2020 ◽  
Author(s):  
Hussein Kadhem Al-Hakeim ◽  
Rana Fadhil Mousa ◽  
Arafat Hussein Al-Dujaili ◽  
Michael Maes
Keyword(s):  
Machine Learning ◽  
Executive Functions ◽  
Semantic Memory ◽  
Negative Symptoms ◽  
Word Association ◽  
Response To Treatment ◽  
Healthy Controls ◽  
Treatment Resistant ◽  
Antipsychotic Therapy ◽  
Specific Symptom

Objective: About a third of schizophrenia patients are treatment-resistant to antipsychotic therapy. No studies established the fingerprints or pathway-phenotypes of treatment-resistant schizophrenia. The present study aimed to delineate the pathway-phenotypes of non-responders (NRTT) and partial responders (PRTT) to treatment using machine learning. Methods: We recruited 115 schizophrenia patients and 43 healthy controls and measured schizophrenia symptom dimensions, neurocognitive tests, plasma CCL11, interleukin-(IL)-6, IL-10, Dickkopf protein 1 (DKK1), high mobility group box-1 protein (HMGB1), κ- and µ-opioid receptors (KOR and MOR, respectively), endomorphin-2 (EM-2), and β-endorphin. Results: Machine learning showed that the NRTT group is a qualitatively distinct class and is significantly discriminated from PRTT with an accuracy of 100% using a neuro-immune-opioid-cognitive (NIOC) pathway-phenotype with as main determinants list learning, controlled word association, and Tower of London test scores, CCL11, IL-6, and EM2. The top-5 symptom domains separating NRTT from PRTT were in descending order: psychomotor retardation, negative symptoms, psychosis, depression, and mannerism. Moreover, a NIOC pathway also discriminated PRTT from healthy controls with an accuracy of 100% while all PRTT and controls were authenticated as belonging to their respective classes. Conclusion: A non-response to treatment with antipsychotics is determined by increased severity of specific symptom profiles coupled with deficits in executive functions, and episodic and semantic memory, and aberrations in neuro-immune and opioid pathways. No patients showed complete remission after treatment indicating that non-remitting in PRTT is attributable to increased HMGB1 and residual deficits in attention, executive functions, and semantic memory.

scholarly journals Pharmacogenetics of schizophrenia in real clinical practice: a clinical case

2018 ◽  
Vol 10 (4) ◽  
pp. 88-93 ◽  
Author(s):  
R. F. Nasyrova ◽  
N. A. Schnaider ◽  
K. O. Mironov ◽  
G. A. Shipulin ◽  
O. P. Dribnokhodova ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Clinical Case ◽  
Adverse Reactions ◽  
Clinical Effect ◽  
Antipsychotic Therapy ◽  
Wide Range ◽  
Daily Dose ◽  
Financial Expenditure ◽  
Genetically Determined ◽  
Positive And Negative Symptoms

Schizophrenia is a socially significant mental disorder characterized by early onset and high time and financial expenditure on treatment. The basic drugs in these patients are antipsychotics that are highly effective against the positive and negative symptoms of schizophrenia, but at the same time have a wide range of adverse reactions (ARs). The clinical effect and tolerability of antipsychotics are variable and depend on the characteristics of genetically determined mechanisms (transportation, biotransformation, and elimination).The paper describes a clinical case of a female patient with schizophrenia who has been noted to be unresponsive to antipsychotic therapy for some years after the onset of the disease. After pharmacogenetic testing, she was found to be homozygous for the nonfunctional allelic variant CYP2D6*4 (1934 G>A, rs3892097), which was the reason for the complete shutdown of isoenzyme 2D6 activity and the development of ARs in the use of initial doses of antipsychotic drugs, as well as for an increase in the severity of ARs with aggravation of psycho-producing symptoms with an even slow titration of the daily dose.

scholarly journals The Use of Stimulant Augmentation of Second Generation Antipsychotics in the Management of Negative Symptoms of Schizophrenia: A Case Report

2018 ◽  
Vol 3 (08) ◽  
Author(s):  
Heela Azizi ◽  
Yu Hao Zeng ◽  
Jisha Kallikkadan ◽  
Alexa Kahn ◽  
Olaniyi Olayinka ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Positive Symptoms ◽  
Antipsychotic Therapy ◽  
Case Presentation ◽  
Point Reduction ◽  
Second Generation Antipsychotics ◽  
Potential Benefits ◽  
Stimulant Medications ◽  
Negative Syndrome ◽  
Mesocortical Pathway

Background: Negative symptoms of schizophrenia have been demonstrated to be due to decreased dopamine in the mesocortical pathways. Stimulant medications are a class of medications that can increase dopamine activity in the mesocortical pathway. Case Presentation: We present the case of a patient whose negative symptoms improved from a Positive and Negative Syndrome (PANSS) score of 39 to 11 on the negative symptoms subscale during a three-week trial of dopamine agonist augmentation of antipsychotic therapy. The score on the positive symptoms subscale on PANSS remained low with a two-point reduction at the end of the three-week period. Conclusion: The potential benefits of using stimulant medications in treating negative symptoms of schizophrenia are discussed.

scholarly journals T118. A CROSS-SECTIONAL STUDY ON OUTCOMES OF INDIVIDUALS WITH FIRST HOSPITALIZATION AND PSYCHOSIS SPECTRUM DISORDER DIAGNOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S275-S276
Author(s):  
Federico Fiori Nastro ◽  
Martina Pelle ◽  
Flavia Di Michele ◽  
Alessandra Talamo ◽  
Cinzia Niolu ◽  
...  
Keyword(s):  
Access To Health Care ◽  
Negative Symptoms ◽  
Rating Scale ◽  
Psychiatric Hospitalization ◽  
Critical Issue ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Antipsychotic Therapy ◽  
Cross Sectional ◽  
Global Improvement

Abstract Background Acute psychosis is one of the most frequent causes of hospital admission. One of the major challenges is how to manage with negative symptoms. Clinical efficacy of treatment of patients at their first hospitalization has been evaluated in several studies. We carried out a cross sectional study focusing on the different outcomes considering the clinical relevance of positive and negative symptoms. Methods We analyzed all the admissions and discharges of patients at their first psychiatric hospitalization after psychosis onset (diagnosed with ICD-9 criteria) in our inpatient psychiatric acute unit of Policlinico Tor Vergata, (located in a suburb of Rome) considering the period of time between January 2017 and September 2019. We characterized all patients according to age, ethnicity, socioeconomic status, substance use/abuse, violent behaviours, voluntary or compulsory treatment, length of hospitalization and use of long acting injection (LAI). We included 73 patients (out of 626 admissions, 12%) with a diagnosis of spectrum psychosis disorder at first hospitalization. We used items 10–11 and 16–17 from the Brief Psychiatric Rating Scale (BPRS) to obtain two groups of patients with different clinical features. Based on the score of these items, patients were divided into two groups: group One characterized by prevalent positive symptomatology and group Two characterized by negative symptoms. Then, we compared clinical outcomes through BPRS, days of Hospital stay and Clinical Global Impression at the end of the hospitalization. Results In our study we found out that patients with BPRS prevalent negative symptoms had longer hospital stays (mean 17.29 days); patients with BPRS positive prevalent symptoms had a mean stay of 15 days. Group Two patients used LAI treatment less frequently (37% of the times) compared to group One, which was treated with LAI 63% of the cases. At discharge, group Two had still higher scores in the Global Improvement Scale compared to group One. Discussion Our study confirms that the use of antipsychotic therapy does not improve negative symptoms. Moreover, psychosis characterized by negative symptoms has a worse outcomes. Furthermore, considering their first hospitalization, it is interesting to note that our participants’ mean age was 37.98 years old, much higher than the one reported in literature. Since our Hospital is located in a very peripheral area of Rome, where social disadvantage represents a critical issue, we hypothesized different reasons to explain this data such as lower level of education, marginalization and socioeconomic adversity that might increase difficulties to access to health care services. In conclusion, further studies are needed to find more useful and alternative treatments and to deepen relationship between sociodemographic context and the time of their first psychiatric assessment.

Glycine transporter inhibitor sarcosine changes neuronal and glial parameters in the left dorsolateral prefrontal cortex and glutamatergic parameters in the left hippocampus in stable schizophrenia

2016 ◽  
Vol 33 (S1) ◽  
pp. s264-s264
Author(s):  
D. Strzelecki ◽  
M. Podgórski ◽  
O. Kałużyńska ◽  
M. Kotlicka-Antczak ◽  
O. Gawlik-Kotelnicka ◽  
...  
Keyword(s):  
Prefrontal Cortex ◽  
Placebo Group ◽  
Negative Symptoms ◽  
Antipsychotic Therapy ◽  
Glycine Transporter ◽  
Left Dlpfc ◽  
Left Hippocampus ◽  
Dorsolateral Prefrontal ◽  
Before And After ◽  
Competing Interest

IntroductionSarcosine - glycine transporter inhibitor - increases glycine concentration around NMDA (N-methyl-D-aspartate) receptors. Function of the glutamatergic system in the prefrontal cortex and hippocampus is impaired in schizophrenia, which may lead to negative and cognitive symptomatology.AimsWe evaluated the influence of sarcosine therapy on the concentration of metabolites (NAA, N-acetylaspartate; Glx, complex of glutamate, glutamine and γ-aminobutyric acid (GABA); mI, myo-inositol; Cr, creatine; Cho, choline) in the left dorso-lateral prefrontal cortex (DLPFC) and left hippocampus in patients with stable schizophrenia.MethodsFifty patients with schizophrenia, treated with constant antipsychotics doses, in stable clinical condition were randomly assigned (25 patients in each group) to administration of sarcosine (2 g) or placebo for six months. 1H-NMR spectroscopy (1.5 T) in both localisations and clinical evaluation (PANSS) was performed before and after sarcosine addition.ResultsInitially we noted no differences in metabolite concentrations between groups. In the left DLPFC, NAA/Cho, mI/Cr and mI/Cho ratios were significantly higher in the sarcosine than the placebo group after six months. In the sarcosine group, NAA/Cr, NAA/Cho, mI/Cr, mI/Cho ratios also increased compared to baseline values. In the placebo group, only the NAA/Cr ratio increased. In the left hippocampus Glx/Cr and Glx/Cho decreased in sarcosine group at the end of our study.ConclusionsThe addition of sarcosine to antipsychotic therapy for six months caused increase of neurons viability (NAA) and neurogilal activity (mI) markers in the left DLPFC and decrease of hyperglutamatergic overstimulation parameters in the left hippocampus with simultaneous improvement of clinical parameters including negative symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pharmacogenetics of antipsychotics in adolescents with acute psychotic episode during first 14 days after admission: effectiveness and safety evaluation

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Dmitriy V. Ivashchenko ◽  
Sofi Z. Khoang ◽  
Bakhu V. Makhmudova ◽  
Nina I. Buromskaya ◽  
Pavel V. Shimanov ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
Safety Evaluation ◽  
Polymerase Chain Reaction Method ◽  
Psychotic Episode ◽  
Antipsychotic Therapy ◽  
Safety Parameters ◽  
Relevant Topic ◽  
Polymerase Chain ◽  
Positive And Negative Symptoms

AbstractObjectivesPrediction of the antipsychotic’s effectiveness is a relevant topic in the field of personalized medicine.MethodsThe research design of this study is a prospective observation with posthoc analysis of associations of genetic polymorphisms with safety parameters and effectiveness of antipsychotic therapy. We observed 53 adolescents with an acute psychotic episode which were prescribed antipsychotics for 14 days. We evaluated the effectiveness of antipsychotics with the Positive and Negative Symptoms Scale and the safety with the UKU Side Effects Rating Scale, Simpson-Angus Scale, and Barnes Akathisia rating scale. We genotyped CYP3A4*22 (rs2740574), CYP3A5*3 (6986A>G, rs7767746), CYP2D6*4, *9, *10 (rs3892097, rs1065852), ABCB1 1236C>T (rs1128503), 2677G>T/A (rs2032582), 3435C>T (rs1045642), DRD2 (rs1800497), DRD4 (rs1800955), HTR2A (rs6313) by the real-time polymerase chain reaction method.ResultsWe found significantly more frequent “increased dream activity” between CYP2D6 intermediate metabolizers and normal metabolizers (54 vs. 22%; p=0.043). The «increased duration of sleep» was more often observed in homozygotes TT of ABCB1 2677G>T/A (50 vs. 15.8%, p=0.006) and TT of 3435C>T (41.7 vs. 8.2%, p=0.007).ConclusionsWe found that CYP2D6 and ABCB1 polymorphisms were associated with the safety of antipsychotics in adolescents with an acute psychotic episode.

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