scholarly journals Current and Novel Approaches to Mitigate Cardiometabolic Adverse Effects of Second-Generation Antipsychotics

2020 ◽  
Vol 23 (8) ◽  
pp. 491-495
Author(s):  
Karolina Skonieczna-Żydecka ◽  
Igor Łoniewski ◽  
Ewa Stachowska ◽  
Wojciech Marlicz ◽  
Christoph U Correll
Keyword(s):  
Adverse Effects ◽  
Second Generation ◽  
Public Health Issue ◽  
Cardiometabolic Health ◽  
Metabolic Disturbances ◽  
Major Public Health Issue ◽  
Second Generation Antipsychotics ◽  
Second Generation Antipsychotic ◽  
Pharmacologic Treatments

Abstract Second-generation antipsychotic–related weight gain and metabolic disturbances are a major public health issue given the widespread prescribing of these medications. The lack of clearly known mechanisms of cardiometabolic adverse effects and the relevance of cardiometabolic health for survival make this an important area for research. While nonpharmacologic and some pharmacologic treatments have shown benefits vs control conditions or placebo, the effects are modest and long-term benefits are less clear. Therefore, new approaches to mitigate second-generation antipsychotic–associated cardiometabolic burden are sorely needed.

Metabolic and Cardiac Side Effects of Second-generation Antipsychotics: What Every Clinician Should Know

2009 ◽  
Vol 22 (5) ◽  
pp. 478-488 ◽  
Author(s):  
Ericka L. Breden ◽  
Mei T. Liu ◽  
Stacey R. Dean ◽  
Toyin S. Tofade
Keyword(s):  
Cardiovascular Disease ◽  
Health Care ◽  
Adverse Effects ◽  
Second Generation ◽  
Antipsychotic Agents ◽  
The United States ◽  
Natural Death ◽  
Cardiac Side Effects ◽  
Second Generation Antipsychotics ◽  
Physical Health Care

In 2007, 5 of the 7 second-generation antipsychotics were listed in the Top 200 Drugs prescribed by retail sales in the United States. Cardiovascular disease is the leading cause of natural death in individuals with schizophrenia. Second-generation antipsychotics have been implicated with metabolic and cardiovascular adverse effects, and it is important for nonpsychiatric practitioners to be familiar with the monitoring parameters recommended for these agents. This article discusses the risk of weight gain, hyperglycemia, hyperlipidemia, hyperprolactinemia, and cardiovascular concerns associated with second-generation antipsychotic agents. It also discusses the proposed mechanisms for each of these adverse effects. Furthermore, it reviews suggested monitoring parameters to help manage cardiovascular disease in this patient population, and to improve the gap that exists between mental health care and physical health care in the schizophrenic population.

scholarly journals New antipsychotic drugs for the treatment of agitation and psychosis in Alzheimer’s disease: focus on brexpiprazole and pimavanserin

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 686 ◽  
Author(s):  
Filippo Caraci ◽  
Mario Santagati ◽  
Giuseppe Caruso ◽  
Dario Cannavò ◽  
Gian Marco Leggio ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Receptor Antagonist ◽  
Safety Profile ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Phase Iii ◽  
Second Generation Antipsychotics ◽  
Recent Phase

Behavioral and psychological symptoms of dementia are symptoms of disturbed perception, mood, behavior, and thought content that occurred frequently. These symptoms, which include apathy, depression, anxiety, psychosis, agitation, and aggression, can serve as predictors of and early clinical diagnostic markers for Alzheimer’s disease (AD) and are common precipitants of institutional care. Agitation and psychosis are associated with accelerated disease progression and increased tau phosphorylation in patients with AD. Current guidelines recommend the use of second-generation antipsychotics for the treatment of agitation and psychosis in AD, but only after first-line non-pharmacological interventions and for no longer than 12 weeks because long-term use of these drugs is associated with an increased risk of mortality and an increased frequency of cerebrovascular events. Therefore, new antipsychotic drugs with improved efficacy and safety are needed as an alternative to current antipsychotic drugs. In this report, we discuss some of the most relevant advances in the field of agitation and psychosis in AD and focus on the recent positive clinical evidence observed with two new antipsychotics drugs: brexpiprazole and pimavanserin. Brexpiprazole is a receptor partial agonist (D2, D3, 5-HT1A), receptor antagonist (5-HT2A/B, α1B/α2C) according to the neuroscience-based nomenclature. Two recent phase III clinical trials have shown that brexpiprazole 2 mg/day is effective for the treatment of agitation in patients with AD and has an improved tolerability and safety profile compared with currently available second-generation antipsychotics. Pimavanserin is a receptor antagonist (5-HT2A, 5-HT2C) that has been given market authorization for psychosis occurring in Parkinson’s disease. Recent phase II studies suggest that this drug is effective in AD patients with more severe psychosis, although further long-term studies are needed to better define the efficacy and long-term safety profile of pimavanserin for the treatment of psychosis in AD.

Antipsychotic utilisation and persistence in Australia: A nationwide 5-year study

2021 ◽  
pp. 000486742110516
Author(s):  
Mark Taylor ◽  
Dante Dangelo-Kemp ◽  
Dennis Liu ◽  
Steve Kisely ◽  
Simon Graham ◽  
...  
Keyword(s):  
First Generation ◽  
Second Generation ◽  
Treatment Persistence ◽  
Persistence Time ◽  
Hazard Ratios ◽  
Second Generation Antipsychotics ◽  
Time In Treatment ◽  
Second Generation Antipsychotic ◽  
Long Acting ◽  
Subsequent Relapse

Objectives: To evaluate the utilisation and persistence of antipsychotics for the treatment of schizophrenia in Australia. Methods: A retrospective study using the Australian Pharmaceutical Benefits Scheme database of a representative 10% sample. All adults with schizophrenia who were dispensed three or more supplies of oral (including clozapine) or long-acting injectable antipsychotics between 1 June 2015 and 31 May 2020 were included. Persistence time in treatment was evaluated using survival analysis and Cox hazard ratios. Results: In all, 26,847 adults with schizophrenia were studied. Oral second-generation antipsychotics were more frequently dispensed than the other antipsychotic groups studied. Median treatment persistence times were 18.3 months for second-generation antipsychotic long-acting injectables, 10.7 months for oral second-generation antipsychotics and were significantly lower for both formulations of first-generation antipsychotics at 5.2 months (long-acting injectables) and 3.7 months (oral). The median persistence time for clozapine was significantly longer than all other antipsychotics groups. Conclusions: Oral second-generation antipsychotics and second-generation antipsychotic long-acting injectables accounted for over 75% and 13% of all antipsychotics in Australia, respectively. Concerns over medication adherence and subsequent relapse have not translated into increased long-acting injectable usage despite their significantly longer persistence. Clozapine, the single most ‘persistent’ antipsychotic, was only used in 9% of people, although up to a third of all cases are likely to be treatment-resistant. Our data suggest clinicians should give consideration to the earlier use of second-generation antipsychotic long-acting injectables and clozapine, to ameliorate prognosis in schizophrenia.

scholarly journals Treatment Response of Add-On Esketamine Nasal Spray in Resistant Major Depression in Relation to Add-On Second-Generation Antipsychotic Treatment

2020 ◽  
Vol 23 (7) ◽  
pp. 440-445 ◽  
Author(s):  
Markus Dold ◽  
Lucie Bartova ◽  
Siegfried Kasper
Keyword(s):  
Major Depressive Disorder ◽  
Confidence Interval ◽  
Depressive Disorder ◽  
Nasal Spray ◽  
Second Generation ◽  
Mean Difference ◽  
Inadequate Response ◽  
Major Depressive ◽  
Second Generation Antipsychotics ◽  
Second Generation Antipsychotic

Abstract In this meta-analysis, we aimed to estimate and compare the efficacy of add-on treatment of antidepressants with esketamine nasal spray and second-generation antipsychotics in patients with nonpsychotic major depressive disorder and inadequate response to antidepressants. Searching for acute-phase, double-blind, placebo-controlled, randomized trials, we found 22 second-generation antipsychotic (n = 8363) and 3 intranasal esketamine (n = 641) studies. Mean change in the Montgomery Åsberg Depression Rating Scale total score served as outcome. We determined a higher mean difference (vs placebo) for the pooled esketamine nasal spray trials (mean difference = 4.09, 95% confidence interval: 2.01 to 6.17) than for the pooled second-generation antipsychotic augmentation trials (mean difference  = 2.05, 95% confidence interval: 1.51 to 2.59). Thus, the effect size for intranasal esketamine was nearly twice as high as those for the second-generation antipsychotics. This indicates high efficacy of add-on esketamine nasal spray in treatment-resistant major depressive disorder compared with other well-established, evidence-based pharmacological options such as augmentation with second-generation antipsychotics.

Textbook of Post-ICU Medicine: The Legacy of Critical Care

2014 ◽  
Keyword(s):  
Recovery Process ◽  
Public Health Issue ◽  
Major Public Health Issue ◽  
Psychological Issues ◽  
Treatment Regimens ◽  
Clinical Syndromes ◽  
Stage Renal Disease ◽  
End Stage

Describing the major clinical syndromes affecting ICU survivors, this resource delineates established or postulated biological mechanisms of the post-acute recovery process, and discusses strategies for treatment and rehabilitation to promote recovery in the ICU and in the long term. Many ICU survivors suffer from a range of long-lasting physical and psychological issues such as end stage renal disease, congestive heart failure, cognitive impairment, neuromuscular weakness, and depression or anxiety, which affect their overall quality of life and ability to lead productive lives. This online work discusses the science of the recovery process and the innovative treatment regimens which are helping ICU survivors regain function as they heal following trauma or disease. This lingering burden or 'legacy' of critical illness is now recognized as a major public health issue, with major efforts underway to understand how it can be prevented, mitigated, or treated.

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