Oral and Palmitate Paliperidone Long-Acting Injectable Formulations use in Schizophrenia Spectrum Disorders: a retrospective cohort study from the CRUPEP First Episode Psychosis Intervention Program

Abstract Background Long-acting injectable antipsychotics (LAIs) may be a suitable therapeutic option for those patients in earlier stages of psychosis to avoid relapses and disease progression. Despite that, there is a lack of evidence in the literature regarding the use of LAIs in this profile of patients. Methods This is a retrospective cohort analysis to assess the efficacy, tolerability, and pattern of use of palmitate paliperidone long-acting injectable (PPLAI) formulations (1-monthly and 3-monthly) compared to oral paliperidone/risperidone in patients with a non-affective First Psychotic Episode(FEP) over a 12-month follow-up. Relevant sociodemographic and clinical information were assessed as well as main clinical scales: Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance Scale (PSP), and Clinical Global Impression Scale (CGI-I and CGI-S). Results Forty-eight patients, 16 per arm, 20-50 year aged with a FEP were included. Significant improvements were registered for all treatment groups. Despite that, patients receiving PPLAI 1-monthly and PPLAI 3-monthly formulations obtained greater improvements than the oral group in the main domains assessed (p<0.001). We found no statistically significant differences in hospitalizations between groups. Side effects were presented in 24% of patients. A trend towards reducing antipsychotic doses was observed in 43.8% of patients to achieve the minimum effective dose and avoid the occurrence of side effects. Conclusions To our knowledge, this is the first study assessing the use of palmitate paliperidone long-acting formulations versus oral risperidone or paliperidone in FEP. Treatment with PPLAI formulations seems to be an effective therapeutic choice at earlier stages of the disease.

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Rehospitalization rate of first episode and chronic schizophrenia patients one year after discharge

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2179 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S587-S587 ◽

Cited By ~ 1

Author(s):

R. Softic ◽

E. Becirovic ◽

M. Mirkovic Hajdukov

Keyword(s):

Relapse Rate ◽

First Generation ◽

Chronic Schizophrenia ◽

First Episode ◽

Psychotic Episode ◽

Rehospitalization Rate ◽

High Relapse Rate ◽

Frequent Use ◽

Long Acting ◽

Multiple Episodes

IntroductionRelapse rate among patients with schizophrenia can determinate outcome of illness. Up to 40% of patients with first psychosis responds well to treatment. Despite this fact relapse rate is still high, in particular if treatment is discontinuated. Frequent use of first generation antipsychotics (FGA) in underdeveloped countries can be one of possible reasons for treatment discontinuation and consequent relapse.AimsTo analyse rehospitalisation rate in patients with first and multiple episodes of schizophrenia, and compare it with medication choice.MethodsRetrospective analysis of medical records of patients with schizophrenia hospitalised in Psychiatry Clinic of University Clinical Center Tuzla in period from year 2011 to 2013.ResultsDuring the two-year period, 37 patients with first episode of schizophrenia were hospitalised. Second generation antipsychotics (SGA) were used in 40.5%, and first generation in 13.5%, long acting injectibles - first generation (LAI) were used in 8.1%, and combination of FGA's and SGA's in 5.4% of cases. In the same period, 121 patients with multiple episodes of schizophrenia were hospitalised. SGA were used in 21.4%, FGA in 33%, LAI's in 47.1%, and combination FGA's and SGA's in 35.5% of cases. Relapse rate in the first year after discharge was 16.2% in group with first psychotic episode, and 33% in the group with multiple episodes of schizophrenia.ConclusionHigh relapse rate in group with multiple episodes can be explained with nonadherence regarding the side effects of too frequent use of FGA's.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Clozapine induced diarrhea

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.633 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s502-s502

Author(s):

S. Ramos-Perdigues ◽

M.J. Gordillo ◽

C. Caballero ◽

S. Latorre ◽

S.V. Boned ◽

...

Keyword(s):

Internal Medicine ◽

Differential Diagnosis ◽

Therapeutic Option ◽

Disease Diagnosis ◽

First Episode ◽

Psychotic Episode ◽

Histological Findings ◽

Anticholinergic Effects ◽

Severe Diarrhea ◽

Competing Interest

IntroductionClozapine (CZP) is the only antipsychotic approved for resistant schizophrenia 1. Due to its side effects, CZP is not the first therapeutic option in a psychotic episode. Its anticholinergic effects often cause constipation, however, diarrhea have also been described in literature.ObjectivesWe describe a patient with two episodes of severe diarrhea after clozapine initiation, which lead to CZP discontinuation.AimsDiscuss about the differential diagnosis of diarrhea in CZP patients and the needing of a further studies for clarify the more appropriate management in CZP induced diarrhea.MethodsWe present a case report of a 46 years man diagnosed with schizoaffective disorder who presented two episodes of severe diarrhea with fever, which forced his transfer to internal medicine and UCI after CZP initiation.ResultsAt the first episode analytical, radiological and histological findings led to Crohn's disease diagnosis, which required budesonide and mesalazine treatment. In the second episode, the digestive team concluded that the episode was due to clozapine toxicity despite the controversial findings (clostridium toxin and Crohn's compatible biopsies)ConclusionsDiarrhea caused by CZP has been controversial in the literature. However due to the severity of digestive episodes and the paucity of alternative treatments further studies for a better understanding of its physiopathology are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Sugammadex Versus Neostigmine for Reversal of Residual Neuromuscular Blocks After Surgery: A Retrospective Cohort Analysis of Postoperative Side Effects

Anesthesia & Analgesia ◽

10.1213/ane.0000000000005842 ◽

2022 ◽

Vol Publish Ahead of Print ◽

Author(s):

Kurt Ruetzler ◽

Kai Li ◽

Surendrasingh Chhabada ◽

Kamal Maheshwari ◽

Praveen Chahar ◽

...

Keyword(s):

Side Effects ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Retrospective Cohort Analysis

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Social cognition, functional capacity and symptoms in the longitudinal prediction of outcome in subjects with first-episode schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.971 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S67-S67

Author(s):

M. Nordentoft ◽

R. Wills ◽

D. Gotfredsen

Keyword(s):

Antipsychotic Medication ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Schizophrenia Spectrum Disorders ◽

National Guidelines ◽

Term Outcome ◽

Long Term Outcome

BackgroundSeveral national guidelines recommend continuous use of antipsychotic medication after a psychotic episode in order to minimize the risk of relapse. However some studies have identified a subgroup of patients who can obtain remission of psychotic symptoms while not being on antipsychotic medication for a long period of time. This study investigated the long-term outcome and characteristics of patients in remission of psychotic symptoms with no use of antipsychotic medication at the 10-year follow-up.MethodsThe study was a cohort study including 496 patients diagnosed with schizophrenia spectrum disorders (ICD 10: F20 and F22-29). Patients were included in the Danish OPUS Trial and followed up 10 years after inclusion, where patient data was collected on socio-demographic factors, psychopathology, level of functioning and medication.FindingsAmong the patients, 30% had remission of psychotic symptoms at the time of the 10-year follow up with no current use of antipsychotic medication. This favorable outcome was associated with female gender, high GAF-F score, participation in the labor market and absence of substance abuse.InterpretationResults from several RCTs advise against discontinuation of antipsychotic medication, but our results from the 10-year follow-up indicate that a subgroup do obtain long-term remission while not being on antipsychotic medication. Hence, guidelines on antipsychotic medication do not pay sufficient attention to patients who discontinue antipsychotic medication and are still able to obtain remission of psychotic symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Oral versus Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia and Special Populations at Risk for Treatment Nonadherence: A Systematic Review

Schizophrenia Research and Treatment ◽

10.1155/2012/407171 ◽

2012 ◽

Vol 2012 ◽

pp. 1-12 ◽

Cited By ~ 30

Author(s):

Simon Zhornitsky ◽

Emmanuel Stip

Keyword(s):

Systematic Review ◽

Side Effects ◽

Psychosocial Interventions ◽

Special Populations ◽

First Episode ◽

Fluphenazine Decanoate ◽

Populations At Risk ◽

History Of ◽

Long Acting ◽

The Impact

Long-acting injectable antipsychotics (LAIs) should offer better efficacy and tolerability, compared to oral antipsychotics due to improved adherence and more stable pharmacokinetics. However, data on LAIs has been mixed, with some studies finding that they are more effective and tolerable than oral antipsychotics, and others finding the contrary. One possibility for the disparate results may be that some studies administered different antipsychotics in the oral and injectable form. The present systematic review examined the efficacy and tolerability of LAIs versus their oral equivalents in randomized and naturalistic studies. In addition, it examined the impact of LAIs on special populations such as patients with first-episode psychosis, substance use disorders, and a history of violence or on involuntary outpatient commitment. Randomized studies suggest that not all LAIs are the same; for example, long-acting risperidone may be associated with equal or less side effects than oral risperidone, whereas fluphenazine decanoate and enanthate may be associated with equal or more side effects than oral fluphenazine. They also suggest that LAIs reduce risk of relapse versus oral antipsychotics in schizophrenia outpatients when combined with quality psychosocial interventions. For their part, naturalistic studies point to a larger magnitude of benefit for LAIs, relative to their oral equivalents particularly among first-episode patients.

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18 What Treatment Would You Prefer if You Were Experiencing a Psychotic Episode? Survey of a Population of Psychiatrists

CNS Spectrums ◽

10.1017/s1092852919000129 ◽

2019 ◽

Vol 24 (1) ◽

pp. 182-183

Author(s):

David Almenta ◽

Marina García-Barrachina ◽

Aina Fernández Vidal ◽

Dolors Puidgemont ◽

Eva María Grasa ◽

...

Keyword(s):

Side Effects ◽

Mental Health Professionals ◽

Close Relative ◽

Psychotic Episode ◽

Treatment Scenario ◽

On Line ◽

The One ◽

Long Acting ◽

Somatic Diseases ◽

Cognitive Problems

AbstractRate of treatment non-compliance in schizophrenia, like in other chronic diseases. Long-acting injectable (LAI) antipsychotics have proven to be more effective than orals in reducing the number of recurrences. Although the perception of LAIs has changed over the last few years with the introduction of new molecules, there might be prejudices regarding these formulations within the mental health professionals community. The exercise of imagining how and with which antipsychotic you would like to treat yourself or a close relative in case of suffering from schizophrenia, can help to emerge true prescription preferences.The objective of the present work is to assess the psychiatrists antipsychotics prescribing preferences for schizophrenia, in the hypothetical case they were patients suffering a 2nd/3rd relapse. With this purpose, we performed an on-line survey in a sample of psychiatrists and trainees fromSpain.Results showed that election of LAIs were less frequent for in Self-prescription scenario, both for the 2nd and 3rd hypothetical recurrence. Also, psychiatrist who chose LAIs for their patients are more likely to choose orals for themselves (p=0.039; p<0.001 for 2nd and 3rd recurrence respectively). The most preferred LAI for both patients and self-prescription was aripiprazole once-monthly (60% and 87% respectively).Interestingly, nearly 70% of psychiatrist choosing a LAI different form Aripiprazole, would change the prescription for themselves; and those choosing aripiprazole once-monthly for their patients were more likely to maintain it for themselves (p<0.001). Practitioners changing from LAIs to orals in the self-treatment scenario perceive LAIs as a more coercive measure (p<0.01), being the degree of coercitivity perceived the only variable associated with a change in prescription's decisions (p=0.002). Curiously, LAIs associated coercitivity was significantly lower for oncologist vs psychiatrists (p<0.001). The level of weight gain, metabolic problems, extrapyramidal symptomatology, sexual dysfunction, sedation and cognitive problems perceived by psychiatrists is significantly lower for Aripiprazole than for the rest of LAIs (p <0.01 for all comparisons), with a comparable perceived efficacy (mean=3.95 and 4 out of possible 5, p=0.7). In light of our results, this is partially explained by a perception of LAIs as coercive measures, in contrast with perception of similar treatments for the control of somatic diseases. The fact of imagining a scene where oneself is the one suffering from a disease, shows preferences in the use of psychotropic drugs for the management of schizophrenia where the profile of side-effects and efficacy has a more equitable balance: starting from comparable effectiveness, we prefer treatments associated with a perception of fewer side-effects

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Cognitive training using a web-based tailor-made program for first-episode psychosis patients: An exploratory trial

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.589 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s235-s235

Author(s):

B. Moura ◽

T. Mendes ◽

F. Antunes ◽

R. Barandas ◽

M. Croca ◽

...

Keyword(s):

Cognitive Training ◽

Intervention Program ◽

Individual Case ◽

First Episode Psychosis ◽

Cognitive Stimulation ◽

First Episode ◽

Psychotic Episode ◽

Training Time ◽

First Psychotic Episode ◽

Episode Psychosis

IntroductionCognitive deficits are a core feature of the first psychotic episode patients and could be an obstacle to functional ability. Cognitive stimulation could be a promising method to surpass neuropsychological deficits.Objectives–to implement an online training protocol to stable first psychotic episode outpatients;–to assess adherence to the intervention;–to measure neurocognitive, psychopathological and functional outcomes pre- and post-training.AimsTo investigate the feasibility of an online-based resource for cognitive stimulation (COGWEB®) and explore possible benefits in different domains.MethodsFifteen patients were enrolled from the Early Psychosis Intervention Program (PROFIP) at the Department of Psychiatry of Santa Maria Hospital, Lisbon. The training consisted on 30-40-minute online sessions performed every weekday during 6 months at home. Assessments were performed at baseline and after program completion and included: psychopathological scores; personal and social functioning scores; Clinical Global Impression and a neuropsychological battery.ResultsEvery participant had some kind of impairment on baseline. Mean training time was 36 h. Six patients left the program before completion (half of them because they got employed). The program showed overall good feasibility and safety with no reported significant psychiatric occurrences or hospitalizations. Results regarding final neuropsychological, psychopathological and functioning showed a tendency for stability or improvement on an individual case analysis.ConclusionsOur results show that cognitive training using an online-based stimulation software is a feasible intervention for first-episode psychosis patients with possible benefits for this population. However, results should be analyzed very carefully because of different participant trajectories and of study limitations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Predicting first-episode psychosis patients who will never relapse over 10 years

Psychological Medicine ◽

10.1017/s0033291718003070 ◽

2018 ◽

Vol 49 (13) ◽

pp. 2206-2214 ◽

Cited By ~ 2

Author(s):

Christy LM Hui ◽

William G Honer ◽

Edwin HM Lee ◽

WC Chang ◽

Sherry KW Chan ◽

...

Keyword(s):

First Episode Psychosis ◽

First Episode ◽

Psychotic Episode ◽

Positive Symptoms ◽

Schizophrenia Spectrum Disorders ◽

Medication Discontinuation ◽

Schizophrenia Spectrum ◽

Episode Psychosis ◽

Spectrum Disorders

AbstractBackgroundAlthough relapse in psychosis is common, a small proportion of patients will not relapse in the long term. We examined the proportion and predictors of patients who never relapsed in the 10 years following complete resolution of positive symptoms from their first psychotic episode.MethodPatients who previously enrolled in a 12-month randomized controlled trial on medication discontinuation and relapse following first-episode psychosis (FEP) were followed up after 10 years. Relapse of positive symptoms was operationalized as a change from a Clinical Global Impression scale positive score of <3 for at least 3 consecutive months to a score of ⩾3 (mild or more severe). Baseline predictors included basic demographics, premorbid functioning, symptoms, functioning, and neurocognitive functioning.ResultsOut of 178 first-episode patients, 37 (21%) never relapsed during the 10-year period. Univariate predictors (p ⩽ 0.1) of patients who never relapsed included a duration of untreated psychosis (DUP) ⩽30 days, diagnosed with non-schizophrenia spectrum disorders, having less severe negative symptoms, and performing better in logical memory immediate recall and verbal fluency tests. A multivariate logistic regression analysis further suggested that the absence of any relapsing episodes was significantly related to better short-term verbal memory, shorter DUP, and non-schizophrenia spectrum disorders.ConclusionsTreatment delay and neurocognitive function are potentially modifiable predictors of good long-term prognosis in FEP. These predictors are informative as they can be incorporated into an optimum risk prediction model in the future, which would help with clinical decision making regarding maintenance treatment in FEP.

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Effectiveness of Paliperidone Palmitate Long-Acting Injectable in the Initial Stages of Psychosis: Clinical and Functional Impact

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.123 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S279-S279

Author(s):

L. Sánchez Blanco ◽

M. Gómez Revuelta ◽

V. Gajardo Galán ◽

M. Juncal Ruíz ◽

R. Landera Rodríguez ◽

...

Keyword(s):

Side Effects ◽

Negative Symptoms ◽

Paliperidone Palmitate ◽

First Episode ◽

Adherence To Treatment ◽

Good Adherence ◽

Cross Sectional ◽

Work Activity ◽

Before And After ◽

Long Acting

IntroductionAn appropriate early intervention (EI) after the onset of a first episode of psychosis (FEP) is a key factor to prevent relapse, cognitive and functional impairment related to neurotoxicity as it is a critical period in order to get good adherence to treatment. This is the most reported factor linked to relapse. Therefore, interventions focused on getting good adherence to treatment may make the difference in terms of outcome.AimsTo compare relapse rates, symptom severity and level of functionality before and after treatment with Paliperidone Palmitate Long-Acting Injectable (PP-LAI). To analyze prior antipsychotic treatments and side effects registered before and after the introduction of (PP-LAI).Material and methodThis is a cross-sectional descriptive study. We analyzed a sample of 15 patients, recruited from PAFIP (an specialized EI unit) and treated with variable doses of PP-LAI. They all met diagnostic criteria for schizophrenia according to DSM-IV. Clinical and functional data of the two years before and after treatment intoroduction were recorded.ResultsTwenty-seven percent of the patients resumed their work activity or studies and 33% of the patients increased their social activity. Thirteen percent of the patients improved from negative symptoms. Prior to treatment introduction, more than a half of the simple, had suffered one or two relapses. After treatment introduction, 87% did not experience more relapses while 13% experienced another relapse.ConclusionsTreatment with PP-LAI is associated to a recovery of functional abilities, and a trend to clinical stability with high adherence to treatment related to few side effects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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CLINICAL INVESTIGATIONS OF A LONG-ACTING OESTRIOL (POLYOESTRIOL PHOSPHATE)

Acta Endocrinologica ◽

10.1530/acta.0.0380073 ◽

1961 ◽

Vol 38 (1) ◽

pp. 73-87 ◽

Cited By ~ 8

Author(s):

Christian Lauritzen ◽

Semih Velibese

Keyword(s):

Side Effects ◽

Phosphoric Acid ◽

Quantitative Data ◽

Water Soluble ◽

Cholesterol Concentration ◽

Experimental Investigations ◽

Clinical Investigations ◽

Prolonged Duration ◽

High Doses ◽

Long Acting

ABSTRACT A description is given of experimental investigations and preliminary clinical experience with the long-acting oestriol compound polyoestriol phosphate – a water-soluble polymere of oestriol and phosphoric acid. The compound seems to exert all the physiologically important effects of oestriol. Even with high doses the hormone causes no proliferation of the endometrium and no withdrawal bleeding. It has no untoward effect on metabolism. It decreases slightly the cholesterol concentration (to the extent of ⅓–⅕ of the effect produced by long-acting oestradiol esters). The compound has a wide therapeutic range. No side-effects have been observed. Doses of 10 mg or more have a prolonged duration. Additional prolongation of the effect is largely dependent on dosage. To ensure an effect lasting for 4 weeks 40 mg polyoestriol phosphate (corresponding with 30 mg oestriol) is required – an amount which roughly corresponds with physiological quantitative data. The compound, which involves an interesting new principle of prolongation, was most effectively used in the treatment of menopausal symptoms and genital organic disorders. For these indications it can be recommended without reservation.

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