Rational Use of Second-Generation Antipsychotics for the Treatment of ICU Delirium

2016 ◽  
Vol 30 (1) ◽  
pp. 121-129 ◽  
Author(s):  
Yoonsun Mo ◽  
Felix K. Yam
Keyword(s):  
Cognitive Deficits ◽  
Second Generation ◽  
Clinical Evidence ◽  
Safety Properties ◽  
Pharmacological Interventions ◽  
Rational Use ◽  
Second Generation Antipsychotics ◽  
Icu Delirium ◽  
Current Guidelines

Delirium, described as an acute neuropsychiatric syndrome, occurs commonly in critically ill patients and leads to many negative outcomes including increased mortality and long-term cognitive deficits. Despite the lack of clinical data supporting the use of antipsychotics for the management of intensive care unit (ICU) delirium, pharmacological interventions are often needed to control acutely agitated patients. Given that the most current guidelines do not advocate the use of haloperidol for either the prevention or treatment of ICU delirium due to a lack of evidence, second-generation antipsychotics (SGAs) have been commonly used as alternatives to haloperidol for ICU patients with delirium. Nonetheless, the evidence supporting the use of SGAs to treat ICU delirium remains limited. This review is designed to assess the available clinical evidence and highlights the different neuropharmacological and safety properties of SGAs in order to guide the rational use of SGAs for the treatment of ICU delirium.

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.

scholarly journals The concomitant use of second-generation antipsychotics and long-term antiretroviral therapy may be associated with increased cardiovascular risk

2014 ◽  
Vol 218 (1-2) ◽  
pp. 201-208 ◽  
Author(s):  
Maria Ferrara ◽  
Anya Umlauf ◽  
Chelsea Sanders ◽  
Jonathan M. Meyer ◽  
John Allen McCutchan ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Antiretroviral Therapy ◽  
Second Generation ◽  
Second Generation Antipsychotics

scholarly journals The Effect of Long-Term Second-Generation Antipsychotics Use on the Metabolic Syndrome Parameters in Jordanian Population

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 320
Author(s):  
Abo Alrob ◽  
Alazzam ◽  
Alzoubi ◽  
Nusair ◽  
Amawi ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Second Generation ◽  
Systolic Pressure ◽  
Clinical Information ◽  
P Value ◽  
Glucose Levels ◽  
The Metabolic Syndrome ◽  
Second Generation Antipsychotics ◽  
Continuous Use

Objectives: The aim of this study was to determine the incidence of metabolic syndrome in patients treated with second-generation antipsychotics (SGAs). Methods: In this retrospective study, we reviewed patients’ electronic medical records (EMRs) of all patients who received one SGA for at least six months, excluding patients who were taking other medications that are associated with significant effect on metabolic syndrome. Relevant clinical information was collected prior to starting the SGA and after six months of continuous use of the same SGA. Results: A total of 91 patients were included in the study. The majority of patients (72%) were diagnosed with schizophrenia. After six months of taking the SGA, 44% of patients experienced elevated systolic pressure, 54.9% had elevated triglyceride, and 31.9% had impaired glucose levels (p value < 0.05). Prior to initiating SGA therapy, 14.3% of patients had metabolic syndrome, while 37.4% had metabolic syndrome after six months of therapy, and it was more prominent in males compared to female patients (p value < 0.05). Conclusion: This study found a strong correlation between SGA use and the appearance of metabolic alterations, such as weight gain, glucose intolerance, and increased triglyceride levels. These findings highlight the importance of assessing metabolic deregulations to minimize SGA associated metabolic abnormalities.

scholarly journals Long-Term Evolution of Metabolic Status in Patients with Schizophrenia Stably Maintained on Second-Generation Antipsychotics

2018 ◽  
Vol 15 (6) ◽  
pp. 628-637 ◽  
Author(s):  
Seong Hoon Jeong ◽  
Nam Young Lee ◽  
Se Hyun Kim ◽  
In Won Chung ◽  
Tak Youn ◽  
...  
Keyword(s):  
Second Generation ◽  
Long Term Evolution ◽  
Metabolic Status ◽  
Term Evolution ◽  
Second Generation Antipsychotics
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