Atypical antipsychotic switching versus atypical antipsychotic combination in schizoaffective disorder – A clinical case

2016 ◽  
Vol 33 (S1) ◽  
pp. S536-S536 ◽  
Author(s):  
A. Ballesteros ◽  
B. Cortés ◽  
A. Petcu ◽  
L. Montes ◽  
W. Jaimes ◽  
...  
Keyword(s):  
Atypical Antipsychotic ◽  
Schizoaffective Disorder ◽  
Drug Combination ◽  
Clinical Case ◽  
Standard Dose ◽  
Clinical Relapse ◽  
Upper Limbs ◽  
Oral Risperidone ◽  
Long Acting

IntroductionRecent studies suggest that aripiprazole (ARP) shows a better profile in terms of mental state and extrapyramidal symptoms (EPS) in psychosis. However, other studies consider that a combination of atypical antipsychotics (AAP) may also be an option for some refractory patients. We present a case of a schizoaffective disorder, manic type (SAFM) (F25.0, ICD-10 criteria) that improved in terms of EPS adverse effects after switching from long-term fluphenazine (LTF) to Long-acting injectable aripiprazole (LAIA) but showed relapse symptoms.ObjectiveWe present a clinical case of SAFM that improved clinically in our outpatient clinic after 1 month of bi-therapy with low doses of oral risperidone and standard dose of LAIA. We study oral AAP-LAIA drug combination utility in this clinical setting.AimsTo study “oral AAP-LAIA combo” benefits in refractory SAFM cases.MethodsOur patient is a 68-year-old female diagnosed of SAFM clinically stable with a combination of lithium and LTF. She presented severe cogwheel stiffness in the upper limbs and postural tremor. We switched from long-term fluphenazine to LAIA and 4 weeks later, she showed discrete cogwheel stiffness but also persecutory delusions and dysphoria.ResultsWe maintained LAIA (400 mg/28 days) and lithium (800 mg/day) doses and added-on risperidone 1 mg/day. She presented clinical relapse 1 month later. She kept her better EPS tolerance as she only had discrete cogwheel in upper limbs only by using attention distraction techniques.ConclusionsOral risperidone-LAIA drug combination appears as an effective and well-tolerated treatment in refractory SAFM cases.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Long-term Remission in Schizophrenia and Schizoaffective Disorder: Results from the Risperidone Long-acting Injectable Versus Quetiapine Relapse Prevention Trial (constatre)

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1 ◽  
Author(s):  
E. Smeraldi ◽  
R. Cavallaro ◽  
V. Folnegovic Smalc ◽  
L. Bidzan ◽  
E. Ceylan ◽  
...  
Keyword(s):  
Adverse Events ◽  
Schizoaffective Disorder ◽  
Relapse Prevention ◽  
Package Insert ◽  
Prevention Trial ◽  
Treatment Groups ◽  
Conventional Antipsychotics ◽  
Full Remission ◽  
Long Acting

Objective:To report the long-term remission results from the relapse prevention trial (ConstaTRE) in stable patients treated either with risperidone long-acting injectable (RLAI) or the oral atypical antipsychotic quetiapine.Methods:Clinically stable adults with schizophrenia or schizoaffective disorder treated with oral risperidone, olanzapine, or oral conventional antipsychotics were randomized to treatment with RLAI or oral quetiapine. Dosing was according to package-insert recommendation. Efficacy and tolerability were recorded for up to 24 months of treatment. Remission was defined as achieving and maintaining mild or less symptoms of schizophrenia over a 6-month period as defined by Andreasen et al, (2005).Results:710 patients were randomized (n=355 per group) to either RLAI or quetiapine. Demographics were similar between treatment groups. Relapse occurred in 54 RLAI (16.5%) and 102 quetiapine (31.3%) patients (p< 0.001). Full remission was achieved by 51% RLAI and 39% of quetiapine-treated patients (p=0.003) and was maintained until the end of the trial by 44% of RLAI and 31% of quetiapine patients. Mean duration of full remission was 540.8±181.4 and 508.1±188.0 days for RLAI and quetiapine groups, respectively (p=0.1325). Tolerability was similar between treatment groups. Most adverse events (AEs) were transient. Six RLAI and 10 quetiapine patients discontinued study treatment due to AEs.Conclusions:Among stable patients with schizophrenia or schizoaffective disorder, remission was more likely to occur in patients switching to RLAI when compared with quetiapine. both RLAI and quetiapine treatments were well tolerated.

Naturalistic Observational Study of Patients Receiving Risperidone Long-acting Injection (RLAI)

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
N. Gupta ◽  
C. Riley ◽  
I. Agell
Keyword(s):  
Observational Study ◽  
Atypical Antipsychotic ◽  
List Type ◽  
Oral Supplementation ◽  
Oral Risperidone ◽  
Injectable Formulation ◽  
Previous Medication ◽  
Patient Refusal ◽  
Long Acting ◽  
To Receive

Background:Risperidone is the first atypical antipsychotic available in a long-acting injection formulation. in United Kingdom, it is licensed for use in treatment of psychosis in patients tolerant of oral Risperidone. the Summary of Product Characteristics clearly defines the methods of initiation and titration.Methods:We performed a naturalistic observational study of 61 patients suffering with psychosis. the cohort comprised patients being prescribed Risperidone long-acting Injection (RLAI) within various Community Mental Health Teams and Assertive Outreach Team of the Trust. the data was collected related to three broad areas: reasons for choice of RLAI, initiation and titration of RLAI, continuation of RLAI.Results:•35/61 patients have been prescribed oral atypical antipsychotic (including 16/61 being prescribed oral Risperidone) prior to the injectable formulation and 3/61 had received Clozapine.•In 12/61 non-compliance was suspected and only 11/25 patients stated a preference for an injectable formulation.•33/61 received oral supplementation during initiation.•29/61 were initiated on dose of RLAI commensurate with the current dose of oral Risperidone•In 35/61, dose was changed in less than 4 weeks intervals.•43/61 continued to receive RLAI. 18/61 discontinued due to patient refusal (6/18), patient not tolerated (3/18), not effective (2/18), patient non-attendance (1/18), patient moved area (1/18), other reasons (2/18), no reasons specified (3/18).Conclusions:Prescribing of RLAI did not follow recommendation from manufacturers during initiation and titration. Non-Compliance with previous medication was main reason for use of RLAI. However, discontinuation with RLAI was primarily related to refusal/intolerance of treatment.

Long-term safety and tolerability of long-acting injectable risperidone in patients with schizophrenia or schizoaffective disorder

2007 ◽  
Vol 17 (2) ◽  
pp. 138-144 ◽  
Author(s):  
Jean-Pierre Lindenmayer ◽  
Akbar Khan ◽  
Mariëlle Eerdekens ◽  
Ilse Van Hove ◽  
Stuart Kushner
Keyword(s):  
Schizoaffective Disorder ◽  
Long Acting

scholarly journals Relapse Prevention in Schizophrenia and Schizoaffective Disorder with Risperidone Long-Acting Injectable vs Quetiapine: Results of a Long-Term, Open-Label, Randomized Clinical Trial

2010 ◽  
Vol 35 (12) ◽  
pp. 2367-2377 ◽  
Author(s):  
Wolfgang Gaebel ◽  
Andreas Schreiner ◽  
Paul Bergmans ◽  
Rosario de Arce ◽  
Frédéric Rouillon ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Schizoaffective Disorder ◽  
Relapse Prevention ◽  
Open Label ◽  
Long Acting

Weight Gain and Hyperprolactinemia in Schizophrenic Patients Treated During Twelve Months with Long Acting Risperidone

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1 ◽  
Author(s):  
F. Duarte Garcia ◽  
F. Duval ◽  
F. Gonzales Lopera ◽  
M.-C. Mokrani ◽  
Y. Hode ◽  
...  
Keyword(s):  
Body Weight ◽  
Weight Gain ◽  
Food Intake ◽  
Oral Risperidone ◽  
Significant Weight Gain ◽  
Length Of Treatment ◽  
Schizophrenic Patients ◽  
Long Acting ◽  
Risperidone Treatment

Background:Risperidone (RISP) may induce both elevated prolactin (PRL) levels and weight gain. the aim of this study was to evaluate body weight and mass index (BMI), and PRL modifications in schizophrenic patients treated for 1 year with long-acting risperidone (LAR).Methods:Body weight and BMI (calculated as weight in kilograms divide by height in meter squared) were determined at baseline and at endpoint in 19 schizophrenic patients (9 men and 10 women; mean[SEM] age 33.4[2.9] years). PRL levels were determined at baseline, after oral risperidone treatment (mean length of treatment: 79[30] days; mean dose: 5.8[0.5] mg daily) and during a 12 month treatment with LAR (mean dose: 50[10] mg every 2 weeks; PRL levels were measured before each injection).Results:At endpoint, a significant weight gain (Δweight: 8,1[1,4] kg) and BMI (ΔBMI: 2,9[0,5] kg/m²) was observed (both p< 0.0002). Compared with baseline, PRL levels were significantly increased (p< 0.0007; mean ΔPRL: 33[8] ng/ml). There was an association between ΔBMI>1,5 kg/m² and ΔPRL>40 ng/ ml (p< 0.04). Moreover ΔBMI was linked to the length of treatment (rho=0.47; n=19; p< 0.05).Conclusions:Our results suggest a link between weight gain and long term hyperprolactinemia in patients treated with LAR. It has been hypothesized that PRL may have a role in the regulation of food intake by increasing leptin synthesis and secretion.

scholarly journals Long-term remission in schizophrenia and schizoaffective disorder: results from the risperidone long-acting injectable versus quetiapine relapse prevention trial (ConstaTRE)

2013 ◽  
Vol 3 (4) ◽  
pp. 191-199 ◽  
Author(s):  
Enrico Smeraldi ◽  
Roberto Cavallaro ◽  
Vera Folnegović-Šmalc ◽  
Leszek Bidzan ◽  
Mehmet Emin Ceylan ◽  
...  
Keyword(s):  
Schizoaffective Disorder ◽  
Relapse Prevention ◽  
Prevention Trial ◽  
Long Acting

scholarly journals Long-Term Real-World Effectiveness of Pharmacotherapies for Schizoaffective Disorder

2021 ◽  
Author(s):  
Jonne Lintunen ◽  
Heidi Taipale ◽  
Antti Tanskanen ◽  
Ellenor Mittendorfer-Rutz ◽  
Jari Tiihonen ◽  
...  
Keyword(s):  
Real World ◽  
Schizoaffective Disorder ◽  
Cox Regression ◽  
Psychiatric Hospitalization ◽  
Mood Stabilizers ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Long Acting ◽  
Swedish Cohort

Abstract Objective To investigate the long-term real-world effectiveness of antipsychotics and other psychopharmacotherapies in the treatment of schizoaffective disorder (SCHAFF). Method Two nationwide cohorts of SCHAFF patients were identified from Finnish and Swedish registers. Within-individual design was used with stratified Cox regression. The main exposure was use of antipsychotics. Adjunctive pharmacotherapies included mood stabilizers, antidepressants, and benzodiazepines and benzodiazepine-related drugs. The main outcome was hospitalization due to psychosis. Results The Finnish cohort included 7655 and the Swedish cohort 7525 patients. Median follow-up time was 11.2 years (IQR 5.6–11.5) in the Finnish and 7.6 years (IQR 3.8–10.3) in the Swedish cohort. Clozapine and long-acting injectable (LAI) antipsychotics were consistently associated with a decreased risk of psychosis hospitalization and treatment failure (psychiatric hospitalization, any change in medication, death) in both cohorts. Quetiapine was not associated with a decreased risk of psychosis hospitalization. Mood stabilizers used in combination with antipsychotics were associated with a decreased risk of psychosis hospitalization (Finnish cohort HR 0.76, 95% CI 0.71–0.81; Swedish cohort HR 0.84, 0.78–0.90) when compared with antipsychotic monotherapy. Combination of antidepressants and antipsychotics was associated with a decreased risk of psychosis hospitalization in the Swedish cohort (HR 0.90, 0.83–0.97) but not in the Finnish cohort (1.00, 0.94–1.07), and benzodiazepine use was associated with an increased risk (Finnish cohort HR 1.07, 1.01–1.14; Swedish cohort 1.21, 1.13–1.30). Conclusions Clozapine, LAIs, and combination therapy with mood stabilizers were associated with the best outcome and use of quetiapine and benzodiazepines with the worst outcome in the treatment of SCHAFF.

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