Can drug interaction be useful? Case report of a schizophrenic patient treated with paliperidone long-acting injection

2017 ◽  
Vol 41 (S1) ◽  
pp. s837-s837
Author(s):  
M. Sarpe ◽  
M. Bran ◽  
L. Maria
Keyword(s):  
Rating Scale ◽  
Involuntary Movement ◽  
Anti Psychotic ◽  
Off Label ◽  
Compliant Patient ◽  
Syndrome Scale ◽  
Competing Interest ◽  
Clinically Significant ◽  
The One ◽  
Long Acting

IntroductionIntramuscular paliperidone palmitate (PLAI) is a long-acting atypical anti-psychotic approved in Romania for the maintenance treatment of adults with schizophrenia.ObjectivesTo determine the efficacy and tolerability of PLAI in a non-compliant patient with previously very low tolerability to oral anti-psychotics. The patient had been on risperidone long acting injection (RLAI) and had significant adverse events (i.e. tremor, akatisia) which persisted even when treated with the lowest dose of PLAI: 50 mg.AimsSince the efficacy of PLAI was good, and since a lower dose (than 50 mg of PLAI) is not available in Romania, we tried different ways to lower plasma concentration (PC) of the anti-psychotic because the patient presented clinically significant adverse effects (AE).MethodsInitially the time between the injections was extended at maximum recommended (35 days), with a slight effect, then an off label treatment was associated in order to lower the PC of PLAI. We used 300 mg of carbamazepine long acting, that may lower the PC of PLAI up to 30%. For the evaluation of the efficacy and tolerability, we applied: the clinical evaluation, the positive and negative syndrome scale, the Barnes Akathisia rating scale, the Simpson-Angus Scale and the abnormal involuntary movement scale.ResultsAfter using the above mentioned, strategies, the one that had indeed good results on reducing AE, with no alteration of the psychic status of the patient, was the association of carbamazepine.ConclusionsIn clinical practice, some off label medication associations may be salutary!Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals M216. ASSOCIATIONS OF EXTRAPYRAMIDAL SYMPTOMS WITH PSYCHOTIC SYMPTOMS IN A COHORT OF HOMELESS OR PRECARIOUSLY HOUSED PERSONS WITH OR WITHOUT SCHIZOPHRENIA

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S218-S218
Author(s):  
David Kim ◽  
Ric Procyshyn ◽  
Lik Hang Lee ◽  
William Panenka ◽  
Olga Leonova ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Analysis ◽  
Extrapyramidal Symptoms ◽  
Analysis Of Covariance ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
Syndrome Scale ◽  
Clinically Significant

Abstract Background There is considerable evidence supporting the association between extrapyramidal symptoms (EPS) and psychotic symptoms in patients with schizophrenia (SCZ). However, it is not well understood whether such an association exists in individuals without SCZ and how the association differs from those with SCZ. Our aim was to examine the associations of EPS with psychotic symptoms and compare them between SCZ and non-SCZ individuals. Methods We used data from a 10-year community-based study of homeless or precariously housed persons from Vancouver, Canada. Diagnosis of SCZ was made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Severity of psychotic symptoms was rated using the Positive and Negative Syndrome Scale (PANSS). Severity of parkinsonism, dyskinesia, and dystonia was rated using the Extrapyramidal Symptom Rating Scale (ESRS), and akathisia using the Barnes Akathisia Rating Scale (BARS). Presence of EPS was defined as having at least moderate severity on the ESRS (i.e., ≥4 out of 8) or BARS (i.e., ≥3 out of 5) Clinical Global Impression-Severity (CGI-S) scale. Absence of EPS was defined as scoring ≤2 on the ESRS or ≤1 on the BARS CGI-S scale. Two-way analysis of covariance was performed using SCZ and EPS as independent variables and PANSS five factors (i.e., positive symptoms, negative symptoms, disorganization, excitement, and depression) as dependent variables, controlling for age, antipsychotic users, and cocaine- or methamphetamine-dependent individuals. Multiple linear regression analysis was performed for both SCZ and non-SCZ groups, controlling for the same confounding variables, to examine 1) associations of the severity of EPS subtypes with PANSS factors and 2) whether the presence of multiple EPS subtypes would be associated with increased SCZ symptoms relative to the presence of a single subtype. Results A total of 223 participants were included in this study (mean age: 44.1 ± 12.0 years; 76.1% male). Eighty-four participants met the diagnosis of SCZ, of whom 39 met our criteria for having EPS and 32 for not having EPS. The remaining 139 participants were not diagnosed with SCZ, of whom 50 had EPS and 72 did not. None of the participants had clinically significant dystonia. Overall, significant main effects of EPS were found for total symptoms (F1,182 = 24.4, p < 0.001), negative symptoms (F1,182 = 16.3, p < 0.001), disorganization (F1,181 = 16.6, p < 0.001), and excitement (F1,182 = 15.8, p < 0.001), but not positive symptoms or depression. The presence of EPS was associated with greater total symptoms and disorganization in both SCZ and non-SCZ groups. Significant interaction effects between SCZ and EPS were found for negative symptoms (F1,182 = 6.0, p = 0.015) and excitement (F1,182 = 3.9, p = 0.050), where the presence of EPS was associated with greater negative symptoms and excitement in SCZ participants, but not in non-SCZ participants. Consistent in both SCZ and non-SCZ groups, there were significant positive associations of the severity of 1) parkinsonism with negative symptoms, 2) dyskinesia with disorganization and total symptoms, and 3) akathisia with excitement. The presence of multiple EPS subtypes, relative to a single subtype, was not associated with significant increases in any SCZ symptoms, except a significant increase in excitement in non-SCZ participants. Discussion The presence of EPS is clearly associated with greater symptoms of SCZ, even in individuals without SCZ. People with SCZ may experience greater negative symptoms and excitement as a result of EPS than those without SCZ. Subtypes of EPS are distinctively associated with factors of SCZ symptoms. Future studies should elucidate the mechanisms underlying these associations.

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.

Effectiveness of long-acting aripiprazole in schizoaffective disorders: A naturalistic longitudinal study

2017 ◽  
Vol 41 (S1) ◽  
pp. S757-S757
Author(s):  
A. Nivoli ◽  
M. Antonioli ◽  
L. Folini ◽  
L. Floris ◽  
G. Meli ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Schizoaffective Disorder ◽  
Rating Scale ◽  
Psychiatric Clinic ◽  
Significant Difference ◽  
Sample Test ◽  
Competing Interest ◽  
Long Acting ◽  
Over Time

IntroductionIntramuscular paliperidone palmitate (PP) is a long-acting, atypical anti-psychotic for once monthly intramuscular (IM) administration in the treatment of patients with schizophrenia.ObjectiveTo study the effectiveness (efficacy and quality of life) of ARP in the maintenance treatment of schizoaffective disorder.MethodsA non-randomized, prospective naturalistic study was performed in out-patients with schizoaffective disorder unsuccessfully treated with oral anti-psychotics. Efficacy of ARP over time was evaluated by using brief psychiatric rating scale (BPRS 24-items), quality of life was evaluated by using QL-Index, both at T0 and at most recent visit (T1). Data were analyzed with Student's t-tests and Pearson correlations (α value, two tailed). Paired t-test was applied for BPRS and for Ql-Index total scores (T0–T1).ResultsData were available for 8 outpatients consecutively prescribed ARP and naturalistically treated attending at the psychiatric clinic, university of Sassari. Mean time on ARP treatment was 207.14 days (sd 137.2). BPRS mean total score at T0 was 57 (sd 13.2) and at T1 was 39.7 (sd 10.8). QL-Index mean total score was at T0 5.43 (sd 1.6) and at T1 7.14 (sd 2.7). Paired sample test showed a statistically significant difference in decreasing symptoms at BPRS over time (P = 0.001) and QL-Index total score (P = 0.023). The analyses showed a significant improving at the following BPRS sub-items: anxiety (P = 0.005), mood elevation (P = 0.014) conceptual disorganization (P = 0.048), emotional withdrawal (P = 0.05), tension (P = 0.02) and distractibility (P = 0.03).Disclosure of interestThe authors have not supplied their declaration of competing interest.

The association of schizophrenia symptoms clusters with obsessive compulsive symptoms

2017 ◽  
Vol 41 (S1) ◽  
pp. S385-S386
Author(s):  
E. Theochari ◽  
E. Tsaltas ◽  
D. Kontis
Keyword(s):  
Chronic Schizophrenia ◽  
Obsessive Compulsive ◽  
General Psychopathology ◽  
Obsessive Compulsive Symptoms ◽  
Syndrome Scale ◽  
Competing Interest ◽  
Clinically Significant ◽  
Psychopathology Symptoms ◽  
Relationship Of ◽  
The Relationship

IntroductionThirty percent of individuals with schizophrenia demonstrate obsessive compulsive symptoms (OCSs). There is conflicting data on the effects of antipsychotic medication on OCSs in schizophrenia. The delineation of the relationship of OCSs with positive, negative and general psychopathology symptoms has theoretical and treatment implications.ObjectivesTo investigate the relationship among OCSs with the symptoms clusters in schizophrenia.MethodsWe recruited 110 chronic schizophrenia patients and assessed OCSs (Yale-Brown Scale) and schizophrenia symptoms (Positive and Negative Syndrome Scale). In order to investigate the relationship of OCSs with clusters of schizophrenia symptoms, we conducted correlation analyses between YBOCS total scores or obsession or compulsion subscores with the PANSS symptoms scores (total, positive, negative and general psychopathology) and the cognitive scores derived from CANTAB. We re-conducted these correlations for the sub groups with clinically detectable OCSs (YBOCS > 8) and clinically significant OCSs (YBOCS > 14).ResultsThe only significant correlation was that of scores of OCSs with PANSS general psychopathology scores (rho = 0.190, P = 0.047). Obsessions and compulsions did not significantly correlate with positive or negative symptom clusters. No significant correlation between OCSs and schizophrenia symptoms were detected in the subgroups with clinically detectable or significant OCSs.ConclusionsOCSs appear to be a separate symptom cluster in the context of schizophrenia, suggesting that OCSs cannot be expected to be influenced by standard antipsychotic treatments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Comparative Assessment of Cognitive Function and Mood Dynamics in Patients with Depression and Eating Disorders in the Process of Treatment

2017 ◽  
Vol 41 (S1) ◽  
pp. S285-S285
Author(s):  
I. Makhortova ◽  
O. Shiryaev
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Cognitive Function ◽  
Rating Scale ◽  
Co Morbidity ◽  
Icd 10 ◽  
Group 2 ◽  
Competing Interest ◽  
Clinically Significant ◽  
Group 1

Eating disorders of bulimic type are among the most common comorbidities with depression. The objective is to evaluate cognitive function and mood dynamics in patients with depression and eating disorders in pharmacotherapy. In total, 52 outpatients, who met criteria for “major depressive episode” (ICD-10), participated. The level of depression was estimated with Hamilton Depression rating scale (HAM-D) and cognitive function–Montreal Cognitive Assessment (MoCa). Sample was divided into two groups. Patients of group 1 also met criteria for eating disorder of bulimic type and patients of group 2 did not have any eating disorder. Treatment included standard doses of SSRI. Assessments were performed after 2, 4 and 8 weeks (D14, D30, D60). The level of HAM-D was significantly greater (P < 0.05) in eating disorders group (16.75 ± 2.83 in group 1; 13.04 ± 1.93 in group 2 at screening) and significance was preserved till D60 (9.39 ± 2.54 in group 1; 6.32 ± 1.27 in group 2 at D60). Clinically significant antidepressive effect was revealed faster in group 2 (at D7) compared to group 1 (at D14). Overall score of MoCA was significantly lower (P < 0.05) in eating disorders group (20.33 ± 0.54 in group 1; 23.43 ± 2.32 in group 2 at screening) at all stages of treatment (23.39 ± 0.78 in group 1; 26.96 ± 3.27 in group 2 at D60) and it reached normal range (25 and more) only in group 2 at D60. Significant change from screening was revealed at D30 at group 2 and at D60 at group 1.ConclusionEating disorder have an impact on SSRI treatment efficacy including antidepressive and procognitive effects. It is necessary to reveal eating disorders as a co-morbidity in patients with depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatment of drug-resistant schizoaffective disorder with aripiprazol depot off-label: A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s820-s820
Author(s):  
L. Niell Galmés ◽  
R.A. Baena Mures ◽  
Í. Alberdi Páramo ◽  
M.M. Tenorio Guadalupe ◽  
G. Montero Hernández ◽  
...  
Keyword(s):  
Schizoaffective Disorder ◽  
Rating Scale ◽  
Treatment Guidelines ◽  
Safety Data ◽  
Psychotic Symptoms ◽  
Good Tolerability ◽  
Off Label ◽  
Competing Interest ◽  
New Treatment ◽  
Higher Doses

IntroductionWe expose a woman diagnosed with schizoaffective disorder 2 years ago, before she received several diagnostics. She was admitted to the psychiatry unit with hyperactivity, pressured speech without taking an appropriate turn, flight-of-ideas, irritability, expansiveness, emotional liability, ideas of reference and insomnia without diurnal tiredness. In addition, she admitted having abandoned the medication one month ago. She was diagnosed with maniac episode with psychotic symptoms and the medication was reintroduced. After two weeks, no response was observed so we decided to introduce ability depot 600 mg/3 weeks.ObjectivesWe want to show that is possible the use of ability depot off-label in patients with a special difficulty in handling. Also, we want to show that higher doses are not dangerous and it's possible to study new treatment guidelines for ability depot.MethodsWe use the Positive and Negative Syndrome Scale (PANSS) pre (the day of the introduction) and post (at two weeks) treatment with aripiprazol depot; the Clinical Global Impression rating scale (CGI), also pre and post.ResultsWe have obtained a punctuation of 180 in PANSS the day of the introduction of the aripiprazol depot and 45 at two weeks. In addition, we obtained 6 in CGI the day of the introduction and 3 at two weeks.ConclusionsIn this case, aripiprazol depot has shown good tolerability and efficacy for the acute phase of schizoaffective disorder at higher doses than recommended in clinical guidelines. The efficacy and safety data are consistent with short-term, placebo-controlled studies of aripiprazol depot conducted in similar populations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Use of inhaled loxapine in acute psychiatric agitation

2016 ◽  
Vol 33 (S1) ◽  
pp. s228-s228
Author(s):  
S. Ovejero ◽  
M. Iza ◽  
S. Vallejo ◽  
C. Vera ◽  
A. Sedano ◽  
...  
Keyword(s):  
Rating Scale ◽  
Psychiatric Inpatient ◽  
Physical Restraint ◽  
Inpatient Unit ◽  
Young Mania ◽  
Non Invasive ◽  
Psychiatric Inpatient Unit ◽  
Syndrome Scale ◽  
Competing Interest ◽  
Negative Syndrome

ObjectivesThe aim of this work is to study the efficacy of loxapine inhalation powder on agitated patients in a psychiatric inpatient unit.MethodsNineteen patients sample, with an average age of 39.4 years old, diagnosed with schizophrenia, bipolar disorder or schizoaffective disorder. Patients inhaled loxapine 10 mg, using the staccato system, when they suffered a psychomotor agitation. The clinical efficacy was measured as a change from baseline in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) and in the Young Mania Rating Scale (YMRS) one hour after the administration of loxapine.ResultsA mean of 9.8 points reduction (22.6 at baseline and 12.7 one hour after the administration) was found on the PANSS-EC (t-test, P < .001) and 68.4% of the patients were considered responders as they obtained a reduction of at least 40% of the basal score. On 10 of the total of the agitated patients showed an improvement of the psychomotor excitement, and this allowed the clinicians to remove the physical restraint; on 6 of the agitated patients the physical restraint could be avoided during the whole treatment; and 3 of the patients experienced a reduction of the excitement. The reduction on PANNS-EC on the latest group was not statistically significant (t-test, P = .121).ConclusionsInhaled loxapine was a non-invasive, rapid and effective alternative treatment for acute agitation in a psychiatric inpatient unit. It resulted more effective on mild and moderate cases; not been significantly effective on the severe cases of agitation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Long acting antipsychotics treatment of schizophrenia: A 24-month prospective study on patient's attitude towards treatment

2017 ◽  
Vol 41 (S1) ◽  
pp. S188-S188
Author(s):  
E. Calderani ◽  
F. Pietrini ◽  
I. Burian ◽  
F. Chiarello ◽  
D. Dahlke ◽  
...  
Keyword(s):  
Rating Scale ◽  
Short Form ◽  
Concomitant Treatment ◽  
Young Mania ◽  
Attitude Inventory ◽  
Schizophrenic Patients ◽  
Competing Interest ◽  
One Year ◽  
Long Acting ◽  
The Impact

IntroductionLong-acting injectable (LAI) second-generation antipsychotics (SGAs) are considered an alternative to oral antipsychotics for schizophrenic patients with low adherence to therapy. However, it is still a matter of debate whether LAI-SGAs are able to significantly improve patient's attitudes towards treatment (ATT) [1].ObjectiveTo investigate the impact of LAI on ATT over 24 months.MethodsNineteen schizophrenic patients were switched from either oral olanzapine (11) or paliperidone (8) to the corresponding LAI. Patients were assessed at baseline (T0), after 6 (T1), 12 (T2) and 24 months (T3). Drug Attitude Inventory-10 (DAI-10) [2] was used to assess ATT. Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), Positive and Negative Syndrome Scale (PANSS), and Short Form Health Survey (SF-36) were used for psychopathology evaluations.ResultsEleven patients reached T3. Eight patients were excluded (4 olanzapine, 4 paliperidone): 4 required a significant change in concomitant treatment, 4 a change of antipsychotic (metabolic comorbidity). No changes in psychopathology occurred between T2 and T3, some scales improved from baseline to T2. DAI-10 mean scores were improved after 12 months, thus not significantly, and were further improved at 24 months (P = .008 vs baseline).ConclusionsATT keeps improving after one year of LAI treatment, unrelated to clinical response.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A case of pharmacologic extrapyramidal syndrome

2017 ◽  
Vol 41 (S1) ◽  
pp. s828-s829
Author(s):  
O. Porta Olivares ◽  
M. Juncal Ruiz ◽  
B. Fernández Abascal Puente ◽  
M. Gómez Revuelta ◽  
G. Pardo de Santayana Jenaro ◽  
...  
Keyword(s):  
First Generation ◽  
Partial Agonist ◽  
Functional Limitation ◽  
Adjustment Disorder ◽  
Psychotic Symptoms ◽  
Extrapyramidal Syndrome ◽  
Extrapyramidal Effects ◽  
Competing Interest ◽  
Clinically Significant ◽  
Long Acting

IntroductionMore than 60% of patients receiving intensive treatment with first generation antipsychotic manifest some type of clinically significant extrapyramidal side effects. Parkinsonian syndrome is the most common and is characterized by rigidity, tremors, akinesia and bradykinesia and usually improves with discontinuation of antipsychotic drug or anticholinergic association.MethodsIt is a 60-year-old man, married with two children. Initiates contact with mental health in 2013 with a diagnosis of adjustment disorder. In February 2014 he requires hospitalisation, establishing the diagnosis of delusional disorder and starting treatment with long-acting injectable paliperidone palmitate (100 mg/month) with remission of psychotic symptoms in a few days. When we receive the patient in our clinic, he presents parkinsonian extrapyramidal symptoms (UKU subscale: 18), with significant functional limitation. We decrease the dose to 75 mg/month and an anticholinergic was added without improvement of Parkinsonian clinic, so we decided to switch to long-acting injectable aripiprazole 400 mg/month, objectifying complete remission of extrapyramidal syndrome (UKU subscale: 0).ConclusionsThe mechanism of action of aripiprazole m LAI (partial agonist of D2 receptors in the brain) without decreases in the nigrostriatal dopamine pathway, of improving extrapyramidal effects associated one other antipsychotics.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A pharmacologic option to reduce hospital admissions and relapses of patients with severe mental illness

2017 ◽  
Vol 41 (S1) ◽  
pp. S753-S753
Author(s):  
N. Gomez-Coronado ◽  
P. Blanco ◽  
I. Martinez
Keyword(s):  
Mental Health ◽  
Hospital Admissions ◽  
Descriptive Analysis ◽  
Psychotic Episode ◽  
Anti Psychotic ◽  
Before And After ◽  
Previously Treated ◽  
Competing Interest ◽  
One Year ◽  
Long Acting

IntroductionSome diseases relapses involve functional impairment that sometimes takes years to recover. We present our experience using long-acting aripiprazole as maintenance therapy in patients diagnosed with psychotic episode, acute mania (bipolar disorder) or personality disorder, who were previously treated with another anti-psychotic.AimsAnalyze what treatment were they taking before aripiprazole depot. Determine the number of hospital admissions and relapses before and after long-acting aripiprazole treatment.MethodsDescriptive analysis based on a sample of 37 patients, aged 18–65 years, treated during one year with anti-psychotics at two community mental health units.ResultsReduction of hospitalization average: 0.59/year with non-long-acting-aripiprazol anti-psychotic, 0.18/year with long-acting aripiprazol (66.6%).ConclusionLong-acting aripiprazole appears to reduce the number of hospitalizations and relapses compared to other anti-psychotics. However, the sample size is small and more studies are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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