scholarly journals Pharmacologic treatment of schizophrenia

2010 ◽  
Vol 12 (3) ◽  
pp. 345-357 ◽  
Keyword(s):  
Adverse Effects ◽  
First Generation ◽  
Second Generation ◽  
Treatment Options ◽  
Patient Choice ◽  
Acute Response ◽  
Augmentation Strategies ◽  
Second Generation Antipsychotics ◽  
New Treatment ◽  
First And Second Generation

Despite pharmacologic advances, the treatment of schizophrenia remains a challenge, and suboptimal outcomes are still all too frequent. Although treatment goals of response, remission, and recovery have been defined more uniformly, a good "effectiveness" measure mapping onto functional outcomes is still lacking. Moreover, the field has to advance in transferring measurement-based approaches from research to clinical practice. There is an ongoing debate whether, and which, first- or second-generation antipsychotics should be used. However an individualized treatment approach needs to consider current symptoms, comorbid conditions, past therapeutic response, and adverse effects, as well as patient choice and expectations. Moreover acute and long-term goals and effects of medication treatment need to be balanced. While the acute response to appropriately dosed first-generation antipsychotics may not differ much from second-generation antipsychotics, advantages of lower rates of extrapyramidal side effects, tardive dyskinesia, and, possibly, relapse may favor second-generation antipsychotics. However when considering individual adverse effect profiles, the differentiation into first- and second-generation antipsychotics as unified classes can not be upheld, and a more differentiated view and treatment selection is required. To date, clozapine is the only evidence-based treatment for refractory patients, and the role of antipsychotic polypharmacy and other augmentation strategies remains unclear, at best. To improve the treatment outcomes in schizophrenia, research efforts are needed that elucidate biomarkers of the illness and of treatment response (both therapeutic and adverse effects). Moreover, new treatment options are needed that affect nondopaminergic targets with relevance for symptom reduction, relapse prevention, enhanced efficacy for nonresponders, and reduced key adverse effects.

scholarly journals Second-Generation Antipsychotics and Extrapyramidal Adverse Effects

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Nevena Divac ◽  
Milica Prostran ◽  
Igor Jakovcevski ◽  
Natasa Cerovac
Keyword(s):  
Adverse Effects ◽  
First Generation ◽  
Second Generation ◽  
Great Expectations ◽  
Extrapyramidal Syndrome ◽  
Generation Agent ◽  
Second Generation Antipsychotics ◽  
History Of ◽  
High Doses ◽  
First And Second Generation

Antipsychotic-induced extrapyramidal adverse effects are well recognized in the context of first-generation antipsychotic drugs. However, the introduction of second-generation antipsychotics, with atypical mechanism of action, especially lower dopamine receptors affinity, was met with great expectations among clinicians regarding their potentially lower propensity to cause extrapyramidal syndrome. This review gives a brief summary of the recent literature relevant to second-generation antipsychotics and extrapyramidal syndrome. Numerous studies have examined the incidence and severity of extrapyramidal syndrome with first- and second-generation antipsychotics. The majority of these studies clearly indicate that extrapyramidal syndrome does occur with second-generation agents, though in lower rates in comparison with first generation. Risk factors are the choice of a particular second-generation agent (with clozapine carrying the lowest risk and risperidone the highest), high doses, history of previous extrapyramidal symptoms, and comorbidity. Also, in comparative studies, the choice of a first-generation comparator significantly influences the results. Extrapyramidal syndrome remains clinically important even in the era of second-generation antipsychotics. The incidence and severity of extrapyramidal syndrome differ amongst these antipsychotics, but the fact is that these drugs have not lived up to the expectation regarding their tolerability.

scholarly journals Psychopharmacology and adverse effects of antipsychotic long-acting injections: A review

2009 ◽  
Vol 195 (S52) ◽  
pp. s13-s19 ◽  
Author(s):  
David Taylor
Keyword(s):  
Weight Gain ◽  
Adverse Effects ◽  
Movement Disorders ◽  
First Generation ◽  
Second Generation ◽  
High Rate ◽  
Metabolic Effects ◽  
Using Data ◽  
Long Acting ◽  
First And Second Generation

BackgroundDepot antipsychotics are widely used in clinical practice. Long-acting formulations of second-generation antipsychotics are now being developed and introduced.AimsTo review the pharmacology, pharmacokinetics and adverse effect profiles of currently available antipsychotic long-acting injections (LAIs).MethodThe psychopharmacological properties of first- and second-generation antipsychotic LAIs are reviewed using data available up to October 2008.ResultsFirst-generation antipsychotic (FGA) LAIs are associated with a high rate of acute and chronic movement disorders. Risperidone LAI is better tolerated in this respect, but is associated with hyperprolactinaemia and weight gain. Olanzapine LAI causes weight gain and other metabolic effects but appears not to be associated with an important incidence of movement disorders.ConclusionsDosing of LAIs is complicated by delayed release of drug, changes in plasma levels without change in dose, and by the lack of data establishing clear dose requirements. All LAIs offer the prospect of assured adherence (although patients may still default on treatment) but their use is complicated by adverse effects, complex pharmacokinetics and confusion over dose–response relationships.

Clozapine augmentation strategies – a systematic meta-review of available evidence. Treatment options for clozapine resistance

2019 ◽  
Vol 33 (4) ◽  
pp. 423-435 ◽  
Author(s):  
Elias Wagner ◽  
Lisa Löhrs ◽  
Dan Siskind ◽  
William G Honer ◽  
Peter Falkai ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Electroconvulsive Therapy ◽  
Second Generation ◽  
Treatment Options ◽  
Symptom Improvement ◽  
Positive Symptoms ◽  
Supporting Evidence ◽  
Augmentation Strategies ◽  
Second Generation Antipsychotics ◽  
Meta Analyses

Background: Treatment options for clozapine resistance are diverse whereas, in contrast, the evidence for augmentation or combination strategies is sparse. Aims: We aimed to extract levels of evidence from available data and extrapolate recommendations for clinical practice. Methods: We conducted a systematic literature search in the PubMed/MEDLINE database and in the Cochrane database. Included meta-analyses were assessed using Scottish Intercollegiate Guidelines Network criteria, with symptom improvement as the endpoint, in order to develop a recommendation grade for each clinical strategy identified. Results: Our search identified 21 meta-analyses of clozapine combination or augmentation strategies. No strategies met Grade A criteria. Strategies meeting Grade B included combinations with first- or second-generation antipsychotics, augmentation with electroconvulsive therapy for persistent positive symptoms, and combination with certain antidepressants (fluoxetine, duloxetine, citalopram) for persistent negative symptoms. Augmentation strategies with mood-stabilisers, anticonvulsants, glutamatergics, repetitive transcranial magnetic stimulation, transcranial direct current stimulation or cognitive behavioural therapy met Grades C–D criteria only. Conclusion: More high-quality clinical trials are needed to evaluate the efficacy of add-on treatments for symptom improvement in patients with clozapine resistance. Applying definitions of clozapine resistance would improve the reporting of future clinical trials. Augmentation with second-generation antipsychotics and first-generation antipsychotics can be beneficial, but the supporting evidence is from low-quality studies. Electroconvulsive therapy may be effective for clozapine-resistant positive symptoms.

scholarly journals Impact of adverse reactions to first-generation antipsychotics on treatment adherence in outpatients with schizophrenia: a cross-sectional study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Merhawi Bahta ◽  
Azieb Ogbaghebriel ◽  
Mulugeta Russom ◽  
Eyasu H. Tesfamariam ◽  
Tzeggai Berhe
Keyword(s):  
Adverse Effects ◽  
Treatment Adherence ◽  
First Generation ◽  
Second Generation ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Second Generation Antipsychotics ◽  
The Impact

Abstract Background Antipsychotics are well-known to cause potentially serious and life-threatening adverse drug reactions (ADRs) that have been reported to be also one of the major reasons for non-adherence. In Eritrea, shortage of psychiatrists and physicians, inadequacy of laboratory setups and unavailability of second-generation antipsychotics in the national list of medicines would seem to amplify the problem. This study’s objective is to determine the impact of adverse effects of first-generation antipsychotics on treatment adherence in outpatients with schizophrenia at Saint Mary Neuro-Psychiatric National Referral Hospital. Methods A cross-sectional study design was employed. All eligible adult patients with diagnosed schizophrenia (n = 242) who visited the hospital during the study period were enrolled. Data on ADRs, adherence and other variables were collected from patients using a self-administered questionnaire, interview and through medical cards review. The collected variables were analyzed using SPSS 22.0 with descriptive and multivariable logistic regression analysis. Statistical significance was tested at p value < 0.05. Results Greater than one-third (35.5%) of the patients with schizophrenia were non-adherent to treatment. The odds of non-adherence increased 1.06 times for each unit increase in the total ADR score (AOR = 1.06, 95% CI 1.04, 1.09). Patients with extrapyramidal (AOR = 44.69, 95% CI 5.98, 334.30), psychic (AOR = 14.90, 95% CI 1.90, 116.86), hormonal (AOR = 2.60, 95% CI 1.41, 4.80), autonomic (AOR = 3.23, 95% CI 1.37, 7.57) and miscellaneous reactions (AOR = 2.16, 95% CI 1.13, 4.13) were more likely to be non-adherent compared to their counterparts. Conclusion Poor treatment adherence was found to be substantial which was attributed to total ADR score, extrapyramidal, hormonal, psychic, autonomic and miscellaneous categories of reactions of the LUNSERS. To improve treatment adherence, early detection and management of adverse effects and inclusion of second-generation antipsychotics are recommended.

Pharmakotherapie update

2020 ◽  
Vol 25 (1) ◽  
pp. 23-32
Author(s):  
Gerd Laux
Keyword(s):  
First Generation ◽  
Second Generation ◽  
Therapeutische Maßnahmen ◽  
Second Generation Antipsychotics

Für die Therapie schizophrener Erkrankungen sind seit fast 60 Jahren Antipsychotika/Neuroleptika aufgrund ihrer antipsychotischen Wirkung von zentraler Bedeutung. Die Einteilung kann unter verschiedenen Gesichtspunkten erfolgen (chemische Struktur, neuroleptische Potenz, Rezeptorprofil), heute werden üblicherweise unterschieden typische (traditionelle, klassische, konventionelle) Antipsychotika der ersten Generation ‒ »First Generation Antipsychotics« (FGA) ‒ und sog. atypische (»neuere«) Neuroleptika bzw. Antipsychotika der zweiten Generation ‒»Second Generation Antipsychotics« (SGA). Hierzu zählen Aripiprazol, Asenapin, Cariprazin, Clozapin, Olanzapin, Quetiapin, Risperidon, Sertindol und Ziprasidon. Hierbei handelt es sich um keine homogene Gruppe – sowohl neuropharmakologisch (Wirkmechanismus), als auch hinsichtlich klinischem Wirkprofil und dem Nebenwirkungsspektrum bestehen z. T. erhebliche Unterschiede. Neben der Akut-Medikation ist eine Langzeitmedikation bzw. Rezidivprophylaxe mit Antipsychotika für die Rehabilitation vieler schizophrener Patienten im Sinne eines »Stresspuffers« von grundlegender Bedeutung. In Placebo-kontrollierten Studien trat bei Patienten, die über ein Jahr behandelt wurden, bei etwa 30% unter Neuroleptika ein Rezidiv auf, unter Placebo bei mehr als 70%. Für die Langzeitbehandlung bietet sich der Einsatz von Depot-Neuroleptika an, neu entwickelt wurden Langzeit-Depot-Injektionen mit Intervallen von bis zu 3 Monaten. Grundsätzlich ist die niedrigstmögliche (wirksame) Dosis zu verwenden. Im Zentrum der Nebenwirkungen (UAW) standen lange Zeit extrapyramidal-motorische Bewegungsstörungen (EPMS), mit der Einführung von Clozapin und anderen atypischen Antipsychotika der zweiten Generation gewannen andere Nebenwirkungen an Bedeutung. Hierzu zählen Gewichtszunahme, Störungen metabolischer Parameter und ein erhöhtes Risiko für Mortalität und zerebrovaskuläre Ereignisse bei älteren Patienten mit Demenz. Entsprechende Kontrolluntersuchungen sind erforderlich, für Clozapin gibt es aufgrund seines Agranulozytose-Risikos Sonderbestimmungen. Immer sollte ein Gesamtbehandlungsplan orientiert an der neuen S3-Praxisleitlinie Schizophrenie der DGPPN aufgestellt werden, der psychologische und milieu-/sozial-therapeutische Maßnahmen einschließt. Standard ist heute auch eine sog. Psychoedukation, für Psychopharmaka liegen bewährte Patienten-Ratgeber vor.

Metabolic and Cardiac Side Effects of Second-generation Antipsychotics: What Every Clinician Should Know

2009 ◽  
Vol 22 (5) ◽  
pp. 478-488 ◽  
Author(s):  
Ericka L. Breden ◽  
Mei T. Liu ◽  
Stacey R. Dean ◽  
Toyin S. Tofade
Keyword(s):  
Cardiovascular Disease ◽  
Health Care ◽  
Adverse Effects ◽  
Second Generation ◽  
Antipsychotic Agents ◽  
The United States ◽  
Natural Death ◽  
Cardiac Side Effects ◽  
Second Generation Antipsychotics ◽  
Physical Health Care

In 2007, 5 of the 7 second-generation antipsychotics were listed in the Top 200 Drugs prescribed by retail sales in the United States. Cardiovascular disease is the leading cause of natural death in individuals with schizophrenia. Second-generation antipsychotics have been implicated with metabolic and cardiovascular adverse effects, and it is important for nonpsychiatric practitioners to be familiar with the monitoring parameters recommended for these agents. This article discusses the risk of weight gain, hyperglycemia, hyperlipidemia, hyperprolactinemia, and cardiovascular concerns associated with second-generation antipsychotic agents. It also discusses the proposed mechanisms for each of these adverse effects. Furthermore, it reviews suggested monitoring parameters to help manage cardiovascular disease in this patient population, and to improve the gap that exists between mental health care and physical health care in the schizophrenic population.

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