An observational study of clozapine-induced sedation and its pharmacological management

2016 ◽  
Vol 33 (S1) ◽  
pp. S106-S106
Author(s):  
S. Ramos Perdigues ◽  
A. Mane Santacana ◽  
R.B. Sauras Quetcuti ◽  
E. Fernandez-Egea
Keyword(s):  
Treatment Strategies ◽  
Schizophrenia Spectrum Disorder ◽  
Cross Sectional ◽  
Pharmacological Management ◽  
Efficacy Analysis ◽  
Schizophrenia Spectrum ◽  
The Hours ◽  
Competing Interest ◽  
Sectional Analysis ◽  
Prospective Analyses

IntroductionClozapine is the only drug approved for resistant schizophrenia, but remains underused because of its side effects. Sedation is common, but its management is unclear.ObjectivesTo analyze factors associated with clozapine-induced sedation and the efficacy of common treatment strategies.AimsTo determine clozapine-induced sedation factors and possible therapeutic strategies.MethodsUsing two years’ electronic records of a community cohort of resistant schizophrenia spectrum disorder cases on clozapine, we performed three analyses: a cross-sectional analysis of which factors were associated with number of hours slept (objective proxy of sedation), and two prospective analyses: which factors were associated with changes in hours slept, and the efficacy of the main pharmacological strategies for improving sedation.ResultsOne hundred and thirty-three patients were included; 64.7% slept at least 9 hours/daily. Among monotherapy patients (n = 30), only norclozapine levels (r = .367, P = .033) correlated with sleeping hours. Multiple regression analyses confirmed the findings (r = .865, P < .00001). Using the cohort prospectively assessed (n = 107), 42 patients decreased the number of hours slept between two consecutive appointments. Decreasing clozapine (40%) or augmenting with aripiprazole (36%) were the most common factors. In the efficacy analysis, these two strategies were recommended to 22 (20.6%) and 23 (21.5%) subjects, respectively. The majority (81.8% and 73.9%) did not report differences in the hours slept.ConclusionsSedationis common and involves pharmacological and non-pharmacological factors. The only correlation was a weak correlation between norclozapine plasma levels and total sleeping hours. Reducing clozapine and aripiprazole augmentation were the most successful strategies to ameliorate sedation, although both strategies were effective only in a limited numbers of subjects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Extrapyramidal side effects and functional remission in schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. S195-S196
Author(s):  
B. Ghajati ◽  
C. Leila ◽  
L. Raja ◽  
C. Majda
Keyword(s):  
Side Effects ◽  
Rating Scale ◽  
Spectrum Disorder ◽  
Extrapyramidal Side Effects ◽  
Schizophrenia Spectrum Disorder ◽  
Cross Sectional ◽  
Schizophrenia Spectrum ◽  
The Social ◽  
Competing Interest ◽  
Social Autonomy

Treating patients with schizophrenia has evolved towards including, as an effective goal, their functional remission. Beyond the discrepancies in this concept definition, a plethora of studies has been conducted trying to identify predictors of functioning in schizophrenia. Among which antipsychotic prescription and related side effects.AimExplore extrapyramidal side effects link with functional prognosis of patients with schizophrenia spectrum disorder.MethodsWe conducted a cross-sectional, retrospective and descriptive study in the psychiatry department “C”, in Razi hospital (Tunis), between October 2014 and March 2015. Sixty patients suffering from schizophrenia spectrum disorder (DSM IV-R) were included. Functional status was explored with the Global Assessment of Functioning Scale (GAF), the Social and Occupational Functioning Assessment Scale (SOFAS) and the Social Autonomy Scale (EAS). Extrapyramidal side effects (EPS) were evaluated using the Simpson and Angus Rating Scale (SAS).ResultsFunctional remission was achieved according to GAF, SOFAS and EAS in respectively: 63,30%, 48,30% and 51,70% of the patients. SAS mean score was 0.898 ± 0.29 (0.4–2). Although SAS showed no significant association with GAF, SOFAS and EAS global scores, patient with less EPS had better autonomy in EAS’ dimension “Relationship with the outside” (P = 0.048).ConclusionEPS may influence functional remission at several levels starting from the neurobiological to the social stigmatization and the treatment adherence levels. Further research in this matter is required.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Non-pharmacological management of adult asthma in Australia: cross-sectional analysis of a population-based cohort study

2018 ◽  
Vol 57 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Daniel J. Tan ◽  
John A. Burgess ◽  
Jennifer L. Perret ◽  
Dinh S. Bui ◽  
Michael J. Abramson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Cross Sectional ◽  
Pharmacological Management ◽  
Adult Asthma ◽  
Cross Sectional Analysis ◽  
Sectional Analysis

C-reactive protein as a marker of cardiovascular disease in patients with a schizophrenia spectrum disorder treated in routine medical practice

2011 ◽  
Vol 28 (3) ◽  
pp. 161-167 ◽  
Author(s):  
A. Sicras-Mainar ◽  
J. Rejas-Gutiérrez ◽  
R. Navarro-Artieda ◽  
M. Blanca-Tamayo
Keyword(s):  
Clinical Chemistry ◽  
Spectrum Disorder ◽  
Administrative Claims ◽  
C Reactive Protein ◽  
Cvd Risk ◽  
Schizophrenia Spectrum Disorder ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Schizophrenia Spectrum ◽  
Very High

AbstractObjectiveInterest in cardiovascular diseases (CVD) in schizophrenia has grown recently due to documented incremental mortality. C-reactive protein (CRP) has been assessed as a marker in individuals with CVD and/or at high risk of developing it. However, its role in schizophrenia patients is unknown. The goal of this research was thus to explore the use of CRP as a marker of CVD risk in patients with schizophrenia.MethodsA cross-sectional analysis of the Badalona Serveis Assistencials (BSA) administrative claims database was conducted including all subjects aged > 18 years with a diagnosis of schizophrenia spectrum disorder. CRP measurement, sociodemographics, medical history, 10-year CVD risk (Framingham function) and clinical chemistry data were extracted for analysis.ResultsSeven hundred and five patients (53.0% men, 48.2 [15.8] years, 78.7% on atypicals) met criteria for analysis. Mean 10-year CVD risk was high; 11.9 ± 5.7% and mean CRP levels were 2.6 ± 2.5 mg/L with 30.4% showing above-normative levels (> 3 mg/L). After adjusting for age, gender, smoking and presence of neoplasm or inflammatory diseases, CRP was linearly associated with 10-year CVD risk stratified by risk (low, moderate, high/very high): respectively, 2.3 (95% CI: 2.1–2.5), 3.1 (2.6–3.5) and 3.7 (3.2–4.1) mg/L; F = 13.5, P < 0.001. Patients with known CVD also showed higher CRP levels: 3.7 (2.9–4.5) vs. 2.5 (2.4–2.7) mg/L, P = 0.008; and higher probability of above-normal values; odds ratio = 4.71 (2.01–11.04), P < 0.001.ConclusionsHigh CRP levels above normative were associated with both known CVD and high/very high 10-year risk of a CVD event in patients with schizophrenia, suggesting CRP could be a marker of CVD in this psychiatric disorder.

Somatic comorbidities are associated with poorer treatment outcome in schizophrenia spectrum disorders, independently of psychiatric comorbidities and other clinical factors

2017 ◽  
Vol 41 (S1) ◽  
pp. S384-S384
Author(s):  
I. Simunovic Filipcic ◽  
F. Igor ◽  
B. Marijana ◽  
K. Matic ◽  
I. Ena ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Cross Sectional Study ◽  
Integrative Approach ◽  
Schizophrenia Spectrum Disorders ◽  
Cross Sectional ◽  
Psychiatric Comorbidities ◽  
Schizophrenia Spectrum ◽  
Somatic Comorbidities ◽  
Schizophrenic Patients ◽  
Competing Interest

IntroductionIncreased somatic morbidities in schizophrenic patients and their association with HRQoL are well documented. Less is known about their association with schizophrenia treatment outcome.ObjectiveTo explore whether the number of somatic comorbidities is associated with poorer psychosis treatment outcome independently of psychiatric comorbidities and other clinical and socio-demographic parameters.AimTo improve understanding of association of somatic morbidities on treatment outcome of schizophrenic patients.MethodsThis nested-cross-sectional study was done during 2016 at Psychiatric hospital Sveti Ivan, Zagreb-Croatia on the sample of 301 patients diagnosed with schizophrenia spectrum disorder. Outcomes were the number of psychiatric rehospitalizations since primary psychiatric diagnosis and the composite of significant improvement measured by CGI-S and the best self-rated health defined as 4th quartile of EQ-5D-5L VAS. Predictors were number of somatic and psychiatric comorbidities. By logistic regression, we controlled socio-demographic and clinical confounders.ResultsHaving two or more somatic comorbidities was significantly associated with the failure to achieve the composite of improvement. The number of somatic comorbidities was significantly associated with increase in psychiatric hospitalizations, even after the adjustment for psychiatric comorbidities and large number of clinical and socio-demographic variables.ConclusionsChronic somatic comorbidities are associated with poorer psychosis treatment outcome independently of psychiatric comorbidities and other factors. Therefore, to treat psychosis effectively it may be essential to treat chronic somatic comorbidities promptly and adequately. The integrative approach should be the imperative in clinical practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Oromandibular Dystonia: A Clinical Examination of 2,020 Cases

2021 ◽  
Vol 12 ◽  
Author(s):  
Laura M. Scorr ◽  
Stewart A. Factor ◽  
Sahyli Perez Parra ◽  
Rachel Kaye ◽  
Randal C. Paniello ◽  
...  
Keyword(s):  
Clinical Features ◽  
Age At Onset ◽  
Treatment Strategies ◽  
Oromandibular Dystonia ◽  
Cross Sectional ◽  
Psychiatric Disturbances ◽  
Segmental Dystonia ◽  
Expert Center ◽  
Sectional Analysis ◽  
Botulinum Toxin Injections

Objective: The goal of this study is to better characterize the phenotypic heterogeneity of oromandibular dystonia (OMD) for the purpose of facilitating early diagnosis.Methods: First, we provide a comprehensive summary of the literature encompassing 1,121 cases. Next, we describe the clinical features of 727 OMD subjects enrolled by the Dystonia Coalition (DC), an international multicenter cohort. Finally, we summarize clinical features and treatment outcomes from cross-sectional analysis of 172 OMD subjects from two expert centers.Results: In all cohorts, typical age at onset was in the 50s and 70% of cases were female. The Dystonia Coalition cohort revealed perioral musculature was involved most commonly (85%), followed by jaw (61%) and tongue (17%). OMD more commonly appeared as part of a segmental dystonia (43%), and less commonly focal (39%) or generalized (10%). OMD was found to be associated with impaired quality of life, independent of disease severity. On average, social anxiety (LSA score: 33 ± 28) was more common than depression (BDI II score: 9.7 ± 7.8). In the expert center cohorts, botulinum toxin injections improved symptom severity by more than 50% in ~80% of subjects, regardless of etiology.Conclusions: This comprehensive description of OMD cases has revealed novel insights into the most common OMD phenotypes, pattern of dystonia distribution, associated psychiatric disturbances, and effect on QoL. We hope these findings will improve clinical recognition to aid in timely diagnosis and inform treatment strategies.

Concomitant psychotropic medications and functional remission in schizophrenia patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S196-S196
Author(s):  
B. Ghajati ◽  
C. Leila ◽  
L. Raja ◽  
C. Majda
Keyword(s):  
Structured Interview ◽  
Psychotropic Medications ◽  
Mood Stabilizers ◽  
Global Assessment Of Functioning ◽  
Cross Sectional ◽  
Schizophrenia Spectrum ◽  
The Social ◽  
Stone Treatment ◽  
Competing Interest ◽  
Social Autonomy

Along with the rise of symptomatic and functional remission concepts in schizophrenia, multiple aspects of the disease treatment have been explored in their link to vocational prognosis. Although antipsychotics are the corner stone treatment, monotherapy is seldom. In fact, concomitant psychotropic medications (CPM) use during treatment of schizophrenia has dramatically increased worldwide.AimTo examine whether concomitant psychotropic medications use is associated to functional remission in schizophrenia patients.MethodsA cross-sectional, retrospective and descriptive study was conducted in the psychiatry department “C”, in Razi hospital (Tunis), between October 2014 and March 2015. Sixty patients suffering from schizophrenia spectrum disorder (DSM IV-R) were included. Functional status was explored with the Global Assessment of Functioning Scale (GAF), the Social and Occupational Functioning Assessment scale and the Social Autonomy Scale (EAS). Sociodemographic and therapeutic characteristics have been collected during a semi-structured interview.ResultsRates of functional remission were respectively: 63.30% at the GAF scale, 48.30% at the SOFAS and 51.70% at the SAS. Antipsychotics were prescribed alone in more than half patients (56.70%), mood stabilizers in 40% and antidepressants in 1.7% of the cases. Benzodiazepines were prescribed in 40% of the patients. There was no association between CPM use and functional remission, using three scales (GAF: P = 0.091; SOFAS = 0.125; EAS = 0.728).ConclusionLargely used, concomitant psychotropic medications can increase side effects, cause drug interactions, escalate treatment costs, and lead to non-adherence. That is said, their therapeutic effectiveness should be thoroughly investigated, aiming to recovery not only symptoms control.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Protein-c-reactive as a marker of inflammation and cardiovascular disease in patients with schizophrenia: a cross-sectional analysis of a healthcare provider administrative claim database

2011 ◽  
Vol 26 (S2) ◽  
pp. 1488-1488 ◽  
Author(s):  
A. Sicras-Mainar ◽  
J. Rejas ◽  
R. Navarro-Artieda ◽  
M. Blanca-Tamayo
Keyword(s):  
Claim Database ◽  
Schizophrenia Spectrum Disorders ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Schizophrenia Spectrum ◽  
Inflammatory Drugs ◽  
Dsm Iv ◽  
Sectional Analysis ◽  
Very High

PurposeThe goal of this research was to explore the use of PCR as a marker of inflammation and CVD in patients with Schizophrenia.MethodsA cross-sectional analysis of the BSA administrative claim database was conducted including all men and women, >18 years, with a schizophrenia spectrum disorders (by DSM-IV criteria) diagnosis. PCR measurement together with socio-demographics, evolution, medical history, 10-years CVD risk (Framingham equation) and biochemistry data was extracted for analysis.Results705 patients [53.0% men, 48.2 ± 15.8 years (mean ± SD), 5.9 ± 3.2 years of evolution, 79.7% on atypical drugs] met criteria for analysis. Mean 10-year CVD risk was high; 11.9% ± 5.7% and mean PCR levels were 2.6 + 2.5 mg/L with 30.4% showing values above normal's (≥ 3 mg/L). Unadjusted PCR slightly correlated with CVD risk; r = 0.171, p < 0.001. After adjusting by age, sex, evolution, smoking and anti-inflammatory drugs treatment, PCR was linearly associated with 10-year CVD risk stratified by its level of risk (low, moderate, high/very high); respectively, 2.3 (95% CI: 2.1–2.5), 3.1 (2.6–3.5) and 3.7 (3.2–4.1) mg/L; F = 13.5, p < 0.001. Patients with known CVD showed also higher PCR levels; 3.7 (2.9–4.5) vs. 2.5 (2.4–2.7) mg/L, p = 0.008, and higher probability of values above normal's; Odds Ratio = 4.71 (2.01–11.04), p < 0.001.ConclusionsHigh PCR levels (above normals) were associated with both known CVD and high/very high 10-year risk of CVD event in patients with schizophrenia. Then, PCR might be a marker of inflammation and CVD in this psychiatric disorder.

Factors Related to Disability Pensions – A Cross-Sectional Analysis From A University Hospital In Istanbul

2016 ◽  
Vol 33 (S1) ◽  
pp. S486-S486
Author(s):  
E. Sönmez ◽  
D. Tunca ◽  
Y. Akvardar
Keyword(s):  
Intellectual Disability ◽  
Psychiatric Diagnosis ◽  
Disability Pension ◽  
University Hospital ◽  
Cultural Perceptions ◽  
Cross Sectional ◽  
Perceptions Of Disability ◽  
Competing Interest ◽  
Somatic Diseases ◽  
Sectional Analysis

IntroductionMental disorders are one of the leading reasons for disability-related retirement and payment of associated long-term benefits in many countries.ObjectivesTo explore the characteristics of psychiatric outpatients who apply for disability pensions and to investigate the factors associated with making an application.MethodsA four-month cross-sectional evaluation of disability pension and retirement applications to the psychiatry outpatient clinic in a university hospital in Istanbul.ResultsThe majority of 144 patients were male (n = 102, 70.8%), based in Istanbul, married, living with their families and had no occupation at the time of inquiry. Excluding applications for individuals with a diagnosis of intellectual disability (n = 44), most applicants were primary school graduates (n = 31, 32.3%). For the whole group, the median age of application was 34. 60%, (n = 87) had an established psychiatric diagnosis before the application, with average duration since diagnosis of approximately 8 years. The most frequent diagnoses were intellectual disability, followed by schizophrenia and depression. More than half of the patients were treated only outpatiently, with no hospitalization (n = 55, 58%). Thirty-two of them (22.4%) had a comorbid psychiatric diagnosis and 58 (40.3%) had at least one comorbid medical diagnosis.ConclusionsThere are some similarities between our findings and findings from other countries, such as low educational level and frequent comorbid somatic diseases among patients applying for disability pension. In contrast with the literature and as an indicator of social inequality, most patients applied for disability pension were male. The results are reflecting the specificities of different health systems and cultural perceptions of disability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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