scholarly journals The Effectiveness of Non-clozapine Antipsychotics Combined with Electroconvulsive Therapy versus Clozapine Combined with Electroconvulsive Therapy for Treatment-resistant Schizophrenia

2021 ◽  
Vol 16 (2) ◽  
pp. 263-273
Author(s):  
Pichai Ittasakul ◽  
Keyword(s):  
Electroconvulsive Therapy ◽  
Rating Scale ◽  
Mmse Score ◽  
Subscale Score ◽  
Mean Difference ◽  
Response To Treatment ◽  
Treatment Resistant ◽  
Mini Mental Status Exam ◽  
The Mean ◽  
Safe Treatment Option

The study aimed to compare the effectiveness and safety of other atypical antipsychotics (non-clozapine) plus electroconvulsive therapy (ECT) (NC+ECT) versus clozapine plus ECT (C+ECT) for treating treatment-resistant schizophrenia (TRS). Data of 32 patients with TRS who was receiving ECT were analysed. We compared clinical characteristics, response to treatment [defined as an improvement of 40% in the Brief Psychotic Rating Scale (BPRS) psychotic symptom subscale from pretreatment scores], change of Mini-mental Status Exam (MMSE) scores, and other adverse effects between the NC+ECT group (N= 16) and C+ECT group (N =16). We found that the overall response rate was 65.6% (75.8% for the NC+ECT group and 56.3% for the C+ECT group, p=0.26). The overall BPRS score in both groups decreased significantly. The mean difference in total BPRS psychotic subscale score between pre-ECT and after last ECT was 10.4 + 5.8 (p<0.001) for the NC+ECT group and 6.6 + 7.3 (p = 0.002) for the C+ECT group. When comparing the NC+ECT group to the C+ECT group, the mean difference in total BPRS psychotic subscale score was not significant. (p = 0.104). The mean difference in MMSE score between pre-ECT and after the last ECT was -1.1 + 5.1 (p =0.45) for the NC+ECT group and 0.2 + 4.3 (p=0.855) for the C+ECT group. The change of MMSE score in the NC+ECT group was not significant different compare to the C+ECT group (p = 0.461). We concluded the combination of antipsychotics and ECT is an effective and safe treatment option for patients with TRS. Other NC+ECT groups’ efficacy may be comparable to that of clozapine plus ECT.

scholarly journals Daily dynamics of negative affect: indicators of rate of response to treatment and remission from depression?

2021 ◽  
Author(s):  
Marieke A. Helmich ◽  
M. Wichers ◽  
Frenk Peeters ◽  
Evelien Snippe
Keyword(s):  
Negative Affect ◽  
Rating Scale ◽  
Supportive Therapy ◽  
Diagnostic Interview ◽  
Response To Treatment ◽  
Symptom Improvement ◽  
Remission Status ◽  
The Mean ◽  
Pre Treatment ◽  
Ecological Momentary

More instability (MSSD) and variability (SD) of negative affect (NA) have been related to current and future depressive symptoms. We investigated whether MSSD and SD of NA were predictive of the rate of symptom improvement during treatment and of reaching remission status. Forty-six individuals with major depressive disorder completed six days of ecological momentary assessments (10 beeps per day) before starting a combination of pharmacotherapy and supportive therapy. During and after treatment, the Hamilton Depression Rating Scale (HDRS) diagnostic interview was performed monthly for 18 months. Using multilevel modeling and logistic regression, a linear decrease in HDRS scores as well as reaching remission status (HDRS of ≤7 within or after five months) were predicted by the mean, SD and MSSD of NA in momentary assessments, and relevant baseline predictors. Mean NA, but not the SD or MSSD of NA, predicted rates of depressive symptom reduction over five months. The odds of remitting during treatment were not associated with any predictors. Our results suggest that pre-treatment assessments of NA instability and variability may not give an indication of the treatment response over time. Clinically, the mean of NA may be more promising as a baseline indicator of response potential.

scholarly journals Time course of improvement with antipsychotic medication in treatment-resistant schizophrenia

2011 ◽  
Vol 199 (4) ◽  
pp. 275-280 ◽  
Author(s):  
Takefumi Suzuki ◽  
Gary Remington ◽  
Tamara Arenovich ◽  
Hiroyuki Uchida ◽  
Ofer Agid ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Time Course ◽  
Rating Scale ◽  
Antipsychotic Treatment ◽  
Treatment Resistant ◽  
Item Score ◽  
Double Blind ◽  
The Mean ◽  
Meta Regression ◽  
Item Scores

BackgroundImprovements are greatest in the earlier weeks of antipsychotic treatment of patients with non-resistant schizophrenia.AimsTo address the early time-line for improvement with antipsychotics in treatment-resistant schizophrenia.MethodRandomised double-blind trials of antipsychotic medication in adult patients with treatment-resistant schizophrenia were investigated (last search June 2010). A series of meta-regression analyses were carried out to examine the effect of time on the average item scores in the Positive and Negative Syndrome Scale (PANSS) or Brief Psychiatric Rating Scale (BPRS) at three or more distinct time points within the first 6 weeks of treatment.ResultsStudy duration varied from 4 weeks to 1 year and the definitions of treatment resistance as well as of treatment response were not necessarily consistent across 19 identified studies, resulting in highly variable rates of response (0–76%). The mean standardised baseline item score in the PANSS or BPRS was 3.4 (s.e. = 0.06) in the five studies included in the meta-regression analysis, with the average baseline Clinical Global Impression – Severity score being 5.2 (marked illness). For the pooled population treated with a range of antipsychotics (n = 1019), significant reductions in the mean item scores occurred during the first 4 weeks; improvements observed in later weeks were smaller and non-significant. In contrast, weekly improvement with clozapine was significant throughout (n = 356).ConclusionsOur findings provide preliminary evidence that the majority of improvement with antipsychotics may occur relatively early. More consistent improvements with clozapine may be associated with a gradual titration. To further elucidate response patterns, future studies are needed to provide data over regular intervals during earlier stages of treatment.

scholarly journals Clinical and Genetic Factors Associated with Resistance to Treatment in Patients with Schizophrenia: A Case-Control Study

2019 ◽  
Vol 20 (19) ◽  
pp. 4753 ◽  
Author(s):  
Aline Hajj ◽  
Sahar Obeid ◽  
Saria Sahyoun ◽  
Chadia Haddad ◽  
Jocelyne Azar ◽  
...  
Keyword(s):  
Genetic Factors ◽  
Case Control Study ◽  
Rating Scale ◽  
Multivariable Analysis ◽  
Case Control ◽  
Response To Treatment ◽  
Treatment Resistant ◽  
Factors Associated ◽  
Resistance To Treatment ◽  
Control Study

Objectives: To assess clinical and genetic factors affecting response to treatment in a sample of patients with schizophrenia (treatment-resistant patients versus treatment responders). We also aimed at examining if these factors are different when we consider two different resistance classifications (the positive and negative syndrome scale, PANSS and the brief psychiatric rating scale, BPRS). Material and Methods: A case-control study included treatment-resistant patients and good responders. Patients were stratified in two groups based on the established criteria for treatment-resistant schizophrenia using BPRS and PANSS. The study was approved by the ethical committees (references: CEHDF1017; HPC-017-2017) and all patients/legal representatives gave their written consent. Clinical factors were assessed. DNA was obtained using a buccal swab and genotyping for OPRM1, COMT, DRD2 et MTHFR genes using the Lightcycler® (Roche). Results: Some discrepancies between the BPRS and PANSS definitions were noted in our study when assessing the patients’ psychopathological symptoms and response to treatment. The multivariable analysis, taking the presence versus absence of treatment resistance as the dependent variable, showed that that family history of schizophrenia, university studies, time since the beginning of treatment and chlorpromazine equivalent dose as well as the COMT gene are associated with resistance to treatment. In addition, a gender-related difference was noted for COMT SNP; men with at least one Met allele were more prone to be resistant to treatment than Val/Val patients. Conclusion: Uncovering the clinical and genetic factors associated with resistance to treatment could help us better treat our schizophrenic patients in a concept of personalized medicine.

Electroconvulsive therapy in elderly - a preliminary study

2016 ◽  
Vol 33 (S1) ◽  
pp. s230-s230
Author(s):  
C. Agostinho ◽  
M. Duarte ◽  
R. Alves ◽  
I. Cunha ◽  
A.M. Batista
Keyword(s):  
Electroconvulsive Therapy ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Severe Depression ◽  
Unipolar Depression ◽  
Normal Range ◽  
Significant Difference ◽  
The Mean ◽  
Preliminary Study ◽  
Competing Interest

IntroductionStudies with electroconvulsive therapy (ECT) in elderly focus mainly on the assessment of possible side effects on the cognitive functioning; there are few studies that evaluate the effectiveness.ObjectiveEvaluate the effectiveness of this treatment in the population over 65 years.AimsPerform a preliminary study to evaluate the response to ECT of ≥ 65 years patients with depression.MethodsWe carry out a descriptive study based on patients treated in the last 10 years in the ECT Unit of Centro Hospitalar Psiquiátrico de Lisboa.ResultsOur initial sample consisted of 457 patients. We select patients aged ≥ 65 years with depression, and with complete data, including electroconvulsive parameters, and initial and final Hamilton Rating Scale for Depression (HRSD) scores (n = 59). Of this, 81.36% (n = 48) had unipolar depression, and 18.64% (n = 11) had bipolar depression. In the first group, the mean variation between the initial and final scores in HRSD was 13.88 points, and 27.10% (n = 13) of the patients ended the treatment in the normal range of HRSD score. In the second group, the mean variation was 12.82, and 63.60% (n = 7) ended the treatment in the normal range of HRSD. Considering the initial and final HRSD scores, it appears that unipolar depression group presents higher values (severe depression) (P < 0.05). When we compare the mean variation between the initial and final HRSD scores, we didn’t observe a statistically significant difference between the two groups. There was a clinical improvement in both.ConclusionsThe acute treatment with ECT appears to improve depressive symptoms in bipolar and unipolar depression, when considering an elderly population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Electroconvulsive therapy in Parkinson´s disease

2015 ◽  
Vol 73 (10) ◽  
pp. 856-860 ◽  
Author(s):  
Humberto Calderón-Fajardo ◽  
Amin Cervantes-Arriaga ◽  
Rodrigo Llorens-Arenas ◽  
Jesús Ramírez-Bermudez ◽  
Ángel Ruiz-Chow ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Rating Scale ◽  
Neuropsychiatric Symptoms ◽  
Review Of The Literature ◽  
Scale Reduction ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
The Mean ◽  
Psychiatric Rating Scale ◽  
Therapy Sessions

Purpose To analyze the effectiveness of electroconvulsive therapy for the management of depression and/or psychosis refractory to drug therapy in patients with Parkinson disease.Methods A retrospective study was carried out including patients treated with electroconvulsive therapy during the period between 2002 and 2013. A review of the literature was performed.Results A total of 27 patients were included. In regards to the neuropsychiatric diagnosis, 14 patients had major depression, 12 patients had both psychosis and depression, and only one patient had isolated psychosis. The mean number of electroconvulsive therapy sessions was 12 ± 2.8. After electroconvulsive therapy, all patients showed a statistically significant improvement in the Brief Psychiatric Rating scale (reduction of 52% points) and Hamilton Depression Rating Scale (reduction of 50% points) independent of the presence of psychosis, depression or both.Conclusion Electroconvulsive therapy is effective for the treatment of refractory neuropsychiatric symptoms in Parkinson’s disease.

Escitalopram improves neural functional prognosis and endothelial dysfunction in patients with acute cerebral infarction

2020 ◽  
Vol 38 (5) ◽  
pp. 385-393
Author(s):  
Jin-Xia Cao ◽  
Li Liu ◽  
Yun-Tao Sun ◽  
Qing-Hong Zeng ◽  
Zhen-Dong Yang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Endothelial Dysfunction ◽  
Acute Ischemic Stroke ◽  
Rating Scale ◽  
Mmse Score ◽  
Neurological Deficits ◽  
Control Group ◽  
Relative Safety ◽  
The Mean

Background: Escitalopram is one of the most commonly used SSRIs at present, which has the characteristics of quick onset, less interactions with other drugs, and relative safety. Objective: This study aims to investigate the effects of escitalopram on neural functional prognoses and endothelial dysfunction after acute ischemic stroke. Methods: One hundred eligible patients afflicted with acute ischemic stroke were randomized into two groups: control and treatment groups. Patients in the treatment group received escitalopram in addition to the basic therapies in the control group over a period of 90 days. Neurological deficits were quantified using the National Institutes of Health Stroke Scale (NIHSS) score and Barthel index (BI) score, cognitive impairment was determined using the Mini-Mental State Examination (MMSE) score, depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (HAMD). Furthermore, post-stroke depression (PSD) was defined based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), with a HAMD score ≥17. Flow-mediated vascular dilatation (FMD) of the brachial artery was use as a surrogate indicator for endothelial dysfunction assessment with ultrasound. Results: The mean NIHSS and HAMD scores on day 90 after treatment were significantly lower in the treatment group than in the control group (2.17±0.36 vs. 4.24±0.85; 5.81±1.35 vs. 10.43±4.91; P < 0.01), while the mean BI score and FMD were significantly higher in the treatment group (93.08±6.23 vs. 79.64±7.56, P < 0.01; 8.71±2.35 vs. 5.83±1.21, P < 0.05) than in the control group. The improvement in MMSE score was not significantly different between the two groups. Conclusions: Treatment with escitalopram early after ischemic stroke can improve neural functional prognoses and endothelial dysfunction. Escitalopram had less side effects, which is worthy of clinical prophylactic application.

Comparative efficacy and safety of oxcarbazepine versus divalproex sodium in the treatment of acute mania: A pilot study

2009 ◽  
Vol 24 (3) ◽  
pp. 178-182 ◽  
Author(s):  
Ashish Kumar Kakkar ◽  
H.S. Rehan ◽  
K.E.S. Unni ◽  
Neeraj Kumar Gupta ◽  
Deepti Chopra ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Drug Events ◽  
Rating Scale ◽  
Response To Treatment ◽  
Acute Mania ◽  
Comparable Efficacy ◽  
Divalproex Sodium ◽  
Efficacy And Safety ◽  
Number Of Patients ◽  
The Mean

AbstractObjectiveThis study compared the efficacy and safety of oxcarbazepine and divalproex sodium in acute mania patients.Subjects and methodsIn this 12 week, randomized, double-blind pilot study, 60 patients diagnosed with acute mania (DSM-IV) and a baseline Young Mania Rating Scale (YMRS) score of 20 or more received flexibly dosed oxcarbazepine (1000–2400 mg/day) or divalproex (750–2000 mg/day). The mean decrease in the YMRS score from baseline was used as the main outcome measure of response to treatment. A priori protocol-defined threshold scores were ≤12 for remission and ≥15 for relapse. Number of patients showing adequate response and the time taken to achieve improvement was compared. Adverse events were systematically recorded throughout the study.ResultsOver 12 weeks, mean improvement in YMRS scores was comparable for both the groups including the mean total scores as well as percentage fall from baseline. There were no significant differences between treatments in the rates of symptomatic mania remission (90% in divalproex and 80% in oxcarbazepine group) and subsequent relapse. Median time taken to symptomatic remission was 56 days in divalproex group while it was 70 days in the oxcarbazepine group (p = 0.123). A significantly greater number of patients in divalproex group experienced one or more adverse drug events as compared to patients in the oxcarbazepine group (66.7% versus 30%, p < 0.01).ConclusionOxcarbazepine demonstrated comparable efficacy to divalproex sodium in the management of acute mania. Also the overall adverse event profile was found to be superior for oxcarbazepine.

Comparison of the Clinical and Treatment Characteristics of Patients Undergoing Electroconvulsive Therapy for Catatonia Indication in the Context of Gender

2021 ◽  
pp. 155005942110258
Author(s):  
Zozan Parsanoglu ◽  
Ozlem Devrim Balaban ◽  
Sakir Gica ◽  
Ozge Canbek Atay ◽  
Ozan Altin
Keyword(s):  
Clinical Data ◽  
Electroconvulsive Therapy ◽  
Response Rate ◽  
Signs And Symptoms ◽  
Response To Treatment ◽  
Global Improvement ◽  
Male And Female ◽  
Opposite Sex ◽  
The Mean

The aim of this study was to compare in the context of gender both clinical diagnosis and disease-related differences and electroconvulsive therapy (ECT)-related differences in data and efficacy in hospitalized patients with catatonic signs and symptoms. Data from 106 patients who received ECT with catatonia indication were retrospectively analyzed. Clinical data of male (n = 58) and female (n = 48) patients were compared. Hospitalization documents and outpatient files, sociodemographic and clinical data form, Clinical Global Improvement scores used by the ECT unit in the follow-up of patients who received ECT were used in the study. It was seen that the mean age of women at the onset of ECT was higher than in men and the presence of prolonged seizures was more common than men. In men, it was found out that the average number of sessions with the onset of clinical response to treatment was higher than the average of women. The distribution of diagnoses by gender showed that the presence of schizophrenia diagnosis in men and of bipolar disorder in women were significantly more frequent compared to the opposite sex. It was found out that there were no significant differences between genders in terms of response rate to ECT. Our study is important for being the first study in the literature investigating the gender differences in ECT used for catatonia. However, gender is not a distinctive factor in the effectiveness of treatment, there are some important differences between male and female patients showing signs and symptoms of catatonia and undergoing ECT.

Assessment of objective response rate (ORR) by investigator versus blinded independent central review in pivotal trials of drugs approved for solid tumor indications.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13570-e13570
Author(s):  
Marjorie E. Zettler ◽  
Choo H. Lee ◽  
Ajeet Gajra ◽  
Bruce A. Feinberg
Keyword(s):  
Solid Tumors ◽  
Solid Tumor ◽  
Objective Response Rate ◽  
Response Rate ◽  
Objective Response ◽  
Progression Free Survival ◽  
Complete Response ◽  
Mean Difference ◽  
Response To Treatment ◽  
The Mean

e13570 Background: Objective response rate (ORR), defined as the proportion of patients with a complete response or partial response to treatment according to Response Evaluation Criteria in Solid Tumors (RECIST), is the most common endpoint used in pivotal trials supporting FDA approval of cancer drugs for solid tumor indications. Blinded independent central review (BICR) is frequently employed in clinical trials to minimize bias in evaluation of response rate, as historically, assessment of response by investigators (INV) has been shown to overestimate treatment effect. In this study, we analyzed the variability in assessment of ORR between INV and BICR in trials supporting recent Food and Drug Administration (FDA) approvals of drugs for solid tumor indications. Methods: The FDA’s novel drug approvals (2015-2019) were reviewed to identify drugs receiving primary approval for solid tumor indications. Drug approval packages accessed via the Drugs@FDA database and primary publications for the pivotal trials accessed via PubMed were reviewed for investigator-assessed and BICR-assessed ORR. For trials reporting both assessments, the difference between INV and BICR ORR was determined across all study arms. Data are presented using descriptive statistics. Results: A total of 36 drugs received primary approval for the treatment of solid tumors between 2015 and 2019. Of the 40 supporting trials, ORR was the primary endpoint for 21 (52.5%), progression-free survival for 13 (32.5%), and overall survival for 2 (5.0%). ORR was evaluated in 35 of the 40 trials (87.5%). Eight (22.9%) of the 35 trials evaluated INV ORR only, 5 (14.3%) evaluated BICR ORR only, and 22 (62.9%) evaluated both INV and BICR ORR. Among the 22 trials (29 arms in total), the mean difference between BICR- and INV-assessed ORR was -4.3% (95% CI: -6.4, -2.3); the range was -13.1 to 5. INV-assessed ORR was greater than BICR-assessed ORR in 22 of 29 arms (75.9%). The mean difference between BICR- and INV-assessed ORR among the 6 arms representing placebo or active control was -6.0 (95% CI: -11.0, -0.9), compared with -3.9 (95% CI: -6.3, -1.5) among the 23 experimental arms. Conclusions: Compared with BICR, INV overestimated ORR in three-quarters of the trial arms, including those representing control and experimental treatments. Despite this variability, for one fifth of the trials supporting approval of drugs to treat solid tumors, INV was the only method used to assess ORR. For consistency, and the ability to make relative cross-trial comparisons of ORR between agents, BICR should be considered for evaluation of tumor response in all registrational trials.

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