scholarly journals Decision analytic economic paliperidone ER in relapsing schizophrenic patients in Italy

2008 ◽  
Vol 9 (2) ◽  
pp. 95-108 ◽  
Author(s):  
Patrizia Berto ◽  
Cristina Negrini ◽  
Luigi Ferrannini
Keyword(s):  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Development Program ◽  
Sensitivity Analyses ◽  
Psychotic Symptoms ◽  
Base Case ◽  
Management Options ◽  
Pharmacological Management ◽  
Clinical Development Program ◽  
Schizophrenic Patients

Schizophrenia, with its typical chronic and relapsing course, is very burdensome, both clinically and economically. Its pharmacological management relies on two main drug classes: the older, or typical, antipsychotics, which are quite effective on positive symptoms, but limited by low tolerability and poor efficacy on negative symptoms, and atypical antipsychotics, which are better tolerated and effective on a wider range of psychotic symptoms. In this article, the authors briefly discuss current management options for patients with schizophrenia and highlight some unmet clinical needs in the field. After outlining the main clinical features shown by paliperidone ER, a novel antipsychotic, in its clinical development program, a decision analytic economic appraisal of its use in relapsing schizophrenic patients in Italy, as compared to the other available atypical antipsychotics, is presented. Under base-case assumption and after applying national costs and tariffs, the model predicts paliperidone ER to be associated with better clinical outcomes, expressed in terms of stable days, and lower costs; this means that paliperidone is dominant over the alternatives, according to the principles of economic evaluation of healthcare technologies. One-way sensitivity analyses conducted on structural and cost parameters indicated robustness of base-case estimates, which remain to be confirmed by “real world” national data.

New dopaminergic and non-dopaminergic theories in schizophrenia and their therapeutic impact

1997 ◽  
Vol 9 (2) ◽  
pp. 64-67
Author(s):  
R.S. Kahn
Keyword(s):  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Dopamine Neurons ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
The Core ◽  
Schizophrenic Patients ◽  
Core Symptoms ◽  
Influential Theory

The dopamine (DA) hypothesis of schizophrenia, postulating that schizophrenia is characterized by increased dopamine function, has been the most influential theory on the pathogenesis of schizophrenia. It has recently been revised based on the appreciation that the core symptoms of schizophrenia may not be the positive (psychotic) symptoms, but rather the negative symptoms and the cognitive deficits found in schizophrenic patients. This revision has prompted the hypothesis that schizophrenia is characterized by both decreased prefrontal dopamine activity (causing deficit symptoms) and increased dopamine activity in mesolimbic dopamine neurons (causing positive symptoms).Notwithstanding this revision of a role for dopamine in schizophrenia, it has become increasingly evident that dysfunction of other monoaminergic systems may be as important in contributing to the pathophysiology of schizophrenia. Specifically, the putative role of serotonin (5-hydroxytryptamine, 5-HT) in schizophrenia is gaining considerable attention. Several observations, such as the ability of the 5-HT antagonist, ritanserin, to alleviate schizophrenic symptoms and, when added to haloperidol (Haldol®), to decrease its extrapyramidal side-effects (EPS), have stimulated studies into a role of 5-HT in schizophrenia. The finding that clozapine (Leponex®), clinically superior to conventional neuroleptics, is a weak DA2 antagonist but a potent 5-HT1c and 5-HT2 antagonist has further stimulated 5-HT-related research in schizophrenia.

scholarly journals Neighbourhood characteristics at birth and positive and negative psychotic symptoms in adolescence: findings from the ALSPAC birth cohort

2018 ◽  
Author(s):  
Francesca Solmi ◽  
Glyn Lewis ◽  
James Bowes Kirkbride
Keyword(s):  
Negative Symptoms ◽  
Sensitivity Analyses ◽  
Risk Scores ◽  
Psychotic Symptoms ◽  
Logistic Regression Models ◽  
White Ethnicity ◽  
Parents And Children ◽  
Increased Risk ◽  
Using Data ◽  
Multivariable Adjustment

Objective: Urban birth is associated with risk of non-affective psychoses. While emerging evidence suggests that this association is also apparent for subclinical positive psychotic phenomena in the general population, few studies have considered which specific aspects of the urban environment predict risk, or whether these factors also increase the likelihood of negative symptoms. Method: Using data from the Avon Longitudinal Study of Parents and Children, linked to census geographical indicators, we examined whether population density, deprivation, inequality, and social fragmentation at birth were associated with negative and positive psychotic symptoms at age 16 and 18 years, respectively. We used logistic regression models, controlling for child’s ethnicity, maternal age, education, marital status, social class, depressive symptoms, other neighbourhood exposures, and, in sensitivity analyses, polygenic risk scores (PRS) for schizophrenia in a sub-sample of children of white ethnicity (N=10,283). Results: Amongst 11,879 adolescents, those born in the most densely populated tertile had greater odds of reporting positive psychotic experiences, after multivariable adjustment (odds ratio (OR): 1.57, 95% confidence intervals (CI): 1.14 – 2.17). Adolescents born in the most socially fragmented neighbourhoods had greater odds of negative symptoms, after multivariable adjustment (OR: 1.43, 95%CI: 1.06 – 1.85). These associations were not confounded by schizophrenia PRS. There was no evidence of any other associations. Discussion: Birth into more densely populated and socially fragmented environments increased risk of positive and negative psychotic phenomena in adolescence. Our findings suggest that different forms of neighbourhood social adversity impinge on different psychopathophysiologies associated with the clinical expression of psychosis.

Quality: A non-interventional study evaluating quality of life in schizophrenic patients treated with atypical antipsychotics in the ambulatory setting

2011 ◽  
Vol 26 (S2) ◽  
pp. 1474-1474
Author(s):  
J. Peuskens ◽  
E. Fontaine ◽  
T. Vanlerberghe
Keyword(s):  
Quality Of Life ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Short Form ◽  
Well Being ◽  
Ambulatory Setting ◽  
Subjective Well Being ◽  
Symptom Scale ◽  
Schizophrenic Patients

ObjectivesThe QUALITY study evaluated Quality-of-Life in schizophrenic patients treated with atypical antipsychotics (AAPs) in the ambulatory setting.MethodsThis study was a 9-month, observational, multicentre prospective study. Patients (18–65 years-old) diagnosed with schizophrenia and treatment started with one AAP before visit-1 (minimum: 4-weeks, maximum: 8-weeks) were enrolled into this Belgian study. At visit-1 patients’ demographics and medical history were recorded with follow-up visits after 3-, 6- and 9-months. At each visit, patients completed the Subjective Well-being under Neuroleptic treatment short form (SWN-K), while investigators assessed the Positive and Negative Symptom Scale (PANSS-8) and Global Assessment of Functioning.Results121 patients were enrolled: 91 male, mean age 36.7 ± 10.8years. The main AAPs were risperidone (38/121), apripirazole (28/121) and quetiapine (25/121). On average, most mean changes from baseline in SWN-K-subscale scores were positive (between −0.5 and +0.5, range −1.8–1.6) suggesting patients felt better, although there were no treatment-group differences. The associations between baseline SWN-K-subscales and age were small (RC [regression co-efficient] range: −0.03–0.01). PANSS-8-score changes were slightly negative (means between −0.77 and −0.43) suggesting decreased symptom severity. Patients with more severe negative symptoms considered their mental- and physical-functioning to be better throughout the study, indicated by significant correlations between these SWN-K-subscale scores and negative PANSS-scores (RC = 0.19, p = 0.0282; RC = 0.15, p = 0.0258). The associations between SWN-K-scores and positive PANSS-scores were small (RC: 0.01–0.14). The number of hospitalizations decreased during the study (9.6% between visit-1 and 2 vs. 7.5% visit-3 and −4).ConclusionsQuality-of-life for all patients seemed to improve slightly, without any differences between treatment-groups.

The Age of Atypical Antipsychotics

1996 ◽  
Vol 9 (2) ◽  
pp. 113-117
Author(s):  
Ronald Pies
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
D2 Receptor ◽  
Receptor Occupancy ◽  
Clinical Development ◽  
Pharmacological Management ◽  
Regional Brain

Atypical antipsychotics (AAPs) have led to refinements in the pharmacological management of schizophrenia and related disorders. Most AAPs produce fewer extra- pyramidal side effects than conventional agents, and appear to ameliorate "negative symptoms" to a greater degree. In general, many AAPs have a higher ratio of 5HT2 to D2 receptor occupancy than do conventional neuroleptics. This ratio may confer some of the "atypical" qualities to these agents, though regional brain selectivity may also be involved. Although clozapine and risperidone are the two AAPs clinicians now have available, many other similar agents are close to clinical development. Copyright © 1996 by W.B. Saunders Company

Tobacco use in schizophrenia: a study of cotinine concentrations in the saliva of patients and controls

2005 ◽  
Vol 20 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Jan-Erik Strand ◽  
Henrik Nybäck
Keyword(s):  
Tobacco Use ◽  
Negative Symptoms ◽  
Smoking Status ◽  
Psychiatric Patients ◽  
Psychotic Symptoms ◽  
Social Avoidance ◽  
Self Medication ◽  
Symptom Profiles ◽  
Schizophrenic Patients ◽  
Drug Doses

AbstractNicotine has been proposed to provide anxiety relief, oral gratification and self-medication of psychotic symptoms in psychiatric patients. In order to investigate the relations between psychopathology and tobacco use we measured the concentration of cotinine, the major metabolite of nicotine, in the saliva of psychiatric patients and healthy volunteers. In a sample of 42 schizophrenic patients we correlated smoking status, cotinine levels, symptom profiles (PANSS), and neuroleptic side effects (Simpson–Angus). Despite reporting the same amount of cigarettes consumed per day the saliva concentration of cotinine was significantly higher in patients with schizophrenia than in the controls. There were no significant differences in clinical characteristics between smoking and non-smoking schizophrenic patients, but smokers tended to be on higher drug doses. High cotinine concentrations correlated significantly with the negative symptoms Passive withdrawal and Social avoidance. The results indicate that the schizophrenic patients smoke cigarettes more intensely than other patients and healthy subjects. The correlation between high cotinine levels and negative symptomatology may reflect an attempt by schizophrenic patients to overcome the emotional withdrawal and thus the results may lend support to a self-medication hypothesis.

scholarly journals The impact of a history of psychotic symptoms on cognitive function in euthymic bipolar patients: a comparison with schizophrenic patients and healthy controls

2011 ◽  
Vol 33 (4) ◽  
pp. 353-361 ◽  
Author(s):  
Sofia Brissos ◽  
Vasco Videira Dias ◽  
Márcio Gerhardt Soeiro-de-Souza ◽  
Vicent Balanzá-Martínez ◽  
Flavio Kapczinski
Keyword(s):  
Negative Symptoms ◽  
Cross Sectional Study ◽  
Psychotic Symptoms ◽  
Neurocognitive Performance ◽  
Cross Sectional ◽  
Neurocognitive Dysfunction ◽  
Schizophrenic Patients ◽  
History Of ◽  
Bipolar Patients ◽  
The Impact

BACKGROUND: About two-thirds of patients with bipolar disorder (BD) have a lifetime history of at least one psychotic symptom. Objective: To compare the neurocognitive performance of four groups: BD patients with and without a history of psychotic symptoms (BD HPS+ and BD HPS-, respectively); patients with schizophrenia (SZ); and healthy control (HC) subjects. METHOD: In this cross-sectional study, 35 stabilized patients with SZ, 79 euthymic (44 HPS+ and 35 HPS-) patients with BD, and 50 HC were administered a comprehensive battery of neuropsychological tests. RESULTS: There was worse neurocognitive functioning in both BD and SZ patients compared to HC. Overall, data from both groups of BD patients did not differ on sociodemographic, clinical, or neurocognitive variables. However, BD HPS+ patients had significantly more negative symptoms, as measured by the Positive and Negative Syndrome Scale (PANSS), and showed a trend toward worse performance on executive functions compared to BD HPS- patients. Moreover, both BD groups had better performance on all neurocognitive tests compared to SZ group. CONCLUSIONS: Neurocognitive dysfunction may be more marked in SZ than in BD, yet qualitatively similar. A history of past psychotic symptoms in BD was not associated with more severe cognitive impairment during euthymia. Therefore, BD with psychotic symptoms does not appear to be a distinct neurocognitive phenotype.

scholarly journals Evaluation of Efficacy, Safety, and Cognitive Profile of Amisulpride Per Se and Its Comparison with Olanzapine in Newly Diagnosed Schizophrenic Patients in an 8-Week, Double-Blind, Single-Centre, Prospective Clinical Trial

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Ganesh R. Pawar ◽  
P. Phadnis ◽  
A. Paliwal
Keyword(s):  
Clinical Trial ◽  
Adverse Effects ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Rating Scale ◽  
Cognitive Profile ◽  
Response To Treatment ◽  
Psychotic Symptoms ◽  
Double Blind ◽  
Minimal Impact

Background. Impaired cognitive functions in schizophrenia are the major deciding factors in response to treatment. Conventional antipsychotics have minimal impact on cognitive dysfunctions and are associated with adverse effects. Atypical antipsychotics have shown promise in treatment of cognitive and negative symptoms of schizophrenia. Efforts are underway to find out the best drug amongst atypical antipsychotics. Objective. To compare efficacy, safety, and cognitive profile of amisulpride and olanzapine in the treatment of acute psychotic exacerbations of schizophrenia. Method. A prospective, randomized, double-blind, single-center, 8-week clinical trial we used. Subjects and Treatments. Seventy four patients were treated for two months with either amisulpride (400–800 mg/d) or olanzapine (10–20 mg/d). Statistics. Mann Whitney U test we used for independent samples with taken as significant. Results. Brief psychiatric rating scale (BPRS) was used as a primary measure of efficacy. Other measures of efficacy and safety were also evaluated. Both amisulpride and olanzapine groups showed equivalent improvement in psychotic symptoms on BPRS scale. Less than five percent of patients suffered adverse effects only to withdraw from the study. Olanzapine group showed statistically significant () weight gain compared with amisulpride group. Amisulpride group showed significant improvement () in various cognitive parameters as compared to olanzapine group.

A Trial of Two Cognitive-Behavioural Methods of Treating Drug-Resistant Residual Psychotic Symptoms in Schizophrenic Patients: I. Outcome

1993 ◽  
Vol 162 (4) ◽  
pp. 524-532 ◽  
Author(s):  
Nicholas Tarrier ◽  
Richard Beckett ◽  
Sue Harwood ◽  
Amanda Baker ◽  
Lawrence Yusupoff ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Controlled Trial ◽  
Psychotic Symptoms ◽  
Behavioural Treatment ◽  
Treatment Benefit ◽  
Residual Symptoms ◽  
Cognitive Behavioural ◽  
Schizophrenic Patients ◽  
Demand Condition

Despite neuroleptic medication, many schizophrenic patients continue to experience residual positive psychotic symptoms. These residual symptoms cause distress and disability. We report a controlled trial of two cognitive-behavioural treatments to alleviate residual hallucinations and delusions. Forty-nine patients were recruited into the trial, of whom 27 entered the trial and completed post-treatment assessment, and 23 were reassessed at six-month follow-up. Patients were randomly allocated to either coping strategy enhancement (CSE) or problem solving (PS). Half the patients were allocated to a high-expectancy positive demand condition and half to a counterdemand condition to evaluate expectation of improvement. Patients receiving either cognitive-behavioural treatment showed significant reductions in pyschotic symptoms compared with those in the waiting period, who showed no improvement. There was some evidence, although equivocal, that patients receiving CSE improved more than those receiving PS. There was no evidence that improvements generalised to negative symptoms or social functioning, nor was there evidence that expectancy of treatment benefit contributed to the treatment effect.

Adjunctive use of reboxetine in schizophrenia

2004 ◽  
Vol 19 (6) ◽  
pp. 366-369 ◽  
Author(s):  
Thomas J. Raedler ◽  
Holger Jahn ◽  
Josef Arlt ◽  
Falk Kiefer ◽  
Mildred Schick ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Effective Treatment ◽  
Antipsychotic Medication ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Adjunctive Treatment ◽  
Before And After ◽  
Schizophrenic Patients ◽  
Typical Antipsychotics

AbstractBackgroundSchizophrenia is frequently complicated by depressive or negative symptoms that respond only moderately to treatment with antipsychotic drugs. Reboxetine is a novel antidepressant, which inhibits the reuptake of norepinephrine. We sought to study the efficacy and tolerability of the adjunctive use of reboxetine in a cohort of schizophrenic patients with prominent depressive or negative symptoms.MethodsSixteen schizophrenic inpatients were recruited for this study. All subjects received 4–8 mg of reboxetine/day while the antipsychotic medication (typical antipsychotics = 4; atypical antipsychotics = 12) was continued. All subjects underwent a standardized assessment including PANSS, CGI, HAMD, and CDSS before and after treatment with reboxetine (mean 26 ± 17 d).ResultsAll subjects tolerated treatment with reboxetine. Adverse effects were mild and did not require discontinuation of reboxetine. All clinical scores (PANSS 93.1 vs. 63.1; CGI 5.4 vs. 4.1; HAMD 20.4 vs. 8.1; CDSS 12.5 vs. 4.6) improved significantly under adjunctive treatment with reboxetine (all P < 0.01).ConclusionThe adjunctive use of reboxetine in schizophrenic patients was safe and well-tolerated. Our results suggest that the adjunctive use of reboxetine may be an effective treatment for depressive and negative symptoms in schizophrenia.

scholarly journals Impact of Duration of Untreated Psychosis on Cognitive Function in Schizophrenia

2021 ◽  
Vol 10 (1) ◽  
pp. 20
Author(s):  
Rina Krismiati Gani ◽  
Erikavitri Yulianti ◽  
Ifa Tunisya
Keyword(s):  
Cognitive Function ◽  
Negative Symptoms ◽  
Clinical Syndrome ◽  
Psychotic Symptoms ◽  
Duration Of Untreated Psychosis ◽  
Disease Symptoms ◽  
Differences Of Opinion ◽  
Schizophrenic Patients ◽  
Neurodevelopmental Hypothesis ◽  
The Impact

Background: Schizophrenia is a chronic and serious clinical syndrome with very aggravating psychopathology involving perception, cognition, emotion, and behaviour. Currently, cognitive dysfunction is seen as a core disorder of schizophrenia. Duration of Untreated Psychosis (DUP) refers to the period from the onset of psychotic symptoms to the first adequate administration of antipsychotics.Aims: This review aims to analyse the impact of DUP on cognitive function in schizophrenia.Methods: PubMed and Google Scholar were searched using the following keyword: (cognitive function) and (neurodevelopmental OR neurotoxicity hypothesis) and (duration of untreated psychosis or DUP) and (schizophrenia or psychosis or psychotic) using the journal publication filter for the 2014-2020 issue. We also used textbooks published in the last 10 years and were related to writing themes.Review: There are two different opinions about the impact of DUP on the cognitive function of schizophrenic patients: (1) the neurodevelopmental hypothesis says there is no impact of the length of DUP on the cognitive function of schizophrenic patients; (2) the neurotoxicity hypothesis says the length of the DUP will impact the patient's cognitive function. Despite differences of opinion about the impact of DUP on cognitive function in schizophrenia, early intervention in schizophrenic patients is important because DUP is associated with worse general disease symptoms, lower likelihood of remission, more severe positive and negative symptoms, and worse social functioning and overall outcomes.Summary: There are differences of opinion about the impact of DUP on cognitive function in schizophrenic patients.

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