Understanding the Results of CATIE in the Context of the Field

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S7) ◽  
pp. 40-47 ◽  
Author(s):  
Ira D. Glick
Keyword(s):  
Side Effects ◽  
Treatment Adherence ◽  
Atypical Antipsychotics ◽  
Phase 1 ◽  
Metabolic Effects ◽  
Valid Assessment ◽  
The Individual ◽  
Meta Analyses ◽  
Term Management

AbstractThe Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study was undertaken to provide a valid assessment of the differences between conventional and atypical antipsychotics and among the atypicals themselves in patients with schizophrenia. The CATIE investigators reported that while none of the study medications were ideal, olanzapine was the most effective in terms of treatment discontinuation, and there were no significant differences in effectiveness between the conventional antipsychotic perphenazine and the atypicals quetiapine, risperidone, and ziprasidone. Each drug differed slightly in rates of side effects, with more patients discontinuing perphenazine due to extrapyramidal side effects and more patients discontinuing olanzapine due to weight gain and metabolic effects. In order for data from phase 1 of the CATIE study to be interpreted within the appropriate context, physicians must understand how aspects of study design and statistical methods affect interpretation, and how this trial weighs against other data in the literature. This article enumerates the factors that complicate our understanding of the CATIE results and compares these findings with those from previously published meta-analyses. It is clear that therapeutic and side effects of antipsychotics vary from person to person. The goal of schizophrenia management is to maintain pharmacotherapeutic efficacy and tolerability over the long-term in order to maximize treatment adherence and benefits. What should emerge from CATIE is a renewed commitment to tailor schizophrenia treatment to the individual patient for long-term management.

Manipulation of fishing effort in Australia's penaeid Prawn Fisheries

1990 ◽  
Vol 41 (1) ◽  
pp. 1 ◽  
Author(s):  
IF Somers
Keyword(s):  
Side Effects ◽  
Great Barrier Reef ◽  
Simulation Model ◽  
Fishing Effort ◽  
Regulatory Mechanisms ◽  
Barrier Reef ◽  
Restrictive Measures ◽  
The Impact ◽  
Term Management

The potentially detrimental side-effects of prawn trawling are coming under increasing scrutiny in Australian waters, particularly in such ecologically sensitive areas as Queensland's Great Barrier Reef, and various restrictive measures are being suggested. Before changes are imposed on the prawning industry, the effects of trawling on the target prawn species and the long-term management of these effects need to be fully understood. Using a simulation model of a simplified prawn fishery, this paper describes the basis for the current regulatory mechanisms for Australian's prawn fisheries, in particular the manipulation of both the level and pattern of fishing effort. It is shown that even in moderately fished stocks, the fishery manager has several options, such as seasonal and nursery area closures, that are consistent with the goal of minimizing the impact of prawn trawling, while in no way penalizing the industry economically. With these in mind, possible ways of resolving or reducing the conflict with groups outside the prawning industry are discussed.

scholarly journals Management of insomnia in older adults

2007 ◽  
Vol 190 (4) ◽  
pp. 285-286 ◽  
Author(s):  
Børge Sivertsen ◽  
Inger Hilde Nordhus
Keyword(s):  
Older Adults ◽  
Behavioural Therapy ◽  
Societal Burden ◽  
Cognitive Behavioural ◽  
Physical Disorders ◽  
Short And Long Term ◽  
Low Threshold ◽  
The Individual ◽  
Term Management

SummaryComplaints of insomnia are very common, especially in older adults. Although pharmacotherapy is the most common form of treatment, recent evidence shows cognitive–behavioural therapy to be superior in the short- and long-term management of insomnia. Low-threshold intervention programmes may reduce both the individual and societal burden of insomnia, coexisting with or without other mental or physical disorders.

scholarly journals Invited Commentary: The Disillusionment of Developmental Origins of Health and Disease (DOHaD) Epidemiology

2019 ◽  
Vol 189 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Stephen E Gilman ◽  
Mady Hornig
Keyword(s):  
Observational Studies ◽  
Meta Analysis ◽  
Autism Spectrum ◽  
Developmental Origins ◽  
Short Term ◽  
Hyperactivity Disorder ◽  
Health And Disease ◽  
The Individual ◽  
Meta Analyses

Abstract The developmental origins of health and disease (DOHaD) model promises a greater understanding of early development but has left unresolved the balance of risks and benefits to offspring of medication use during pregnancy. Masarwa et al. (Am J Epidemiol. 2018;187(8):1817–1827) conducted a meta-analysis of the association between in utero acetaminophen exposure and risks of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). A challenge of meta-analyzing results from observational studies is that summary measures of risk do not correspond to well-defined interventions when the individual studies adjusted for different covariate sets, which was the case here. This challenge limits the usefulness of observational meta-analyses for inferences about etiology and treatment planning. With that limitation understood, Masarwa et al. reported a 20%–30% higher risk of ADHD and ASD following prenatal acetaminophen exposure. Surprisingly, most of the original studies did not report diagnoses of ADHD or ASD. As a result, their summary estimates of risk are not informative about children’s likelihood of ADHD and ASD diagnoses. The long-term promise of DOHaD remains hopeful, but more effort is needed in the short-term to critically evaluate observational studies suggesting risks associated with medications used to treat conditions during pregnancy that might have adverse consequences for a developing fetus.

Use of atypical antipsychotics in early onset schizophrenia

2011 ◽  
Vol 26 (S2) ◽  
pp. 324-324
Author(s):  
M. Marin Mayor ◽  
N. Martinez Martin ◽  
E. Verdura Vizcaino ◽  
R.A. Codesal Julian
Keyword(s):  
Side Effects ◽  
Children And Adolescents ◽  
Early Onset ◽  
Atypical Antipsychotics ◽  
Metabolic Effects ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Childhood And Adolescence ◽  
Early Onset Schizophrenia ◽  
Children And Adolescent

IntroductionChildhood or Early Onset Schizophrenia (EOS), defined as the onset of psychotic symptoms before the thirteenth birthday, represents a rare, clinically severe variant, associated with significant chronic functional impairment and poor response to antipsychotic treatment. Despite of that, in clinical practice, atypical agents have become the treatment of choice in patients with EOS.AimsTo review the different pharmacological strategies, in which an atypical antipsychotic was used in the management of EOS in childhood and adolescence.MethodsWe conducted a literature search of articles related to the use of atypical antipsychotics in children and adolescents with EOS in the last 20 years from the Medline database.ResultsSeveral atypical antipsychotics, such as Risperidone, Olanzapine, Quetiapine, Aripiprazol and Clozapine were consistently found to reduce the severity of psychotic symptoms in EOS when compared to placebo. Although Clozapine has demonstrated to be more efficacious than other atypical and typical antipsychotics, it remains the medication of last resort due to its profile of side effects. Finally, in general, children and adolescent have a higher risk of extrapyramidal symptoms, akathisia, prolactin elevation, sedation and metabolic effects of atypical antipsychotics than adults.ConclusionsAntipsychotics are the mainstay of treatment of EOS. Randomized controlled trials suggest a trend to superior efficacy for atypical antipsychotics over classic antipsychotic. Children and adolescents trend to be more sensible to antipsychotic side effects. Clinicians should be aware of this problem and be careful when monitoring this type of treatment.

First-line atypical antipsychotics for schizophrenia are appropriate – with psychosocial interventions

2001 ◽  
Vol 25 (8) ◽  
pp. 287-288 ◽  
Author(s):  
A. M. Mortimer
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Treatment Resistance ◽  
Psychosocial Interventions ◽  
First Line ◽  
Conventional Antipsychotics ◽  
Increased Risk ◽  
Loss Of Libido ◽  
The Individual

Conventional antipsychotics, historically the mainstay of schizophrenia treatment, were ineffective in many patients, at least 30% fitting treatment-resistance criteria (Kane & Lieberman, 1987). All had the same mechanism of action: none was any more effective in the individual than any other. Therapeutic nihilism accepted poorly controlled positive symptoms and disabling negative symptoms: nearly all patients suffered side-effects (Barnes & Edwards, 1993), particularly extrapyramidal side-effects (EPS) and hyperprolactinaemia. Conventional antipsychotics raise prolactin to a range associated with sexual dysfunction or even macroprolactinoma: effects in men include erectile dysfunction and hypospermatogenesis; in women, galactorrhoea, oligo- or amenorrhoea, hirsutism and increased risk of osteoporosis. In both men and women there is loss of libido, and a link between hyperprolactinaemia and weight gain.

Regular Hemoperfusion in Regular Dialysis Treatment. A Long-Term Study

1980 ◽  
Vol 3 (6) ◽  
pp. 348-353 ◽  
Author(s):  
S. Stefoni ◽  
L. Colì ◽  
G. Feliciangeli ◽  
L. Baldrati ◽  
V. Bonomini
Keyword(s):  
Side Effects ◽  
Clinical Signs ◽  
Metabolic Effects ◽  
Term Study ◽  
Dialysis Treatment ◽  
Long Term Study ◽  
Regular Dialysis Treatment ◽  
Uremic Patients ◽  
Major Objection

The capacity of activated charcoal to remove toxins from the blood is well established. Its poor biocompatibility, inability to remove urea, electrolytes and water, and high cost have so far been the major objection to a wider use of charcoal with chronic uremic patients. The availability of a charcoal coated by a new highly hydrophilic methacrylate based membrane enabled us to keep 18 uremic patients on a combined hemodialysis-hemoperfusion schedule for 4–52 weeks. Investigations concerned patients in whom relapsing signs of uremia occurred despite technically adequate dialysis, and other cases where dialysis was both technically and clinically adequate. In the first group of patients, the conbined programme led to an improvement of the dialysis resistent clinical signs, while certain positive metabolic effects were also observed. In the second group, the hemodialysis-hemoperfusion treatment allowed a reduction of about 30% in time of treatment per week. Tolerance of the new coated charcoal was good throughout treatment in terms both of biocompatibility and of side effects.

scholarly journals Levetiracetam Induced Hyperkalemia – A Rare Side Effect in Elderly with Pre-Existing Subclinical Renal Insufficiency Presenting with Bradyarrhythmia

2021 ◽  
pp. 185-190
Author(s):  
Abhishek Chande ◽  
Vidyashree Hulkoti ◽  
Shivam Khanna ◽  
Sunil Kumar
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Case Scenario ◽  
Rare Form ◽  
P Waves ◽  
Generalized Seizures ◽  
Rare Side Effect ◽  
Severe Hyperkalemia ◽  
Term Management

Levetiracetam is a commonly used drug in today’s world for long term management of partial as well as generalized seizures mainly due its major advantage that is has so few and non-threatening side effects[1].In the following case scenario, we show how a 70 years old male presented with severe hyperkalemia and after no other common culprits were seen, it was thought to be a side effect therapy with levetiracetam and after discontinuing it and managing hyperkalemia, the patient’s condition improved from a very critical state. We also show a rare form ECG presentation of severe hyperkalemia in the form of bradyarrhythmia with absent P waves. Our experience shows that unpredictable and rare side effects of new anti-epileptic drugs should be given attention and such cases often go undiagnosed.

Long-Term Treatment of Patients with Recurrent Unipolar Major Depression: Evidence to Clinical Practice

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S15) ◽  
pp. 4-5 ◽  
Author(s):  
Martin B. Keller
Keyword(s):  
Treatment Strategies ◽  
Patient Characteristics ◽  
Evidence Base ◽  
Term Treatment ◽  
Recurrent Depression ◽  
Long Term Treatment ◽  
Risk Factors For Recurrence ◽  
The Individual ◽  
Term Management

Major depressive disorder (MDD) is almost exclusively recurrent. The vast majority of patients who experience one episode of MDD will eventually experience at least one more episode during their lifetime. The recurrent nature of MDD increases the burden to both the individual and society. Hence, it is imperative that treatment strategies focus on achieving remission acutely, as well as maintaining of remission and preventing recurrence. The articles in this supplement are based on presentations and a dialogue among a group of experts who convened for a roundtable discussion on improving long-term outcomes with antidepressant therapy.Improving long-term treatment of MDD begins with understanding the clinical course of recurrent depression and the ability to recognize those patients who are at greatest risk for recurrence. James H. Kocsis, MD, reviews the course of recurrent depression, emphasizing the tendency for it to progressively worsen. He also discusses patient characteristics and other risk factors for recurrence as well as current recommendations for long-term management of recurrent depression.Although long-term antidepressant maintenance treatment studies are somewhat limited in number, they provide the evidence base that shapes existing guidelines for long-term management of recurrent depression. Michael E. Thase, MD, examines this evidence for the different classes of antidepressants. In addition, Thase reviews evidence for the efficacy of psychotherapy and discusses its potentially important role in long-term depression management.

Metabolic Findings From the CATIE Trial and Their Relation to Tolerability

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S7) ◽  
pp. 32-39 ◽  
Author(s):  
Henry A. Nasrallah
Keyword(s):  
Cardiovascular Risk ◽  
Side Effects ◽  
Atypical Antipsychotics ◽  
Patient Adherence ◽  
Metabolic Effects ◽  
Individual Treatment ◽  
Adherence To Medication ◽  
The Metabolic Syndrome ◽  
Conventional Drug ◽  
Negative Side Effects

AbstractThe overall effectiveness of antipsychotics for the management of schizophrenia is restricted by their side-effect profiles, particularly over an extended treatment period. Intolerable side effects can reduce patient adherence to medication and often lead to treatment discontinuation. Some side effects that result from antipsychotic use are precursors to the metabolic syndrome, which is prevalent among individuals with schizophrenia and represents a significant source of cardiovascular risk. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia study assessed the efficacy of the atypical antipsychotics olanzapine, quetiapine, risperidone, and ziprasidone relative to the conventional drug perphenazine. Additional assessments included the metabolic effects of these agents in patients with schizophrenia and the incidence of negative side effects. No significant differences were found between treatment groups for time to discontinuation due to intolerability, but the rates of side effects significantly differed (P=.04). For metabolic parameters, olanzapine was associated with greater and significant adverse effects on weight, lipids, and glucose metabolism versus the other antipsychotics tested. The CATIE results show that important distinctions exist among currently available atypical antipsychotics. Physicians should be aware of the propensity of these drugs to increase the risks of cardiovascular disease and diabetes in treated patients and tailor individual treatment decisions accordingly. This article highlights the metabolic findings from the CATIE schizophrenia study, and explores the differences shown by atypical antipsychotics, with regard to metabolic side effects that increase cardiovascular risk.

scholarly journals Management strategies on territories with special status of protection in the Czech Republic

2012 ◽  
Vol 50 (No. 11) ◽  
pp. 510-513 ◽  
Author(s):  
J. Simon
Keyword(s):  
Czech Republic ◽  
Management Strategies ◽  
Forest Policy ◽  
Anthropogenic Pressure ◽  
The Czech Republic ◽  
Forest Condition ◽  
The Individual ◽  
Term Management ◽  
Selection Of

About 15% of the area of the Czech Republic is classified as territories with special status of protection, most of which is covered with forests. At present, at the time of integration of the country into the European structures, an increase in the area of such territories by approximately 20% is expected. The territories show significant variation of protection objectives, management restrictions, profound differentiation in natural conditions, structure of ownership and different levels of damage, especially that caused by anthropogenic pressure. This situation requires the formulation of long-term management strategies. The problem can be solved in the following successive steps: formulation of variants and alternatives of management strategies based on a retrospective analysis of forest development; prognosis of the forest condition development after application of the individual management strategies on the basis of growth and development simulations; addition of technological and economical bases; selection of optimal variants and alternatives from the viewpoint of the fulfilment of the owner’s management goals, in accordance with the principles of forest policy and from the viewpoint of the fulfilment of the protection objective formulated for a specific territory with special status of protection. A set of methods for following the above-mentioned steps is specified in the presented contribution.

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