Management of Complex Treatment-resistant Psychotic Disorders

2021 ◽  
Keyword(s):  
Mental Health Professionals ◽  
Psychotic Disorders ◽  
Response Monitoring ◽  
Complex Treatment ◽  
Treatment Resistant ◽  
Full Color ◽  
Medication Guide ◽  
Essential Resource ◽  
Typical Treatment ◽  
Derived Data

This full-color, practical handbook provides a concise, evidence-based psychopharmacological approach to the management of complex treatment-resistant psychotic disorders. Part I focuses uniquely on topics and strategies relevant to treating this challenging patient population. These approaches go beyond standard guidelines while adhering to research and clinically derived data. Part II provides a concise array of information regarding those classes of medications most commonly used when treating complex treatment-resistant psychotic disorders. Each medication guide contains sections including mechanisms of action, typical treatment response, monitoring, dosing and kinetics, medications to avoid in combination/warnings, and take-home pearls. Part III offers tips in brief appendix chapters for managing common issues ranging from loading lithium and valproic acid to the treatment of acute psychomotor agitation. An essential resource for psychiatrists, forensic clinicians, psychiatric trainees, and all mental health professionals involved with, or interested in, the treatment of challenging psychotic disorders.

The Novel Antipsychotic Drug Cariprazine and Cognition Enhancing Drugs: Indications for Their Use as an Add-on Therapy in Schizophrenia

2020 ◽  
Vol 26 ◽  
Author(s):  
Felix-Martin Werner ◽  
Rafael Coveñas
Keyword(s):  
Clinical Trials ◽  
Maintenance Therapy ◽  
Antipsychotic Drug ◽  
Cognitive Functions ◽  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
Therapeutic Effects ◽  
Treatment Resistant ◽  
Long Acting ◽  
Novel Antipsychotic

Background: Schizophrenia and schizoaffective disorder are treated with antipsychotic drugs. Some patients show treatment-resistant forms of psychotic disorders and, in this case, they can be treated with clozapine. In these patients and based on previous reviews on novel antipsychotic drugs, it is important to know whether an add-on therapy with new drugs can ameliorate the positive and negative schizophrenic scale (PANSS) total score. Objective: The aim of this review is to suggest an appropriate treatment for patients with treatment-resistant forms of psychotic disorders. A combination of current available antipsychotic drugs with novel antipsychotic or modulating drugs might improve negative schizophrenic symptoms and cognitive function and thereby social functioning and quality of life. Results: The mechanisms of action, the therapeutic effects and the pharmacokinetic profiles of novel antipsychotic drugs such as cariprazine, brexipiprazole and lumateperone are up-dated. Published case reports of patients with treatmentresistant psychoses are also discussed. These patients were treated with clozapine but a high PANSS total score was observed. Only an add-on therapy with cariprazine improved the score and, above all, negative schizophrenic symptoms and cognitive functions. To ensure a constant antipsychotic drug concentration, long-acting injectable antipsychotic drugs may be a choice for a maintenance therapy in schizophrenia. New modulating drugs, such as receptor positive allosteric modulators (N-methyl-D-aspartate receptor; subtype 5 of the metabotropic glutamatergic receptor) and encenicline, an alpha7 nicotinic cholinergic receptor agonist, are being investigated in preclinical and clinical trials. Conclusion: In clinical trials, patients with treatment-resistant forms of psychosis should be examined to know whether a combination therapy with clozapine and a novel antipsychotic drug can ameliorate the PANSS total score. In schizophrenia, long-acting injectable antipsychotic drugs are a safe and tolerable maintenance therapy. In further clinical studies, it should be investigated whether patients with treatment-resistant forms of psychoses can improve negative schizophrenic symptoms and cognitive functions by an add-on therapy with cognition enhancing drugs.

Demographics, Prevalence, and Clinical Features of the Schizo-obsessive Subtype of Schizophrenia

CNS Spectrums ◽  
1999 ◽  
Vol 4 (12) ◽  
pp. 50-56 ◽  
Author(s):  
Roberto A. Dominguez ◽  
Karl E. Backman ◽  
Susana C. Lugo
Keyword(s):  
Clinical Features ◽  
Mental Health Professionals ◽  
Public Hospital ◽  
Psychotic Disorders ◽  
Screening Tool ◽  
Principal Diagnosis ◽  
Obsessive Compulsive ◽  
Screening Criteria ◽  
Hispanic Patients ◽  
Psychiatric Population

AbstractThe schizo-obsessive subtype of schizophrenia has been proposed to describe the condition of patients with chronic psychotic disorders and prominent obsessive-compulsive (OC) symptoms. These patients differ from others with schizophrenia not only in their psychopathology, but perhaps also in their prognosis and pharmacotherapeutic response. Potent serotonin reuptake blockers, such as clomipramine, fluvoxamine, andfluoxetine, in conjunction with antipsychotics, can prove helpful in improving these patients' OC symptoms. The current study to access the demographics, prevalence, and clinical features of the schizo-obsessive subtype included established outpatients with a principal diagnosis of schizophrenia or schizoaffective disorder treated at a large urban public hospital. More than 50% of the hospital's psychiatric population is Hispanic. The Modified Maudsley Obsessive Compulsive Inventory (MMOCI) was used to identify prominent compulsive symptoms. Of the 52 patients who fulfilled the specific screening criteria, 17 (33%) also had prominent OC symptoms. Surprisingly, there was a statistical trend (P=0.06) for Hispanic patients to meet our threshold for the schizo-obsessive subtype. The MMOCI proved to be an adequate and efficient self-rated screening tool. The prevalence of the schizo-obsessive subtype, especially among Hispanic patients, highlights the importance for mental health professionals working with this population to identify and appropriately treat this group of patients.

Homicide

2020 ◽  
pp. 1478-1486
Author(s):  
Matthew Large ◽  
Olav Nielssen
Keyword(s):  
Domestic Violence ◽  
Mental Illness ◽  
Substance Use ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Psychotic Disorders ◽  
Domestic Homicide ◽  
People With Mental Illness ◽  
Geographic Regions ◽  
Disproportionate Number

A range of killings of one person by another can be described as a homicide. Homicide rates vary greatly between geographic regions, reflecting differences in social factors such as weapon availability, patterns of substance use, the efficacy of the police and other institutions, and overall levels of violent crime. Domestic homicide is killing within a family and includes fatal domestic violence and most homicides of infants, children, and older people. Most homicides by people with mental illness are of family members, but most domestic homicide offenders are not mentally ill. People with mental illness, particularly those with schizophrenia, commit a small percentage of all homicides, but a disproportionate number, compared to the incidence of mental illness. Mental health professionals have a role in preventing homicides by offering interventions for domestic violence, substance use disorder, and the early and continued treatment of psychotic disorders.

scholarly journals Resolution without discontinuation: heart failure during clozapine treatment

2020 ◽  
Vol 10 ◽  
pp. 204512532092478 ◽  
Author(s):  
Eromona Whiskey ◽  
Shirley Yuen ◽  
Emma Khosla ◽  
Susan Piper ◽  
David O’Flynn ◽  
...  
Keyword(s):  
Heart Failure ◽  
Psychotic Disorders ◽  
Cardiac Complications ◽  
Antipsychotic Treatment ◽  
Treatment Resistant ◽  
Clozapine Treatment ◽  
Cardiac Condition ◽  
Life Threatening ◽  
Psychotic Exacerbation ◽  
Cessation Of Treatment

Clozapine is an atypical antipsychotic recommended for patients with treatment-resistant schizophrenia whose illness has not responded adequately to treatment despite the sequential use of at least two different antipsychotic drugs at therapeutic doses. Unfortunately, clozapine is frequently discontinued due to both real and perceived serious, and potentially life-threatening, adverse effects, contributing to the underutilisation of the most effective treatment in refractory psychotic disorders. Here, we present the case of a 51-year-old man with treatment-resistant schizoaffective disorder, who was admitted to a locked rehabilitation unit for a clozapine rechallenge. Within 6 months after the clozapine rechallenge, he was diagnosed with heart failure likely secondary to his antipsychotic treatment. Clozapine-induced heart failure usually prompts immediate cessation of treatment. However, in this case, clozapine was continued with cardiology consultation. Ramipril and bisoprolol were initiated and the patient’s cardiac condition progressively improved over time. Clozapine-induced heart failure is a serious cardiovascular complication of treatment, usually resulting in discontinuation of treatment. Although there are cases of successful rechallenge, temporary cessation of treatment can lead to severe psychotic exacerbation and non-engagement with cardiac specialists. More evidence is required for continued use of clozapine in a patient with clozapine-induced cardiac complications.

scholarly journals Mental health professionals’ experiences with shared decision-making for patients with psychotic disorders: a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Espen W. Haugom ◽  
Bjørn Stensrud ◽  
Gro Beston ◽  
Torleif Ruud ◽  
Anne S. Landheim
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Psychotic Disorders ◽  
Successful Implementation ◽  
Practical Training ◽  
Shared Decision ◽  
Antipsychotic Medications

Abstract Background Shared decision-making (SDM) is a process whereby clinicians and patients work together to select treatments based on both the patient’s preferences and clinical evidence. Although patients with psychotic disorders want to participate more in decisions regarding their care, they have limited opportunities to do so because of various barriers. Knowing about health professionals’ experiences with SDM is important toward achieving successful implementation. The study aim was to describe and explore health professionals’ SDM experiences with patients with psychotic disorders. Methods Three focus group interviews were conducted, with a total of 18 health professionals who work at one of three Norwegian community mental health centres where patients with psychotic disorders are treated. We applied a descriptive and exploratory approach using qualitative content analysis. Results Health professionals primarily understand the SDM concept to mean giving patients information and presenting them with a choice between different antipsychotic medications. Among the barriers to SDM, they emphasized that patients with psychosis have a limited understanding of their health situation and that time is needed to build trust and alliances. Health professionals mainly understand patients with psychotic disorders as a group with limited abilities to make their own decisions. They also described the concept of SDM with little consideration of presenting different treatment options. Psychological or social interventions were often presented as complementary to antipsychotic medications, rather than as an alternative to them. Conclusion Health professionals’ understanding of SDM is inconsistent with the definition commonly used in the literature. They consider patients with psychotic disorders to have limited abilities to participate in decisions regarding their own treatment. These findings suggest that health professionals need more theoretical and practical training in SDM.

Clozapine: Serious Adverse Side Effects, Drug Interactions, and Other Complications of Therapy

1996 ◽  
Vol 9 (2) ◽  
pp. 118-129 ◽  
Author(s):  
Deanna M. Guith
Keyword(s):  
Side Effects ◽  
Health Care Professionals ◽  
Elderly Population ◽  
Adverse Reactions ◽  
Psychotic Disorders ◽  
Antipsychotic Agent ◽  
The Elderly ◽  
Pharmacological Properties ◽  
Treatment Resistant ◽  
Clozapine Therapy

Clozapine (Clozaril®, Sandoz, East Hanover, NJ), an atypical antipsychotic agent with pharmacological properties considerably different from standard neuroleptics, has been found to be of great benefit especially to patients with treatment-resistant psychotic disorders. However, it is these unique pharmacological properties that have also been associated with mul tiple side effects ranging from the relatively benign (ie, sialorrhea during sleep, dizziness) to the potentially fatal (ie, agranulocytosis, seizures, and respiratory depression) which have limited its use. These untoward side effects are particularly problematic in the elderly population who often have concomitant medi cal illnesses requiring multiple medication regimens, including psychotropics that may interact with cloza pine (ie, benzodiazepines, cimetidine, fluoxetine). Because even the most benign of side effects has the potential of becoming fatal in certain circumstances if left unaddressed, it is imperative for patients, clinicians, pharmacists, and all health care professionals to be aware of adverse reactions and possible complica tions of clozapine therapy to prevent significant morbidity and mortality. Copyright © 1996 by W.B. Saunders Company

scholarly journals Psychiatric disorders in children with demyelinating diseases of the central nervous system

2017 ◽  
Vol 24 (9) ◽  
pp. 1243-1250 ◽  
Author(s):  
Julia Pakpoor ◽  
Raph Goldacre ◽  
Klaus Schmierer ◽  
Gavin Giovannoni ◽  
Emmanuelle Waubant ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Intellectual Disability ◽  
Psychiatric Disorders ◽  
Behavioral Disorders ◽  
Mental Health Professionals ◽  
Psychotic Disorders ◽  
Somatoform Disorders ◽  
Demyelinating Diseases ◽  
Hospital Episode

Introduction: The profile of psychiatric disorders associated with multiple sclerosis (MS) may differ in children. We aimed to assess the risk of psychiatric disorders in children with MS and other demyelinating diseases, and vice versa. Patients and methods: We analyzed linked English Hospital Episode Statistics, and mortality data, 1999–2011. Cohorts were constructed of children admitted with MS and other central nervous system (CNS) demyelinating diseases. We searched for any subsequent episode of care with psychiatric disorders in these cohorts and compared to a reference cohort. Results: Children with CNS demyelinating diseases had an increased rate of psychotic disorders (rate ratio (RR) = 5.77 (95% confidence interval (CI) = 2.48–11.41)); anxiety, stress-related, and somatoform disorders (RR = 2.38 (1.39–3.81)); intellectual disability (RR = 6.56 (3.66–10.84)); and other behavioral disorders (RR = 8.99 (5.13–14.62)). In analysis of the pediatric MS cohort as the exposure, there were elevated rates of psychotic disorders (RR = 10.76 (2.93–27.63)), mood disorders (RR = 2.57 (1.03–5.31)), and intellectual disability (RR = 6.08 (1.25–17.80)). In reverse analyses, there were elevated rates of a recorded hospital episode with CNS demyelinating disease after a previous recorded episode with anxiety, stress-related, and somatoform disorders; attention-deficit hyperactivity disorder (ADHD); autism; intellectual disability; and other behavioral disorders. Conclusion: This analysis of a national diagnostic database provides strong evidence for an association between pediatric CNS demyelinating diseases and psychiatric disorders, and highlights a need for early involvement of mental health professionals.

Clinical Handbook of Psychotropic Drugs

2021 ◽  
Keyword(s):  
Side Effects ◽  
Mental Health Professionals ◽  
Psychotropic Drugs ◽  
Treatment Options ◽  
The Elderly ◽  
Relevant Information ◽  
Full Color ◽  
Us Fda ◽  
Trade Names ◽  
Health Canada

Quick and comprehensive information on psychotropic drugs for adults. - Accurate and up-to-date - Comparison charts help decision-making - Icons and full color - Available in print and online - Downloadable patient info sheets More about this book The Clinical Handbook of Psychotropic Drugs has become a standard reference and working tool for psychiatrists, psychologists, physicians, pharmacists, nurses, and other mental health professionals. - Independent, unbiased, up-to-date -Packed with unique, easy-to-read comparison charts and tables (dosages, side effects, pharmacokinetics, interactions…) for a quick overview of treatment options - Succinct, bulleted information on all classes of medication: on- and off-label indications, (US FDA, Health Canada), recommended dosages, US and Canadian trade names, side effects, interactions, pharmacodynamics, precautions in the young, the elderly, and pregnancy, nursing implications, and much more – all you need to know for each class of drug -Potential interactions and side effects summarized in comparison charts -With instantly recognizable icons and in full color throughout, allowing you to find at a glance all the information you seek -Clearly written patient information sheets available for download as printable PDF files This book is a must for everyone who needs an up-to-date, easy-to-use, comprehensive summary of all the most relevant information about psychotropic drugs.

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