scholarly journals 185 Second Generation Antipsychotics and Catatonia: A Literature Review

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 105-106
Author(s):  
Ryan Slauer ◽  
Mina Boazak ◽  
Michael Lowley ◽  
Jeffrey Lawrence ◽  
Zachary Hudson ◽  
...  
Keyword(s):  
Second Generation ◽  
Case Reports ◽  
Controlled Trial ◽  
Treatment Options ◽  
Antipsychotic Treatment ◽  
Patient Demographics ◽  
Second Generation Antipsychotics ◽  
Psychiatric Units ◽  
Pubmed Search ◽  
Pharmacologic Agents

AbstractIntroductionCatatonia is an underrecognized neuropsychiatric syndrome affecting approximately 10% of individuals hospitalized on inpatient psychiatric units. First-line treatments for this condition include benzodiazepines (BZD) and/or electroconvulsive therapy (ECT). However, 20-40% of individuals do not respond to BZD alone and ECT is not always accessible. Second generation antipsychotics (SGA) have been used to treat catatonia in these circumstances. Here, we review the literature pertaining to the efficacy and safety of SGA in the treatment of catatonia.MethodsWe conducted a PubMed search for articles linking catatonia to antipsychotics, under the search heading “catatonia” or “kahlbaum” and “risperidone”, “amisulpride”, “iloperidone”, “olanzapine”, “aripiprazole”, “paliperidone”, “clozapine”, “brexpiprazole”, or “cariprazine”. Reports commenting on SGA treatment efficacy and/or their role in the development of catatonia were included in the analysis. Selected articles were reviewed for patient demographics, psychiatric/medical history, symptoms, cause of catatonia and treatment, and co-administered agents. For each SGA, we calculated the number of cases in which catatonia was likely improved with antipsychotic treatment, and the number of cases in which catatonia was precipitated or worsened with antipsychotic treatment (improved/worsened ratio). Case data was assessed using the Naranjo Adverse Drug Reaction Probability Scale. Descriptive statistics were used to analyze the data.ResultsAt the time this abstract was written, we reviewed 480 of the original 507 articles. One hundred and seventeen of the 480 met inclusion criteria. There was one randomized controlled trial (RCT), five prospective studies, four retrospective studies and 107 case reports. Of all reviewed literature quetiapine (34:3, 92%), aripiprazole (16:2, 89%), amisulpride (18:1, 95%), andclozapine (19:1, 95%) had the highest improved/worsened ratio, conversely paliperidone (0:5, 0%) had the lowest improved/worsened ratio.ConclusionOf the available literature quetiapine, amisulpride, aripiprazole, and clozapine were found to be relatively safe andeffective as treatment options in catatonia, while palipderidone was found to have reports pointing to its role in the development/worsening, but none on the improvement, of catatonia. These results need to be interpreted with caution. In the majority of cases where SGA’s were effective, patients were co- treated with other pharmacologic agents (most frequently benzodiazepines), making it difficult to assess the role of the antipsychotic alone. Also, given that the preponderance of studies were case reports, publication bias may be an important limitation. Further studies are needed to examine the safety and efficacy of SGA in treating catatonia.Funding AcknowledgementsNo funding.

scholarly journals First- v. second-generation antipsychotics and risk for diabetes in schizophrenia: Systematic review and meta-analysis

2008 ◽  
Vol 192 (6) ◽  
pp. 406-411 ◽  
Author(s):  
M. Smith ◽  
D. Hopkins ◽  
R. C. Peveler ◽  
R. I. G. Holt ◽  
M. Woodward ◽  
...  
Keyword(s):  
Systematic Review ◽  
First Generation ◽  
Second Generation ◽  
Psychotic Disorders ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Antipsychotic Treatment ◽  
Cross Sectional ◽  
Increased Risk ◽  
Second Generation Antipsychotics

BackgroundThe increased prevalence of diabetes in schizophrenia is partly attributed to antipsychotic treatment, in particular second-generation antipsychotics, but the evidence has not been systematically reviewed.AimsSystematic review and meta-analysis comparing diabetes risk for different antipsychotics in people with schizophrenia.MethodWe searched MEDLINE, PsycINFO, EMBASE, International Pharmaceutical Abstracts, CINAHL and Web of Knowledge until September 2006. Studies were eligible for inclusion if the design was cross-sectional, case-control, cohort or a controlled trial in individuals with schizophrenia or related psychotic disorders, where second-generation antipsychotics (defined as clozapine, olanzapine, risperidone and quetiapine) were compared with first-generation antipsychotics and diabetes was an outcome. Data were pooled using random effects inverse variance weighted meta-analysis.ResultsOf the studies that met the inclusion criteria (n=14), 11 had sufficient data to include in the meta-analysis. Four of these were retrospective cohort studies. The relative risk of diabetes in patients with schizophrenia prescribed one of the second-generation v. first-generation antipsychotics was 1.32 (95% CI 1.15-1.51). There were insufficient data to include aripiprazole, ziprasidone and amisulpride in this analysis.ConclusionsThere is tentative evidence that the second-generation antipsychotics included in this study are associated with a small increased risk for diabetes compared with firstgeneration antipsychotics in people with schizophrenia. Methodological limitations were found in most studies, leading to heterogeneity and difficulty interpreting data. Regardless of type of antipsychotic, screening for diabetes in all people with schizophrenia should be routine.

Clozapine-Induced Hypersalivation

2000 ◽  
Vol 34 (5) ◽  
pp. 662-665 ◽  
Author(s):  
Liya Davydov ◽  
Sheila R Botts
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Receptor Activation ◽  
Data Synthesis ◽  
Search Terms ◽  
Primary Literature ◽  
Adrenoceptor Agonists ◽  
Swallowing Reflex ◽  
Pharmacologic Agents ◽  
Underlying Pathophysiology

OBJECTIVE: To review underlying pathophysiology and possible treatments for clozapine-induced hypersalivation. DATA SOURCES: Primary literature was accessed through MEDLINE (1966–May 1999). Key search terms included clozapine, hypersalivation, sialorrhea, and treatment. DATA SYNTHESIS: Hypersalivation occurs in up to 54% of patients receiving clozapine. An evaluation of studies and case reports focusing on management of clozapine-induced hypersalivation was conducted. CONCLUSIONS: It is unclear whether clozapine increases salivation through its muscarinic M4 receptor activation and/or blockade of α2-adrenoceptors, or by causing a distortion in swallowing reflex. Treatment options include chewing gum, reducing the dosage of clozapine, or prescribing pharmacologic agents such as anticholinergics or α2-adrenoceptor agonists.

scholarly journals A Randomized Controlled Trial of the Cost-Utility of Second-Generation Antipsychotics in People with Psychosis and Eligible for Clozapine

2008 ◽  
Vol 11 (4) ◽  
pp. 549-562 ◽  
Author(s):  
Linda M. Davies ◽  
Thomas R.E. Barnes ◽  
Peter B. Jones ◽  
Shôn Lewis ◽  
Fiona Gaughran ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Second Generation ◽  
Controlled Trial ◽  
Cost Utility ◽  
Randomized Controlled ◽  
Second Generation Antipsychotics ◽  
The Cost

scholarly journals Second Generation Antipsychotics (SGAs) in Schizophrenic Patients and Bipolar Disorder: Correlation With Metabolic Syndrome (NCEP ATP III(a))

2018 ◽  
Vol 11 (1) ◽  
pp. 28
Author(s):  
Consuelo Roldan Menco ◽  
Anderson Díaz-Pérez ◽  
Zoraida Barrios Puerta
Keyword(s):  
Metabolic Syndrome ◽  
Bipolar Disorder ◽  
Second Generation ◽  
Mental Illnesses ◽  
Abdominal Circumference ◽  
High Density Lipoproteins ◽  
P Value ◽  
Antipsychotic Treatment ◽  
The Metabolic Syndrome ◽  
Second Generation Antipsychotics

INTRODUCTION: The Metabolic Syndrome is a set of diverse clinical situations such as diabetes mellitus, hypertension and dyslipidemia. Patients with mental illnesses such as schizophrenia or bipolar disorder have a higher mortality than the general population attributable in 60% to somatic diseases and metabolic syndrome, where second generation antipsychotics increase the risk of weight gain and insulin resistance. Objectives. Correlate the treatment with second generation antipsychotics (SGAs) as a possible predictor for Metabolic Syndrome according to the NCEP ATP III (a) classification. METHODS: Descriptive, cross-sectional correlational study. The sample was of 92 patients, applying an open and convenience sampling due to the mental state of the patients in order to determine their degree of acceptance to the study (Informed Assent) and consent to the legal guardian as the main inclusion criterion. For the analysis, the following variables were considered: blood pressure, weight, height, abdominal circumference, serum levels of triglycerides, glucose and high density lipoproteins. The SPSS 20.0 ® program was used logistic regression analysis with a p-value <0.05 and a confidence level of 95%. RESULTS: SGAs most used was clozapine (54.3%). The correlation analysis showed that sociodemographic aspects such as personal history, habits, physical activity and paraclinical and anthropometric records correlated with the possible diagnosis of metabolic syndrome (p <0.05), but not with SGAs (p> 0.05). ). CONCLUSION: No correlation was found between the presence of the metabolic syndrome and the type of antipsychotic treatment.

Antipsychotic polypharmacy in the treatment of schizophrenia in China and Japan

2018 ◽  
Vol 52 (12) ◽  
pp. 1202-1212 ◽  
Author(s):  
Hong Qiu ◽  
Yong He ◽  
Yongjing Zhang ◽  
Minfu He ◽  
Jin Liu ◽  
...  
Keyword(s):  
Second Generation ◽  
International Classification Of Diseases ◽  
Medical Data ◽  
Antipsychotic Treatment ◽  
Study Cohort ◽  
Younger Patients ◽  
Data Centre ◽  
Second Generation Antipsychotics ◽  
Classification Of Diseases ◽  
China And Japan

Background: Although antipsychotic monotherapy is recommended as the main treatment for schizophrenia, antipsychotic polypharmacy is not rare in practice. However, longitudinal data on antipsychotic polypharmacy in schizophrenia treatment are limited. Methods: This longitudinal database study described antipsychotic polypharmacy in the treatment of schizophrenia in real-world settings in China and Japan. We retrieved information about antipsychotic treatment for schizophrenia from January 2010 to December 2014 from two hospital Electronic Medical Records databases in China and one claims database, Japan Medical Data Centre in Japan. Eligible patients had a diagnosis of schizophrenia (International Classification of Diseases, Tenth Revision F20.x) and at least one prescription for first or second generation antipsychotics. Antipsychotic polypharmacy was defined as having more than one antipsychotic medication overlapping for ⩾60 days. The Japan Medical Data Centre study cohort was further stratified by employees (insurance beneficiaries) and their dependents. Results: The study cohorts comprised 11,961 patients from China and 25,034 (10,661 employee sub-cohort and 14,373 dependent sub-cohort) from 14 days Japan Medical Data Centre in Japan. Most patients were prescribed monotherapy (87.3% in China and 80.1% in Japan), of which oral second-generation antipsychotics were the majority (78.9% in China and 65.8% in Japan). The prevalence rate of antipsychotic polypharmacy was 12.7% in China and 19.9% in Japan (13.7% in employees vs 24.5% in dependents). The most common combinations were two oral antipsychotics. Combinations of more than two drugs were uncommon in China (0.3%) but were prescribed for 5.3% of patients in Japan. Among patients treated with monotherapy, 12.6/100 person-years (11.8%) in China and 9.6/100 person-years (11.0%) in Japan switched to antipsychotic polypharmacy during follow-up. Younger patients were more likely to switch to antipsychotic polypharmacy than older patents in all study cohorts. Conclusion: The observed rates of antipsychotic polypharmacy ranged from 12.7% in China to 19.9% in Japan. Switching from monotherapy to antipsychotic polypharmacy was most likely to occur in younger patients with schizophrenia.

Pandrug-resistant Gram-negative bacteria: a systematic review of current epidemiology, prognosis and treatment options

2019 ◽  
Author(s):  
Stamatis Karakonstantis ◽  
Evangelos I Kritsotakis ◽  
Achilleas Gikas
Keyword(s):  
Case Reports ◽  
Controlled Trial ◽  
Treatment Options ◽  
Relevant Literature ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Treatment Regimens ◽  
Synergistic Combinations

Abstract Background The literature on the epidemiology, mortality and treatment of pandrug-resistant (PDR) Gram-negative bacteria (GNB) is scarce, scattered and controversial. Objectives To consolidate the relevant literature and identify treatment options for PDR GNB infections. Methods A systematic search in MEDLINE, Scopus and clinical trial registries was conducted. Studies reporting PDR clinical isolates were eligible for review if susceptibility testing for all major antimicrobials had been performed. Characteristics and findings of retrieved studies were qualitatively synthesized. Results Of 81 studies reviewed, 47 (58%) were published in the last 5 years. The reports reflected a worldwide dissemination of PDR GNB in 25 countries in 5 continents. Of 526 PDR isolates reported, Pseudomonas aeruginosa (n=175), Acinetobacter baumannii (n=172) and Klebsiella pneumoniae (n=125) were most common. PDR GNB were typically isolated in ICUs, but several studies demonstrated wider outbreak potential, including dissemination to long-term care facilities and international spread. All-cause mortality was high (range 20%–71%), but appeared to be substantially reduced in studies reporting treatment regimens active in vitro. No controlled trial has been performed to date, but several case reports and series noted successful use of various regimens, predominantly synergistic combinations, and in selected patients increased exposure regimens and newer antibiotics. Conclusions PDR GNB are increasingly being reported worldwide and are associated with high mortality. Several treatment regimens have been successfully used, of which synergistic combinations appear to be most promising and often the only available option. More pharmacokinetic/pharmacodynamic and outcome studies are needed to guide the use of synergistic combinations.

Efficacy and Safety Considerations With Second-Generation Antipsychotics as Adjunctive Analgesics: A Review of Literature

2021 ◽  
pp. 875512252110041
Author(s):  
Belinda Coronado ◽  
Jacob Dunn ◽  
Michael A. Veronin ◽  
Justin P. Reinert
Keyword(s):  
Extended Release ◽  
Second Generation ◽  
Rating Scale ◽  
Data Extraction ◽  
Controlled Trial ◽  
Numeric Rating Scale ◽  
Efficacy And Safety ◽  
Study Selection ◽  
Second Generation Antipsychotics ◽  
Safety Considerations

Objective: To determine the efficacy and safety of second-generation antipsychotics (SGAs) as adjunctive analgesics. Data Sources: A comprehensive literature review was conducted between August 2020 and January 2021 on PubMed, Scopus, and ProQuest Central. Study Selection and Data Extraction: Keyword and Boolean phrase searches using the following terminology were conducted: “Quetiapine” OR “Risperidone” OR “Olanzapine” OR “Ziprasidone” AND “Analgesia” NOT “Psychosis” NOT “Psych.” Articles that involved human adult patients who received any of the SGAs mentioned in the searching filter with an opioid were included. Articles that described pediatrics, pregnant women, patients who received any of these agents for treatment of psychosis and articles that were not in English, or readily translatable to English, were excluded. Data Synthesis: Three articles were selected for inclusion in this review, with 2 articles detailing reports with olanzapine and 1 article describing a randomized, controlled trial with extended-release quetiapine. Both olanzapine and quetiapine were able to decrease pain scores on the numeric rating scale, indicating a reduction pain experienced, and additionally reduced opioid craving behavior in patients. Depression scores and quality-of-life indicators improved with quetiapine, though those metrics were not studied with olanzapine. Conclusions: Select SGAs, specifically extended-release quetiapine and olanzapine, may serve as an appropriate adjunctive analgesic choice in select patients. Further research is required in a clinical setting to determine the exact role of this drug class in pain management.

scholarly journals Review: Influence of the CYP450 Genetic Variation on the Treatment of Psychotic Disorders

2021 ◽  
Vol 10 (18) ◽  
pp. 4275
Author(s):  
Lorena Carrascal-Laso ◽  
María Isidoro-García ◽  
Ignacio Ramos-Gallego ◽  
Manuel A. Franco-Martín
Keyword(s):  
Second Generation ◽  
Psychotic Disorders ◽  
State Of The Art ◽  
Current Knowledge ◽  
Pharmacokinetic Parameters ◽  
Antipsychotic Treatment ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Second Generation Antipsychotics ◽  
Second Generation Antipsychotic

Second-generation antipsychotic metabolism is mainly carried out by the CYP450 superfamily, which is highly polymorphic. Therefore, knowing the influence of the different known CYP450 polymorphisms on antipsychotic plasmatic levels and, consequently, the biological effect could contribute to a deeper knowledge of interindividual antipsychotic treatment variability, prompting possible solutions. Considering this, this state of the art review aimed to summarize the current knowledge about the influence of the diverse characterized phenotypes on the metabolism of the most used second-generation antipsychotics. Forty studies describing different single nucleotide polymorphisms (SNPs) associated with the genes CYP1A2, CYP2D6, CYP3A4, CYP3A5, and ABCB1 and their influence on pharmacokinetics of olanzapine, clozapine, aripiprazole, risperidone, and quetiapine. Most of the authors concluded that although significant differences in the pharmacokinetic parameters between the different phenotypes could be observed, more thorough studies describing pharmacokinetic interactions and environmental conditions, among other variables, are needed to fully comprehend these pharmacogenetic interactions.

scholarly journals Augmentation of Antipsychotic Medications with Low-Dose Clozapine in Treatment-Resistant Schizophrenia—Case Reports and Discussion

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Zoe Harrison ◽  
Owen Haeney ◽  
William Brereton
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Relevant Literature ◽  
Treatment Resistance ◽  
Antipsychotic Treatment ◽  
Forensic Mental Health ◽  
Forensic Hospital ◽  
Novel Approach ◽  
Appropriate Therapy ◽  
Schizophrenia Case

Treatment resistance in schizophrenia is often encountered in clinical practice, with clozapine usually recommended as the appropriate therapy. However, where clozapine proves ineffective or cannot be tolerated due to side effects, treatment options are limited. In patients within forensic mental health services, residual symptomatology often presents a barrier to discharge and can have lasting effects on prospects for rehabilitation as well as risk to self and others. This paper presents a review of the relevant literature and three cases of a novel approach, utilising clozapine in doses usually considered subtherapeutic, in combination with the primary antipsychotic treatment. In all three patients, it improved clinical efficacy as well as tolerability, resulting in improvement that allowed discharge from the forensic hospital.

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