P.2.156 Atypical versus typical antipsychotic treatment prognosis based on VEPs and WCST scores in paranoid schizophrenia

Background:In contrast to delta-9-tetrahydrocannabinol, the phytocannabinoid cannabidiol does not exert psychotomimetic effects. Cannabidiol was suggested a re-uptake inhibitor of anandamide and potential antipsychotic properties have been hypothesized for it. We therefore performed a clinical trial to investigate thesis hypothesis and to clarify the underlying link to the neurobiology of schizophrenia.Methods:We performed an explorative, 4-week, double-blind, controlled clinical trial on the effects of purified cannabidiol in acute schizophrenia compared to the antipsychotic amisulpride. The antipsychotic properties of both drugs were the primary target of the study. Furthermore, side-effects and anxiolytic capabilities of both treatments were investigated.Results:42 patients fulfilling DSM-IV criteria of acute paranoid schizophrenia participated in the study. Both treatments were associated with a significant decrease of psychotic symptoms after 2 and 4 weeks as assessed by BPRS and PANSS. However, there was no statistical difference between both treatment groups. In contrast, cannabidiol induced significantly less side effects (EPS, increase in prolactin, weight gain) when compared to amisulpride.Conclusions:Cannabidiol revealed substantial antipsychotic properties in acute schizophrenia. This is in line with our suggestion of an adaptive role of the endocannabinoid system in paranoid schizophrenia, and raises further evidence that this adaptive mechanism may represent a valuable target for antipsychotic treatment strategies.The Stanley Medical Research Institute (00-093 to FML) and the Koeln Fortune Program (107/2000 + 101/2001 to FML) funded this study.

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Safety, Tolerability and Efficacy of Flexible doses of Paliperidone ER in Non-acute Patients with Schizophrenia

European Psychiatry ◽

10.1016/s0924-9338(09)71426-9 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

A. Schreiner ◽

M. Franco ◽

D. Buccomino ◽

E. Lara ◽

K.U. Kühn ◽

...

Keyword(s):

Weight Change ◽

Paranoid Schizophrenia ◽

International Study ◽

Antipsychotic Treatment ◽

Open Label ◽

Loss To Follow Up ◽

Randomized Controlled Studies ◽

Syndrome Scale ◽

Oral Antipsychotic ◽

Acute Patients

Objective:To explore tolerability, safety and efficacy of flexible doses of oral paliperidone ER in adult non-acute patients with schizophrenia requiring a change in their medication due to lack of efficacy with their previous oral antipsychotic.Methods:Interim analysis of a prospective 6-month, open-label, international study. Patients completing the first 3 months of this study were analyzed. Endpoints were the change in the Positive and Negative Syndrome Scale (PANSS) from baseline to endpoint, Clinical Global Impression-Severity Scale (CGI-S), weight change and adverse events (AEs).Results:81 patients were included (57% male, mean age 41.3±13.6 years, 85% paranoid schizophrenia). 89% of the 81 patients completed the first 3 months of the study. Reasons for early discontinuation were lack of efficacy (3.7%), subject choice (2.5%), loss to follow-up (2.5%) and AE (1.2%). the mean mode dose of paliperidone ER was 6 mg/day. Mean total PANSS decreased from 82.8±16.0 at baseline to 69.2±19.1 at endpoint (mean change -13.6±15.6; 95% confidence interval [CI]-17.0;-10.1, p< 0.0001). the percentage of patients rated mildly ill or less in CGI-S increased from 19.8% to 49.4%. AEs reported in ≥3% were insomnia (4.9%), somnolence (4.9%), extrapyramidal disorder (3.7%), restlessness (3.7%) and psychotic disorder (3.7%). Mean weight change from baseline to endpoint was 0.34 kg (95%CI -0.35;1.03, p=0.71).Conclusion:These interim open-label data support results from recent randomized controlled studies that flexibly dosed paliperidone ER is safe, well tolerated and effective in patients with schizophrenia requiring a change in medication due to lack of efficacy with their previous oral antipsychotic treatment.

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SZ1 EFFECTIVENESS AND COSTS OF ATYPICAL VERSUS TYPICAL ANTIPSYCHOTIC TREATMENT FOR SCHIZOPHRENIA IN ROUTINE CARE

Value in Health ◽

10.1016/s1098-3015(10)63183-x ◽

2006 ◽

Vol 9 (6) ◽

pp. A196

Author(s):

T Stargardt ◽

S Weinbrenner ◽

R Busse ◽

G Juckel ◽

CA Gericke

Keyword(s):

Routine Care ◽

Antipsychotic Treatment ◽

Typical Antipsychotic

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Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence

European Psychiatry ◽

10.1016/j.eurpsy.2004.06.031 ◽

2004 ◽

Vol 19 (7) ◽

pp. 415-422 ◽

Cited By ~ 149

Author(s):

M. Lambert ◽

P. Conus ◽

P. Eide ◽

R. Mass ◽

A. Karow ◽

...

Keyword(s):

Side Effects ◽

Negative Impact ◽

Psychiatric Hospitals ◽

Antipsychotic Treatment ◽

Typical Antipsychotic ◽

Negative Attitudes ◽

Conventional Antipsychotics ◽

Schizophrenic Patients ◽

The Impact ◽

Antipsychotic Side Effects

AbstractObjective(1) determine which antipsychotic side effects (SE) schizophrenic patients consider the most distressing during treatment with typical antipsychotics, (2) measure the impact of actual and past SE on patients' attitude toward antipsychotics and (3) assess the influence of both on adherence.MethodsThe 213 schizophrenics, treated with conventional antipsychotics, were recruited in two psychiatric hospitals in Hamburg. Subjects were assessed about type and severity of present and past side effects and their attitude and adherence to antipsychotic treatment.ResultsThe 82 (39%) patients presented present SE while 131 (61%) did not. Sexual dysfunctions (P<0.001), extrapyramidal (P<0.05) and psychic side effects (P<0.05) were rated as significantly subjectively more distressing than sedation or vegetative side effects. Patients presenting with present SE compared with patients without present SE had a significantly more negative general attitude toward antipsychotics (P<0.05), were more doubtful about their efficacy (P<0.01) and were less likely to encourage a relative to take such a medication in case of need (P<0.001). A regression analysis indicated that nonadherence was mainly influenced by negative general and efficacy attitudes toward antipsychotics and the experience of past or present antipsychotic side effects.ConclusionsAll antipsychotic side effects, present or past, can have a durable negative impact on patient's attitude toward antipsychotic treatment and adherence. Non-adherence is mainly determined, among other factors, by these negative attitudes, which are partly influenced by the experience of past or present antipsychotic-induced side effects.

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Treatment patterns in schizophrenia: Clinical case of successful management with a series of long acting injectable antipsychotics

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1616 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s826-s826

Author(s):

M. Palomo Monge ◽

J.F. Calvo Mauri ◽

M.F. Tascon Guerra ◽

A. Duque Domínguez ◽

S. Díaz Conde ◽

...

Keyword(s):

Weight Gain ◽

Hospital Admissions ◽

Negative Impact ◽

Paranoid Schizophrenia ◽

Serum Prolactin ◽

Antipsychotic Treatment ◽

Tolerability Profile ◽

Successful Management ◽

Good Tolerability ◽

Fluphenazine Decanoate

IntroductionWe report the successful management of a 57-year-old woman with a 20 year diagnostic of paranoid schizophrenia (first visit November, 1995). She presented several comorbidities (arterial hypertension, diabetes mellitus and morbid obesity), with a history of five previous hospitalizations (1995, 2012, January and May 2014, and April 2016).Aims/methodsThe patient was always prescribed depot antipsychotics: she was treated for 14 years with Zuclopentixol depot (discontinued due to dermic adverse reactions and weight gain). After a period with oral paliperidone (from 2012 until 2013) and due to lack of adherence to oral therapy, in August 2013 she was prescribed paliperidone palmitate. The treatment was discontinued after nine months (May 2014) due to weight gain, a significant increase of serum prolactin levels and two psychotic relapses that led to hospital admissions.ResultsShe was then prescribed Fluphenazine decanoate depot for one year and 4 months, but she was switched to Aripiprazole once monthly (AOM) in September 2015 to avoid metabolic syndrome.ConclusionsNon-personalized antipsychotic treatment in a patient with a complicated comorbidity history can result in lack of compliance and a risk of relapse, and in a worsening of her medical conditions, with the consequential negative impact in her functioning and quality of life. Based on our results, the treatment with AOM resulted in a positive evolution of the patient, with a good tolerability profile, in an improvement of treatment-caused adverse events (weight loss, and prolactin serum levels normalization); all factors that enable treatment adherence and good clinical response.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Searching for the genetic markers connected with paranoid schizophrenia and conditioning the treatment efficiency

European Psychiatry ◽

10.1016/s0924-9338(11)73201-1 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1497-1497

Author(s):

P. Tybura ◽

J. Samochowiec

Keyword(s):

Genetic Markers ◽

Paranoid Schizophrenia ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Control Group ◽

Antipsychotic Treatment ◽

Treatment Efficiency ◽

Chi Square ◽

Icd 10 ◽

Chi Square Test

AimThe aim of the study was to find genetic markers which can influence on susceptibility of paranoid schizophrenia and the treatment efficiency measured by the PANSS. We analyzed genes polymorphisms: DRD2 (Taq 1A, in egzon 8, - 141 C ins/del), DAT, GRIK3, SERT, 5HT2A, MAO-A, COMT.MethodOne hundred and ninety one patients with the diagnosis of paranoid schizophrenia were recruited as study group. To obtain the diagnosis meeting the criteria to ICD-10 we used the polish version of CIDI - Composite International Diagnostic Interview. Exclusion criteria included serious neurological disorders, major somatic disorders impairing cognitive functions and diagnosed mental impairment. The intensity of psychopathological symptoms was examined using the PANSS. Genomic DNA was extracted from leucocytes using the Miller's salting method. Polymorphisms were studied by the PCR method.Statistical analyses were performed by the Statistica computer program, specifically Pearson's chi-square test. Associations between the treatment progress and the genotype were studied by analysis of variance (ANOVA).ResultsWe didn’t find associations between investigated genes polymorphisms and susceptibility of paranoid schizophrenia. Probably, there is no influence of studied polymorphisms on the treatment efficiency.ConclusionsNo differences were found in the genotypes distribution in investigated genes polymorphisms between the whole schizophrenics and the control group. No association was found between any particular genotype and the effect of antipsychotic treatment.

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