Adjunctive use of reboxetine in schizophrenia

2004 ◽  
Vol 19 (6) ◽  
pp. 366-369 ◽  
Author(s):  
Thomas J. Raedler ◽  
Holger Jahn ◽  
Josef Arlt ◽  
Falk Kiefer ◽  
Mildred Schick ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Effective Treatment ◽  
Antipsychotic Medication ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Adjunctive Treatment ◽  
Before And After ◽  
Schizophrenic Patients ◽  
Typical Antipsychotics

AbstractBackgroundSchizophrenia is frequently complicated by depressive or negative symptoms that respond only moderately to treatment with antipsychotic drugs. Reboxetine is a novel antidepressant, which inhibits the reuptake of norepinephrine. We sought to study the efficacy and tolerability of the adjunctive use of reboxetine in a cohort of schizophrenic patients with prominent depressive or negative symptoms.MethodsSixteen schizophrenic inpatients were recruited for this study. All subjects received 4–8 mg of reboxetine/day while the antipsychotic medication (typical antipsychotics = 4; atypical antipsychotics = 12) was continued. All subjects underwent a standardized assessment including PANSS, CGI, HAMD, and CDSS before and after treatment with reboxetine (mean 26 ± 17 d).ResultsAll subjects tolerated treatment with reboxetine. Adverse effects were mild and did not require discontinuation of reboxetine. All clinical scores (PANSS 93.1 vs. 63.1; CGI 5.4 vs. 4.1; HAMD 20.4 vs. 8.1; CDSS 12.5 vs. 4.6) improved significantly under adjunctive treatment with reboxetine (all P < 0.01).ConclusionThe adjunctive use of reboxetine in schizophrenic patients was safe and well-tolerated. Our results suggest that the adjunctive use of reboxetine may be an effective treatment for depressive and negative symptoms in schizophrenia.

The effect of Zotepine on productive and negative symptoms in schizophrenic patients

1988 ◽  
Vol 3 (2) ◽  
pp. 125-130
Author(s):  
D.M. Dieterle ◽  
M. Ackenheil ◽  
H.P. Kapfhammer ◽  
F. Müller-Spahn
Keyword(s):  
Adverse Effects ◽  
Negative Symptoms ◽  
Suicide Attempts ◽  
Positive Effects ◽  
Antipsychotic Efficacy ◽  
Schizophrenic Patients ◽  
Dose Dependent ◽  
Low Dosage ◽  
Motor Disturbances

RésuméZotepine was studied in 15 schizophrenic patients over a period of 28 days with regard to its antipsychotic efficacy, effect on negative schizophrenic symptoms, tolerability and adverse effects. Nine patients received Zotepine in a high dosage of 230 mg/die±52 mg, 6 patients in a low dosage of 168 mg/die ± 18 mg. Two patients receiving the high dosage dropped out after 21 days because of worsening of symptomatology and suicide attempts. Zotepine had rapid antipsychotic effects with sedative properties during the initial days of treatment. Minimal adverse effects and extra-pyramidal motor disturbances as well as dose-dependent positive effects on negative schizophrenie symptoms were found.

scholarly journals Assessment of adverse effects in clinical studies of antipsychotic medication: survey of methods used

2010 ◽  
Vol 197 (1) ◽  
pp. 67-72 ◽  
Author(s):  
Alison Pope ◽  
Clive Adams ◽  
Carol Paton ◽  
Tim Weaver ◽  
Thomas R. E. Barnes
Keyword(s):  
Adverse Effects ◽  
Antipsychotic Medication ◽  
Clinical Studies ◽  
Antipsychotic Drugs ◽  
Rating Scales ◽  
Primary Source ◽  
Subjective Experiences ◽  
Schizophrenia Group ◽  
Tolerability Data ◽  
Definition Of

BackgroundClinical studies of antipsychotic medication are a primary source of data on the nature of, and relative liability for, adverse effects, relevant to prescribing decisions in clinical practice.AimsTo identify how safety and tolerability data were collected and reported in recent clinical studies of antipsychotics.MethodA survey was conducted of all 167 eligible studies published between 2002 and 2007 on the Cochrane Schizophrenia Group register.ResultsExtrapyramidal side-effects (EPS) and weight gain were most frequently assessed. A minority of reports addressed metabolic abnormalities, aversive subjective experiences and sexual dysfunction. Published rating scales were frequently used to evaluate EPS, but systematic methods were rarely applied to other treatment-emergent problems. The definition of individual adverse effects and the manner of reporting were inconsistent.ConclusionsThe way in which safety and tolerability data are collected and reported in clinical studies does not allow for fair and meaningful comparison of the relative risk profiles of individual antipsychotic drugs.

scholarly journals Decision analytic economic paliperidone ER in relapsing schizophrenic patients in Italy

2008 ◽  
Vol 9 (2) ◽  
pp. 95-108 ◽  
Author(s):  
Patrizia Berto ◽  
Cristina Negrini ◽  
Luigi Ferrannini
Keyword(s):  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Development Program ◽  
Sensitivity Analyses ◽  
Psychotic Symptoms ◽  
Base Case ◽  
Management Options ◽  
Pharmacological Management ◽  
Clinical Development Program ◽  
Schizophrenic Patients

Schizophrenia, with its typical chronic and relapsing course, is very burdensome, both clinically and economically. Its pharmacological management relies on two main drug classes: the older, or typical, antipsychotics, which are quite effective on positive symptoms, but limited by low tolerability and poor efficacy on negative symptoms, and atypical antipsychotics, which are better tolerated and effective on a wider range of psychotic symptoms. In this article, the authors briefly discuss current management options for patients with schizophrenia and highlight some unmet clinical needs in the field. After outlining the main clinical features shown by paliperidone ER, a novel antipsychotic, in its clinical development program, a decision analytic economic appraisal of its use in relapsing schizophrenic patients in Italy, as compared to the other available atypical antipsychotics, is presented. Under base-case assumption and after applying national costs and tariffs, the model predicts paliperidone ER to be associated with better clinical outcomes, expressed in terms of stable days, and lower costs; this means that paliperidone is dominant over the alternatives, according to the principles of economic evaluation of healthcare technologies. One-way sensitivity analyses conducted on structural and cost parameters indicated robustness of base-case estimates, which remain to be confirmed by “real world” national data.

Efficacy and tolerability of clobazam in adults with drug-refractory epilepsy

2020 ◽  
pp. 10.1212/CPJ.0000000000000992
Author(s):  
Alisha Jamil ◽  
Noah Levinson ◽  
Michael Gelfand ◽  
Chloe E. Hill ◽  
Pouya Khankhanian ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Seizure Frequency ◽  
Retrospective Chart Review ◽  
Adjunctive Treatment ◽  
Drug Resistant ◽  
Before And After ◽  
Initial Cohort ◽  
Epilepsy Classification ◽  
Drug Resistant Epilepsy

ObjectivesTo evaluate the effectiveness and tolerability of clobazam as an adjunctive treatment for adults with drug-resistant epilepsy.MethodsWe performed a single-center, retrospective chart review of patients ≥18 years of age with drug-resistant epilepsy who started clobazam between 2010 and 2018. Included patients had outpatient visits both before and ≥1 month after clobazam initiation. Epilepsy classification, seizure frequency before and after clobazam, duration of clobazam treatment, and adverse effects were analyzed.ResultsA total of 417 patients met inclusion criteria. Mean age was 37.5 years, and 54% of patients were female. Patients were on a mean of 2.4 antiepileptic drugs at time of initiation of clobazam. Epilepsy types were focal (56.8%), Lennox-Gastaut syndrome (LGS) (21.1%), generalized (15.1%), and unclassified (7.0%). At the first follow-up visit ≥1 month after clobazam initiation, 50.3% of patients had >50% reduction in seizure frequency, and 20.5% were seizure-free. Of the initial cohort, 17.1% were followed >1 year and were seizure-free at last follow-up. Response rates did not differ between different epilepsy classifications. Fifty-one percent of patients experienced ≥1 side effect, most commonly lethargy/fatigue (30.7%) or mood changes (10.8%). A total of 178 (42.6%) patients discontinued clobazam, most commonly due to adverse effects (55%).ConclusionsClobazam is effective and safe as a long-term adjunctive therapy for adults with drug-resistant epilepsy; efficacy in off-label use is similar to that in LGS.Classification of evidenceThis study provides Class IV evidence that clobazam is an effective treatment for adults with drug-resistant epilepsy, independent of epilepsy classification.

scholarly journals Individual differences in schizophrenia

BJPsych Open ◽  
2017 ◽  
Vol 3 (6) ◽  
pp. 265-273 ◽  
Author(s):  
Edmund T. Rolls ◽  
Wenlian Lu ◽  
Lin Wan ◽  
Hao Yan ◽  
Chuanyue Wang ◽  
...  
Keyword(s):  
Individual Differences ◽  
Antipsychotic Medication ◽  
Negative Symptoms ◽  
Unimodal Distribution ◽  
Multiple Episode ◽  
Syndrome Scale ◽  
Before And After ◽  
Motor Retardation ◽  
Negative Syndrome

BackgroundWhether there are distinct subtypes of schizophrenia is an important issue to advance understanding and treatment of schizophrenia.AimsTo understand and treat individuals with schizophrenia, the aim was to advance understanding of differences between individuals, whether there are discrete subtypes, and how fist-episode patients (FEP) may differ from multiple episode patients (MEP).MethodThese issues were analysed in 687 FEP and 1880 MEP with schizophrenia using the Positive and Negative Syndrome Scale for (PANSS) schizophrenia before and after antipsychotic medication for 6 weeks.ResultsThe seven Negative Symptoms were correlated with each other and with P2 (conceptual disorganisation), G13 (disturbance of volition), and G7 (motor retardation). The main difference between individuals was in the cluster of seven negative symptoms, which had a continuous unimodal distribution. Medication decreased the PANSS scores for all the symptoms, which were similar in the FEP and MEP groups.ConclusionsThe negative symptoms are a major source of individual differences, and there are potential implications for treatment.

scholarly journals Atypical antipsychotics and the negative symptoms of schizophrenia

1998 ◽  
Vol 4 (1) ◽  
pp. 53-61 ◽  
Author(s):  
David J. King
Keyword(s):  
Nervous System ◽  
Antipsychotic Medication ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Genetic Factors ◽  
Cortical Atrophy ◽  
Positive Symptoms ◽  
Type I ◽  
Type Ii ◽  
Positive And Negative Symptoms

The concept of positive and negative symptoms in schizophrenia can be traced back to Hughlings Jackson (1889) who taught that disease does not create, it sets free, and accordingly positive symptoms could be seen as ‘release’ phenomena resulting from ‘dissolution’ of the highest cerebral centres of the nervous system. Crow (1980) revived the dichotomy and proposed a Type I syndrome, characterised by positive symptoms, and a Type II syndrome, characterised by negative symptoms. He thought the latter was due to cortical atrophy and responded poorly to antipsychotic medication. In their review of the distinction, Walker & Lewine (1988) found a stronger relationship between premorbid dysfunction and negative symptoms than with positive symptoms. They also found there was a stronger influence of genetic factors on negative symptoms than positive symptoms.

Efficacy of Adjunctive Carbamazepine in the Treatment of Chronic Schizophrenia

1987 ◽  
Vol 21 (4) ◽  
pp. 355-358 ◽  
Author(s):  
John M. Herrera ◽  
John J. Sramek ◽  
Jerome F. Costa
Keyword(s):  
Negative Symptoms ◽  
Antipsychotic Drugs ◽  
Treatment Resistance ◽  
Chronic Schizophrenia ◽  
Neuroleptic Drugs ◽  
Treatment Resistant ◽  
Blind Trial ◽  
Schizophrenic Patients ◽  
Single Blind ◽  
Single Blind Trial

Six treatment-resistant schizophrenic patients were given a ten-week single-blind trial of carbamazepine. Treatment resistance was determined on the basis of documented failure to respond to treatment with at least three neuroleptic drugs from two different chemical classes. The adjunctive use of carbamazepine resulted in a significant improvement of the negative symptoms of schizophrenia. These symptoms are often poorly responsive to conventional antipsychotic drugs. Therefore, controlled studies should be performed to further assess the possible efficacy of carbamazepine in schizophrenia.

Quality: A non-interventional study evaluating quality of life in schizophrenic patients treated with atypical antipsychotics in the ambulatory setting

2011 ◽  
Vol 26 (S2) ◽  
pp. 1474-1474
Author(s):  
J. Peuskens ◽  
E. Fontaine ◽  
T. Vanlerberghe
Keyword(s):  
Quality Of Life ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Short Form ◽  
Well Being ◽  
Ambulatory Setting ◽  
Subjective Well Being ◽  
Symptom Scale ◽  
Schizophrenic Patients

ObjectivesThe QUALITY study evaluated Quality-of-Life in schizophrenic patients treated with atypical antipsychotics (AAPs) in the ambulatory setting.MethodsThis study was a 9-month, observational, multicentre prospective study. Patients (18–65 years-old) diagnosed with schizophrenia and treatment started with one AAP before visit-1 (minimum: 4-weeks, maximum: 8-weeks) were enrolled into this Belgian study. At visit-1 patients’ demographics and medical history were recorded with follow-up visits after 3-, 6- and 9-months. At each visit, patients completed the Subjective Well-being under Neuroleptic treatment short form (SWN-K), while investigators assessed the Positive and Negative Symptom Scale (PANSS-8) and Global Assessment of Functioning.Results121 patients were enrolled: 91 male, mean age 36.7 ± 10.8years. The main AAPs were risperidone (38/121), apripirazole (28/121) and quetiapine (25/121). On average, most mean changes from baseline in SWN-K-subscale scores were positive (between −0.5 and +0.5, range −1.8–1.6) suggesting patients felt better, although there were no treatment-group differences. The associations between baseline SWN-K-subscales and age were small (RC [regression co-efficient] range: −0.03–0.01). PANSS-8-score changes were slightly negative (means between −0.77 and −0.43) suggesting decreased symptom severity. Patients with more severe negative symptoms considered their mental- and physical-functioning to be better throughout the study, indicated by significant correlations between these SWN-K-subscale scores and negative PANSS-scores (RC = 0.19, p = 0.0282; RC = 0.15, p = 0.0258). The associations between SWN-K-scores and positive PANSS-scores were small (RC: 0.01–0.14). The number of hospitalizations decreased during the study (9.6% between visit-1 and 2 vs. 7.5% visit-3 and −4).ConclusionsQuality-of-life for all patients seemed to improve slightly, without any differences between treatment-groups.

scholarly journals Mechanism of Action of Atypical Antipsychotic Drugs in Mood Disorders

2020 ◽  
Author(s):  
Daniil Grinchii ◽  
Eliyahu Dremencov
Keyword(s):  
Mood Disorders ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Antidepressant Drugs ◽  
Dopamine Neurons ◽  
Atypical Antipsychotic Drugs ◽  
Experimental Drugs ◽  
Catecholamine Neurons ◽  
Typical Antipsychotics

Atypical antipsychotic drugs were introduced in the early 1990th. Unlike typical antipsychotics, which are effective only against positive symptoms of schizophrenia, atypical antipsychotics show effectiveness against negative and cognitive symptoms as well. Furthermore, they are effective not only in psychotic, but also in affective disorders, by their own or as adjuncts to antidepressant drugs. While typical antipsychotics act, almost exclusively, via dopamine-2 (D2) receptors, atypical target serotonin-1A/1B/2A/2C (5-HT1A/1B/2A/2C), &alpha;1/2-adrenergic, and/or histamine-1 (H1) receptors as well. Blocking of 5-HT1A/1B autoreceptors, inducing their early desensitization, and/or activation of &alpha;1-adrenoceptors, allow some atypical drugs to enhance 5-HT transmission. Blocking of 5-HT2A/2C and/or &alpha;2-adrenoceptors enable some atypical antipsychotics to stimulate catecholamine transmission and/or diminish the inhibition of catecholamine neurons induced by some antidepressants. It is possible, that the activation of H1 and/or blocking of H3 boost monoamine transmission as well, via a mechanism involving stimulation of firing activity of dopamine neurons. The experimental drugs with antipsychotic potential, acting on adenosine and trace amino associated (TAAR) receptors, might be effective in mood disorders as well, because of the ability to modulate the excitability of monoamine-secreting neurons and to potentiate extracellular concentrations of monoamines in the limbic areas of the brain.

scholarly journals Atypical Antipsychotics Mediate Dynamics of Intrinsic Brain Activity in Early-Stage Schizophrenia? A Preliminary Study

2021 ◽  
Vol 18 (12) ◽  
pp. 1205-1212
Author(s):  
Yingchan Wang ◽  
Yuchao Jiang ◽  
Dengtang Liu ◽  
Jianye Zhang ◽  
Dezhong Yao ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Early Stage ◽  
Brain Activity ◽  
Low Frequency ◽  
Antipsychotic Treatment ◽  
Before And After ◽  
Middle Occipital Gyrus ◽  
The Right ◽  
Intrinsic Brain Activity

Objective Abnormalities of static brain activity have been reported in schizophrenia, but it remains to be clarified the temporal variability of intrinsic brain activities in schizophrenia and how atypical antipsychotics affect it.Methods We employed a resting-state functional magnetic resonance imaging (rs-fMRI) and a sliding-window analysis of dynamic amplitude of low-frequency fluctuation (dALFF) to evaluate the dynamic brain activities in schizophrenia (SZ) patients before and after 8-week antipsychotic treatment. Twenty-six schizophrenia individuals and 26 matched healthy controls (HC) were included in this study.Results Compared with HC, SZ showed stronger dALFF in the right inferior temporal gyrus (ITG.R) at baseline. After medication, the SZ group exhibited reduced dALFF in the right middle occipital gyrus (MOG.R) and increased dALFF in the left superior frontal gyrus (SFG.L), right middle frontal gyrus (MFG.R), and right inferior parietal lobule (IPL.R). Dynamic ALFF in IPL.R was found to significant negative correlate with the Scale for the Assessment of Negative Symptoms (SANS) scores at baseline.Conclusion Our results showed dynamic intrinsic brain activities altered in schizophrenia after short term antipsychotic treatment. The findings of this study support and expand the application of dALFF method in the study of the pathological mechanism in psychosis in the future.

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