Neurofarmagen® Testing and Drug Side Effects: An Evaluation of its Use Among a Real-world Case Series

2016 ◽  
Vol 33 (S1) ◽  
pp. S466-S466
Author(s):  
F. Oliva ◽  
A. Portigliatti Pomeri ◽  
G. Nibbio ◽  
M. Giuseppe
Keyword(s):  
Clinical Practice ◽  
Side Effects ◽  
Case Series ◽  
Intermediate Phenotype ◽  
Genomic Alteration ◽  
Antipsychotic Treatment ◽  
Genetic Profile ◽  
Drug Induced ◽  
Testing Tool ◽  
Competing Interest

IntroductionVarious pharmacokinetic and pharmacodynamics features have proven to be involved in the development of drug-induced side effects in psychiatry and thus pharmacogenetic profiling should be considered during drug selection to avoid the onset of side effects.AimTo explore the usefulness of Neurofarmagen® testing in clinical practice by evaluating whether the genetic profile given by the tool could properly explain the onset of side effects during antipsychotic treatment.MethodsThe pharmacogenetic profile of ten patients having a history of side effect appeared during to specific a psychopharmacologic treatment was determined by Neurofarmagen® testing tool. The relationship between genetic profile and side effects was evaluated and classified.ResultsSixty percent of the sample showed a genomic alteration related to a increased likelihood of having any side effects, one half of which presented pharmacokinetic alteration (slow or intermediate phenotype for the implicated cytochrome) whereas the other half had a pharmacodynamic gene variant (related to dopamine or serotonin pathway).Conclusionthe Neurofarmagen® testing tool may be useful in the clinical practice in order to avoid drug-induced side effects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Reasons to choose a long acting antipsychotic and tolerability

2017 ◽  
Vol 41 (S1) ◽  
pp. s822-s822
Author(s):  
I. Martínez Molina ◽  
N. Gómez-Coronado Suárez de Venegas ◽  
P. Blanco Ramón
Keyword(s):  
Side Effects ◽  
Sexual Dysfunction ◽  
Negative Symptoms ◽  
Descriptive Analysis ◽  
Hypertensive Crisis ◽  
Antipsychotic Treatment ◽  
Competing Interest ◽  
One Year ◽  
Long Acting ◽  
Positive And Negative Symptoms

IntroductionAripiprazole depot is an atypical antipshycotic used to treat positive and negative symptoms of psychosis or acute mania.AimDescribe the reason why psychiatrists switch the current antipsychotic treatment on to aripiprazol depot, its tolerability and the reasons to stop aripiprazol depot treatment.MethodsDescriptive analysis based on a sample of 37 patients, aged 18–65 years, treated during one year with antipsychotics at two community mental health units.ResultsSwitching on to aripiprazole depot principal reasons: promote adherence (25%), persistence of symptoms (25%) and high levels of prolactin or sexual dysfunction (16.66%):– side effects of aripiprazole depot: insomnia (11.11%), inquietude (8.33%), sexual dysfunction (2.77%) and hypertensive crisis during administration (2.77%);– 83.33% of the patients are still taking it after one year. The most common reasons to stop or change it were the presence of secondaries (11.11%) and clinical exacerbation (5.55%).ConclusionsAripiprazole depot is well tolerated (even better than other antipsychotics). Common side effects are not severe and appear in a small percent of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Intramuscular maintenance treatment with ultra-high-dose long-acting injectable aripiprazole in an elderly patient suffering from chronic refractory schizophrenia: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S573-S573 ◽  
Author(s):  
L. Bartova ◽  
M. Dold ◽  
N. Praschak-Rieder ◽  
A. Naderi-Heiden ◽  
S. Kasper
Keyword(s):  
Side Effects ◽  
Maintenance Treatment ◽  
Rating Scale ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Symptom Scale ◽  
Meaningful Improvement ◽  
Plasma Level Monitoring ◽  
Competing Interest ◽  
Long Acting

Long-acting injectable (LAI) aripiprazole is increasingly appreciated in the course of a maintenance treatment of schizophrenia due to efficacy in delaying – and decreasing relapse, and low rates of feared side effects. In line with the prescribing information, the maximal starting – as well as maintenance dose was restricted to 400 mg following a 26-day interval between the single doses.We present a 72-year-old female inpatient (66 kg) with an acute exacerbation of chronic refractory schizophrenia, exhibiting primarily positive symptoms including excessive persecutory delusions, self-care deficit, poor insight and insufficient adherence to continuous intake of oral medication. Since she developed a post-injection syndrome after an accidental intravascular administration of olanzapine LAI 405 mg, the antipsychotic treatment was switched to aripiprazole LAI 300 mg once monthly. Due to insufficient clinical response, aripiprazole LAI was gradually increased up to 1200 mg per month under continuous plasma level monitoring. Here, 2 single injections of aripiprazole LAI 300 mg were delivered into both gluteal muscles concurrently, every 14 days.Consequently, we observed a clinically meaningful improvement (a total-score reduction from 111 to 75 on the Positive and Negative Syndrome Scale), as well as no objectifiable side effects, assessed by “The Dosage Record Treatment Emergent Symptom Scale” and “The Barnes Akathisia Rating Scale”, despite multi-morbidity and rather advanced age of the patient.Our safe experience with applying the almost threefold higher monthly dose over 12 weeks may encourage researchers to further investigate the efficacy, tolerability as well as handling of highly dosed aripiprazole LAI in refractory schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Subjective well-being under clozapine measured with the Serbian version of GASS-C: Preliminary results

2017 ◽  
Vol 41 (S1) ◽  
pp. s815-s815
Author(s):  
D. Ignjatovic Ristic ◽  
C. Dan ◽  
D. Hinic ◽  
J. Jovic
Keyword(s):  
Side Effects ◽  
Psychotic Disorder ◽  
Well Being ◽  
Future Research ◽  
Antipsychotic Treatment ◽  
Subjective Well Being ◽  
Clinical Benefits ◽  
Serbian Version ◽  
Competing Interest ◽  
Headache Pain

IntroductionClinical benefits of antipsychotic treatment depend on the efficacy and on the patients’ tolerability and compliance. To reduce patient initiated treatment discontinuation, timely detection of treatment emergent side effects is essential. The Glasgow Antipsychotic Side-effects scale for clozapine (GASS-C) is a recently developed instrument to measure subjectively experienced clozapine side effects.ObjectivesTimely detection of unreported clozapine related side-effects.AimDocumenting the prevalence of side-effects in schizophrenia or chronic psychotic disorder with the Serbian version of the GASS-C.MethodsThe sample included 95 in and outpatients with schizophrenia or chronic psychotic disorder. All subjects filled out the Serbian version of the GASS-C and a sociodemographic questionnaire.ResultsThe median age was 46.1 years; 53.7% of subjects were male. Clozapine doses ranged from 25 to 423 mg. Drowsiness (78%) was the most commonly reported side-effect. Overall, 16.8% of the patients added other complaints, such as headache, pain, hand or leg numbing or nightmares. According to GASS-C total score categorization [2], only 4.2. % of subjects were rated with severe side-effects, while 14% of themselves rated their symptoms as severe or distressing. More side effects were reported by female patients and by inpatients. Only a weak positive correlation was found between the severity of the side effects and clozapine dosage.ConclusionsWe found the GASS-C to be a useful instrument that elicits both unknown side-effects and patients rating of their severity. Side effects did not clearly relate to the prescribed dose. Future research should include the relation of clozapine plasma levels with side effects assessed with GASS-C.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Long-term metabolic effect of second-generation antipsychotics in first episode of psychosis

2017 ◽  
Vol 41 (S1) ◽  
pp. S388-S388
Author(s):  
J. Vázquez Bourgon ◽  
R. Pérez-Iglesias ◽  
V. Ortiz-García de la Foz ◽  
B. Crespo-Facorro
Keyword(s):  
Side Effects ◽  
Second Generation ◽  
Resistance Index ◽  
Metabolic Parameters ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Metabolic Side Effects ◽  
Long Term Follow Up ◽  
Competing Interest

IntroductionThere is growing evidence indicating that the use of second-generation antipsychotic (SGA) treatments in psychosis is related to potential metabolic side effects. Previous studies have shown clear metabolic side effects at short-term (12 weeks). However, to detect clinically-relevant impairment in metabolic parameters a long-term follow-up is preferred.ObjectivesThe aim of this study was to investigate the effect of aripiprazole, ziprasidone and quetiapine on metabolic measures in medication-naïve first episode psychosis patients after 1 year of treatment.MethodsOne hundred and sixty-eight, drug-naïve patients, suffering from a non-affective first episode of psychosis, were included in the present study. Patients were randomly assigned to quetiapine, ziprasidone or aripiprazole treatment lines. Weight and glucemic/lipid parameters were recorded at baseline and after 1 year of treatment. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects.ResultsWeight (t = −10.85; P < 0.001), BMI (t = −11.38; P < 0.001), total cholesterol (t = −5.37; P < 0.001), LDL-cholesterol (t = −5.21; P < 0.001), triglycerides (t = −5.18; P < 0.001) and the triglyceride/HDL insulin resistance index (t = −4.09; P < 0.001), showed statistically significant increments after 1 year of treatment.Moreover, on comparing the percentage of patients with pathological levels before and 1 year after the antipsychotic treatment, we detected higher percentages of patients with obesity (5.1% vs. 15.3%; P < 0.001), hypercholesterolemia (23.2% vs. 39.6%; P < 0.001) and hypertriglyceridemia (5.8% vs. 14.2%; P = 0.021) after 1 year of treatment.ConclusionsThe primary exposure to SGAs during the first year of psychosis was associated with significant increments in weight and metabolic parameters leading to a significant increment in the proportion of obesity, hypertriglyceridemia and hypercholesterolemia in our sample.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pool-data of clinical cases of inhaled loxapine (Adasuve)

2016 ◽  
Vol 33 (S1) ◽  
pp. s238-s238
Author(s):  
E. Gil Luna ◽  
J. Morato Parcerisa ◽  
P. Roset Arisso ◽  
A. Boldeanu
Keyword(s):  
Clinical Practice ◽  
Orthostatic Hypotension ◽  
Real World ◽  
Case Series ◽  
Pool Data ◽  
Mechanical Restraint ◽  
Satisfaction With Treatment ◽  
Competing Interest ◽  
Reported Data ◽  
Almost All

IntroductionAgitation is a psychiatric emergency that requires immediate assistance. Inhaled loxapine is a new option for achieving rapid tranquillisation avoiding coercive measures and over-sedation, which fits with patient's preferences and increases their satisfaction with treatment.ObjectiveReview the experience of use of inhaled loxapine in clinical practice.MethodsWe included data from all reports of case series with 10 or more patients published by European prescribers.ResultsTen posters were included that reported data on 116 patients, mostly diagnosed with psychotic or bipolar diseases. Among the 60 patients that were evaluated using PANSS-EC, baseline agitation intensity was above 20 in 45 of them (75%) and between 15 and 32 in 15 (25%). Regarding patients evaluated with the CGI-S scale, 17 patients had a score between 6 and 7 points and 4 had scores between 4 and 5. All patients were able to properly inhalate the drug. In some patients agitation receded as early as 2 minutes, and almost all of them were controlled within 10 minutes. Only 6 patients required the 2nd dose of loxapine within 24 hours. When patients were asked for, they showed a preference for inhaled administration instead of intramuscular one, manifested high levels of satisfaction with inhaled treatment, and in one report inhaled loxapine was stated to contribute to avoid mechanical restraint. Inhaled loxapine was well tolerated and no over-sedation was reported or any EPS, just a case of mild orthostatic hypotension.ConclusionThis pool-data review of inhaled loxapine in real world clinical practice shows that it is an effective treatment, with a very rapid response, easy to administer and well tolerated, with a good acceptance from patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effect of switching to long-acting injectable (LAI) aripiprazole on long-lasting antipsychotic-induced hyperprolactinemia: A report of two cases

2016 ◽  
Vol 33 (S1) ◽  
pp. S579-S579 ◽  
Author(s):  
M. Juncal Ruiz ◽  
B. Fernández-Abascal Puente ◽  
R. Landera Rodríguez
Keyword(s):  
Side Effects ◽  
Outpatient Treatment ◽  
Effective Alternative ◽  
Drug Induced ◽  
Partial Agonism ◽  
Menstrual Function ◽  
Blood Tests ◽  
Competing Interest ◽  
Long Acting ◽  
Brain Condition

IntroductionAntipsychotic-induced hyperprolactinemia (> 29 ng/ml in women) is associated with relevant side-effects.AimWe describe the case of two women aged 50 and 54 years, respectively, diagnosed with schizophrenia who were receiving outpatient treatment with paliperidone depot 100 mg/month and risperidone depot 50 mg/2 weeks, respectively and complained of oligoamenorrhoea and amenorrhoea for at least 6 months.MethodsRoutine blood tests showed hyperprolactinemia of 203.5 ng/ml and 306.2 ng/ml, respectively. The patients were evaluated by the Endocrinology unit and an MRI was performed discarding the presence of any primary brain condition. Both patients were switched to LAI aripiprazole due to its partial agonism of D2-brain receptors. At the time of switching both patients were stable in terms of psychopathology.ResultsChanges in prolactin levels 3 months after switching are shown in the Fig. 1. Two months after switching, both patients regained cyclic menstrual function. After 6 months, they still showed psycopathological stability.ConclusionsSeveral studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In these two cases, the normalization of prolactin levels and the resolution of oligoamenorrhoea/amenorrhoea were observed as soon as 2–3 months after switching to LAI aripiprazole. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A molecular Pathway Analysis Informs the Genetic Risk for Arrhythmia During Antipsychotic Treatment

2017 ◽  
Vol 41 (S1) ◽  
pp. S164-S164
Author(s):  
E.K. Fischer ◽  
H. Dyrby Andersen ◽  
M. Braun Jepsen ◽  
A. Drago
Keyword(s):  
Antipsychotic Treatment ◽  
Genetic Profile ◽  
Predictive Tool ◽  
Molecular Pathway ◽  
Mixed Regression ◽  
Cardiac Disorders ◽  
Inflation Factor ◽  
Competing Interest ◽  
Pathway Analyses

BackgroundArrhythmia is a potentially fatal side effect of antipsychotics. A biologic predictive tool to prevent it is missing.AimIdentification of a genetic profile at risk for antipsychotic induced arrhythmia.ObjectiveIdentifying a molecular pathway enriched for antipsychotic induced QT-modifications.MethodsSeven hundred and sixty-five SKZ individuals, M = 556, age = 40.93 ± 11.03 were included. QT-variation was a phase-specific created variable. A nested mixed regression served in R for clinical and molecular pathway analyses. Plink served for genetic analyses. Quality checking was standard, inflation factor was controlled by lambda values.ResultsQuetiapine and Perphenazine were associated with QT variation (P = 0.002; Estimate = 5.79 and P = 5.67e-06; Estimate = 8.96 respectively). No other significant association was detected. No inflation was detected. Axon guidance and Collagen biosynthesis (Table 1) were associated with QT variation at a conservative (adjusted) P value < 0.01.ConclusionsTwo molecular pathways were identified as possibly involved in QT modifications during antispsychotic treatment in SKZ patients. Previous evidence supports a role of the same pathways in cardiac disorders [1,2]. Interaction of specific SNPs with the drugs will be focus of further research.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effect in antipsychotic-induced hyperprolactinemia after switching to long-acting injectable aripiprazole: A 1-year study

2017 ◽  
Vol 41 (S1) ◽  
pp. s815-s816
Author(s):  
M. Juncal Ruiz ◽  
B. Fernández-Abascal Puente ◽  
O. Porta Olivares ◽  
M. Gómez Revuelta ◽  
R. Landera Rodríguez ◽  
...  
Keyword(s):  
Side Effects ◽  
Sexual Dysfunction ◽  
Clinical Improvement ◽  
Drug Induced ◽  
Oral Olanzapine ◽  
Competing Interest ◽  
One Year ◽  
Long Acting ◽  
Almost All

IntroductionAntipsychotic-induced hyperprolactinemia is associated with relevant side effects: short-term as hypogonadism, gynecomastia, amenorrhoea, sexual dysfunction and galactorrhoea; long-term as cardiovascular disease, bone demineralization and breast and prostate tumors.AimsTo evaluate the effect of switching to long-acting injectable aripiprazole on long-lasting antypsychotic-induced hyperprolactinemia.MethodsThis was a prospective observational 1-year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another antipsychotic was indicated. We measured the basal prolactine at the start of the study and 1 year after switching to long acting injecatable (LAI) aripiprazole.ResultsIn basal analytic, 48% had hyperprolactinemia (21.8–306.2 ng/mL) and 66.5% of them described side effects: 78% sexual dysfunction (72% men), 11% galactorrhoea (100% women), 5.5% amenorrhoea and 5.5% bone pain (100% women). In 48% of patients with hyperprolactinemia, the previous antipsychotics comprised: LAI-paliperidone (65,7%), oral-risperidone (7%), oral-olanzapine (6.1%), oral-paliperidone (5.2%), LAI-risperidone (4%) and others (12%). One year after switching to LAI-aripiprazole, prolactine levels were lower in all patients and in 85% prolactine levels were normalized. Overall, 72% described a clinical improvement, especially in terms of sexual dysfunction.ConclusionsSeveral studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In our study, we observed that levels of prolactine were normalized in 85% of patients with a clinical improvement in almost all of cases. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia due to its partial agonism in D2 brain receptors, especially in tuberoinfundibular pathway.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Protocol for a pharmacogenomic study on individualised antipsychotic drug treatment for patients with schizophrenia

BJPsych Open ◽  
2021 ◽  
Vol 7 (4) ◽  
Author(s):  
Yi Su ◽  
Hao Yu ◽  
Zhiren Wang ◽  
Sha Liu ◽  
Liansheng Zhao ◽  
...  
Keyword(s):  
Side Effects ◽  
Prediction Model ◽  
Total Sample ◽  
Antipsychotic Treatment ◽  
Efficacy Evaluation ◽  
Drug Induced ◽  
Extensive Experience ◽  
Clinical Cohort ◽  
Treatment Prediction ◽  
Set Up

Background Schizophrenia is a severe and complex psychiatric disorder that needs treatment based on extensive experience. Antipsychotic drugs have already become the cornerstone of the treatment for schizophrenia; however, the therapeutic effect is of significant variability among patients, and only around a third of patients with schizophrenia show good efficacy. Meanwhile, drug-induced metabolic syndrome and other side-effects significantly affect treatment adherence and prognosis. Therefore, strategies for drug selection are desperately needed. In this study, we will perform pharmacogenomics research and set up an individualised preferred treatment prediction model. Aims We aim to create a standard clinical cohort, with multidimensional index assessment of antipsychotic treatment for patients with schizophrenia. Method This trial is designed as a randomised clinical trial comparing treatment with different kinds of antipsychotics. A total sample of 2000 patients with schizophrenia will be recruited from in-patient units from five clinical research centres. Using a computer-generated program, the participants will be randomly assigned to four treatment groups: aripiprazole, olanzapine, quetiapine and risperidone. The primary outcomes will be measured as changes in the Positive and Negative Syndrome Scale of schizophrenia, which reflects the efficacy. Secondary outcomes include the measure of side-effects, such as metabolic syndromes. The efficacy evaluation and side-effects assessment will be performed at baseline, 2 weeks, 6 weeks and 3 months. Results This trial will assess the efficacy and side effects of antipsychotics and create a standard clinical cohort with a multi-dimensional index assessment of antipsychotic treatment for schizophrenia patients. Conclusion This study aims to set up an individualized preferred treatment prediction model through the genetic analysis of patients using different kinds of antipsychotics.

Antipsychotic-induced tardive dyskinesia: The role of glutamatergic system

2016 ◽  
Vol 33 (S1) ◽  
pp. S97-S97
Author(s):  
A. Boiko ◽  
S. Ivanova ◽  
A. Semke
Keyword(s):  
Tardive Dyskinesia ◽  
Glutamate Transporter ◽  
Antipsychotic Treatment ◽  
Nucleotide Polymorphisms ◽  
Antipsychotic Therapy ◽  
Drug Induced ◽  
Schizophrenic Patients ◽  
Competing Interest

Tardive dyskinesia (TD) occurs in 20–25% of patients with long-term antipsychotic therapy. Abnormalities in glutamatergic transmission are considered one of the key components of the pathogenesis of drug-induced side effects. Glutamate acts as excitotoxin under certain conditions and in excessive concentrations.Aim is to study the concentration of glutamate and analysis of single nucleotide polymorphisms (SNP) in genes coding the glutamate transporter and NMDA-receptors in schizophrenic patients with TD and without it.The study group included 156 patients with schizophrenia receiving long-term antipsychotic treatment. Patients were divided into two groups: 63 patients with TD and 93 patients without it. Glutamate was determined in serum by spectrophotometric method. Determination of allelic variants of gene SLC1A2 (rs4354668) and GRIN2A (rs2650427, rs1969060) was performed by polymerase chain reaction in real-time.We found a significant (P < 0.05) increase of the concentration of glutamate in patients with TD. Significant (P < 0.05) reduction in frequency of genotype GG of GRIN2A (rs1969060) and TT of SLC1A2 (rs4354668) were found in patients with TD in comparison to group without TD. In the study of glutamate concentration depending on the genotype GRIN2A (rs1969060) and genotype SLC1A2 (rs4354668) we observed a statistically significant change: elevated levels of glutamic acid identified with the heterozygous genotype in patients.It is possible to suggest that reduction in frequency of these genotypes increases the risk of movement disorders due to the protective effect of these genotypes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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