scholarly journals Review of the efficacy of placebo in comparative clinical trials between typical and atypical antipsychotics

2009 ◽  
Vol 31 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Irismar Reis de Oliveira ◽  
Paulo Menezes Nunes ◽  
Domingos Macedo Coutinho ◽  
Eduardo Pondé de Sena
Keyword(s):  
Clinical Trials ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Rating Scale ◽  
Study Drug ◽  
Typical Antipsychotic ◽  
The Difference ◽  
Psychiatric Rating Scale ◽  
Efficacy Parameters ◽  
Typical Antipsychotics

OBJECTIVE: To review the efficacy of placebo in comparison with atypical and typical antipsychotics for the treatment of schizophrenia and schizoaffective disorder and to evaluate the pertinence of using placebo in clinical trials with antipsychotics. METHOD: Trials in which the atypical antipsychotics were compared with typical antipsychotics and placebo were included. A search was conducted using the terms "amisulpride", "aripiprazole", "clozapine", "olanzapine", "quetiapine", "risperidone", "sertindole", "ziprasidone" and "zotepine". Main efficacy parameters were calculated using the proportion of "events" (defined as a deterioration or lack of improvement by at least 20% in Positive and Negative Syndrome Scale or Brief Psychiatric Rating Scale) and the pooled relative risk with random effects, with their respective 95% confidence intervals. We also calculated the necessary sample sizes in studies in which the study drug is compared to a typical antipsychotic or placebo. RESULTS: The pooled efficacy rates observed were 40.8%, 34.9% and 21.3% for the atypical antipsychotics, typical antipsychotics and placebo, respectively. One hundred and sixty six patients would have to be included when a new drug is compared with placebo if calculation is based on a difference of 20% found between the atypical antipsychotic and placebo and 2,054 if the difference sought were that found between the atypical antipsychotic and the typical antipsychotic, i.e. 6%. The estimated therapeutic failures would be 115 of the 166 patients when the study drug is compared with placebo, and 1,274 failures in the 2,054 patients when the study drug is compared to the typical antipsychotic. CONCLUSIONS: Placebo controlled studies may reduce the number of individuals exposed to the harmful effects of ineffective drugs.

scholarly journals A comparative study of the efficacy of amisulpride and olanzapine in patients with schizophrenia attending the outpatient Department of Psychiatry in a tertiary care hospital, Silchar, Assam, India

2019 ◽  
Vol 8 (2) ◽  
pp. 284
Author(s):  
Ali N. Yashin ◽  
Dolly Roy ◽  
Prosenjit Ghosh
Keyword(s):  
Atypical Antipsychotics ◽  
Rating Scale ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Brief Psychiatric Rating Scale ◽  
Parallel Group ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

Background: Schizophrenia is one of the most commonly encountered psychiatric disorders. It is characterized by impairment in perception or expression of reality, leading to occupational and social dysfunction. Now a day’s mainstay of treatment of schizophrenia is by using atypical antipsychotics. Amisulpride and olanzapine are atypical antipsychotics which are commonly used in treatment of schizophrenia. The current study is undertaken to assess the efficacy of amisulpride which is a relatively newer antipsychotics against existing antipsychotic olanzapine.Methods: This was designed as a single-blind, prospective, parallel-group, observational study. Eighty adult patients of either sex were randomized to receive standard doses of the two drugs orally for 12 weeks, with follow up at 4 and 8 weeks. Effectiveness was assessed by change in the score of Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) score during the treatment period. Data were entered in Microsoft excel and statistical analysis were done using graph pad and p value <0.05 considered to be statistically significant.Results: Out of 80 adults patients 76 patients were evaluated by dividing into two groups, 38 patients were included in each group. Final BPRS score was less for olanzapine as compared to amisulpride (p<0.001). Improvement in CGI score is more in olanzapine group than amisulpride group which became statistically significant from 8th weeks onwards.Conclusions: Both amisulpride and olanzapine are very effective in controlling the symptoms of schizophrenia which is evident by significant decrease in BPRS, CGI-S and CGI-I score, but efficacy of amisulpride is still inferior to olanzapine.

The Importance of Serotonin-Dopamine Interactions in the Action of Clozapine

1992 ◽  
Vol 160 (S17) ◽  
pp. 22-29 ◽  
Author(s):  
Herbert Y. Meltzer
Keyword(s):  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Typical Antipsychotic ◽  
Atypical Antipsychotic Drugs ◽  
Clinical Dose ◽  
High Affinity ◽  
The Relationship

Clozapine has an affinity for the dopamine (DA) D2 receptor which is relatively weak but is in line with its average clinical dose when compared with typical neuroleptic drugs. A few atypical antipsychotic drugs may have high absolute affinities for the D2 receptor, but most are weak D2 blockers. The atypical antipsychotic drugs also differ from the typical antipsychotic drugs by a relatively high affinity for the serotonin (5-HT2) receptor. This is evident on both in vitro and in vivo binding to cortical 5-HT2 receptors. The atypical antipsychotics are best distinguished from the typical antipsychotics on the basis of the relationship between strong 5-HT2 and weak D2 affinities. High D1 receptor binding is not characteristic of the group of atypical drugs. A new group of putative atypical antipsychotic drugs with high affinities for 5-HT2 compared to D2 receptors is under study.

Comparison of treatment response of typical and atypical antipsychotics in acute mania

2016 ◽  
Vol 33 (S1) ◽  
pp. S127-S127
Author(s):  
C.R. Medici ◽  
L.M. Kai ◽  
C. Kirkedal ◽  
S.P.V. Straszek
Keyword(s):  
Atypical Antipsychotics ◽  
Rating Scale ◽  
Data Extraction ◽  
Real Life ◽  
Acute Mania ◽  
Duration Of Treatment ◽  
Retrospective Case ◽  
Short Term Treatment ◽  
Case Record ◽  
Typical Antipsychotics

IntroductionThe medical treatment of acute mania today mainly includes atypical and typical antipsychotics, lithium or valproat. Atypical antipsychotics are often used as first-line treatment, while typical antipsychotics come with the risk of severe long-term side effects and less used today. However, typical antipsychotics may lead to a faster reduction in the severity of mania or a faster remission of symptoms.ObjectiveTo investigate whether the acute effect of typical antipsychotics differs from atypical antipsychotics measured by a daily mania rating-scale (MAS-M) and duration of treatment in a real-life clinical setting.AimTo help determine if short-term treatment with typical antipsychotics may still be of benefit in the acute treatment of mania.MethodsThis is a retrospective case record study. Patients admitted to an acute hospital ward with acute mania between 2012 and 2015 were included (n = 100). The daily use of atypical and typical antipsychotics will be compared by daily change in Bech-Rafaelsen Modified Mania Scale (Mas-M) score and time to discharge. The change in mania over time is presented visually using graph curves.ResultsThe data extraction and data handling will be executed in the winter 2015–2016.ConclusionsAny preliminary findings will be presented at EPA 2016.

scholarly journals Mechanism of Action of Atypical Antipsychotic Drugs in Mood Disorders

2020 ◽  
Author(s):  
Daniil Grinchii ◽  
Eliyahu Dremencov
Keyword(s):  
Mood Disorders ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Antidepressant Drugs ◽  
Dopamine Neurons ◽  
Atypical Antipsychotic Drugs ◽  
Experimental Drugs ◽  
Catecholamine Neurons ◽  
Typical Antipsychotics

Atypical antipsychotic drugs were introduced in the early 1990th. Unlike typical antipsychotics, which are effective only against positive symptoms of schizophrenia, atypical antipsychotics show effectiveness against negative and cognitive symptoms as well. Furthermore, they are effective not only in psychotic, but also in affective disorders, by their own or as adjuncts to antidepressant drugs. While typical antipsychotics act, almost exclusively, via dopamine-2 (D2) receptors, atypical target serotonin-1A/1B/2A/2C (5-HT1A/1B/2A/2C), &alpha;1/2-adrenergic, and/or histamine-1 (H1) receptors as well. Blocking of 5-HT1A/1B autoreceptors, inducing their early desensitization, and/or activation of &alpha;1-adrenoceptors, allow some atypical drugs to enhance 5-HT transmission. Blocking of 5-HT2A/2C and/or &alpha;2-adrenoceptors enable some atypical antipsychotics to stimulate catecholamine transmission and/or diminish the inhibition of catecholamine neurons induced by some antidepressants. It is possible, that the activation of H1 and/or blocking of H3 boost monoamine transmission as well, via a mechanism involving stimulation of firing activity of dopamine neurons. The experimental drugs with antipsychotic potential, acting on adenosine and trace amino associated (TAAR) receptors, might be effective in mood disorders as well, because of the ability to modulate the excitability of monoamine-secreting neurons and to potentiate extracellular concentrations of monoamines in the limbic areas of the brain.

scholarly journals Antipsychotic Prescribing Practices in Those with Parkinsonism: Adherence to Guidelines

2017 ◽  
Vol 44 (5) ◽  
pp. 603-606 ◽  
Author(s):  
Heather B. Rigby ◽  
Sara Rehan ◽  
Barbara Hill-Taylor ◽  
Kara Matheson ◽  
Ingrid Sketris
Keyword(s):  
Older Adults ◽  
Atypical Antipsychotics ◽  
Treatment Guidelines ◽  
Inappropriate Prescribing ◽  
Typical Antipsychotic ◽  
Potentially Inappropriate Prescribing ◽  
Prescribing Practices ◽  
Adherence To Guidelines ◽  
Informed Treatment ◽  
Typical Antipsychotics

ABSTRACTSeveral evidence-informed treatment guidelines recommend against the use of typical antipsychotics in patients with Parkinson’s disease; of the atypical antipsychotics, clozapine and quetiapine are preferred. The purpose of this study is to determine the frequency with which potentially inappropriate antipsychotics are dispensed to older adults in Nova Scotia who are on levodopa-containing medications. In this cohort, 59.9% were dispensed a preferred atypical antipsychotic and 12.6% a potentially harmful typical antipsychotic. Our results suggest that potentially inappropriate prescribing practices are common in the neuropsychiatric management of patients with parkinsonism and that there is an opportunity for education and improvement in prescribing practices.

Use of Atypical Antipsychotics on an As-Needed Basis

1996 ◽  
Vol 12 (4) ◽  
pp. 145-148 ◽  
Author(s):  
Dorothy Demczar ◽  
Gary M Levin
Keyword(s):  
English Language ◽  
Atypical Antipsychotics ◽  
Data Extraction ◽  
Cost Effective ◽  
Antipsychotic Agents ◽  
Therapeutic Benefit ◽  
Pharmacokinetic Parameters ◽  
Typical Antipsychotic ◽  
Medline Search ◽  
Typical Antipsychotics

Objective: To review the literature and determine whether atypical antipsychotics should be used on an as-needed (prn) basis. Data Sources: Pertinent English-language literature dealing with atypical antipsychotics, typical antipsychotics, phamacokinetics, and prn dosing strategies was retrieved from a MEDLINE search (1960–1995). Data Extraction: Articles that discussed either pharmacokinetic parameters or the rationale for using antipsychotics on a prn basis. Data Synthesis: Administration of typical antipsychotics on a prn basis, either alone or in combination with scheduled antipsychotics, is a common practice. However, it has recently been recognized that the atypical agents, clozapine and risperidone, are also being prescribed for prn dosing. Clozapine has a sedative component that may provide a therapeutic benefit when prescribed prn, but it is also associated with dose-related seizures and orthostatic hypotension. Risperidone does not appear to exhibit sedation, except at very high doses. Conclusions: The risk-to-benefit ratio is not acceptable in using the atypical antipsychotic agents on a prn basis. There are documented safety and efficacy data that support the use of the typical antipsychotic agents such as chlorpromazine, or haloperidol in combination with lorazepam, on a prn basis. These latter choices are also more cost-effective.

Effects of Language and Related Variables on the Expression of Psychopathology in Mexican American Psychiatric Patients

1981 ◽  
Vol 3 (2) ◽  
pp. 145-160 ◽  
Author(s):  
Criselda Segovia Price ◽  
Israel Cuellar
Keyword(s):  
Mental Health Professionals ◽  
Verbal Fluency ◽  
Mexican American ◽  
English Language ◽  
Rating Scale ◽  
Psychiatric Patients ◽  
Self Disclosure ◽  
Psychiatric Rating ◽  
The Difference ◽  
Psychiatric Rating Scale

Thirty-two Mexican American patients at the Bilingual/Bicultural Unit at the San Antonio State Hospital participated in a study that investigated the effect of interview language on the expression of psychopathology and the relationship of this effect to the variables of verbal fluency, acculturation, and self-disclosure. The patients were interviewed in separate Spanish- and English-language interviews that were videotaped. The videotaped interviews were then independently rated by bicultural/bilingual mental health professionals who used the Brief Psychiatric Rating Scale to determine the extent of psychopathology expressed by the patients during each interview. The patients were found to significantly express more symptomatology indicative of psychopathology during the Spanish interview. In addition, verbal fluency, acculturation, and self-disclosure were found to be significant multiple predictors of the difference in expressed psychopathology in the two interviews. Under different forms of analysis, verbal fluency and acculturation were also found to be unique predictors of this difference.

scholarly journals Mechanism of Action of Atypical Antipsychotic Drugs in Mood Disorders

2020 ◽  
Vol 21 (24) ◽  
pp. 9532
Author(s):  
Daniil Grinchii ◽  
Eliyahu Dremencov
Keyword(s):  
Mood Disorders ◽  
Atypical Antipsychotic ◽  
Mechanism Of Action ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Therapeutic Potential ◽  
Antidepressant Drugs ◽  
Atypical Antipsychotic Drugs ◽  
Experimental Drugs ◽  
Typical Antipsychotics

Atypical antipsychotic drugs were introduced in the early 1990s. Unlike typical antipsychotics, which are effective only against positive symptoms of schizophrenia, atypical antipsychotics are effective against negative and cognitive symptoms as well. Furthermore, they are effective not only in psychotic but also in affective disorders, on their own or as adjuncts to antidepressant drugs. This review presents the neural mechanisms of currently existing atypical antipsychotics and putative antipsychotics currently being investigated in preclinical and clinical studies and how these relate to their effectiveness in mood disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD). Typical antipsychotics act almost exclusively on the dopamine system. Atypical drugs, however, modulate serotonin (5-HT), norepinephrine, and/or histamine neurotransmission as well. This multimodal mechanism of action putatively underlies the beneficial effect of atypical antipsychotics in mood and anxiety disorders. Interestingly, novel experimental drugs having dual antipsychotic and antidepressant therapeutic potential, such as histamine, adenosine, and trace amine-associated receptors (TAAR) ligand, are also characterized by a multimodal stimulatory effect on central 5-HT, norepinephrine, and/or histamine transmission. The multimodal stimulatory effect on central monoamine neurotransmission may be thus primarily responsible for the combined antidepressant and antipsychotic therapeutic potential of certain central nervous system (CNS) drugs.

scholarly journals COST AND EFFECTIVENESS OF ATYPICAL-ATYPICAL ANTIPSYCHOTIC COMBINATIONS AND ATYPICAL-TYPICAL ANTIPSYCHOTIC COMBINATIONS IN PATIENTS OF PSYCHOTIC DISORDERS IN INSTALLATION OF EMERGENCY IN GRHASIA MENTAL HOSPITAL, YOGYAKARTA

2021 ◽  
Vol 18 (2) ◽  
pp. 112-117
Author(s):  
Arya Dibyo Adisaputra ◽  
Endang Darmawan ◽  
Arum Siwinarni
Keyword(s):  
Atypical Antipsychotic ◽  
Average Cost ◽  
Psychotic Disorders ◽  
Combination Group ◽  
Typical Antipsychotic ◽  
Total Cost ◽  
Time Period ◽  
The Difference ◽  
The Government ◽  
The Cost

Psychotic disorders create a burden on the government, family, and society because of decreasing patient productivity. The use of atypical-atypical and atypical-typical antipsychotic combinations is one of the most commonly used combinations for patients with psychotic disorders. The study was conducted to determine the average total cost and effectiveness of the therapy measured by the difference in PANSS-EC pre-post scores during intensive care. The study was conducted prospectively to analyse the total cost and effectiveness of the therapy using combinations of antipsychotics in psychotic disorders patients. The measured costs include the cost of nursing classes, laboratory, medical treatment, doctor's visit, and antipsychotic. The effectiveness is measured by the difference in PANSS-EC pre-post scores. As many as 32 treated patients with psychotic disorders met the inclusion criteria. The average cost of atypical-typical antipsychotic combination group (Rp1,184,043) was higher than atypical atypical antipsychotic combination group (Rp1,115,829). The effectiveness of the therapy was represented by the value of the difference between the PANSS-EC pre and post scores, which in this research yielded a mean of 7,125 for atypical-atypical antipsychotic combinations and 8,375 for atypical-typical antipsychotic combinations. In conclusion, there is a difference in the total average cost and effectiveness of the therapy. There is a difference between PANSS-EC pre and post scores during the time period from intensive room to quiet room in atypical-typical antipsychotic combinations compared with atypical-atypical antipsychotic combinations.

Preliminary Comparison of Predictive and Empiric Lithium Dosing: Impact on Patient Outcome

1994 ◽  
Vol 28 (10) ◽  
pp. 1148-1152 ◽  
Author(s):  
Patricia A. Marken ◽  
Kay E. McCrary ◽  
Sylvia Lacombe ◽  
Roger W. Sommi ◽  
Robijn K. Hornstra ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Length Of Stay ◽  
Rating Scale ◽  
Lithium Concentration ◽  
Statistical Significance ◽  
Cost Savings ◽  
Study Endpoint ◽  
Systematic Assessment ◽  
The Difference ◽  
Psychiatric Rating Scale

OBJECTIVE: To evaluate whether initiating lithium with predictive dosing compared with empiric dosing improves outcome in patients with manic symptoms. DESIGN: The study was a randomized, single-blind design and used the Modified Slattery predictive method. SETTING AND PARTICIPANTS: Eighteen inpatients at an urban psychiatric hospital with a Mania Rating Scale (MRS) score greater than or equal to 24 were enrolled. OUTCOME MEASURES: The study endpoint was defined as an MRS rating less than or equal to 14 or discharge from the hospital. Assessments (MRS, Brief Psychiatric Rating Scale, Clinical Global Impression, Systematic Assessment for Treatment of Emergent Events Scale, quality of life measures) were completed at baseline, on days 3 or 4 and 7 or 8, and weekly thereafter. RESULTS: The predictive group achieved a therapeutic concentration significantly sooner than did the empiric group (p=0.004); however, the mean serum lithium concentration at discharge did not differ between the groups. The predictive group was taking significantly higher dosages of antipsychotics in chlorpromazine equivalents on day 3 or 4 (p=0.05). Significantly fewer gastrointestinal/genitourinary adverse effects on day 3 or 4 were reported by patients in the predictive group (p=0.04). No difference was found between groups with any rating scale or other pharmacokinetic or medication item. Even though the difference did not meet statistical significance, the predictive group's length of stay in the acute unit was three days shorter than that of the empiric group, which may represent significant cost savings. CONCLUSIONS: The preliminary data do not suggest that patient outcome is improved by using Modified Slattery predictive dosing; however, the suggestion of a shorter length of stay in a restrictive unit merits further evaluation.

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