scholarly journals Second-Generation Antipsychotics and Extrapyramidal Adverse Effects

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Nevena Divac ◽  
Milica Prostran ◽  
Igor Jakovcevski ◽  
Natasa Cerovac
Keyword(s):  
Adverse Effects ◽  
First Generation ◽  
Second Generation ◽  
Great Expectations ◽  
Extrapyramidal Syndrome ◽  
Generation Agent ◽  
Second Generation Antipsychotics ◽  
History Of ◽  
High Doses ◽  
First And Second Generation

Antipsychotic-induced extrapyramidal adverse effects are well recognized in the context of first-generation antipsychotic drugs. However, the introduction of second-generation antipsychotics, with atypical mechanism of action, especially lower dopamine receptors affinity, was met with great expectations among clinicians regarding their potentially lower propensity to cause extrapyramidal syndrome. This review gives a brief summary of the recent literature relevant to second-generation antipsychotics and extrapyramidal syndrome. Numerous studies have examined the incidence and severity of extrapyramidal syndrome with first- and second-generation antipsychotics. The majority of these studies clearly indicate that extrapyramidal syndrome does occur with second-generation agents, though in lower rates in comparison with first generation. Risk factors are the choice of a particular second-generation agent (with clozapine carrying the lowest risk and risperidone the highest), high doses, history of previous extrapyramidal symptoms, and comorbidity. Also, in comparative studies, the choice of a first-generation comparator significantly influences the results. Extrapyramidal syndrome remains clinically important even in the era of second-generation antipsychotics. The incidence and severity of extrapyramidal syndrome differ amongst these antipsychotics, but the fact is that these drugs have not lived up to the expectation regarding their tolerability.

scholarly journals Pharmacologic treatment of schizophrenia

2010 ◽  
Vol 12 (3) ◽  
pp. 345-357 ◽  
Keyword(s):  
Adverse Effects ◽  
First Generation ◽  
Second Generation ◽  
Treatment Options ◽  
Patient Choice ◽  
Acute Response ◽  
Augmentation Strategies ◽  
Second Generation Antipsychotics ◽  
New Treatment ◽  
First And Second Generation

Despite pharmacologic advances, the treatment of schizophrenia remains a challenge, and suboptimal outcomes are still all too frequent. Although treatment goals of response, remission, and recovery have been defined more uniformly, a good "effectiveness" measure mapping onto functional outcomes is still lacking. Moreover, the field has to advance in transferring measurement-based approaches from research to clinical practice. There is an ongoing debate whether, and which, first- or second-generation antipsychotics should be used. However an individualized treatment approach needs to consider current symptoms, comorbid conditions, past therapeutic response, and adverse effects, as well as patient choice and expectations. Moreover acute and long-term goals and effects of medication treatment need to be balanced. While the acute response to appropriately dosed first-generation antipsychotics may not differ much from second-generation antipsychotics, advantages of lower rates of extrapyramidal side effects, tardive dyskinesia, and, possibly, relapse may favor second-generation antipsychotics. However when considering individual adverse effect profiles, the differentiation into first- and second-generation antipsychotics as unified classes can not be upheld, and a more differentiated view and treatment selection is required. To date, clozapine is the only evidence-based treatment for refractory patients, and the role of antipsychotic polypharmacy and other augmentation strategies remains unclear, at best. To improve the treatment outcomes in schizophrenia, research efforts are needed that elucidate biomarkers of the illness and of treatment response (both therapeutic and adverse effects). Moreover, new treatment options are needed that affect nondopaminergic targets with relevance for symptom reduction, relapse prevention, enhanced efficacy for nonresponders, and reduced key adverse effects.

Increased rate of psychosis among African–Caribbeans in Britain is not due to an excess of pregnancy and birth complications

1997 ◽  
Vol 171 (2) ◽  
pp. 145-147 ◽  
Author(s):  
G. Hutchinson ◽  
N. Takei ◽  
D. Bhugra ◽  
T. A. Fahy ◽  
C. Gilvarry ◽  
...  
Keyword(s):  
Odds Ratio ◽  
First Generation ◽  
Second Generation ◽  
Psychotic Illness ◽  
Comparable Group ◽  
Birth Complications ◽  
African Caribbean ◽  
History Of ◽  
First And Second Generation ◽  
Pregnancy And Birth

BackgroundIt has been suggested that the increased rate of psychotic illness among African–Caribbeans living in Britain is due to an excess of pregnancy and birth complications (PBCs).MethodWe therefore compared the frequency of PBCs in a group of White psychotic patients (n=103) and a comparable group of patients of African–Caribbean origin (n=61); the latter consisted of 30 first-generation (born in the Caribbean) and 31 second-generation (born in Britain) individuals.ResultsWhite psychotic patients were more than twice as likely to have a history of PBCs as their African–Caribbean counterparts (odds ratio=2.34, 95% confidence interval (CI) 0.88–6.47, P=0.062). The same trend was observed among patients with a DSM–III diagnosis of schizophrenia (odds ratio=l.65, 95% CI 0.56–4.97, P=0.32). The rate of PBCs was similar among the first- and second-generation Caribbean psychotic patients.ConclusionsThe increased rate of psychotic illness that has been reported among the African–Caribbean population in Britain is not due to an increased prevalence of PBCs.

scholarly journals Psychopharmacology and adverse effects of antipsychotic long-acting injections: A review

2009 ◽  
Vol 195 (S52) ◽  
pp. s13-s19 ◽  
Author(s):  
David Taylor
Keyword(s):  
Weight Gain ◽  
Adverse Effects ◽  
Movement Disorders ◽  
First Generation ◽  
Second Generation ◽  
High Rate ◽  
Metabolic Effects ◽  
Using Data ◽  
Long Acting ◽  
First And Second Generation

BackgroundDepot antipsychotics are widely used in clinical practice. Long-acting formulations of second-generation antipsychotics are now being developed and introduced.AimsTo review the pharmacology, pharmacokinetics and adverse effect profiles of currently available antipsychotic long-acting injections (LAIs).MethodThe psychopharmacological properties of first- and second-generation antipsychotic LAIs are reviewed using data available up to October 2008.ResultsFirst-generation antipsychotic (FGA) LAIs are associated with a high rate of acute and chronic movement disorders. Risperidone LAI is better tolerated in this respect, but is associated with hyperprolactinaemia and weight gain. Olanzapine LAI causes weight gain and other metabolic effects but appears not to be associated with an important incidence of movement disorders.ConclusionsDosing of LAIs is complicated by delayed release of drug, changes in plasma levels without change in dose, and by the lack of data establishing clear dose requirements. All LAIs offer the prospect of assured adherence (although patients may still default on treatment) but their use is complicated by adverse effects, complex pharmacokinetics and confusion over dose–response relationships.

scholarly journals The ages of Galactic globular clusters in the context of self-enrichment

2008 ◽  
Vol 4 (S258) ◽  
pp. 265-274 ◽  
Author(s):  
T. Decressin ◽  
H. Baumgardt ◽  
P. Kroupa ◽  
G. Meynet ◽  
C. Charbonnel
Keyword(s):  
Globular Clusters ◽  
First Generation ◽  
Second Generation ◽  
Age Determination ◽  
Dynamical Evolution ◽  
Low Velocity ◽  
Tidal Forces ◽  
History Of ◽  
First And Second Generation

AbstractA significant fraction of stars in globular clusters (about 70%-85%) exhibit peculiar chemical patterns, with strong abundance variations in light elements along with constant abundances in heavy elements. These abundance anomalies can be created in the H-burning core of a first generation of fast-rotating massive stars, and the corresponding elements are conveyed to the stellar surface thanks to rotational induced mixing. If the rotation of the stars is fast enough, this material is ejected at low velocity through a mechanical wind at the equator. It then pollutes the interstellar medium (ISM) from which a second generation of chemically anomalous stars can be formed. The proportion of anomalous stars to normal stars observed today depends on at least two quantities: (1) the number of polluter stars; (2) the dynamical history of the cluster, which may lose different proportions of first- and second-generation stars during its lifetime. Here we estimate these proportions, based on dynamical models for globular clusters. When internal dynamical evolution and dissolution due to tidal forces are accounted for, starting from an initial fraction of anomalous stars of 10% produces a present-day fraction of about 25%, still too small with respect to the observed 70-85%. In the case of gas expulsion by supernovae, a much higher fraction is expected to be produced. In this paper we also address the question of the evolution of the second-generation stars that are He-rich, and deduce consequences for the age determination of globular clusters.

scholarly journals Impact of adverse reactions to first-generation antipsychotics on treatment adherence in outpatients with schizophrenia: a cross-sectional study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Merhawi Bahta ◽  
Azieb Ogbaghebriel ◽  
Mulugeta Russom ◽  
Eyasu H. Tesfamariam ◽  
Tzeggai Berhe
Keyword(s):  
Adverse Effects ◽  
Treatment Adherence ◽  
First Generation ◽  
Second Generation ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Second Generation Antipsychotics ◽  
The Impact

Abstract Background Antipsychotics are well-known to cause potentially serious and life-threatening adverse drug reactions (ADRs) that have been reported to be also one of the major reasons for non-adherence. In Eritrea, shortage of psychiatrists and physicians, inadequacy of laboratory setups and unavailability of second-generation antipsychotics in the national list of medicines would seem to amplify the problem. This study’s objective is to determine the impact of adverse effects of first-generation antipsychotics on treatment adherence in outpatients with schizophrenia at Saint Mary Neuro-Psychiatric National Referral Hospital. Methods A cross-sectional study design was employed. All eligible adult patients with diagnosed schizophrenia (n = 242) who visited the hospital during the study period were enrolled. Data on ADRs, adherence and other variables were collected from patients using a self-administered questionnaire, interview and through medical cards review. The collected variables were analyzed using SPSS 22.0 with descriptive and multivariable logistic regression analysis. Statistical significance was tested at p value < 0.05. Results Greater than one-third (35.5%) of the patients with schizophrenia were non-adherent to treatment. The odds of non-adherence increased 1.06 times for each unit increase in the total ADR score (AOR = 1.06, 95% CI 1.04, 1.09). Patients with extrapyramidal (AOR = 44.69, 95% CI 5.98, 334.30), psychic (AOR = 14.90, 95% CI 1.90, 116.86), hormonal (AOR = 2.60, 95% CI 1.41, 4.80), autonomic (AOR = 3.23, 95% CI 1.37, 7.57) and miscellaneous reactions (AOR = 2.16, 95% CI 1.13, 4.13) were more likely to be non-adherent compared to their counterparts. Conclusion Poor treatment adherence was found to be substantial which was attributed to total ADR score, extrapyramidal, hormonal, psychic, autonomic and miscellaneous categories of reactions of the LUNSERS. To improve treatment adherence, early detection and management of adverse effects and inclusion of second-generation antipsychotics are recommended.

Pharmakotherapie update

2020 ◽  
Vol 25 (1) ◽  
pp. 23-32
Author(s):  
Gerd Laux
Keyword(s):  
First Generation ◽  
Second Generation ◽  
Therapeutische Maßnahmen ◽  
Second Generation Antipsychotics

Für die Therapie schizophrener Erkrankungen sind seit fast 60 Jahren Antipsychotika/Neuroleptika aufgrund ihrer antipsychotischen Wirkung von zentraler Bedeutung. Die Einteilung kann unter verschiedenen Gesichtspunkten erfolgen (chemische Struktur, neuroleptische Potenz, Rezeptorprofil), heute werden üblicherweise unterschieden typische (traditionelle, klassische, konventionelle) Antipsychotika der ersten Generation ‒ »First Generation Antipsychotics« (FGA) ‒ und sog. atypische (»neuere«) Neuroleptika bzw. Antipsychotika der zweiten Generation ‒»Second Generation Antipsychotics« (SGA). Hierzu zählen Aripiprazol, Asenapin, Cariprazin, Clozapin, Olanzapin, Quetiapin, Risperidon, Sertindol und Ziprasidon. Hierbei handelt es sich um keine homogene Gruppe – sowohl neuropharmakologisch (Wirkmechanismus), als auch hinsichtlich klinischem Wirkprofil und dem Nebenwirkungsspektrum bestehen z. T. erhebliche Unterschiede. Neben der Akut-Medikation ist eine Langzeitmedikation bzw. Rezidivprophylaxe mit Antipsychotika für die Rehabilitation vieler schizophrener Patienten im Sinne eines »Stresspuffers« von grundlegender Bedeutung. In Placebo-kontrollierten Studien trat bei Patienten, die über ein Jahr behandelt wurden, bei etwa 30% unter Neuroleptika ein Rezidiv auf, unter Placebo bei mehr als 70%. Für die Langzeitbehandlung bietet sich der Einsatz von Depot-Neuroleptika an, neu entwickelt wurden Langzeit-Depot-Injektionen mit Intervallen von bis zu 3 Monaten. Grundsätzlich ist die niedrigstmögliche (wirksame) Dosis zu verwenden. Im Zentrum der Nebenwirkungen (UAW) standen lange Zeit extrapyramidal-motorische Bewegungsstörungen (EPMS), mit der Einführung von Clozapin und anderen atypischen Antipsychotika der zweiten Generation gewannen andere Nebenwirkungen an Bedeutung. Hierzu zählen Gewichtszunahme, Störungen metabolischer Parameter und ein erhöhtes Risiko für Mortalität und zerebrovaskuläre Ereignisse bei älteren Patienten mit Demenz. Entsprechende Kontrolluntersuchungen sind erforderlich, für Clozapin gibt es aufgrund seines Agranulozytose-Risikos Sonderbestimmungen. Immer sollte ein Gesamtbehandlungsplan orientiert an der neuen S3-Praxisleitlinie Schizophrenie der DGPPN aufgestellt werden, der psychologische und milieu-/sozial-therapeutische Maßnahmen einschließt. Standard ist heute auch eine sog. Psychoedukation, für Psychopharmaka liegen bewährte Patienten-Ratgeber vor.

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