Combined pharmacotherapy involving aripiprazole and clozapine for controlling the positive symptoms refractory to other antipsychotic treatments in a patient with schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. s814-s814
Author(s):  
G. Hernandez Santillan ◽  
K. Lazo-Chávez ◽  
M. Blanco-Prieto
Keyword(s):  
Latin American ◽  
Negative Symptoms ◽  
Treatment Resistance ◽  
Positive Symptoms ◽  
Social Functions ◽  
Male Resident ◽  
Clozapine Therapy ◽  
Cultural Aspects ◽  
Clozapine Dose ◽  
Competing Interest

IntroductionTreatment resistance is considered a challenging problem of antipsychotic pharmacotherapy in schizophrenia, especially, when it is associated with other factors, such as cultural aspects, diverse clinical presentation, furthermore functional impact. Then, combination approaches are commonly used, for instance, the add-on of aripiprazole to clozapine; which allows increasing of efficacy and safety.ObjectiveAssess the response to clozapine–aripiprazole combination treatment in the management of resistant schizophrenia.AimTreatment of resistant schizophrenia.MethodAnalysis of a clinical case.ResultA 27-year-old male resident in an Iberian country two years ago, is from a Latin American country, lives with his mother, his sister and his nephew. Their parents were separated. Eight years ago, his father died and shortly thereafter, he started impaired behavior, auditory and visual hallucinations, delusions about referentiality, persecution and prejudice, which required a brief hospitalization in their country. Upon arrival, he is included in the network of Mental Health, with positive symptoms, significant behavioral and cognitive disorganization and he needed hospitalization again. Then, treatment is instituted in different lines with risperidone, quetiapine, olanzapine, haloperidol, amisulpride, without results. Then, combined clozapine therapy is initiated up to 400 mg/day, more aripiprazole 20 mg/day, which switch after to pattern injectable depot, with informed consent. Six months after, he presents encapsulated delirium and improvement of disorganization, allowing the patient to retake studies.ConclusionClozapine–aripiprazole combination was associated with 22% reduction of clozapine dose. There was improvement in positive and negative symptoms, social functions and amelioration in their metabolic profile.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Anti-DNA antibodies in the blood of patients with schizophrenia possess DNA-hydrolyzing activity

2016 ◽  
Vol 33 (S1) ◽  
pp. s247-s248
Author(s):  
E. Ermakov ◽  
L. Smirnova ◽  
L. Sinyanskii ◽  
D. Dobrygina ◽  
A. Semke ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Infectious Diseases ◽  
Negative Symptoms ◽  
Clinical Symptoms ◽  
Dnase Activity ◽  
Positive Symptoms ◽  
Linear Forms ◽  
Dna Antibodies ◽  
Competing Interest ◽  
Positive And Negative Symptoms

IntroductionAutoantibodies (Abs) to different neuronal receptors and DNA were detected in the blood of patients with schizophrenia. Abs hydrolyzing DNA were detected in pool of polyclonal autoantibodies in autoimmune and infectious diseases, such catalytic Abs were named abzymes.ObjectivesTo investigate the level of anti-DNA antibodies and DNA-hydrolyzing activity of IgG from the serum of patients with schizophrenia depending on leading clinical symptoms.Aims– To measure the concentration of anti-DNA Abs in serum of patients with leading positive and negative symptoms;– to determine DNA-hydrolyzing activity of IgG.MethodsIn our study, 51 patients were included. The levels of antiDNA Abs were determined using ELISA. DNA-hydrolyzing activity was detected as the level(%) of supercoiled pBluescript DNA transition in circular and linear forms. Statistical analysis was performed in “Statistica 9.0”.ResultsAnti-DNA Abs of patients with schizophrenia not only bind DNA, but quite efficiently hydrolyze the substrate. IgG of patient with schizophrenia were shown to possess DNA hydrolyzing activity. It should be noted that DNAase activity of IgG in patients with schizophrenia with a negative symptoms was significantly higher, than in patients with positive symptoms (Table 1).ConclusionsThe data show a correlation with the level of DNase activity and leading symptoms of patients with schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Efficacy of memantine in schizophrenic patients: A systematic review

2017 ◽  
Vol 41 (S1) ◽  
pp. s824-s824
Author(s):  
C. Montemitro ◽  
M.C. Spano ◽  
M. Lorusso ◽  
G. Baroni ◽  
G. Di Iorio ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Positive Symptoms ◽  
Aspartate Receptor ◽  
Sigma 1 ◽  
Schizophrenic Patients ◽  
Promising Treatment ◽  
High Concentrations ◽  
Competing Interest ◽  
Image Position

IntroductionSeveral evidences support the hypothesis that glutamatergic dysfunction may be implicated in the pathogenesis of schizophrenia and in the last few year great interest has been focused on the role of the N-methyl-D-aspartate receptor (NMDAR). Memantine is a noncompetitive NMDARs antagonist, binds the same site of NMDARs of Mg2+, endogenous blocker of NMDARs, with moderate affinity, rapid unblocking kinetics and strong functional voltage-dependency. Memantine does not affect the physiological activation of NMDARs whereas it blocks the sustained activation under pathological conditions. Preclinical studies have demonstrated that memantine at high concentrations targets many receptors, including serotonin, nicotinic acetylcholine, sigma-1 and serotonin and dopamine receptors.ObjectivesIncreasing interest in memantine add-on therapy in schizophrenic patients with negative and cognitive symptoms may suggest that memantine could be a new promising treatment in schizophrenia.AimsThe aim of this update was to evaluate clinical data about the memantine effectiveness in schizophrenic patients.MethodsWe searched on PubMed to identify original studies about the use of memantine in treatment of schizophrenic patients. The search conducted on June 16th, 2016 yielded 135 records. Neuf papers met our inclusion criteria.ResultsNegative symptoms improved in the large majority of patients treated, however there is not a clear evidence on cognitive and positive symptoms (Table 1)ConclusionsMemantine therapy in schizophrenic patients has given unclear results. It seems that memantine improves mainly negative symptoms, while cognitive and positive symptoms did not improve significantly. Further trials with a more numerous sample are required obtain an objective result.Table 1Observation during Memantime administration.↓: reduction in severity of symptoms; -: no relevant modifications; +: onset of new symptomsDisclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Keeping up with the therapeutic advances in schizophrenia: a review of novel and emerging pharmacological entities

CNS Spectrums ◽  
2019 ◽  
Vol 24 (S1) ◽  
pp. 38-69 ◽  
Author(s):  
Amanda Krogmann ◽  
Luisa Peters ◽  
Laura von Hardenberg ◽  
Katja Bödeker ◽  
Viktor B. Nöhles ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Negative Symptoms ◽  
Partial Agonist ◽  
Treatment Resistance ◽  
Positive Symptoms ◽  
Acid Oxidase ◽  
Cognitive Symptoms ◽  
Amino Acid Oxidase ◽  
Negative Results ◽  
Long Acting

Schizophrenia remains one of the most severe medical diseases. Current dopamine modulating first-generation and second-generation antipsychotics target mainly positive symptoms, but not/inadequately negative and cognitive symptoms. Additional challenges include non-adherence and adverse effects, especially cardiometabolic dysregulation. This review evaluates new/emerging pharmacological treatments for schizophrenia. Therapies targeting total symptoms include cannabidiol, D3 antagonist/5-HT1A partial agonist F17464, lumateperone (ITI-007), phosphodiesterase 10A (PDE10A) inhibitors MK-8189 and TAK-063, sodium nitroprusside, and trace amine-associated receptor-1 (TAAR1) agonist RO5263397 and SEP-363856. Treatments targeting negative symptoms include the PDE10A inhibitor LuAF-11167, 5-HT2A inverse agonist pimavanserin, sigma-2/5-HT2A antagonist roluperidone (MIN-101), and d-amino acid oxidase (DAAO) inhibitor TAK-831. Agents targeting primarily cognitive dysfunction are the glycine transporter-1 inhibitor BI-425809 and cannabidiol. Therapies targeting residual positive symptoms/treatment-resistant schizophrenia include pimavanserin, dopamine D1/D2 antagonist LuAF-35700, and DAAO inhibitor sodium benzoate. Two new long-acting injectable antipsychotic formulations, Aripiprazole Lauroxil NanoCrystal® and the first subcutaneous injectable LAI Perseris (RBP-7000), were recently approved by U.S. Food and Drug Administration, and positive results were announced for Risperidone ISM®, each achieving therapeutic levels within 24 hours, without need for initial oral cotreatment/loading injection-strategies. Paliperidone palmitate 6-monthly intramuscularly injectable and Risperidone subcutaneously injectable TV46000 are currently under investigation. Finally, the samidorphan+olanzapine combination targets reduced weight gain liability, while maintaining olanzapine’s efficacy. Most of these trial programs are still ongoing or have yielded mixed or even negative results. Thus, additional mechanisms of action and agents require study to improve schizophrenia outcomes for total/positive symptoms with reduced adverse effects, but also cognitive symptoms, negative symptoms, and treatment resistance, the areas of greatest need in schizophrenia currently.

Toxic role in schizophrenia: A review by a clinical case

2016 ◽  
Vol 33 (S1) ◽  
pp. S292-S292
Author(s):  
M. Canseco Navarro ◽  
A. Peña Serrano ◽  
J.M. Hernández Sánchez ◽  
M. Canccino Botello ◽  
F. Molina López ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Negative Symptoms ◽  
Clinical Case ◽  
Paranoid Schizophrenia ◽  
Clinical History ◽  
Positive Symptoms ◽  
History Of ◽  
Competing Interest ◽  
Hospital General

IntroductionOften find it difficult diagnostic approach to patients with symptoms that could correspond to several clinical entities. This requires making a correct differential diagnosis to enable a better understanding and addressing the disease in an individualized way.ObjectiveDescribe pathogenetic factors of paranoid schizophrenia highlighting their relationship with drug consumption.MethodsReview of the clinical history of a patient admitted to acute ward of the Hospital General Universitario of Valencia.ResultsA case of a 30-year-old man, whose income is motivated by persistent and structured autolytic ideation occurs. It presents positive symptoms for several years and amotivational syndrome ago. It has a history of cannabis, cocaine and alcohol since he was thirteen and remains abstinent for more than six months ago. Differential diagnosis arises between amotivational toxic syndrome, reactive depressive symptoms to the disease and negative symptoms for chronic psychotic process. Finally diagnosed with paranoid schizophrenia and is included in the program of first psychotic episodes.Today the productive symptoms disappeared and remain negative though with less intensity achieving an improvement in overall activity.ConclusionsConsumption of toxic influences the development of a chronic psychotic process that may appear years later, becoming a etiological and maintainer factor, not only if its consumption continue, but other effects that occur long term amotivational syndrome and worsening prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

III. Clinical Findings. Abnormalities of the Mental State and Movement Disorder and their Correlates

1991 ◽  
Vol 159 (S13) ◽  
pp. 21-25 ◽  
Author(s):  
Eve C. Johnstone ◽  
D. G. C. Owens ◽  
C. D. Frith ◽  
J. Leary
Keyword(s):  
Movement Disorder ◽  
Mental State ◽  
Negative Symptoms ◽  
Clinical Evidence ◽  
Treatment Resistance ◽  
Clinical Findings ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
Schizophrenic Patients ◽  
Unselected Sample

Persisting positive symptoms largely unresponsive to treatment (Tuma & May, 1979; Macmillan et al, 1986; May et al, 1989) occur in about 7% of patients with schizophrenia but lesser degrees of treatment resistance are common (Hogarty, 1988; Johnstone, 1990) and problems of recurrence of positive symptoms and deterioration of negative symptoms are well known (Johnstone, 1990). Schizophrenic patients have also been found to have persisting non-psychotic symptoms, particularly depression (Cheadle et al, 1978). Disorders of movement in relation to schizophrenia and their treatment have been found to be disabling in a few patients and to cause lesser problems for many (Kane et al, 1985). The assessment of the mental state and of clinical evidence of movement disorder in the patients who form the subjects of the Harrow study was therefore clearly of interest, as it is rarely possible to examine these issues in a large, unselected sample.

Morphophenotypical patterns in patients with negative symptoms in schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. s818-s818
Author(s):  
E. Kornetova ◽  
A.V. Semke ◽  
A.N. Kornetov ◽  
E.G. Dmitrieva ◽  
V.V. Dubrovskaya ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Influence Factors ◽  
Clinical Feature ◽  
Positive Symptoms ◽  
Body Type ◽  
Routine Examination ◽  
Basic Symptoms ◽  
Clinical Presentations ◽  
Icd 10 ◽  
Competing Interest

IntroductionPositive-negative dichotomy in course of schizophrenia leads to search for factors which could influence the formation of basic symptoms. The study of patients’ body types and morphological peculiarities according clinical feature of schizophrenia could find some influence factors. Body type and regional morphologic dysplasias (RMD) are basically morphophenotypical patterns available for routine examination in usual clinical psychiatric practice.AimsTo reveal associations between body type, morphologic dysplasias and course of schizophrenia.MethodsAnthropometric, somatoscopy examination of patients with schizophrenia with gradually progressive negative disorders: emotional, volition, thought disturbances, increasing autism and social isolation, stable anhedonia with motivation defect were conducted. The accounted morbidity of 168 patients from the whole group of individuals with schizophrenia was about 10% (128 [76%] males, 40 [23.8%] females). Clinical presentations of schizophrenia met the criteria of ICD-10. Anthropometric investigation was conducted with the help of Martin's anthropometer and major thickness compasses for recognition of body type. RMD was registered descriptively.ResultsIt was shown that in patients with negative course of schizophrenia asthenic body type prevailed (60%) with the accumulation of RMD (94,4%) in comparison with healthy individuals (26.2%, P< 0.001). Among patients with positive symptoms of schizophrenia picnic body type prevailed (P < 0.001).ConclusionsAsthenic body type, accumulation of multiple RMD is associated with the domination of negative symptoms and continuous course of schizophrenia. Results of the study indicate the need for a deeper study of this issue on constitutional approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effect of Disrupted-in-Schizophrenia 1 gene on treatment response in patients with a first episode of psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S183-S183
Author(s):  
J. Vázquez Bourgon ◽  
R. Ayesa Arriola ◽  
P. Suarez Pinilla ◽  
R. Roiz Santiañez ◽  
D. Tordesillas Gutierrez ◽  
...  
Keyword(s):  
Treatment Response ◽  
Negative Symptoms ◽  
Rating Scale ◽  
Genetic Alterations ◽  
Individual Variability ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Positive Symptoms ◽  
Drug Naïve ◽  
Competing Interest

IntroductionThere is substantial evidence suggesting that individual variability in antipsychotic treatment response could be genetically determined. Disrupted-in-Schizophrenia 1 (DISC1) gene has been previously associated to the illness and to treatment response in a sample of patients suffering from psychosis. However, there is a lack of studies on the effect of DISC1 on treatment response in samples of first episode psychosis.ObjectivesThe aim of this study was to explore the relation between variations in DISC1 gene and treatment response to antipsychotics in a sample of drug-naïve patients with a first episode of psychosis.MethodsTwo hundred and twenty Caucasian drug-naive patients experiencing a first episode of non-affective psychosis were genotyped for rs821616 (Ser704Cys), rs6675281 (Leu607Phe) and rs1000731. Early (6 weeks) response to antipsychotic treatment was assessed with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects.ResultsWe found a significant association between rs1000731 and treatment response. Thus, those patients homozygous for the G allele of rs1000731 were more frequently non-responders, measured with SANS, after 6 weeks of treatment, than those carrying the A allele (X2 = 4.019; P = 0.032). Moreover, when analysing the clinical improvement longitudinally, we observed that those patients carrying the A allele for the rs1000731 presented a greater improvement in positive symptoms dimension (F = 8.905; P = 0.003).ConclusionsOur results suggest a minor contribution to antipsychotic drug response of genetic alterations in the DISC1 gene.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Performance of patients with different schizophrenia subtypes on the Synthetic House–Tree–Person Test

2019 ◽  
Vol 47 (11) ◽  
pp. 1-8 ◽  
Author(s):  
AiBao Zhou ◽  
Pei Xie ◽  
ChaoChao Pan ◽  
Zhe Tian ◽  
Junwei Xie
Keyword(s):  
Negative Symptoms ◽  
Positive Symptoms ◽  
Study Results ◽  
Symptom Type ◽  
Positive And Negative Symptoms

We explored differences in performance on the Synthetic House–Tree–Person Test between people with mainly positive symptoms and those with mainly negative symptoms of schizophrenia and, further, aimed to provide a basis for the diagnosis of schizophrenia symptom type. Participants were 58 people receiving treatment for schizophrenia, and we asked them to complete the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, and the Synthetic House–Tree–Person Test. There were significant differences in results on the Synthetic House–Tree–Person Test between the group with positive symptoms, the group with a mix of positive and negative symptoms, and the group with negative symptoms. There were 12 features of participants' drawings, such as big hands, which were correlated with hallucinations and delusions in positive symptoms, and 9 features, such as trees in a landscape, which were correlated with avolition and anhedonia in negative symptoms. Our study results suggest differences in performance on the Synthetic House–Tree–Person Test between these different symptom subtypes of schizophrenia; hence, the features that appear in drawings made during the test may contribute to the diagnosis of symptoms of people with schizophrenia.

Evaluation of positive and negative symptoms in schizophrenia

1986 ◽  
Vol 1 (2) ◽  
pp. 108-122 ◽  
Author(s):  
Nancy C. Andreasen ◽  
William M. Grove
Keyword(s):  
Negative Symptoms ◽  
The United States ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
University Of Iowa ◽  
Normal Functions ◽  
Subsequent Investigation ◽  
The University ◽  
The Relationship ◽  
Positive And Negative Symptoms

SummaryMost investigators concur that schizophrenia is probably a heterogeneous group of disorders that share the common features of psychotic symptoms, partial response to neuroleptics, and a relatively poor outcome. The subdivision of schizophrenia into two subtypes, positive versus negative, has achieved wide acceptance throughout the world during recent years. This distinction has heuristic and theoretical appeal because it unites phenomenology, pathophysiology, and etiology into a single comprehensive hypothesis.In spite of its wide appeal, the distinction has a number of problems. These include the failure to distinguish between symptom syndromes and diseases; failure to deal with the mixed patient; failure to take longitudinal course into account; and failure to address conceptually and methodologically the distinction between positive and negative symptoms.This paper focuses primarily on the conceptual basis for two instruments designed to measure positive and negative symptoms, the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS), originally described in 1982. Since their description, these scales have been used in a variety of other centers. These scales are based on the hypothesis that negative symptoms represent a deficit or diminution in normal psychological functions wliile positive symptoms represent an excess or distortion of normal functions. Reliability data are now available from Italy, Spain, and Japan which suggest that these scales can be used reliably in cultural settings outside the United States. The results of these studies are summarized in this paper. In addition, a replication study involving a new sample of 117 schizophrenics collected at the University of Iowa is described. In this second study of the SANS and SAPS, internal consistency is found to be quite high in the SANS. Thus negative symptoms appear to be more internally correlated with one another than are positive symptoms. The implications of this result are discussed. A principal components analysis is used to explore the relationship between positive and negative symptoms. While the study reported in 1982 suggested that positive and negative symptoms are negatively correlated, in the present study they appear to be uncorrelated. Overall, the results suggest that the SANS and SAPS are useful comprehensive instruments for the evaluation of positive and negative symptoms. The relationship between these symptoms and external validators such as cognitive functioning or CT scan abnormalities will be reported in a subsequent investigation.

scholarly journals Paliperidone to Treat Psychotic Disorders

2021 ◽  
Vol 13 (3) ◽  
pp. 343-358
Author(s):  
Hormazd D. Minwalla ◽  
Peter Wrzesinski ◽  
Allison Desforges ◽  
Joshua Caskey ◽  
Brittany Wagner ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Schizoaffective Disorder ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Drug Information ◽  
The United States ◽  
Mental Illnesses ◽  
Positive Symptoms ◽  
Review Of The Literature ◽  
Second Generation Antipsychotics

Purpose of Review: This is a comprehensive review of the literature regarding the use of paliperidone in the treatment of schizophrenia and schizoaffective disorder. It covers the background and presentation of schizophrenia and schizoaffective disorder, as well as the mechanism of action and drug information for paliperidone. It covers the existing evidence of the use of paliperidone for the treatment of schizophrenia and schizoaffective disorder. Recent Findings: Schizophrenia and schizoaffective disorder lead to significant cognitive impairment. It is thought that dopamine dysregulation is the culprit for the positive symptoms of schizophrenia and schizoaffective disorder. Similar to other second-generation antipsychotics, paliperidone has affinity for dopamine D2 and serotonin 5-HT2A receptors. Paliperidone was granted approval in the United States in 2006 to be used in the treatment of schizophrenia and in 2009 for schizoaffective disorder. Summary: Schizophrenia and schizoaffective disorder have a large impact on cognitive impairment, positive symptoms and negative symptoms. Patients with either of these mental illnesses suffer from impairments in everyday life. Paliperidone has been shown to reduce symptoms of schizophrenia and schizoaffective disorder.

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