Psychiatrists’ opinions on long-acting anti-psychotics drugs: Perceived differences and identification of the ideal patient for each of these medications

IntroductionLong-acting anti-psychotic drugs (LAI) are increasingly used in clinical practice, owing to their ability to improve adherence.Objectives and aimsTo understand the variables that inform treatment choice, within the LAI anti-psychotics, in the daily clinical practice.MethodsFifteen attending psychiatrists from the university clinic of Siena and the community mental health service USL 7 Siena and Val d’Elsa were asked to answer a questionnaire comprising 4 questions, and asking for their clinical experience regarding olanzapine, risperidone, haloperidol, zuchlopentixol, paliperidone and aripiprazole LAISs.In particular, they were asked to indicate:– which LAI has been their mostly used;– what have been the most relevant side effects;– an efficacy score ranging from 0 to 5;– who the ideal patient for each of these medications could be.The answers were statistically assessed and the final results described as a percentage of the total.ResultsThe results are shown by the Tables 1 and 2.ConclusionsLAI are still heterogeneously used in the daily clinical practice: their actual use depends on the individual experience with a specific drug as well as on their costs and the availability of resources within the medical service. The most used LAI resulted to be risperidone, although haloperidol LAI is still considered to be the most effective one. Those psychiatrists interviewed had an overall good opinion about the most recent LAI such as paliperidone and aripiprazole. This is due to their good tolerability, which allows them to be administered more safely to the youngest, in order to preserve their good functioning.Table 1Table 2Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Patients with severe schizophrenia. functioning improvement after 7-year of comprehensive treatment

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2133 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S195-S195

Author(s):

J.J. Fernandez-Miranda ◽

S. Díaz-Fernández ◽

D.F. Frías-Ortiz

Keyword(s):

Treatment Adherence ◽

Psychosocial Functioning ◽

Hospital Admissions ◽

Functional Improvement ◽

Comprehensive Treatment ◽

Good Tolerability ◽

Time In Treatment ◽

Competing Interest ◽

Retention In Treatment ◽

Long Acting

IntroductionTo reach not only clinical but also rehabilitation (especially to improve psychosocial functioning) goals in people with schizophrenia is a need.ObjectiveTo know the retention in treatment and functional outcomes of patients with severe schizophrenia enrolled in a specific and comprehensive programme for 7 years.MethodA 7-year prospective, observational study of patients with severe schizophrenia (CGI-S of 5 or over) undergoing comprehensive programme (n = 200). Assessment included at the beginning and after 3, 6, 12, 24, 36 and 84 months: the CGI-S, the Camberwell Assessment of Needs (CAN) and the WHO-DAS. Time in treatment, reasons for discharge, laboratory tests, weight, medications, adverse effects and hospital admissions in the previous six years and during the follow-up were registered.ResultsCGI at baseline was 5.9 (0.7). After seven years, 44% of patients continued under treatment (CGI = 4.3 (0.8); P < 0.01); 36% were medical discharged (CGI = 3.4 (1.5); P < 0.001); WHO-DAS decreased in the four areas (P < 0.005) and also CAN (P < 0.01); 8% were voluntary discharges. Ten patients dead; three of them committed suicide (1.5%). Hospital admission decreased significantly (P < 0.001), and also antipsychotic combinations and antiparkinsonian medications. Fifty-five percent of all of them were treated with atypical long-acting antipsychotics, with good tolerability and few side effects (among them, only 4% were voluntary discharges).ConclusionRetention of patients with schizophrenia with severe symptoms and impairment in a specific and comprehensive programme was really high. Such good treatment adherence helped to get remarkable clinical and functional improvement. Long-acting medication seemed to be useful in improving treatment adherence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Patch bulging after plaque incision and grafting procedure for Peyronie’s disease. Surgical repair with a collagen fleece

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2015.2.173 ◽

2015 ◽

Vol 87 (2) ◽

pp. 173 ◽

Cited By ~ 7

Author(s):

Andrea Fabiani ◽

Fabrizio Fioretti ◽

Alessandra Filosa ◽

Lucilla Servi ◽

Gabriele Mammana

Keyword(s):

Clinical Practice ◽

Surgical Therapy ◽

Surgical Repair ◽

Daily Clinical Practice ◽

Peyronie’S Disease ◽

Boston Scientific ◽

Peyronie's Disease ◽

Grafting Materials ◽

Grafting Procedure ◽

The Ideal

The incision/excision and grafting techniques (PIG) for surgical therapy of Peyronie’s disease (PD) have gained popularity in recent years. Several different graft materials have been used but the ideal graft has yet to be established. The use of grafting materials could cause complications. In the daily clinical practice it will always be more frequent to manage complications arising from their use. We present herein the case of a patch bulging repaired with a ready-to-use collagen fleece (Tachosil®, Takeda, Linz, Austria, Europe) in a 61 years old man subjected to intervention of geometric corporoplasty with Paulo Egydio technique using an acellular collagen material (Xenform® patch, Boston Scientific, Natick, MA, USA) as graft. We also discuss the possible implications of PIG procedure.

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Clinical and functional outcomes of patients with severe schizophrenia undergoing comprehensive treatment: A 6-year follow-up

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.629 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s248-s248

Author(s):

J.J. Fernandez-Miranda ◽

S. Diaz-Fernandez

Keyword(s):

Functional Outcomes ◽

Hospital Admissions ◽

Treatment Compliance ◽

Functional Improvement ◽

Comprehensive Treatment ◽

Good Tolerability ◽

Care Programme ◽

Main Challenge ◽

Competing Interest ◽

Long Acting

IntroductionTo increase treatment compliance and consequently to reach clinical and rehabilitation goals in people with schizophrenia is a main challenge in their treatment.Objectives and aimsTo know the retention in treatment (and reasons for discharge) of people with severe schizophrenia enrolled in a specific, intensive, comprehensive and community programme for them; and also to know treatment (clinical and functional) outcomes.MethodsA 6-year prospective, observational study of patients with severe schizophrenia (ICD 10: F 20; CGI-S ≥ 5) undergoing specific severe mental illness programme (n = 200). Assessment included the Clinical Global Impression-Severity scale (CGI-S), the Camberwell Assessment of Needs (CAN) and the WHO Disability Assessment Schedule (WHO-DAS). Time in treatment and reasons of discharge were measured. Laboratory tests, weight and medications were reported. Hospital admissions were measured.ResultsCGI at baseline was 5.86 ± 0.7. After 6 years 48% of patients continued under treatment (CGI = 4.31 ± 0.8; P < 0.01); 31% were medical discharged (CGI = 3.62 ± 1.6; P < 0.001); DAS decreased in the four areas (P < 0.01) and also CAN (P < 0.01); 7% had moved to other places; 8% were voluntary discharges. Eight patients dead; three of them committed suicide. Forty-five percent of all of them were treated with atypical long-acting antipsychotics, with good tolerability. There were significantly less hospital admissions than during the previous 6 years (P < 0.001).ConclusionsRetention of severe mentally ill patients with schizophrenia in a specific and intensive care programme was really high; and seemed to help getting in remarkable clinical and functional improvement. Long-acting medication also seemed to be useful on improving treatment adherence, mainly due to their good tolerability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Tolerability of desvenlafaxine in clinical practice: An observational phase-IV study

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2022 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S547-S547

Author(s):

B. Navarro ◽

I. Perez ◽

L. Perez ◽

L. Erkoreka ◽

A. Arroita

Keyword(s):

Clinical Practice ◽

Hepatic Metabolism ◽

Daily Clinical Practice ◽

Health Centers ◽

Tolerability Profile ◽

Blurred Vision ◽

Competing Interest ◽

Mental Health Centers ◽

Favorable Tolerability Profile

IntroductionDesvenlafaxine is a SNRI which presents low affinity for muscarinic, H1 and α1 in vitro receptors and a marginal hepatic metabolism. Different studies have shown effectiveness and a favorable tolerability profile, but only a few of them have been realized independently.Objectives and aimsTo study the incidence and characteristics of short-term desvenlafaxine side effects (SE) in daily clinical practice.MethodsA total of 123 patients with recently introduced desvenlafaxine treatment are recruited from Barakaldo and Uribe-Kosta Mental Health Centers, and UKU scale is administered to measure SE. Descriptive data are calculated using SPSS v.22.ResultsSE are observed in 30.09%. Among these, 5.69% experimented improvement or disappearance of SE with dose reduction, whereas 16.26% had to stop DVF treatment. The most frequent SE was nausea/vomiting (7.3%), followed by dry mouth (4.9%), blurred vision (4.9%), tachycardia (4.1%), sexual SE (4.1%) and tension/inner unrest (4.1%). Among the patients with anxiety disorders, 27.78% present SE versus 30.47% of patients with other diagnoses.ConclusionsThe characteristics of SE with DVF in daily clinical practice are comparable to those found in previous studies, and the overall profile is more benign than other AD. Aspects such as gender and sexual function must be considered. In patients with anxious symptoms DVF is also effective and ES are presented similarly, opening a new line of research and treatment of conditions with these characteristics.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Updated safety result of a large Italian early access program (EAP) with cabazitaxel plus prednisone (CbzP) in metastatic castration-resistant prostate cancer (mCRPC) patients who progressed during or after docetaxel (D) therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15185 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15185-e15185

Author(s):

Sergio Bracarda ◽

Giuseppe Di Lorenzo ◽

Donatello Gasparro ◽

Paolo Marchetti ◽

Francesco Boccardo ◽

...

Keyword(s):

Clinical Practice ◽

Daily Clinical Practice ◽

Castration Resistant Prostate Cancer ◽

Good Tolerability ◽

Early Access ◽

Castration Resistant ◽

Heavily Pretreated ◽

Practice Methods ◽

Ecog Ps ◽

Access Program

e15185 Background: A significant percentage of mCRPC pts, who have progressed on D therapy, have a long life expectancy and are candidates for additional treatments. In TROPIC trial pts who progressed during or after D had a statistically significant OS advantage and clinical benefit with CbzP in respect to mitoxantrone plus prednisone (MP). Benefits observed in the TROPIC study supported a global EAP, to allow pts with mCRPC to have an early access to CbzP and provide confirmatory data in daily clinical practice Methods: We report the safety results of the first 90 pts entered into EAP and treated with CbzP, out of 232 pts enrolled by 25 Italian centers between Jan and Aug 2011 Results: Pts characteristics were median age 70 years (≥ 75 years 22.2%); ECOG PS 0-1, 97.8%; median N. of previous D cycles 8 (median cumulative D 675mg/m2); 14.1% received 675 ÷ 900 mg and 40.0% ≥ 900 mg of D. Median time from last D dose to first CbzP dose was 5.29 months including any other chemotherapy treatment.At the time of this analysis 50% of pts had received 4 cycles of CbzP. 33 pts discontinued CbzP mainly due to PD (42.4%), AEs (related/not related, 27.3%), investigator’s (3.0 %) / pts decision (18.2%) and others (9.1%). AEs resulting in CbzP discontinuation (10.0%) are mainly fatigue, pyrexia and haematological disorders. A total of 57 pts were still on treatment. In the 33 discontinued pts, CbzP has been delayed in 24.2% while a dose reduction occurred in 21.2% of pts. AEs of any grade were observed in 81/90 pts. Most common G 3/4 AEs were leukopenia (25.6%), neutropenia (48.9%), anaemia (6.7%), diarrhoea (1.1%), asthenia (3.3%) and fatigue (5.6%). One death occurred during the study period in a heavily pretreated pt who received 33 cycles of D Conclusions: This preliminary safety analysis suggests the good tolerability of cabazitaxel, in terms of haematological as well as non-haematological AEs even in heavily pretreated pts according to the previous experience of Italian Centers in theTROPIC trial. This is remarkable because of the increased similarity of the patient’ populations treated in the EAP and daily clinical practice

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Effective doses of paliperidone palmitate (PAP): Retrospective analysis from three years of treatment

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1996 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S540-S540

Author(s):

S. Galiano Rus ◽

A. Soler Iborte ◽

C. Quesada González

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Hospital Admissions ◽

Average Length ◽

Average Hospital ◽

Icd 10 ◽

Effective Doses ◽

Technical Specifications ◽

Competing Interest ◽

Long Acting

IntroductionThe use of PAP is already much extended in general. The recommended doses in the technical specifications of the drugs, as the result of trial studies, differ from the doses administered in habitual clinical practice. Therefore, the justification of this study is to monitor the average doses prescribed, to be able to reach an agreement on the best doses. To retrospectively analyze the first 32 patients in our area of healthcare, who were prescribed PAP, the doses used at the start of treatment and after 3 years.Materials and methodsTwo initial doses of PAP were analyzed, maximum and current (outpatient) in 32 patients attended in the area of mental health of North Jaen, who started the treatment with PAP between 2012 and 2013, with an average length of time of 2.55 years (SD 2.02). We evaluated the diagnosis (schizophrenia and related disorders, ICD-10 F20), the number of hospital admissions previous and posterior to the start of the treatment and change in weight.ResultsAverage doses: initial: 110.15 mg (SD 32.83), maximum: 165.51 mg (SD 29.76) and maintenance: 146.81 mg (SD 29.59). Average hospital admissions: prior and posterior to the start of treatment: 1.5 and 0.83. An average reduction of 44.06% in admissions was observed.ConclusionsThe data obtained suggests that a dose of 75–200 mg could be effective in the maintenance of patients with schizophrenia and for decreasing the number of new hospital admissions. Fifty percent of the cases can be compensated with long acting peliperidone as a monotherapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Plasma levels of long-acting injectable antipsychotics in outpatient care: a retrospective analysis

10.21203/rs.3.rs-31648/v1 ◽

2020 ◽

Author(s):

Martin Hýža ◽

Šilhán Petr ◽

Češková Eva ◽

Skřont Tomáš ◽

Kacířová Ivana ◽

...

Keyword(s):

Clinical Practice ◽

Plasma Levels ◽

Drug Application ◽

Individual Variability ◽

Therapeutic Drug ◽

Fluphenazine Decanoate ◽

Blood Samples ◽

Usual Clinical Practice ◽

Long Acting ◽

The Individual

Abstract Background The antipsychotic efficacy in schizophrenia depends on its availability in the organism. Although therapeutic outcomes remain still far from satisfactory, therapeutic drug monitoring is not a common part of clinical practice during a treatment with long-acting injectable antipsychotics (LAI AP). The real effectiveness of LAI AP is thus uncertain. Methods We made a retrospective evaluation of plasma levels of LAI AP. Collection of blood samples was performed just before the drug application and one week later. Fourty patients with a stabilized clinical condition and steady-state plasma levels were included. Results In the observed cohort of patients, flupentixol decanoate (n = 23) was the most often used drug, followed by fluphenazine decanoate (n = 7), haloperidol decanoate (n = 5), paliperidon palmitate (n = 3), and risperidone microspheres (n = 2). Just 5 of 40 patients were treated with a monotherapy. At the time before the application, 60% of the patients did not reach the therapeutic reference range (TRR) and 20% of the patients had an undetectable plasma level. At the time of collection of the second blood samples performed after 7 days, 24% of the patients were under the TRR. Conclusion We have found the surprisingly high incidence of plasma levels under the TRR in patients treated with LAI AP. Notwithstanding the individual variability in pharmacokinetics, it seems the LAI AP may be underdosed in the usual clinical practice.

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