Use of Psychoeducation for Psychotic Disorder Patients Treated With Modern, Long-Acting, Injected Antipsychotics

Introduction: There is an increased risk of adverse metabolic effects of some modern antipsychotic drugs, and concern that long-acting, injected preparations of them may increase such risk. We now report on clinical and metabolic outcomes in patient-subjects diagnosed with affective and non-affective psychotic disorders following exposure to psychoeducation on metabolic risks of modern antipsychotics followed by treatment with long-acting atypical injected antipsychotics over 6-months.Materials and Methods: 85 psychotic disorder outpatients (42 affective [AP]; 43 non-affective [NAP]) at the University of Foggia were treated with long-acting, injected, second-generation antipsychotics in association with a set of psychoeducational sessions concerning general health and potential effects of antipsychotic drug treatments. They were evaluated at baseline and six months.Results: Initially, NAP subjects reported higher ratings of positive and negative symptoms than AP subjects, were more likely to receive risperidone or paliperidone, with higher CPZ-eq doses of antipsychotics (294.0 ± 77.8 vs. 229.3 ± 95.8 mg/day), and shorter QTc electrocardiographic recovery intervals. During the 6-month follow-up, ratings of treatment-adherence improved through overall (+8.75%), and symptom-ratings decreased (−7.57%) as did Body-Mass Index (−2.40%; all p ≤ 0.001). Moreover, serum levels of fasting glucose, hemoglobin glycosylation, cholesterol and prolactin concentrations all decreased, with little difference between subjects with AP vs. NAP.Discussion and Conclusions: A psychoeducational program was associated with consistent improvement in psychotic symptoms and several metabolic and physiological measures, as well as with treatment-adherence during six months of treatment with long-acting, injected, second-generation antipsychotics, in association with both affective and non-affective psychotic disorders.

Download Full-text

Efficacy and tolerability of switching to long-acting injectable (LAI) aripiprazole in outpatients with schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.646 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s255-s256

Author(s):

B. Fernández-Abascal Puente ◽

M. Juncal Ruiz ◽

R. Landera Rodríguez

Keyword(s):

Side Effects ◽

Treatment Regimen ◽

Treatment Adherence ◽

Side Effect ◽

Negative Symptoms ◽

Psychotic Symptoms ◽

Oral Olanzapine ◽

Insufficient Response ◽

Competing Interest ◽

Long Acting

IntroductionSwitching antipsychotics is a therapeutic alternative for managing side-effects, or efficacy and compliance issues.AimTo evaluate the efficacy and tolerability of switching to LAI-aripiprazole in patients who had insufficient response or were intolerant to the previous antipsychotic, or required a more convenient treatment regimen.MethodsThis was a prospective, observational, 6-months study carried out in 45 outpatients with schizophrenia who were clinically stabilized but a switching to another antipsychotic was clinically indicated. Patients who required hospitalization, treatment discontinuation or adding another antipsychotic (including supplementation with oral-aripiprazole) were considered treatment failures. Switching was considered successful if the side-effect/symptom/adherence/convenience improved or, if applicable, disappeared.ResultsPatients aged 38 years, 51% women, and previous antipsychotics comprised: LAI-paliperidone (42%), oral-aripiprazole (22%), oral-olanzapine (11%), oral-risperidone (7%), LAI-risperidone (4%) and others (14%). The efficacy results of the switching are presented in the table. Of the 45 patients, 7 (15%) were considered treatment failures: 3 patients were hospitalized due to recurrence of psychotic symptoms, 2 discontinued LAI-aripiprazole, and 2 required supplementation with oral-aripiprazole (Fig 1).ConclusionsOur results suggest that switching to LAI-aripiprazole is an efficacious strategy for managing some antipsychotic-induced side-effects, persistence of negative symptoms and/or lack of treatment adherence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

P01-366-New treatment option in resistant schizophrenia in adolescence - case study

European Psychiatry ◽

10.1016/s0924-9338(11)72077-6 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 368-368 ◽

Cited By ~ 1

Author(s):

A. Wisniewski

Keyword(s):

Negative Symptoms ◽

Poor Response ◽

Psychotic Symptoms ◽

Psychotic Episode ◽

Antipsychotic Treatment ◽

Second Generation Antipsychotics ◽

Paranoid Type ◽

New Treatment ◽

Long Acting

Early-onset schizophrenia has not only more severe course than in adults, it is also associated with poor response to antipsychotic treatment. There are only limited data about effectiveness, safety and tolerability of second generation antipsychotics (SGA) in children, but current recommendations suggest using atypical antipsychotics as the first line treatment.Case study15-year-old schoolboy admitted to psychiatric hospital after acute psychotic episode. His symptoms started 2 years ago. After a few months he was diagnosed schizophrenia paranoid type. During 2 years he has been hospitalized many times because of persistent psychotic symptoms. He was treated using: risperidon, olanzapine, amisulpride, quetiapine, ziprasidone, perfenazin. All the drugs were ineffective, all were used in full doses, given no shorter than 8 weeks. Patient did not cooperate in treatment - he spits out or has hide the tablets, has to be controlled during drug supplies. He did not responded to long-acting injections of risperidon. Finally the treatment has been changed to new form of olanzapine in extended release injections started 210 mg i.m. every 14 days increased to 300 mg after 2 weeks. After 2 months of treatment (5 injections) reduction of positive and negative symptoms of schizophrenia was observed. Patients starts to socialize, attend school. He is on the drug now, the drug is well tolerated.

Download Full-text

Use of Aripiprazole Long Acting Injection in Negative Symptoms of Schizophrenia

Case Reports in Psychiatry ◽

10.1155/2016/7912083 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Suneeta James ◽

Chaya Kapugama ◽

Mohammed Al-Uzri

Keyword(s):

Negative Symptoms ◽

Second Generation ◽

Research Needs ◽

Case Presentation ◽

Level Of Functioning ◽

Second Generation Antipsychotics ◽

Long Acting

Background. Evidence for the efficacious use of second-generation antipsychotics for the treatment of negative symptoms in schizophrenia is scant.Case Presentation. We report the case of a 34-year-old female of Afro-Caribbean origin, who presented with prominent negative symptoms of schizophrenia and was successfully treated with aripiprazole long acting injection. Within a period of six to nine months, the patient returned to her premorbid level of functioning.Conclusion. Aripiprazole long acting injection promises benefits in the treatment of negative symptoms of schizophrenia. Further research needs to be conducted on the use of this drug.

Download Full-text

First- v. second-generation antipsychotics and risk for diabetes in schizophrenia: Systematic review and meta-analysis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.107.037184 ◽

2008 ◽

Vol 192 (6) ◽

pp. 406-411 ◽

Cited By ~ 180

Author(s):

M. Smith ◽

D. Hopkins ◽

R. C. Peveler ◽

R. I. G. Holt ◽

M. Woodward ◽

...

Keyword(s):

Systematic Review ◽

First Generation ◽

Second Generation ◽

Psychotic Disorders ◽

Controlled Trial ◽

Meta Analysis ◽

Antipsychotic Treatment ◽

Cross Sectional ◽

Increased Risk ◽

Second Generation Antipsychotics

BackgroundThe increased prevalence of diabetes in schizophrenia is partly attributed to antipsychotic treatment, in particular second-generation antipsychotics, but the evidence has not been systematically reviewed.AimsSystematic review and meta-analysis comparing diabetes risk for different antipsychotics in people with schizophrenia.MethodWe searched MEDLINE, PsycINFO, EMBASE, International Pharmaceutical Abstracts, CINAHL and Web of Knowledge until September 2006. Studies were eligible for inclusion if the design was cross-sectional, case-control, cohort or a controlled trial in individuals with schizophrenia or related psychotic disorders, where second-generation antipsychotics (defined as clozapine, olanzapine, risperidone and quetiapine) were compared with first-generation antipsychotics and diabetes was an outcome. Data were pooled using random effects inverse variance weighted meta-analysis.ResultsOf the studies that met the inclusion criteria (n=14), 11 had sufficient data to include in the meta-analysis. Four of these were retrospective cohort studies. The relative risk of diabetes in patients with schizophrenia prescribed one of the second-generation v. first-generation antipsychotics was 1.32 (95% CI 1.15-1.51). There were insufficient data to include aripiprazole, ziprasidone and amisulpride in this analysis.ConclusionsThere is tentative evidence that the second-generation antipsychotics included in this study are associated with a small increased risk for diabetes compared with firstgeneration antipsychotics in people with schizophrenia. Methodological limitations were found in most studies, leading to heterogeneity and difficulty interpreting data. Regardless of type of antipsychotic, screening for diabetes in all people with schizophrenia should be routine.

Download Full-text

Increased risk of psychotic disorder among immigrants in Malmö: a 3-year first-contact study

Psychological Medicine ◽

10.1017/s0033291705004721 ◽

2005 ◽

Vol 35 (8) ◽

pp. 1155-1163 ◽

Cited By ~ 38

Author(s):

ELIZABETH CANTOR-GRAAE ◽

KRYSTYNA ZOLKOWSKA ◽

THOMAS F. McNEIL

Keyword(s):

Psychotic Disorder ◽

First Generation ◽

Second Generation ◽

Psychotic Disorders ◽

Adjusted Relative Risk ◽

White Skin ◽

First Generation Immigrants ◽

Second Generation Immigrants ◽

Increased Risk ◽

First Contact

Background. Previous findings of increased rates of psychotic disorders among immigrants to Sweden are primarily based on hospital samples. The aim of the current study was to compare the risks of first contact for psychotic and schizophrenic disorders among first- and second-generation immigrants to the risks in native ‘Swedes’.Method. During a 3-year period, diagnostic information was collected on all patients with a possible psychotic disorder who made a first-in-lifetime contact with both in-patient and out-patient psychiatric services in Malmö.Results. First-generation immigrants to Sweden had an increased risk of developing psychotic and schizophrenic disorders compared to Swedes (age- and gender-adjusted relative risk, RR 2·9, 95% CI 2·0–4·0 and RR 4·0, 95% CI 1·8–8·6 respectively). Risks for these disorders were not significantly increased in second-generation immigrants. The highest risks of developing psychotic disorder compared to Swedes were found in first-generation immigrants with ‘black’ (versus ‘neither black nor white’, or ‘white’) skin colour (RR 5·8, 95% CI 2·8–13·4) and birthplace in a developing (versus developed) country (RR 3·3, 95% CI 2·3–4·8).Conclusion. The increased risks of psychosis obtained especially in immigrant groups having relatively disadvantaged status in Sweden suggest that psychosocial factors may contribute to the development of psychotic disorders.

Download Full-text

Long-Acting Injectable Second-Generation Antipsychotics Improve Negative Symptoms and Suicidal Ideation in Recent Diagnosed Schizophrenia Patients: A 1-Year Follow-up Pilot Study

Schizophrenia Research and Treatment ◽

10.1155/2018/4834135 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Valentina Corigliano ◽

Anna Comparelli ◽

Iginia Mancinelli ◽

Benedetta Montalbani ◽

Dorian A. Lamis ◽

...

Keyword(s):

Suicidal Ideation ◽

Early Phase ◽

Negative Symptoms ◽

Second Generation ◽

Rating Scale ◽

Chronic Schizophrenia ◽

Illness Duration ◽

Second Generation Antipsychotics ◽

Long Acting

Long-acting injectable second-generation antipsychotics (LAI-SGA) are typically used to maintain treatment adherence in patients with chronic schizophrenia. Recent research suggests that they may also provide an effective treatment strategy for patients with early-phase disease. The aim of this study is to evaluate clinical and psychosocial outcomes among recent and long-term diagnosed schizophrenia outpatients treated with LAI-SGA during a follow-up period of 12 months. Stable schizophrenia patients receiving LAI-SGA with 5 or less years of illness duration (n = 10) were compared to those with more than 5 years of illness duration (n = 15). Clinical data was assessed through the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), the Columbia Suicide Severity Rating Scale (C-SSRS), the Recovery Style Questionnaire (RSQ), and the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) Managing Emotion branch. Recently diagnosed patients showed greater improvement versus patients diagnosed for more than 5 years in adjusted mean GAF score, in PANSS factor score for negative and depressive symptoms, and in severity and intensity of suicidal ideation. Our preliminary findings support the hypothesis that LAI-SGA may influence the course of the illness if administered at the early phase of the illness. However, replicate studies are needed, possibly with larger samples.

Download Full-text

The Comparison Between Positive & Negative Symptoms Severity in Prolonged Methamphetamine-Induced Psychotic Disorder and Schizophrenia

Basic and Clinical Neuroscience Journal ◽

10.32598/bcn.2021.2837.1 ◽

2021 ◽

Author(s):

Hamidreza Ahmadkhaniha ◽

◽

Nazanin Ayazi ◽

Kaveh Alavi ◽

Mohammad Reza Najarzadegan ◽

...

Keyword(s):

Psychotic Disorder ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Structured Interview ◽

Psychotic Symptoms ◽

Control Group ◽

Case Group ◽

Chi Square ◽

Significant Difference ◽

The Difference

Introduction: This study aims to compare the positive and negative symptoms of schizophrenia in patients who had psychotic symptoms more than one month after discontinuation of methamphetamine abuse. These factors were analyzed by the PANSS (Positive and Negative Syndrome Scale) questionnaire. Materials and Methods: 60 participants were selected from patients referred to Iran Psychiatric Hospital with psychotic symptoms (delusions or hallucinations, disorganized behavior, and speech). The control group was 30 patients with schizophrenia based on a semi-structured interview according to DSM-IV-TR (SCID). 30 patients with the prolonged methamphetamine-induced psychotic disorder had been also placed in the case group. For both groups of patients, questionnaires of PANSS, BPRS, GAF was filled after obtaining the consent of the company. The scale scores were compared between groups. To evaluate the mean of PANSS, BPRS, and the GAF scores between the two groups we used the Mann-Whitney and the chi-square test. Results: There was no significant difference in terms of positive and general pathology scores between two groups but the total score of negative symptoms in the schizophrenia group was significantly higher than the group of prolonged methamphetamine psychotic disorders (P = 0.034). Average scores of Uncooperativeness (0.013), Unusual thought content (0.004), Motor retardation (0.011), unusual thought content (0.002) and, Hostility (0.001) in schizophrenia were significantly higher than prolonged methamphetamine psychosis. Conclusion: The results showed that most of the disturbances in patients with schizophrenia may be more influenced by the expression of cognitive disabilities in them compared to patients with methamphetamine psychosis. The difference in scores of negative symptoms suggesting that schizophrenia and prolonged methamphetamine psychotic disorder can be two different disorders.

Download Full-text

Paliperidone to Treat Psychotic Disorders

Neurology International ◽

10.3390/neurolint13030035 ◽

2021 ◽

Vol 13 (3) ◽

pp. 343-358

Author(s):

Hormazd D. Minwalla ◽

Peter Wrzesinski ◽

Allison Desforges ◽

Joshua Caskey ◽

Brittany Wagner ◽

...

Keyword(s):

Cognitive Impairment ◽

Schizoaffective Disorder ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Drug Information ◽

The United States ◽

Mental Illnesses ◽

Positive Symptoms ◽

Review Of The Literature ◽

Second Generation Antipsychotics

Purpose of Review: This is a comprehensive review of the literature regarding the use of paliperidone in the treatment of schizophrenia and schizoaffective disorder. It covers the background and presentation of schizophrenia and schizoaffective disorder, as well as the mechanism of action and drug information for paliperidone. It covers the existing evidence of the use of paliperidone for the treatment of schizophrenia and schizoaffective disorder. Recent Findings: Schizophrenia and schizoaffective disorder lead to significant cognitive impairment. It is thought that dopamine dysregulation is the culprit for the positive symptoms of schizophrenia and schizoaffective disorder. Similar to other second-generation antipsychotics, paliperidone has affinity for dopamine D2 and serotonin 5-HT2A receptors. Paliperidone was granted approval in the United States in 2006 to be used in the treatment of schizophrenia and in 2009 for schizoaffective disorder. Summary: Schizophrenia and schizoaffective disorder have a large impact on cognitive impairment, positive symptoms and negative symptoms. Patients with either of these mental illnesses suffer from impairments in everyday life. Paliperidone has been shown to reduce symptoms of schizophrenia and schizoaffective disorder.

Download Full-text

Frontal Lobe Epilepsy Presenting as a Psychotic Disorder With Delusions and Hallucinations: A Case Study

CNS Spectrums ◽

10.1017/s1092852900012207 ◽

1999 ◽

Vol 4 (9) ◽

pp. 64-66,82 ◽

Cited By ~ 4

Author(s):

Bonnie J. Ramsey

Keyword(s):

Temporal Lobe Epilepsy ◽

Frontal Lobe ◽

Psychotic Disorder ◽

Temporal Lobe ◽

Psychotic Disorders ◽

Psychotic Symptoms ◽

Frontal Lobe Epilepsy ◽

Unique Case ◽

Frontal Lobe Seizures

AbstractAlthough psychotic symptoms are a recognized manifestation of epilepsy, these are more often associated with seizures of the temporal lobe type. While 10% of children with temporal lobe epilepsy develop a psychotic disorder by adulthood, the literature does not report any cases of psychotic disorders associated with frontal lobe seizures in children. This article presents a unique case of a girl whose frontal lobe seizures were associated with delusional psychotic symptoms. Once her seizure disorder was identified through electroencephalography (EEG) and appropriate anticonvulsant therapy was initiated, her associated psychotic symptoms resolved.

Download Full-text

The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study

Psychological Medicine ◽

10.1017/s0033291713003188 ◽

2014 ◽

Vol 44 (11) ◽

pp. 2419-2430 ◽

Cited By ~ 17

Author(s):

F. J. Oher ◽

A. Demjaha ◽

D. Jackson ◽

C. Morgan ◽

P. Dazzan ◽

...

Keyword(s):

Depressive Symptoms ◽

Population Density ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Urban Environments ◽

Psychotic Symptoms ◽

First Episode ◽

Multilevel Regression ◽

Symptom Dimensions ◽

Reality Distortion

BackgroundThe extent to which different symptom dimensions vary according to epidemiological factors associated with categorical definitions of first-episode psychosis (FEP) is unknown. We hypothesized that positive psychotic symptoms, including paranoid delusions and depressive symptoms, would be more prominent in more urban environments.MethodWe collected clinical and epidemiological data on 469 people with FEP (ICD-10 F10–F33) in two centres of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study: Southeast London and Nottinghamshire. We used multilevel regression models to examine neighbourhood-level and between-centre differences in five symptom dimensions (reality distortion, negative symptoms, manic symptoms, depressive symptoms and disorganization) underpinning Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Item Group Checklist (IGC) symptoms. Delusions of persecution and reference, along with other individual IGC symptoms, were inspected for area-level variation.ResultsReality distortion [estimated effect size (EES) 0.15, 95% confidence interval (CI) 0.06–0.24] and depressive symptoms (EES 0.21, 95% CI 0.07–0.34) were elevated in people with FEP living in more urban Southeast London but disorganized symptomatology was lower (EES –0.06, 95% CI –0.10 to –0.02), after controlling for confounders. Delusions of persecution were not associated with increased neighbourhood population density [adjusted odds ratio (aOR) 1.01, 95% CI 0.83–1.23], although an effect was observed for delusions of reference (aOR 1.41, 95% CI 1.12–1.77). Hallucinatory symptoms showed consistent elevation in more densely populated neighbourhoods (aOR 1.32, 95% CI 1.09–1.61).ConclusionsIn people experiencing FEP, elevated levels of reality distortion and depressive symptoms were observed in more urban, densely populated neighbourhoods. No clear association was observed for paranoid delusions; hallucinations were consistently associated with increased population density. These results suggest that urban environments may affect the syndromal presentation of psychotic disorders.

Download Full-text