Prevalence of Obesity in Patients Receiving Depot Antipsychotics

1988 ◽  
Vol 153 (2) ◽  
pp. 214-217 ◽  
Author(s):  
T. Silverstone ◽  
Glenyss Smith ◽  
Elizabeth Goodall
Keyword(s):  
Antipsychotic Drugs ◽  
Clinical Importance ◽  
Chronic Schizophrenia ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
London Borough ◽  
Prevalence Of Obesity ◽  
Depot Neuroleptic ◽  
Depot Antipsychotics

Antipsychotic drugs have long been noted to cause pronounced weight gain, and drug-induced obesity can assume major clinical importance in long-term medication in the management of chronic schizophrenia. Obesity is associated with increased morbidity and may reduce compliance, leading to a return of psychotic symptoms. In a survey of 226 patients attending depot neuroleptic clinics in one inner London borough, it was found that the prevalence of clinically relevant obesity was four times that in the general population.

scholarly journals A comparative study of effectiveness, safety and cost effectiveness of olanzapine, risperidone and aripiprazole therapy in schizophrenia

2020 ◽  
Vol 9 (5) ◽  
pp. 786
Author(s):  
Pooja R. Kanani ◽  
Ajita Pillai
Keyword(s):  
Cost Effectiveness ◽  
Antipsychotic Drugs ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Psychotic Symptoms ◽  
Average Dose ◽  
Psychiatric Hospitalizations ◽  
Score Analysis ◽  
Risperidone Group

Background: Schizophrenia is the most common psychotic disorder and responsible for approximately half of long-term psychiatric hospitalizations. Antipsychotic medications reduce the psychotic symptoms and prevent relapses. The choice of drug for treatment of schizophrenia depends on many issues, including effectiveness, cost, side-effect burden, availability, and tolerability. Many studies have compared antipsychotic drugs with one another, but no broad consensus has been reached. Our study compares the clinical effectiveness, safety and cost effectiveness of atypical antipsychotics in our setting.Methods: This was an observational, prospective study in which schizophrenia patients receiving either olanzapine, risperidone or aripiprazole were enrolled. Patients were followed up for 3 months. Evaluation of effectiveness was done by analysing mean reduction in PANSS score. Analysis of ADRs was done using WHO causality scale and Hartwig and Siegel severity scale. Cost analysis was done by comparing all three groups in term of cost range of antipsychotic drugs per improvement in PANSS score during the study period.Results: In the present study, the average dose of antipsychotic drugs received by a patient per day was 8.83±2.98 mg in olanzapine group, 4.76±1.12 mg in risperidone group and 20.43±8.5 mg in aripiprazole group. Mean reduction in PANSS score from baseline to 12 weeks was 23.79% in olanzapine group, 25.41% in risperidone group and 24.65% in aripiprazole group. Conclusions: All the groups were equally effective in reduction in PANSS score while risperidone was the most cost effective.

The health economic implications of treatment with quetiapine: an audit of long-term treatment for patients with chronic schizophrenia

2001 ◽  
Vol 16 (5) ◽  
pp. 307-312 ◽  
Author(s):  
J. Lynch ◽  
J. Morrison ◽  
N. Graves ◽  
D. Meddis ◽  
M.F. Drummond ◽  
...  
Keyword(s):  
Health Economic ◽  
Case Series ◽  
Chronic Schizophrenia ◽  
Term Treatment ◽  
Revolving Door ◽  
Psychotic Symptoms ◽  
Open Label ◽  
Economic Implications ◽  
Long Term Treatment

SummaryThis retrospective, case series audit assessed the clinical and health-economic impact of long-term treatment with quetiapine (‘Seroquel’), a new atypical antipsychotic, in patients with chronic schizophrenia.The study design was of a case series format, comprising patients entered from one centre into the open-label extension of a multicentre 6-week efficacy study. Twenty-one patients (15 male, six female; mean age 39 years) were studied, of whom 17 (81%) had been rated as ‘partially responsive’ to previous antipsychotics. Data on hospitalisations and information on symptoms were collected retrospectively for the 12 months before quetiapine treatment was initiated and for the 12 months after.Quetiapine was effective in reducing psychotic symptoms with mean BPRS scores reducing significantly, from 38 to 21 (P < 0.005). Motor function was also significantly improved with mean Simpson scale scores reducing from 15 to 12 (P < 0.005). Average inpatient days were reduced by 11% in year two (97 compared with 109 days) while the overall costs of treatment, including drug costs, fell by 5% (I£20,843 to I£19,827).Four patients had been hospitalised for longer than 5 years before starting quetiapine; these chronically institutionalised patients remained in hospital, despite improved clinical outcomes (mean BPRS scores after treatment of 34, compared with 43 before), for the full 12 months of quetiapine treatment. Were the data from this audit to be re-analysed excluding these four patients then average inpatient days would have been reduced by 33% (45 to 30 days) and overall cost of treatment by 19% (I£8617 to I£7011).This audit suggests that treatment with quetiapine over this 1-year period was associated with both clinical improvements and a decreased usage of inpatient services. The reduction in hospitalisation costs would appear to compensate for the increased cost of drug treatment. Significantly, potential savings appear to be greatest for those patients with a ‘revolving door’ pattern of repeated readmission.

scholarly journals A Case Report of Severe Delirium after Amantadine Withdrawal

2017 ◽  
Vol 9 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Franz Marxreiter ◽  
Jürgen Winkler ◽  
Martin Uhl ◽  
Dominik Madžar
Keyword(s):  
Cognitive Impairment ◽  
Case Report ◽  
Withdrawal Syndrome ◽  
Dopamine Agonists ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
Comt Inhibitors ◽  
Mao B ◽  
Psychotropic Substance

Amantadine is frequently used in addition to dopaminergic substances like dopamine agonists or L-Dopa in advanced Parkinson disease (PD). However, adverse effects like hallucinations limit its use. PD patients developing severe psychotic symptoms upon treatment with either dopaminergic substances and/or amantadine need to stop intake of any psychotropic substance. Here, we report the case of a 71-year-old PD patient without previously known cognitive impairment. He presented with drug-induced psychotic symptoms due to changes in his therapeutic regimen (increase in COMT inhibitors, newly introduced MAO B inhibitors). Also, amantadine had been part of his long-term medication for more than 2 years. The severity of his psychotic symptoms required a L-Dopa monotherapy. After changing his medication, the patient developed severe delirium that resolved rapidly after i.v. amantadine infusion, suggesting an amantadine withdrawal syndrome. Amantadine withdrawal syndrome is a rare adverse event that may present even in PD patients without cognitive impairment. This case report highlights the need for a gradual withdrawal of amantadine even if acute and severe psychotic symptoms are present. Moreover, this is the first report of a cognitively unimpaired patient developing an amantadine withdrawal syndrome.

scholarly journals Antipsychotic drugs increase Neuregulin1b1 serum levels in first-episode drug-naïve patients and chronic schizophrenia with suggestions for improving the treatment of psychotic symptoms

2021 ◽  
Author(s):  
Haidong Yang ◽  
Wen Pan ◽  
Wenhuan Xiao ◽  
Man Yang ◽  
Jianchun Xu ◽  
...  
Keyword(s):  
Antipsychotic Drugs ◽  
Chronic Schizophrenia ◽  
Serum Levels ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Therapeutic Effects ◽  
Pathophysiological Mechanism ◽  
Healthy Controls ◽  
Drug Naïve

Abstract Background: Neuregulin1 (NRG1) plays a role in neuronal migration, regulation of synaptic plasticity, and neural survival, and has been considered to be among the candidate genes for schizophrenia. This study focused on the variations in serum NRG1b1 levels following antipsychotic treatment and the relationship between NRG1b1 level and improvements in psychotic symptoms in first-episode drug-naïve (FEDN) patients and chronic schizophrenia.Methods: A total of 100 patients with schizophrenia were recruited and compared with 79 matched healthy controls. All patients had been drug-naïve for at least four weeks. Serum NRG1b1 levels and positive and negative syndrome scale (PANSS) scores were measured at the baseline and after four weeks. Serum NRG1b1 levels were measured using sandwich enzyme-linked immunosorbent assays (ELISA).Results: Baseline NRG1b1 levels were significantly lower in the patients with schizophrenia compared with the healthy controls. NRG1b1 levels increased significantly following antipsychotic treatment. NRG1b1 levels gradually increased with declining PANSS scores and its three subscales during antipsychotic therapy. The levels of NRG1b1 increased significantly in responders after four weeks of treatment, although non-responders showed no such effect. Correlation analyses showed that the levels of NRG1b1 were negatively correlated with the duration of illness and positively correlated with improvement in symptoms.Conclusion: The levels of serum NRG1b1 and the therapeutic effects gradually increased following treatment, indicating that NRG1b1 may be an indicator of therapy, and that it may also be associated with the pathophysiological mechanism causing schizophrenia, although this possible pathway requires further investigation. Antipsychotic drugs increase Neuregulin1b1 serum levels in first-episode drug-naïve patients and chronic schizophrenia with suggestions for improving the treatment of psychotic symptoms

Antipsychotic and anticholinergic drugs

2012 ◽  
pp. 1208-1231
Author(s):  
Herbert Y. Meltzer ◽  
William V. Bobo
Keyword(s):  
Atypical Antipsychotic ◽  
Antipsychotic Drugs ◽  
Antipsychotic Agents ◽  
Psychotic Symptoms ◽  
Anticholinergic Drugs ◽  
Typical Antipsychotic ◽  
Drug Induced ◽  
Atypical Antipsychotic Drugs ◽  
Normal Limits ◽  
Psychotic Features

The discovery by Delay and Denicker in 1953 that chlorpromazine was highly effective in alleviating delusions, hallucinations, and disorganized thinking, was the seminal breakthrough in the treatment of schizophrenia, the first agent to produce sufficient relief of core psychotic symptoms to permit life outside of institutions for many patients with schizophrenia, and even a return to a semblance of function within normal limits. Chlorpromazine and the other related typical antipsychotic drugs which were introduced over the next 30 years have proven to be of immense benefit to vast numbers of people who experience psychotic symptoms as a component of a diverse group of neuropsychiatric and medical disorders, as well as drug-induced psychoses. These drugs have been invaluable in providing clues to the aetiology of schizophrenia and other forms of mental illness with psychotic features and as tools in understanding fundamental neural processes, especially those involving dopamine, a key neurotransmitter involved in psychosis. This class of drugs has now been supplanted by the so-called atypical antipsychotic drugs, of which clozapine is the prototype. This chapter will describe the various classes of antipsychotic agents, with emphasis on the atypical antipsychotic drugs, their benefits and adverse effects, recommendations for use in clinical practice, and mechanism of action. The drugs used to treat the extrapyramidal side-effects (EPS) produced mainly by the typical antipsychotic drugs are also considered.

New insights into the mechanism of drug-induced dyskinesia

CNS Spectrums ◽  
2012 ◽  
Vol 18 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Anton J. M. Loonen ◽  
Svetlana A. Ivanova
Keyword(s):  
Antipsychotic Drugs ◽  
Term Treatment ◽  
Medium Spiny Neurons ◽  
Indirect Pathway ◽  
Drug Induced ◽  
Disease Research ◽  
Spiny Neurons ◽  
Long Term Treatment ◽  
Cortical Circuit

Dyskinesia is an extrapyramidal movement disorder characterized by involuntary, repetitive, irregular motions that affect the mouth and face and/or the limbs and trunk. Tardive dyskinesia (TD) is a well-known complication of long-term treatment with antipsychotic drugs. Dyskinesia is also induced with levodopa, a treatment for Parkinson's disease, and it occurs spontaneously as a symptom of Huntington's disease. Research on the pathogenesis of TD has focused on a dysfunction of either the dopaminergic or serotonergic system. However, recent evidence has suggested that we should focus on the possible damage of GABAergic medium spiny neurons (MSNs). MSNs are the first station in the cortico-striato-thalamo-cortical circuit that regulates the amplitude and velocity of movements. Two pathways can be distinguished in this circuit: a direct pathway, which increases movements (hyperkinesia), and an indirect pathway, which decreases movements (hypokinesia). Both pathways are activated by glutamatergic corticostriatal neurons. Here, we discuss some evidence that supports the hypothesis that indirect pathway MSNs are damaged in dyskinesia.

scholarly journals The use of tetrabenazine for the treatment of drug-induced tardive dyskinesia – report of four cases

2016 ◽  
Vol 16 (4) ◽  
pp. 194-200
Author(s):  
Ewa Szczepocka ◽  
◽  
Radosław Magierski ◽  
Tomasz Sobów ◽  
Adam Wysokiński ◽  
...  
Keyword(s):  
Movement Disorders ◽  
Mental Condition ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
Symptoms Of Depression ◽  
The Face ◽  
History Of ◽  
Chronic Neuroleptic ◽  
Written Informed Consent

Tardive dyskinesias are defined as a syndrome of involuntary, irregular, hyperkinetic movement disorders, including mixed movement disorders of the face and the mouth as well as choreoathetoid movements of the trunk and limbs. They are a serious and usually irreversible side effect of chronic neuroleptic treatment and affect approximately 15–20% of patients. Treatment attempts using amantadine, levetiracetam, piracetam, clonazepam, propranolol, vitamin B6, vitamin E, ondansetron, botulinum toxin and Ginkgo biloba were made. However, in many cases the treatment efficacy has not been confirmed in long-term studies in larger groups of patients. Tetrabenazine, registered in Poland for the treatment of hyperkinetic motor disorders in the Huntington’s disease, is one of the available therapeutic options. We present the course and the effects of tetrabenazine therapy in four patients with antipsychotic-induced tardive dyskinesias. Based on the experience gained during the research program using tetrabenazine, we believe that the use of this agent should be limited to patients in a stable mental condition, with no current symptoms of depression or active psychotic symptoms. In our opinion, suicidal tendencies or thoughts and a history of neuroleptic malignant syndrome are absolute contraindications. The off-label use of tetrabenazine requires a written informed consent of the patient and careful monitoring of their mental and neurological condition.

The Clinical Importance of the Neuroleptic Threshold and its Fine Motor Determination by the Handwriting Test

1974 ◽  
Vol 2 (5) ◽  
pp. 321-330 ◽  
Author(s):  
H J Haase ◽  
L Floru
Keyword(s):  
Practical Importance ◽  
Clinical Importance ◽  
Chronic Schizophrenia ◽  
Fine Motor ◽  
Neuroleptic Drug ◽  
Work Team ◽  
Anti Psychotic ◽  
Close Relationship ◽  
Neuroleptic Potency

This paper discusses the present state of investigations concerning the concepts of ‘neuroleptic threshold’ and fine motor extrapyramidal inhibition. The publication also includes reports on studies carried out by thirty-one collaborators from the Haase work-team based on over 50,000 handwriting tests. The main results of the following studies are presented and discussed: Investigations effected by fourteen authors on 328 cases of schizophrenia proving the close relationship between crossing the neuroleptic threshold and onset of the anti-psychotic effect. By a gradual increase of dosage a neuroleptic-anti-psychotic action was obtained in the days following the crossing of the neuroleptic threshold for a total of 87% of cases, 52% of which took place in the first three days, another 16% within the following three days and the rest after a longer interval. In another series of investigations the actions of a neuroleptic drug above and under the neuroleptic threshold were systematically compared in twenty-four cases of chronic schizophrenia. Concerning the action of anti-parkinson drugs on motor and psychic neuroleptic efficiency, results are reported on two series of investigations. Furthermore, the concepts of ‘neuroleptic-therapeutic range’ and ‘neuroleptic potency’ are defined and the problem of different individual predispositions to the neuroleptic threshold is discussed. Fine motor extrapyramidal handwriting symptomatology was quantified by means of Haase's handwriting test and evaluated according to the following degrees: mild, moderate and severe. The relevancy of determining the impressive character of handwriting was proved by the work of three different independent investigators, each separately assessing the samples resulting from the same 300 handwriting tests. Two measuring procedures were evolved for the planimetric evaluation of handwriting. The application of handwriting tests in the therapy of long-term neuroleptics is discussed, viz. in determining duration of activity, in controlling cumulative tendency and in studies on under-threshold neuroleptic action. This paper stresses the clinical and practical importance of these results.

A Profile of Obsessive-Compulsive Symptoms In Schizophrenia

CNS Spectrums ◽  
1997 ◽  
Vol 2 (3) ◽  
pp. 21-25 ◽  
Author(s):  
Linda Porto ◽  
Paul C. Bermanzohn ◽  
Simcha Pollack ◽  
Richard Morrissey ◽  
Samuel G. Siris
Keyword(s):  
Day Treatment ◽  
Active Phase ◽  
Chronic Schizophrenia ◽  
Psychotic Symptoms ◽  
Inclusion Criteria ◽  
Obsessive Compulsive ◽  
Dsm Iv ◽  
Clinically Significant ◽  
Day Treatment Program

AbstractObsessive-compulsive (OC) symptoms and schizophrenia may present, as intertwined phenomena whose relationship remains poorly understood. The purpose of this paper is to provide a detailed phenomenological description of OC symptoms in schizophrenia.Fifty long-term patients with chronic schizophrenia or schizoaffective disorder from a continuing day-treatment program were assessed using the Structured Clinical Interview for DSM-IV and the Yale-Brown Obsessive-Compulsive Scale symptom checklist. Forty-six percent (n=23) reported clinically significant OC symptoms. Twenty-six percent (n=13) met criteria for OCD, from which three subgroups emerged: (1) patients whose OCD was unrelated to their psychotic symptoms, (2) patients whose OCD was related to, but not restricted to, their psychotic symptoms, and (3) patients whose OC symptoms existed on a continuum with their psychosis. The last group tended to incorporate their OC symptoms into delusional beliefs during the active phase of illness and shift to OCD during full or partial remissions. Eight percent met all inclusion criteria for OCD, but their OC symptoms were better accounted for by their psychosis.We conclude that these findings support previous clinical constructs that OCD and schizophrenia are not always dichotomous disorders, but may be interconnected.

Plasma homovanillic acid, noradrenaline and psychotic symptoms in chronically medicated schizophrenic in patients

2001 ◽  
Vol 13 (2) ◽  
pp. 49-52
Author(s):  
Y. Kaneda ◽  
A. Fujii
Keyword(s):  
Informed Consent ◽  
Patient Group ◽  
Homovanillic Acid ◽  
Psychiatric Symptoms ◽  
Chronic Schizophrenia ◽  
Normal Subjects ◽  
Psychotic Symptoms ◽  
Neuroleptic Medication ◽  
Dsm Iv

SummaryObjective:The authors investigated plasma homovanillic acid (HVA) levels and noradrenaline (NA) in chronically medicated schizophrenic inpatients.Methods:The subjects were 55 inpatients who were diagnosed according to the DSM-IV criteria for schizophrenia. Nine normal subjects were compared to the patient group. Each patient gave informed consent for the research involved in this study. Psychiatric symptoms were assessed using the BPRS.Results:(1) The medicated schizophrenic inpatients had significantly greater plasma NA levels, and higher but nonsignificant plasma HVA levels than the normal subjects.(2) In patients, there was a positive but nonsignificant correlation between the plasma NA levels and positive symptomatology. In contrast, plasma HVA levels were not correlated with either positive or negative symptomatology.Conclusion:On the basis of these results, we hypothesize that, mainly because of their catecholaminergic dysfunction, there is an increase in plasma NA and a tendency for increased plasma HVA in patients with chronic schizophrenia, regardless of long-term neuroleptic medication.

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