The interaction of subjective experience and attitudes towards specific antipsychotic-related adverse effects in schizophrenia patients

AbstractBackground:Discontinuation of antipsychotic drugs in schizophrenia patients is a major concern, since it results in relapse and re-hospitalizations. Non-adherence is strongly associated with negative-subjective response to antipsychotics, which is composed of the subjective experience of negative drug effects and attitude towards the treatment.Objective:To investigate the elements of subjective experience and subjective attitude towards specific drug-related adverse effects, leading to a generally negative-subjective attitude towards antipsychotics.Methods:Schizophrenia inpatients (n = 84) were administered a questionnaire measuring attitude and experience on eight subscales: weight gain, sedation, sexual anhedonia, extra-pyramidal syndrome, affective flattening, excessive sleep, diminished sociability and metabolic syndrome. DAI-30 was used to measure attitude towards drugs, and PANSS to assess psychopathology.Results:Weak correlation was found between subjective experience and attitude on most of the subscales. The only strong, albeit inverse, correlation between experience and attitude that was found was with regard to affective flattening, experienced by 37% of the sample, and it also predicted negative drug attitude as measured by the DAI-30, RR: 1.87 (95% CI: 1.06–3.3, df = 1, χ2 = 4.525, P < 0.05).Conclusion:Negative attitude towards most adverse drug effects did not correlate with personal experience. Drug-related affective flattening should be evaluated routinely, since experiencing it may predict negative attitude towards drugs, potentially leading to poor compliance and relapse.

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Receptor mechanisms of antipsychotic drug action in bipolar disorder – focus on asenapine

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125311430112 ◽

2011 ◽

Vol 1 (6) ◽

pp. 197-204 ◽

Cited By ~ 20

Author(s):

Gavin P Reynolds

Keyword(s):

Bipolar Disorder ◽

Weight Gain ◽

Adverse Effects ◽

Serotonin Receptors ◽

Antipsychotic Drugs ◽

Dopamine D2 Receptor ◽

D2 Receptor ◽

Drug Effects ◽

Antipsychotic Treatment ◽

Dopamine D2

The atypical antipsychotic drugs are considered a first-line treatment for mania in bipolar disorder with many having a proven superiority to the classical mood stabilisers. This review addresses the pharmacological mechanisms underlying this therapeutic efficacy, as well as those mechanisms considered responsible for the adverse effects of antipsychotic drugs, with a particular focus on the recently introduced asenapine. The high efficacy in bipolar mania of haloperidol, a relatively selective dopamine D2-like receptor antagonist, indicates that the one common receptor mechanism underlying antipsychotic effects on mania is antagonism at the D2 receptor. Serotonin receptors are implicated in antidepressant response, and relief of depressed mood in mixed states is likely to involve drug effects at one, or more likely several interacting, serotonin receptors. Asenapine shows a unique breadth of action at these sites, with potential effects at clinical doses at 5HT1A, 1B, 2A, 2C, 6 and 7 receptors. Antagonism at alpha2 adrenoceptors may also be involved. Adverse effects include those classically associated with dopamine D2 receptor blockade, the extrapyramidal side effects (EPS), and which are relatively diminished in the atypical (in comparison with the conventional) antipsychotics. A variety of protective mechanisms against EPS associated with different drugs include low D2 affinity, D2 partial agonism, high 5-HT2A and 2C antagonism. Similar effects at the D2 and 5-HT2C receptors may underlie the low propensity for hyperprolactinaemia of the atypicals, although the strong prolactin-elevating effect of risperidone reflects its relatively high blood/brain concentration ratio, a consequence of it being a substrate for the p-glycoprotein pump. Weight gain is a further concern of antipsychotic treatment of bipolar disorder which is particularly severe with olanzapine. Histamine H1, alpha1 adrenergic and particularly 5-HT2C receptors are implicated in this effect, although the lower propensity for weight gain shown by asenapine which, like olanzapine, binds to these receptors, indicates that other protective receptor mechanisms, or subtle differences in the 5-HT2C receptor-mediated effects, may be important. Of other peripheral and central effects, the pharmacological basis of sedation (H1 receptors) and postural hypotension (alpha1 adrenoceptors) are rather better understood. The relative benefits of atypical antipsychotics like asenapine can be understood from their receptor pharmacology, and this understanding is key to the future development of improved treatment for bipolar disorder.

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Adverse effects of antipsychotics as outcome measures

The British Journal of Psychiatry ◽

10.1192/bjp.191.50.s64 ◽

2007 ◽

Vol 191 (S50) ◽

pp. s64-s70 ◽

Cited By ~ 39

Author(s):

Samantha Hamer ◽

Peter M. Haddad

Keyword(s):

Adverse Effects ◽

Outcome Measures ◽

Antipsychotic Drugs ◽

Subjective Experience ◽

Advantages And Disadvantages ◽

Post Marketing Surveillance ◽

Post Marketing ◽

Clinical Meaning ◽

Randomised Controlled

BackgroundAntipsychotic drugs are associated with adverse effects that can lead to poor medication adherence, stigma, distress and impaired quality of lifeAimsTo review the use of adverse effects of antipsychotic drugs as outcome measures, with a particular emphasis on methodological issuesMethodReview of data on adverse effects from sources including randomised controlled trials (RCTs), post-marketing surveillance and naturalistic studiesResultsAll have advantages and disadvantages and the best overview comes from considering all sources of data together. Adverse effects are inconsistently reported, hampering cross-study comparisons. Many outcome measures lack clinical meaning. In both naturalistic studies and RCTs adverse effects often account for less treatment discontinuation than lack of efficacyConclusionsStandardisation in the reporting of adverse effects is needed. Patients' subjective experience of medication should be given more consideration. Total discontinuation rates provide a useful global outcome measure that incorporates tolerability and efficacy as well as patient and clinician viewpoints. Patients should be informed of common side-effects prior to treatment and monitored for their occurrence during treatment

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Applicability of somatic monitoring instructions in clinical practice guidelines on antipsychotic drug use

BMC Psychiatry ◽

10.1186/s12888-021-03162-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jurriaan M. J. L. Brouwer ◽

Erien Olde Hengel ◽

Arne J. Risselada ◽

Eric N. van Roon ◽

Hans Mulder

Keyword(s):

Clinical Practice ◽

Drug Use ◽

Adverse Effects ◽

Antipsychotic Drug ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Frail Elderly ◽

Antipsychotic Drugs ◽

Electronic Database ◽

Elderly Populations

Abstract Background Clinical practice guidelines (CPGs) recommend the monitoring of somatic parameters in patients treated with antipsychotic drugs in order to detect adverse effects. The objective of this study was to assess, in adult and (frail) elderly populations, the consistency and applicability of the somatic monitoring instructions recommended by established CPGs prior to and during antipsychotic drug use. Methods A search for national and international CPGs was performed by querying the electronic database PubMed and Google. Somatic monitoring instructions were assessed for adult and (frail) elderly populations separately. The applicability of somatic monitoring instructions was assessed using the Systematic Information for Monitoring (SIM) score. Somatic monitoring instructions were considered applicable when a minimum SIM score of 3 was reached. Results In total, 16 CPGs were included, with a total of 231 somatic monitoring instructions (mean: 14; range: 0–47). Of the somatic monitoring instructions, 87% were considered applicable, although critical values and how to respond to aberrant values were only present in 28 and 52% of the available instructions respectively. Only 1 CPG presented an instruction specifically for (frail) elderly populations. Conclusions We emphasize the need for a guideline with somatic monitoring instructions based on the SIM definition for both adult and (frail) elderly populations using antipsychotic drugs. In addition, CPGs should state that clear agreements should be made regarding who is responsible for interventions and somatic monitoring prior to and during antipsychotic drug use.

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Characteristics of voluntary reporting of adverse drug events related to antipsychotics in Australia: 14-year analysis

Therapeutic Advances in Drug Safety ◽

10.1177/20420986211012854 ◽

2021 ◽

Vol 12 ◽

pp. 204209862110128

Author(s):

Hanan Khalil ◽

Dimi Hoppe ◽

Nabil Ameen

Keyword(s):

Adverse Event ◽

Adverse Effects ◽

Adverse Events ◽

Neuroleptic Malignant Syndrome ◽

Antipsychotic Drug ◽

Antipsychotic Drugs ◽

Common Adverse Event ◽

Drug Misuse ◽

Large Databases ◽

Chi Squared

Background: Retrospective analyses of large databases of treated patients can provide useful links to the presence of drug misuse or rare and infrequent adverse effects, such as agranulocytosis, diabetic ketoacidosis or neuroleptic malignant syndrome. The aim of this study is to describe the adverse effects to antipsychotics reported in the Australian Database of Adverse Event Notifications (DAEN). Methods: Data were collected from the DAEN – a spontaneous reporting database. The database, which covered the period from January 2004 to December 2017, was obtained from the Therapeutic Goods Administration (TGA) website ( www.TGA.gov ). The drugs selected for this investigation are the following: aripiprazole, clozapine, olanzapine, paliperidone, risperidone, ziprasidone, quetiapine, haloperidol and pimozide. All data were analysed descriptively. Comparison of reporting and management of adverse events between adults (older than 20 years) and children (5–19 years) was undertaken using chi squared test, where p < 0.05 is significant. Results: A total of 7122 adverse events associated with the antipsychotics aripiprazole, clozapine, haloperidol, olanzapine, paliperidone, pimozide, quetiapine and risperidone were reported to the TGA between January 2004 and December 2017. On average, there were 2.6 adverse events reported for each case. The most common adverse event reported for antipsychotics was neuroleptic malignant syndrome. There were no significant differences in the number of co-medications, formulations, indications, therapeutic dose, hospital admission and overdose among the antipsychotics between paediatric and adult populations. However, there were significant differences between causality, death and the management of adverse events between adult and paediatric populations (5–19 years) ( p < 0.05, chi squared test). Conclusion: The antipsychotic drug associated with the highest adverse events in adults was clozapine, followed by olanzapine. The most common adverse event in adults, and reported with a number of antipsychotic drugs, was neuroleptic malignant syndrome. In children, the highest numbers of adverse events reported in the database were associated with risperidone, clozapine and olanzapine. Plain language summary Adverse events reported of antipsychotics Background: Retrospective analyses of large databases of treated patients can provide useful clues to the presence of drug misuse or rare and infrequent adverse effects associated with antipsychotics. The drugs selected for this investigation are the following: aripiprazole, clozapine, olanzapine, paliperidone, risperidone, ziprasidone, quetiapine, haloperidol and pimozide. Methods: All data were analysed descriptively and investigated for any associations between the variables collected. Comparison of reporting and management of adverse events between adults (older than 20 years) and children (5–19 years) was undertaken using chi squared test, where p < 0.05 is significant. Results: The antipsychotic drug associated with the highest adverse events was clozapine, followed by olanzapine. In children, the highest numbers of adverse events reported in the database were associated with risperidone, clozapine and olanzapine. The most common adverse event in adults, and reported with a number of antipsychotic drugs, was neuroleptic malignant syndrome. Conclusion: There were significant differences between causality, death and the management of adverse events between adult and paediatric populations (5–19 years).Keywords: Antipsychotics, adverse effects, adverse events, safety

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Correlates of Neutralizing/SARS-CoV-2-S1-binding Antibody Response with Adverse Effects and Immune Kinetics in BNT162b2-Vaccinated Individuals

10.21203/rs.3.rs-847396/v1 ◽

2021 ◽

Author(s):

Kenji Maeda ◽

Masayuki Amano ◽

Yukari Uemura ◽

Kiyoto Tsuchiya ◽

Tomoko Matsushima ◽

...

Keyword(s):

Adverse Effects ◽

Inverse Correlation ◽

Significant Rise ◽

Neutralization Titer ◽

Symptomatic Infection ◽

Protective Measures ◽

Neutralizing Activity ◽

Pain Scores ◽

Binding Antibody ◽

Moderate Inverse Correlation

Abstract While mRNA vaccines against SARS-CoV-2 are exceedingly effective in preventing symptomatic infection, their immune response features remain to be clarified. In the present prospective study, 225 healthy individuals in Japan, who received two BNT162b2 doses, were enrolled. Correlates of BNT162b2-elicited SARS-CoV-2-neutralizing activity (50% neutralization titer: NT50; assessed using infectious virions) with various determinants were examined and the potency of serums against variants of concerns was determined. Significant rise in NT50s was seen in serums on day 28 post-1st dose. A moderate inverse correlation was seen between NT50s and ages, but no correlation seen between NT50s and adverse effects. NT50s and SARS-CoV-2-S1-binding-IgG levels on day 28 post-1st dose and pain scores following the 2nd shot were greater in women than in men. The average half-life of NT50s was ~ 68 days and the estimated average time length till the total disappearance of neutralizing activity was ~ 198 days. While serums from elite-responders (NT50s > 1,500-fold: the top 4% among the participants) potently to moderately blocked all variants of concerns examined, some serums with low NT50s failed to block the B.1.351-beta strain. Since BNT162b2-elicited immunity against SARS-CoV-2 is short, an additional vaccine or other protective measures are needed.

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ELT- Autobiographic memory: a source for communicative competence

Scholedge International Journal of Multidisciplinary & Allied Studies ISSN 2394-336X ◽

10.19085/journal.sijmas030102 ◽

2016 ◽

Vol 3 (1) ◽

pp. 9

Author(s):

A.V.S. Jayaannapurna

Keyword(s):

Personal Experience ◽

Subjective Experience ◽

Aesthetic Experience ◽

Communicative Competence ◽

New Horizons ◽

Autobiographic Memory ◽

Inherent Nature

Language with all its paraphernalia, opens its wings of expression and communication in to new horizons of aesthetic experience. In addition, there is the inherent nature of language itself, which ultimately represents, symbolises, expresses, and can even shape our experience, but it is not the experience itself .With in communication, there is a lot of translation that must take place to go from the essence of our personal experience to the communication of words. In order to understand autobiographic memories, we use language to bridge the gap between dimensions ― between the dimension of subjective experience and the dimension of objective manifestation.

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Video Meeting Signals: A randomised controlled trial of a technique to improve the experience of video conferencing

10.31234/osf.io/q3sa6 ◽

2021 ◽

Author(s):

Daniel C. Richardson ◽

Miles R. A. Tufft ◽

Mackenzie Clavin ◽

Paul Hills

Keyword(s):

Randomised Controlled Trial ◽

Social Interactions ◽

Personal Experience ◽

Subjective Experience ◽

Video Conferencing ◽

Controlled Trial ◽

Training Session ◽

Socially Isolated ◽

Randomised Controlled ◽

Video Meeting

We found evidence from a randomised controlled trial that a simple set of techniques can improve the experience of online meetings. Video conferencing technology has practical benefits, but psychological costs. It has allowed industry, education and social interactions to continue in some form during the covid-19 lockdowns. But it has left many users feeling fatigued and socially isolated, perhaps becausethe limitations of video conferencing disrupt users’ability to coordinate interactions and foster social affiliation. Video Meeting Signals (VMS™) is a simple technique that uses gestures to overcome some of these limitations. We carried out a randomisedcontrolled trial with over 100 students, in which half underwent a short training session in VMS. All participants rated their subjective experience of two weekly seminars, and transcripts were objectively coded for the valence of language used. Compared to controls, seminar groups with VMS training rated their personal experience, their feelings toward their group, and their perceived learning outcomes as significantly higher. Also, they were more likely to use positive language and less likely to use negative language. While future, pre-registered experiments will explore which aspects of the technique are responsible for these benefits, the current results establish that VMS has great potential to overcome the psychological problems of group video meetings.

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