Clozapine: Current Status and Role in the Pharmacotherapy of Schizophrenia

1996 ◽  
Vol 41 (3) ◽  
pp. 161-166 ◽  
Author(s):  
Gary J Remington ◽  
Donald Addington ◽  
Evan J Collins ◽  
Barry D Jones ◽  
Pierre Lalonde ◽  
...  
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Neuropsychological Functioning ◽  
Treatment Options ◽  
Clinical Status ◽  
Current Status ◽  
Integral Role ◽  
Neuroleptiques Atypiques ◽  
Care Costs ◽  
Positive And Negative Symptoms

Objective: This study evaluates clozapine and its present role in the pharmacotherapy of schizophrenia. Method: Clozapine's current clinical status is reviewed, as is its position with respect to other treatment options. Results: Clozapine represents the prototype of “atypical” neuroleptics, with evidence of clinical efficacy in both positive and negative symptoms, as well as a diminished risk of extrapyramidal side effects. It is the only neuroleptic to date that has established itself as having little, if any, risk of tardive dyskinesia. More recent research has focused on its potential for overall savings in health care costs, as well as possible benefits in the area of neuropsychological functioning. Conclusion: Evidence suggesting that the course of schizophrenia can be altered by effective treatment favours a systematic approach that optimizes treatment options. While clozapine does not represent a 1st-line agent because of its risk of agranulocytosis, it has an integral role to play in treatment-resistant schizophrenia or in individuals experiencing intolerable side effects with conventional neuroleptics. Objectif: La présente étude vise à évaluer la clozapine et son rôle actuel dans la pharmacothérapie de la schizophrénie. Méthode: On évalue l'emploi clinique actuel de la clozapine ainsi que sa position par rapport à d'autres options de traitement. Résultats: La clozapine constitue le prototype des neuroleptiques «atypiques,» révélant une efficacité clinique autant sur les symptômes positifs que négatifs ainsi qu'un risque réduit d'effets secondaires extrapyramidaux. Elle constitue le seul neuroleptique à ce jour associé à peu, voire pas du tout, de risque de dyskinésie tardive. De récentes recherches se sont penchées sur son potentiel d'économies globales en soins de santé ainsi que sur ses avantages en matière de fonctionnement neuropsychologique. Conclusion: L'information qui suggère que l'évolution de la schizophrénie peut être modifiée par un traitement efficace encourage une approche systématique optimisant les options de traitement. Bien que la clozapine ne soit pas un médicament d'élection étant donné le risque d'agranulocytose, elle joue un rôle important dans le traitement de la schizophrénie résistante au traitement ou chez les personnes pour qui les effets secondaires des neuroleptiques conventionnels sont intolérables.

Reasons to choose a long acting antipsychotic and tolerability

2017 ◽  
Vol 41 (S1) ◽  
pp. s822-s822
Author(s):  
I. Martínez Molina ◽  
N. Gómez-Coronado Suárez de Venegas ◽  
P. Blanco Ramón
Keyword(s):  
Side Effects ◽  
Sexual Dysfunction ◽  
Negative Symptoms ◽  
Descriptive Analysis ◽  
Hypertensive Crisis ◽  
Antipsychotic Treatment ◽  
Competing Interest ◽  
One Year ◽  
Long Acting ◽  
Positive And Negative Symptoms

IntroductionAripiprazole depot is an atypical antipshycotic used to treat positive and negative symptoms of psychosis or acute mania.AimDescribe the reason why psychiatrists switch the current antipsychotic treatment on to aripiprazol depot, its tolerability and the reasons to stop aripiprazol depot treatment.MethodsDescriptive analysis based on a sample of 37 patients, aged 18–65 years, treated during one year with antipsychotics at two community mental health units.ResultsSwitching on to aripiprazole depot principal reasons: promote adherence (25%), persistence of symptoms (25%) and high levels of prolactin or sexual dysfunction (16.66%):– side effects of aripiprazole depot: insomnia (11.11%), inquietude (8.33%), sexual dysfunction (2.77%) and hypertensive crisis during administration (2.77%);– 83.33% of the patients are still taking it after one year. The most common reasons to stop or change it were the presence of secondaries (11.11%) and clinical exacerbation (5.55%).ConclusionsAripiprazole depot is well tolerated (even better than other antipsychotics). Common side effects are not severe and appear in a small percent of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatment Modalities for Anastomotic Leakage in Rectal Cancer Surgery

2021 ◽  
Vol 34 (06) ◽  
pp. 431-438
Author(s):  
Deborah S. Keller ◽  
K. Talboom ◽  
C.P.M van Helsdingen ◽  
Roel Hompes
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Treatment Options ◽  
Cancer Surgery ◽  
Clinical Severity ◽  
Oncologic Outcomes ◽  
Current Status ◽  
Treatment Modalities ◽  
Rectal Cancer Surgery ◽  
Care Costs

AbstractDespite advances in rectal cancer surgery, anastomotic leakage (AL) remains a common complication with a significant impact on patient recovery, health care costs, and oncologic outcomes. The spectrum of clinical severity associated with AL is broad, and treatment options are diverse with highly variable practices across the colorectal community. To be effective, the treatment must match not only the patient's current status but also the type of leak, the surgeon's skill, and the resources available. In this chapter, we will review the current and emergent treatment modalities for AL after rectal cancer surgery.

scholarly journals Clozapine-induced intestinal obstruction - a critical examination of four cases

2006 ◽  
Vol 12 (1) ◽  
pp. 4
Author(s):  
C Seller ◽  
L Koen ◽  
D J H Niehaus
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Critical Examination ◽  
Antipsychotic Treatment ◽  
Extrapyramidal Side Effects ◽  
Atypical Antipsychotic Drug ◽  
Superior Efficacy ◽  
Added Benefit ◽  
Treatment Refractory ◽  
Positive And Negative Symptoms

Clozapine is an atypical antipsychotic drug indicated for the management of severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment. It has demonstrated superior efficacy in treating both the positive and negative symptoms in treatment-refractory cases. It also has the added benefit of causing minimal extrapyramidal side- effects, producing no tardive dyskinesia and having little effect on prolactin levels

Relationship between Neuroleptic Dose and Positive and Negative Symptoms

1994 ◽  
Vol 74 (2) ◽  
pp. 481-482 ◽  
Author(s):  
Patrick B. Johnson ◽  
Lewis A. Opler ◽  
Paul M. Ramirez ◽  
Robert Malgady
Keyword(s):  
Side Effects ◽  
Negative Symptom ◽  
Negative Symptoms ◽  
Zero Order ◽  
Standardized Assessments ◽  
Symptom Scores ◽  
Medication Dose ◽  
Schizophrenic Patients ◽  
Positive And Negative Symptoms

The present study explored possible connections between neuroleptic dose and the positive and negative symptoms of schizophrenic patients. Zero-order correlations between medication dose as measured in CPZ equivalent units and standardized assessments of positive (hallucinations, delusions) and negative (blunted affect, poor rapport) symptoms were carried out on 28 hospitalized schizophrenics. While dose was positively related to over-all negative symptom scores as well as specific negative symptoms, no relation was found with positive scores. The discussion focused on the possibility that negative symptoms might represent medication-induced side effects and the need for further research.

Emerging Treatment Options for Migraine

2020 ◽  
Vol 49 (4) ◽  
pp. 226-235
Author(s):  
Yi Jing Zhao ◽  
Jonathan JY Ong ◽  
Peter J Goadsby
Keyword(s):  
Side Effects ◽  
Treatment Options ◽  
Preventive Treatment ◽  
Calcitonin Gene Related Peptide ◽  
Non Invasive ◽  
Related Peptide ◽  
Calcitonin Gene ◽  
The World ◽  
Integral Role ◽  
Years Lived With Disability

Migraine is one of top 5 medical conditions that contribute to Years Lived with Disability and affects approximately 1 billion people from around the world. To date, preventive treatment and acute therapies for migraine are limited, have undesirable side effects and are poorly tolerated in patients. In the last few decades, considerable advances in our understanding of migraine and its pathophysiology have paved the way for the development of targeted treatment options. Calcitonin gene-related peptide (CGRP) plays an integral role in the neurobiology of migraine, and new classes of drugs that target the CGRP pathway have included gepants and CGRP pathway monoclonal antibodies. Serotonin 5-HT1F receptor agonists—namely ditans—have also been developed to treat acute migraine. Lastly, non-invasive neuromodulation offers another treatment option for migraine patients who prefer treatments that have fewer side effects and are well tolerated. In this review, we discussed emerging treatment options for migraine that were made available in recent years. Ann Acad Med Singapore 2020;49:226–35 Key words: Calcitonin gene-related peptide monoclonal antibody, Gepants, Headache, Lasmiditan, Neuromodulation

scholarly journals Positive and negative symptoms of schizophrenia as correlates of help-seeking behaviour and the duration of untreated psychosis in south-east Nigeria

2014 ◽  
Vol 20 (4) ◽  
pp. 6 ◽  
Author(s):  
Paul Chigozie Odinka ◽  
A C Ndukuba ◽  
R C Muomah ◽  
M Oche ◽  
M U Osika ◽  
...  
Keyword(s):  
Mental Illness ◽  
Help Seeking ◽  
Negative Symptoms ◽  
Early Recognition ◽  
Treatment Options ◽  
Psychiatric Hospitals ◽  
World Health ◽  
Duration Of Untreated Psychosis ◽  
Early Presentation ◽  
Positive And Negative Symptoms

<p><strong>Background.</strong> Duration of untreated psychosis (DUP) has been widely recognised in recent years as a potentially important predictor of illness outcome, and the manifestations of schizophrenia have been known to influence its early recognition as a mental illness. </p><p><strong>Objective.</strong> To assess the association between the positive and negative symptoms of schizophrenia, help-seeking and DUP. </p><p><strong>Methods.</strong> We performed a cross-sectional study of 360 patients with schizophrenia, who had had no previous contact with Western mental health services. The Sociodemographic Questionnaire, World Health Organization Pathway Encounter Form and a questionnaire to establish DUP were used. The positive and negative syndrome scale and Composite International Diagnostic Interview were used for the assessment of mental disorders and to diagnose.</p><p><strong>Results.</strong> Respondents who had predominant positive symptoms and who had a median DUP of 8 weeks or 24 weeks, tended to use psychiatric hospitals and other Western medical facilities, respectively, as their first treatment options. However, those who had predominant negative symptoms and who had a median DUP of 144 weeks or 310 weeks, tended to use faith healers and traditional healers, respectively, as first treatment options.</p><p><strong>Conclusion.</strong> The predominance of negative symptoms could militate against early presentation among people with schizophrenia, probably because negative symptoms are poorly recognised as indicating mental illness in Nigeria, as they could be interpreted as deviant behaviour or spiritual problems that would require spiritual solutions.</p>

The Safety and Efficacy of Clozapine in Severe Treatment-Resistant Schizophrenic Patients in the UK

1993 ◽  
Vol 163 (2) ◽  
pp. 150-154 ◽  
Author(s):  
C. E. Adams ◽  
T. R. E. Barnes ◽  
M. A. Essali ◽  
S. R. Hirsch ◽  
A. V. P. MacKay ◽  
...  
Keyword(s):  
Adverse Event ◽  
Side Effects ◽  
Negative Symptoms ◽  
Extrapyramidal Side Effects ◽  
Treatment Resistant ◽  
Frequent Adverse Event ◽  
Safety And Efficacy ◽  
Schizophrenic Patients ◽  
The Uk ◽  
Positive And Negative Symptoms

In order to assess the safety and some efficacy aspects of clozapine under UK conditions, 54 in-patients with severe treatment-resistant schizophrenic disorders were evaluated using several scales before and during treatment. Of the 54 evaluated, 26 completed the 26-week study. Of these patients, 20 showed improvement in psychopathology, often to a marked degree, involving both positive and negative symptoms. Some oral-facial extrapyramidal side-effects decreased as well. Two patients developed neutropenia, but recovered on discontinuation of clozapine. The most frequent adverse event was hypersalivation, and five patients suffered from seizures. It is concluded that clozapine is worth considering for the treatment of severe treatment-resistant patients in the UK.

The role of limbic and cortical regions in schizophrenia: Focus on dopamine

2002 ◽  
Vol 17 (S4) ◽  
pp. 349s-354s
Author(s):  
G. Marchese ◽  
L. Pani
Keyword(s):  
Side Effects ◽  
Dopamine Receptors ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Selective Targeting ◽  
Cortical Regions ◽  
The Brain ◽  
Positive And Negative Symptoms

SummaryDopamine is implicated in the pathogenesis of both the positive and the negative symptoms of schizophrenia. Clinical efficacy of antipsychotic drugs, without the production of side-effects, may be achieved by a dose–response separation of pharmacological function, regional (i.e., anatomical) selectivity of action, or by the selective targeting of neuroreceptors. The atypical antipsychotics have many different ways of acting on receptors in the brain, but they have in common a decreased likelihood of producing extrapyramidal side-effects. Patients respond well to them by showing improvements of both positive and negative symptoms. The preclinical profile of amisulpride shows specificity for D2/D3 dopamine receptors and selective activity in the limbic system. There is evidence that amisulpride is effective in treating both the negative and positive symptoms of schizophrenia, and that it has a low propensity to induce motor side-effects. Therefore, both positive and negative symptoms can be treated, without inducing these side-effects, by selectively targeting dopamine receptors.

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