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.

A case of acute and transient psychosis–What to expect?

2016 ◽  
Vol 33 (S1) ◽  
pp. S364-S365
Author(s):  
M. Oliveira ◽  
J. Rebelo ◽  
A.S. Costa ◽  
C. Santos
Keyword(s):  
Psychotic Disorders ◽  
Fast Response ◽  
International Classification Of Diseases ◽  
Acute Onset ◽  
Antipsychotic Treatment ◽  
Duration Of Treatment ◽  
Diagnostic Stability ◽  
Affective Symptoms ◽  
Classification Of Diseases ◽  
Competing Interest

IntroductionThe Tenth Revision of the International Classification of Diseases (ICD-10) introduced the category of Acute and transient psychotic disorders (ATPD), that assimilate clinical concepts such as the French Bouffée Délirante, Kleist and Leonhard's cycloid psychosis, and the scandinavian reactive psychosis.Methods and aimsThe authors present a clinical case of ATPD and a literature review based on PubMed/MEDLINE, using the keywords: “acute and transient psychotic disorder”, “prognosis” and “diagnostic stability”, aiming to discuss the main challenges regarding the diagnosis, treatment and prognosis.ResultsThe patient is a male with 37 years old with two previous psychotic episodes (with 2.5 years of interval), both with an acute onset (of 7 and 3 days respectively), and a fast response to antipsychotic treatment, with periods of complete symptom's remission. He maintains treatment with 6 mg of paliperidone. In the literature, we found scarce information on ATPD. Though several variables have been described as having influence on the prognosis (gender, pre-morbid functioning, acute onset and presence of affective symptoms), this topic remains controversial. Another difficult aspect about ATPD seems to be its low diagnostic stability, with diagnosis changing mostly to Schizophrenia, Schizoaffective disorder and Bipolar disorder. Duration of treatment after complete remission of symptoms is another controversial aspect of this disease.ConclusionsATPD seems to have low diagnostic stability and poor research investment, and so it represents a challenge for psychiatrists on managing these patients in terms of treatment and follow-up plan. Further studies should be held regarding prognosis and treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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.

Mayak Workers Study Cohort

2012 ◽  
Vol 51 (02) ◽  
pp. 144-149 ◽  
Author(s):  
T. V. Azizova ◽  
V. Fedirko ◽  
Y. Tsareva ◽  
F. Tretyakov ◽  
C. Funch Lassen ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Southern Urals ◽  
International Classification Of Diseases ◽  
Study Cohort ◽  
The Southern Urals ◽  
Cancer Society ◽  
Main Category ◽  
Occupationally Exposed ◽  
Classification Of Diseases ◽  
High Doses

Summary Background: The cause-of-death register at the Southern Urals Biophysics Institute (SUBI), Ozyorsk, Russia, was established to document the number and causes of deaths in the Mayak workers cohort, which includes all persons (N = 22,377) employed at Mayak nuclear facility between 1948 and 1982. Most workers were occupationally exposed to high doses of ionizing radiation and have been shown to have increased risks of various chronic diseases including cancer. Objectives: To investigate the quality of cause of death coding in the SUBI register. Methods: A random sample of 246 deaths (~1% of the total) was coded independently at the SUBI and the Danish Cancer Society using the International Classification of Diseases 9 (ICD-9). Proportions of matching codes were calculated. Results: Overall, 233 deaths (95%) were identically classified using the ICD-9 main category matching. Excluding mismatches that were considered to be incorrectly coded during validation, the validity of the register increased to 98%. Using the specific ICD-9 first three-digit matching, 182 deaths were identically coded (74%) and the respective validity of the register was 85%. There were also some non-resolvable discrepancies demonstrating limitations of assigning one code for each death or using language-adapted ICD-9 version. Conclusions: This validation study was an important quality check of a register used for mortality follow-up in a highly influential epidemiological study on radiation-related health effects. The results of the inter-institutional comparison were generally favourable; however, since the comparison revealed individual mismatches and some systematically differing coding practices, it is essential to repeat it on a regular basis in order to maintain a high quality.

scholarly journals A Population-Based Study of Antipsychotic Prescription Trends in Children and Adolescents in British Columbia, from 1996 to 2011

2013 ◽  
Vol 58 (6) ◽  
pp. 361-369 ◽  
Author(s):  
Rebecca Ronsley ◽  
David Scott ◽  
William P Warburton ◽  
Ramsay D Hamdi ◽  
Dianna Clare Louie ◽  
...  
Keyword(s):  
British Columbia ◽  
Depressive Disorders ◽  
Second Generation ◽  
Family Physicians ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Primary Diagnosis ◽  
Specialty Training ◽  
Hyperkinetic Syndrome ◽  
Classification Of Diseases

Objectives: To establish prevalence rates of antipsychotic (AP) prescriptions for children 18 years of age or younger in British Columbia (BC) from 1996 to 2011 by age, sex, AP type, and primary diagnosis; and to identify the predominant AP prescribers for children by specialty training. Methods: BC Ministry of Health administrative data were used to describe AP prescriptions for youth aged 18 years or younger. Comparisons were made using population prevalence based on sex; age group; AP; International Classification of Diseases, Ninth Revision, diagnosis; and prescriber specialty. Results: From 1996 to 2011, overall AP (both first and second generation) prescription prevalence rate increased 3.8-fold (1.66 to 6.37 per 1000 population); second-generation AP (SGA) prescriptions increased 18.1-fold (0.33 to 5.98 per 1000 population). The highest increase in all AP prescriptions occurred in males aged 13 to 18 years (3.3 to 14.4 per 1000 population; 4.4-fold), followed by similar increases in males aged 6 to 12 years (2.3 to 8.6 per 1000 population; 3.7-fold) and in females aged 13 to 18 years (2.8 to 10.7 per 1000 population; 3.8-fold). Overall, the 3 most common diagnoses associated with all AP prescriptions were depressive disorders (12.8%), hyperkinetic syndrome of childhood (11.7%), and neurotic disorders (11.1%); however, variation was observed by prescriber specialty training. Among all new AP prescriptions in 2010/11, 38.6%, 34.3%, and 15.6% were provided by psychiatrists, family physicians, and pediatricians, respectively. Conclusions: There has been an exponential rise in SGA prescriptions in BC secondary to extensive off-label use, not only by psychiatrists but also by family physicians and pediatricians. Knowledge translation initiatives promoting evidence-based prescribing and monitoring practices related to SGA treatment need to target all 3 prescriber groups and be tailored for age subgroups.

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.

A comprehensive epidemiological review of spinal astrocytomas in the United States

2020 ◽  
pp. 1-7
Author(s):  
Jianning Shao ◽  
Jaes Jones ◽  
Patrick Ellsworth ◽  
Ghaith Habboub ◽  
Gino Cioffi ◽  
...  
Keyword(s):  
United States ◽  
Epidemiological Data ◽  
International Classification Of Diseases ◽  
The United States ◽  
Study Cohort ◽  
Who Grade ◽  
The Us ◽  
Classification Of Diseases ◽  
Asian Pacific ◽  
Adjusted Incidence

OBJECTIVESpinal cord astrocytoma (SCA) is a rare tumor whose epidemiology has not been well defined. The authors utilized the Central Brain Tumor Registry of the United States (CBTRUS) to provide comprehensive up-to-date epidemiological data for this disease.METHODSThe CBTRUS was queried for SCAs on ICD-O-3 (International Classification of Diseases for Oncology, 3rd edition) histological and topographical codes. The age-adjusted incidence (AAI) per 100,000 persons was calculated and stratified by race, sex, age, and ethnicity. Joinpoint was used to calculate the annual percentage change (APC) in incidence.RESULTSTwo thousand nine hundred sixty-nine SCAs were diagnosed in the US between 1995 and 2016, resulting in an average of approximately 136 SCAs annually. The overall AAI was 0.047 (95% CI 0.045–0.049), and there was a statistically significant increase from 0.051 in 1995 to 0.043 in 2016. The peak incidence of 0.064 (95% CI 0.060–0.067) was found in the 0- to 19-year age group. The incidence in males was 0.053 (95% CI 0.050–0.055), which was significantly greater than the incidence in females (0.041, 95% CI 0.039–0.044). SCA incidence was significantly lower both in patients of Asian/Pacific Islander race (AAI = 0.034, 95% CI 0.028–0.042, p = 0.00015) and in patients of Hispanic ethnicity (AAI = 0.035, 95% CI 0.031–0.039, p < 0.001). The incidence of WHO grade I SCAs was significantly higher than those of WHO grade II, III, or IV SCAs (p < 0.001).CONCLUSIONSThe overall AAI of SCA from 1995 to 2016 was 0.047 per 100,000. The incidence peaked early in life for both sexes, reached a nadir between 20 and 34 years of age for males and between 35 and 44 years of age for females, and then slowly increased throughout adulthood, with a greater incidence in males. Pilocytic astrocytomas were the most common SCA in the study cohort. This study presents the most comprehensive epidemiological study of SCA incidence in the US to date.

DIAGNOSES MADE BY LEADERS OF EMERGENCY MEDICA L SERVICES TEAMS WITHIN THE OPERAT ION AREA OF THE EMERGENCY MEDICA L SERVICES STAT ION IN MINSK MAZOWIECKI IN 2013-2017

2020 ◽  
Vol 7 (2) ◽  
pp. 103-112
Author(s):  
Krzysztof Mitura ◽  
Beata Łaziuk ◽  
Daniel Celiński ◽  
Agnieszka Hawrylewicz-Łuka ◽  
Leszek Szpakowski ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
Medical Data ◽  
Team Leaders ◽  
Aim Analysis ◽  
State Of Emergency ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
The Mean ◽  
Mean Time

Introduction: The activities of the Emergency Medical Services (EMS) Station in Minsk Mazowiecki are based on the provision of medical aid to persons in a state of emergency. The aim: Analysis of interventions of EMS teams operating in the structure of the EMS Station in Minsk Mazowiecki, including diagnoses made by team leaders based on the International Classification of Diseases. Material and methods: The study was retrospective. The analysis covered 39,027 dispatches of EMS teams in Minsk Mazowiecki in the period from January 1, 2013 to December 31, 2017. The study was conducted on the basis of medical data collected in SP ZOZ RM-MEDITRANS computer systems in Siedlce. Results: The results indicated an increase in the number of interventions performed by EMS teams working in the EMS Station in Minsk Mazowiecki (by 30.80%) in the period from 2013 to 2017. In that period, interventions in code 2 (69.12%) dominated. The EMS teams reached the event site much faster in code 1 than in code 2. The mean time needed to reach the event site was noticeable. Most interventions took place in the patient’s home (73.14%). The leaders of EMS teams made diagnoses mainly on the basis of a group of ICD-10 codes regarding symptoms and disease features (37.39%), followed by injuries, poisoning, external factors (20.58%) and cardiovascular diseases (15.64%). Of all interventions, 68.60% of patients were transported to hospitals, and 23.97% remained at the place of call. Conclusions: The analysis of interventions of EMS teams in Minsk Mazowiecki indicated an increase in the society’s demand for services in the field of EMS, while the optimization of their use and verification of the legitimacy of their interventions is warranted. In addition, EMS team leaders made diagnoses mainly on the basis of a group of ICD-10 codes regarding symptoms and disease features.

scholarly journals Cardiovascular Adverse Reactions During Antipsychotic Treatment: Results of AMSP, A Drug Surveillance Program Between 1993 and 2013

2019 ◽  
Vol 23 (2) ◽  
pp. 67-75 ◽  
Author(s):  
Michaela-Elena Friedrich ◽  
Dietmar Winkler ◽  
Anastasios Konstantinidis ◽  
Wolfgang Huf ◽  
Rolf Engel ◽  
...  
Keyword(s):  
First Generation ◽  
Adverse Reactions ◽  
Second Generation ◽  
Antipsychotic Agents ◽  
Surveillance Program ◽  
Antipsychotic Treatment ◽  
Drug Surveillance ◽  
Cardiovascular Side Effects ◽  
Second Generation Antipsychotics ◽  
The Given

Abstract Background Cardiovascular diseases are still the leading cause of global mortality. Some antipsychotic agents can show severe cardiovascular side effects and are also associated with metabolic syndrome. Methods This observational study was based on data of AMSP (Arzneimittelsicherheit in der Psychiatrie), a multicenter drug surveillance program in Austria, Germany and Switzerland, that recorded severe drug reactions in psychiatric inpatients. Results A total of 404 009 inpatients were monitored between 1993 and 2013, whereas 291 510 were treated with antipsychotics either in combination or alone. There were 376 cases of severe cardiovascular adverse reactions reported in the given timespan, yielding a relative frequency of 0.13%. The study revealed that incidence rates of cardiovascular adverse reactions were highest during treatment with ziprasidone (0.35%), prothipendyl (0.32%), and clozapine (0.23%). The lowest rate of cardiovascular symptoms occurred during treatment with promethazine (0.03%) as well as with aripiprazole (0.06%). The most common clinical symptoms were orthostatic collapse and severe hypotonia, sinustachycardia, QTc prolongation, myocarditis, and different forms of arrhythmia. The dosage at the timepoint when severe cardiovascular events occurred was not higher in any of the given antipsychotics than in everyday clinical practice and was in average therapeutic ranges. In terms of subclasses of antipsychotics, no significant statistical difference was seen in the overall frequencies of adverse reactions cases, when first-generation high potency, first-generation low potency, and second-generation antipsychotics were compared. Thirty percent of adverse events among second-generation antipsychotics were induced by clozapine. Conclusions Our findings on cardiovascular adverse reactions contribute to a better understanding of cardiovascular risk profiles of antipsychotic agents in inpatients.

scholarly journals Regional Variation in Nonoperative Therapy Utilization for Symptomatic Lumbar Stenosis and Spondylolisthesis: A 2-Year Costs Analysis

2019 ◽  
Vol 10 (2) ◽  
pp. 138-147
Author(s):  
Mark A. Davison ◽  
Daniel T. Lilly ◽  
Jessica Moreno ◽  
Joseph Cheng ◽  
Carlos Bagley ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
Census Bureau ◽  
Study Cohort ◽  
Lumbar Stenosis ◽  
Regional Variations ◽  
Nonoperative Therapy ◽  
Lumbar Decompression ◽  
Number Of Patients ◽  
Significant Difference ◽  
Classification Of Diseases

Study Design: Retrospective cohort study. Objectives: To characterize regional variations in maximal nonoperative therapy (MNT) costs in patients suffering from lumbar stenosis or spondylolisthesis. Methods: Medical records from patients with symptomatic lumbar stenosis or spondylolisthesis undergoing primary ≤3-level lumbar decompression and fusion procedures from 2007 to 2016 were gathered from a large insurance database. Geographic regions (Midwest, Northeast, South, and West) reflected the US Census Bureau definitions. Records were searchable by International Classification of Diseases diagnosis/procedure codes, Current Procedural Terminology codes, and insurance-specific generic drug codes. Utilization of MNT, defined as cost billed, prescriptions written, and number of units disbursed, within 2-years prior to index surgery was assessed. Results: A total of 27 877 patients underwent 1-, 2-, or 3-level lumbar decompression and fusion surgery. Regional breakdown of the study cohort was as follows: South 62.3%, Midwest 25.2%, West 10.4%, Northeast 2.1%. Regional variations in the number of patients using nonsteroidal anti-inflammatory drugs (NSAIDs) ( P < .0001), opioids ( P < .0001), muscle relaxants ( P < .0001), and lumbar steroid injections ( P < .0001) were detected. A significant difference was identified in the regional MNT failure rates ( P < .0001). The total cost associated with MNT prior to index surgery was $48 411 125 ($1736.60/patient), with the Midwest ($1943.83/patient) responsible for the greatest average spending. Despite comprising 62.3% of the cohort, the South was accountable for 67.5% of NSAID prescriptions, 64.6% of opioid prescriptions, and 71.2% of muscle relaxant prescriptions. Conclusions: Regional differences exist in the costs of MNT in patients with lumbar stenosis and spondylolisthesis prior to surgery. Future studies should focus on identifying patients likely to fail prolonged nonoperative management.

Neuroleptic Malignant Syndrome: A Pilot Study on Psychiatric Inpatients in Iran

2019 ◽  
Vol 8 (3) ◽  
pp. 207-212
Author(s):  
Saeed S. Shafti ◽  
Alireza Memarie ◽  
Masomeh Rezaie ◽  
Masomeh Hamidi
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
First Generation ◽  
Second Generation ◽  
Psychiatric Patients ◽  
Statistical Significance ◽  
P Value ◽  
Antipsychotic Treatment ◽  
Second Generation Antipsychotics ◽  
Significant Difference ◽  
Male Patients

Background: Neuroleptic malignant syndrome is a life-threatening complication that can occur anytime during antipsychotic treatment. Objective: The present assessment has probed the incidence and clinical profile of neuroleptic malignant syndrome among a sample of non-western psychiatric patients and compared with the available data in the literature with regard to prevalence and other associated clinical physiognomies. Methods: As a retrospective, record-based evaluation, all cases with diagnosis of neuroleptic malignant syndrome during the last sixty-two months, after ruling out other imaginable differential diagnoses, like encephalitis, meningitis and serotonin syndrome, entered the present investigation. Clinical diagnosis, was in essence also based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. The assessment of independent variables was analyzed by ‘Compression of proportions’. Statistical significance is, defined as p value ≤0.05. Results: Among 19814 psychiatric patients, during a sixty-two months’ period, eighteen cases received the diagnosis of neuroleptic malignant syndrome. The most prevalent symptom was fever, which was observed in 100% of cases. Also, there was no significant difference between the first generation versus second-generation antipsychotics. Neuroleptic malignant syndrome was meaningfully more prevalent among male patients suffering from schizophrenia. Similarly, it was significantly more widespread amid 18-65 years old agegroup. Conclusion: While no significant difference was found between first-generation as opposed to second-generation antipsychotics, neuroleptic malignant syndrome was significantly more prevalent among young and male patients suffering from schizophrenia.

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