Tropicamide eye drops reduce clozapine-induced hypersalivation: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S543-S544 ◽  
Author(s):  
O. Kilic ◽  
H.M. Ozturk ◽  
E. Ata
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Side Effect ◽  
Negative Symptoms ◽  
Rating Scale ◽  
Short Form ◽  
Eye Drops ◽  
Oral Application ◽  
Competing Interest ◽  
Pressure Changes

IntroductionClozapine-induced sialorrhea (CIS) is a common, treatment-limiting and stigmatizing side effect. All systemic agents that are used for hypersalivation may increase clozapine side effects such as blood pressure changes, constipation, or arrythmias. Oral application of topical anti-muscarinic agents may be a low side effect option for treatment of CIS.ObjectiveThe aim of this case report was to propose an off-label treatment of tropicamide drops to CIS and to stimulate further investigation.Case reportA 33-year-old male inpatient with schizophrenia has been on clozapine 800 mg and amisulpride 600 mg/day. His drooling was occasional and severe as drool drips off his chin during the day and night. Wet area over the pillow, visual analog scale (VAS), the short form of health survey (SF-36), UKU side effect rating scale, scale for the assessment of negative symptoms (SANS), scale for the assessment of positive symptoms (SAPS) were applied at baseline and in one-week intervals. Oral application of one drop of tropicamide % 0.5 (5 mg/mL) to left and one drop to right side before going to bed in the first week and two drops to each side were administered subsequently. Informed consent was given by the patient.ResultsNo psychological, neurological, autonomic and other side effects were observed associated with tropicamide. On VAS, the patient rated hypersalivation 5/7 at baseline, 4/7 after one drop each, 3/7 after two drops each.ConclusionsThe reduction of CIS by oral use of tropicamide eye drops is promising and should be explored with randomized controlled trials.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Efficacy and tolerability of switching to long-acting injectable (LAI) aripiprazole in outpatients with schizophrenia

2016 ◽  
Vol 33 (S1) ◽  
pp. s255-s256
Author(s):  
B. Fernández-Abascal Puente ◽  
M. Juncal Ruiz ◽  
R. Landera Rodríguez
Keyword(s):  
Side Effects ◽  
Treatment Regimen ◽  
Treatment Adherence ◽  
Side Effect ◽  
Negative Symptoms ◽  
Psychotic Symptoms ◽  
Oral Olanzapine ◽  
Insufficient Response ◽  
Competing Interest ◽  
Long Acting

IntroductionSwitching antipsychotics is a therapeutic alternative for managing side-effects, or efficacy and compliance issues.AimTo evaluate the efficacy and tolerability of switching to LAI-aripiprazole in patients who had insufficient response or were intolerant to the previous antipsychotic, or required a more convenient treatment regimen.MethodsThis was a prospective, observational, 6-months study carried out in 45 outpatients with schizophrenia who were clinically stabilized but a switching to another antipsychotic was clinically indicated. Patients who required hospitalization, treatment discontinuation or adding another antipsychotic (including supplementation with oral-aripiprazole) were considered treatment failures. Switching was considered successful if the side-effect/symptom/adherence/convenience improved or, if applicable, disappeared.ResultsPatients aged 38 years, 51% women, and previous antipsychotics comprised: LAI-paliperidone (42%), oral-aripiprazole (22%), oral-olanzapine (11%), oral-risperidone (7%), LAI-risperidone (4%) and others (14%). The efficacy results of the switching are presented in the table. Of the 45 patients, 7 (15%) were considered treatment failures: 3 patients were hospitalized due to recurrence of psychotic symptoms, 2 discontinued LAI-aripiprazole, and 2 required supplementation with oral-aripiprazole (Fig 1).ConclusionsOur results suggest that switching to LAI-aripiprazole is an efficacious strategy for managing some antipsychotic-induced side-effects, persistence of negative symptoms and/or lack of treatment adherence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Side Effects of Clozapine and Their Relationship with Clinical Variables in Patients with Schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. S197-S197
Author(s):  
G. Gürcan ◽  
Ş. Hun Şenol ◽  
A.E. Anıl Yağcıoğlu ◽  
A. Ertuğrul
Keyword(s):  
Metabolic Syndrome ◽  
Side Effects ◽  
Plasma Levels ◽  
Rating Scale ◽  
Clinical Status ◽  
Clinical Variables ◽  
Clozapine Treatment ◽  
Clozapine Dose ◽  
Severity Of Disability ◽  
Competing Interest

IntroductionThe side effects of clozapine may affect the treatment process negatively, and increase the disability.AimsWe aimed to assess the side effects of clozapine, and their relationship with the clinical variables in schizophrenia patients, and study the predictors of disability.MethodsConsecutive 122 outpatients who met DSM-IV criteria for schizophrenia, and were on clozapine treatment were included in the study. Information about sociodemographic characteristics, past and current clinical status were gathered through a clinical interview and review of the medical records, and physical measures and laboratory tests, including clozapine plasma levels, were recorded. The patients were assessed with SCID-I, Positive and Negative Syndrome Scale, UKU-Side Effect Rating Scale, WHO-Disability Assessment Schedule-II.ResultsHypersalivation, weight gain, sedation and constipation were the most common side effects of clozapine. Although the mean plasma clozapine levels were high (828.11 ± 445.5 ng/mL), no significant effect of clozapine dose and plasma levels were detected on the severity of side effects, except for constipation. Metabolic syndrome prevalence was found to be 50% according to ATP IIIA criteria. Duration of clozapine treatment, clozapine dose and plasma levels were not significantly different between patients with and without metabolic syndrome. Regression analysis showed that the severity of schizophrenia psychopathology and the number of side effects predicted the severity of disability.ConclusionsSide effects of clozapine increase the disability of patients with schizophrenia and should be monitored regularly. On the other hand, clozapine dose and plasma levels do not determine the severity of most of the common side effects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Science of Antipsychotics: Mechanistic Insight

CNS Spectrums ◽  
2003 ◽  
Vol 8 (S2) ◽  
pp. 5-9 ◽  
Author(s):  
Carol A. Tamminga
Keyword(s):  
Side Effects ◽  
Tardive Dyskinesia ◽  
Side Effect ◽  
Negative Symptoms ◽  
New Drugs ◽  
Receptor Subtypes ◽  
Side Effect Profile ◽  
Cognitive Symptoms ◽  
Conventional Antipsychotics ◽  
New Antipsychotics

ABSTRACTWith the introduction of conventional antipsychotics in the 1950s, clinicians began to expect effective treatment of positive symptoms of schizophrenia. However, these drugs do not resolve negative and cognitive symptoms of schizophrenia and are also associated with serious side effects, including extrapyramidal side effects (EPS) and tardive dyskinesia. In 1989, clozapine was introduced and labeled the first new antipsychotic owing to its improved efficacy and side-effect profile. Clozapine proved effective in alleviating many of the positive, negative, and cognitive symptoms of schizophrenia, without causing inevitable EPS or tardive dyskinesia. Over the past decade, a number of different new antipsychotics have been developed. These drugs have an affinity for multiple dopamine-receptor subtypes as well as serotonin, norepinephrine, and glutamate receptors, allowing for better treatment outcomes. The antagonism of the 5-HT2A receptor may be responsible for improvement in negative symptoms and decrease in EPS. In addition to providing enhanced efficacy, the affinity of the new drugs for multiple receptors introduces new side effects not seen with the conventional agents, including weight gain. Each new antipsychotic has a unique receptor-binding profile that corresponds to its pharmacologic and side-effect profile. Understanding the differences in mechanisms of action of new antipsychotics will allow physicians to better choose treatment that meets the needs of each individual patient.

Short communication: reliability and validity of the UKU Side Effect Rating Scale for adults with intellectual disabilities

2016 ◽  
Vol 10 (3) ◽  
pp. 166-171 ◽  
Author(s):  
Anne Louise Tveter ◽  
Trine Lise Bakken ◽  
Jan Ivar Røssberg ◽  
Egon Bech-Pedersen ◽  
Jørgen G. Bramness
Keyword(s):  
Side Effects ◽  
Focus Group ◽  
Intellectual Disabilities ◽  
Side Effect ◽  
Rating Scale ◽  
Reliability And Validity ◽  
Medical Doctor ◽  
Face Validity ◽  
Content Type ◽  
Adults With Intellectual Disabilities

Purpose – The UKU side effect rating scale for adults with intellectual disabilities (UKU-SERS-ID) was developed to detect side effects among patients with intellectual disabilities (ID). The purpose of this paper is to examine the reliability and face validity of the UKU-SERS-ID. Design/methodology/approach – UKU-SERS-ID comprises 35 items. In total, 22 patients with ID were included from two specialized services for adults with ID and comorbid mental illness. All patients were rated on three different occasions by three clinicians; two nurses and one medical doctor. Reliability was estimated with Cohen’s κ. A focus group discussed the face validity of the items comprising the UKU-SERS-ID. Findings – Respectively ten (nurse-nurse scores) and eight (nurse-doctor scores) items were considered difficult to score due to low prevalence of the symptoms. For the other items the reliability was acceptable. Through discussion in a focus group, with the reliability scores in mind, only one of the items of the UKU-SERS-ID was discarded. Practical implications – The authors have developed a feasible side effect instrument for clinical practice. It is easy to score and relevant regarding important side effects. Originality/value – The UKU-SERS-ID seems to be a feasible tool. Further investigations are mandatory in order to gain knowledge about distribution and phenomenology of side effects from psychotropic medication for individuals with ID.

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.

Pregabalin Pain and Anxiety Treatment in Oncological Patient–Case Report

2017 ◽  
Vol 41 (S1) ◽  
pp. S669-S670
Author(s):  
D. Popovic ◽  
D. Pavicevic
Keyword(s):  
Drug Abuse ◽  
Side Effects ◽  
Rating Scale ◽  
Physical Symptom ◽  
Pain Level ◽  
Oncological Patient ◽  
Anxiety Control ◽  
Hamilton Anxiety Rating Scale ◽  
Anxiety Treatment ◽  
Competing Interest

Severe side effects of chemotherapy during treatment of malignant disease significantly disrupt patient's mental and physical state. Seventy five-years-old female patient was treated for breast cancer by protocol (operation, radiotherapy, chemotherapy-paclitaxel (CHT-PX) every tree weeks) and for dysthymia and generalized anxiety disorder with escitalopram (ESC). Tramadol (TRA) and clonazepam (KLO) given by oncologist due to severe side effects of CHT-PX: muscle cramps, lower back pain, walking difficulties, had partial results, increased anxiety and drug abuse (TRA doses increase from 100 to 300 mg/day and KLO from 4 to 6 mg/day). Efficiency of pregabalin (PG) in pain and anxiety control during CHT-PX application. The assessment was made by 100 mm visual analogue scale (VAS), which assessed physical symptom severity and Hamilton Anxiety Rating Scale (HAMA) on the first day after CHT-PX application, on the 7th, 14th and 21th day. Effective PG dose was 300 mg/day with EST, KLO and TRA previously taken. On the first day after CHT-PX, patient rated pain level as 9 according to VAS. During TRA and KLO treatment, pain level on VAS was 6 from the 7th till 14th day after CHT-PX, on 21th day deceased to 2. HAMA score was 49. After PG augmentation, according to VAS, pain level was 3 on the 7th day and 0 on 14th day. HAMA score was 20. Tapering off the dose of TRA and KLO started till discontinuation of both medications. Pregabalin efficiency in pain and anxiety control increase compliance of oncological patient and reduce harm of drug abuse.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.

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.

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