Treatment of Psychosis: 30 Years of Progress
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Dopamine D2 Receptor Occupancy by Perospirone: a Positron Emission Tomography Study in Patients with Schizophrenia and Healthy Subjects
Psychopharmacology (2010) 209:285–290 DOI 10.1007/s00213-010-1783-1 ORIGINAL INVESTIGATION Dopamine D2 receptor occupancy by perospirone: a positron emission tomography study in patients with schizophrenia and healthy subjects Ryosuke Arakawa & Hiroshi Ito & Akihiro Takano & Masaki Okumura & Hidehiko Takahashi & Harumasa Takano & Yoshiro Okubo & Tetsuya Suhara Received: 3 September 2009 /Accepted: 18 January 2010 /Published online: 27 March 2010 # Springer-Verlag 2010 Abstract striatum of healthy subjects was 74.8% at 1.5 h, 60.1% at Rationale Perospirone is a novel second-generation antipsy- 8 h, and 31.9% at 25.5 h after administration. chotic drug with high affinity to dopamine D2 receptor and Conclusion Sixteen milligrams of perospirone caused over short half-life of plasma concentration. There has been no 70% dopamine D2 receptor occupancy near its peak level, investigation of dopamine D2 receptor occupancy in patients and then occupancy dropped to about half after 22 h. The with schizophrenia and the time course of occupancy by time courses of receptor occupancy and plasma concentra- antipsychotics with perospirone-like properties. tion were quite different. This single dosage may be Objective We investigated dopamine D2 receptor occupan- sufficient for the treatment of schizophrenia and might be cy by perospirone in patients with schizophrenia and the useful as a new dosing schedule choice. time course of occupancy in healthy subjects. Materials and methods Six patients with schizophrenia Keywords Dopamine D2 receptor occupancy. taking 16–48 mg/day of perospirone participated. Positron Perospirone . Positron emission tomography . emission tomography (PET) scans using [11C]FLB457 were Schizophrenia . Time course performed on each subject, and dopamine D2 receptor occupancies were calculated. -
Quantitative Resting State Electroencephalography in Patients with Schizophrenia Spectrum Disorders Treated with Strict Monotherapy Using Atypical Antipsychotics
Original Article https://doi.org/10.9758/cpn.2021.19.2.313 pISSN 1738-1088 / eISSN 2093-4327 Clinical Psychopharmacology and Neuroscience 2021;19(2):313-322 Copyrightⓒ 2021, Korean College of Neuropsychopharmacology Quantitative Resting State Electroencephalography in Patients with Schizophrenia Spectrum Disorders Treated with Strict Monotherapy Using Atypical Antipsychotics Takashi Ozaki1,2, Atsuhito Toyomaki1, Naoki Hashimoto1, Ichiro Kusumi1 1Department of Psychiatry, Graduate School of Medicine, Hokkaido University, 2Department of Psychiatry, Hokkaido Prefectural Koyogaoka Hospital, Sapporo, Japan Objective: The effect of antipsychotic drugs on quantitative electroencephalography (EEG) has been mainly examined by the administration of a single test dose or among patients using combinations of other psychotropic drugs. We therefore investigated the effects of strict monotherapy with antipsychotic drugs on quantitative EEG among schizophrenia patients. Methods: Data from 2,364 medical reports with EEG results from psychiatric patients admitted to the Hokkaido University Hospital were used. We extracted EEG records of patients who were diagnosed with schizophrenia spectrum disorders and who were either undergoing strict antipsychotic monotherapy or were completely free of psychotropic drugs. The spectral power was compared between drug-free patients and patients using antipsychotic drugs. We also performed multiple regression analysis to evaluate the relationship between spectral power and the chlorpromazine equivalent daily dose of antipsychotics in all the patients. Results: We included 31 monotherapy and 20 drug-free patients. Compared with drug-free patients, patients receiving antipsychotic drugs demonstrated significant increases in theta, alpha and beta power. When patients taking different types of antipsychotics were compared with drug-free patients, we found no significant change in any spectrum power for the aripiprazole or blonanserin groups. -
Schizophrenia Care Guide
August 2015 CCHCS/DHCS Care Guide: Schizophrenia SUMMARY DECISION SUPPORT PATIENT EDUCATION/SELF MANAGEMENT GOALS ALERTS Minimize frequency and severity of psychotic episodes Suicidal ideation or gestures Encourage medication adherence Abnormal movements Manage medication side effects Delusions Monitor as clinically appropriate Neuroleptic Malignant Syndrome Danger to self or others DIAGNOSTIC CRITERIA/EVALUATION (PER DSM V) 1. Rule out delirium or other medical illnesses mimicking schizophrenia (see page 5), medications or drugs of abuse causing psychosis (see page 6), other mental illness causes of psychosis, e.g., Bipolar Mania or Depression, Major Depression, PTSD, borderline personality disorder (see page 4). Ideas in patients (even odd ideas) that we disagree with can be learned and are therefore not necessarily signs of schizophrenia. Schizophrenia is a world-wide phenomenon that can occur in cultures with widely differing ideas. 2. Diagnosis is made based on the following: (Criteria A and B must be met) A. Two of the following symptoms/signs must be present over much of at least one month (unless treated), with a significant impact on social or occupational functioning, over at least a 6-month period of time: Delusions, Hallucinations, Disorganized Speech, Negative symptoms (social withdrawal, poverty of thought, etc.), severely disorganized or catatonic behavior. B. At least one of the symptoms/signs should be Delusions, Hallucinations, or Disorganized Speech. TREATMENT OPTIONS MEDICATIONS Informed consent for psychotropic -
Management of Side Effects of Antipsychotics
Management of side effects of antipsychotics Oliver Freudenreich, MD, FACLP Co-Director, MGH Schizophrenia Program www.mghcme.org Disclosures I have the following relevant financial relationship with a commercial interest to disclose (recipient SELF; content SCHIZOPHRENIA): • Alkermes – Consultant honoraria (Advisory Board) • Avanir – Research grant (to institution) • Janssen – Research grant (to institution), consultant honoraria (Advisory Board) • Neurocrine – Consultant honoraria (Advisory Board) • Novartis – Consultant honoraria • Otsuka – Research grant (to institution) • Roche – Consultant honoraria • Saladax – Research grant (to institution) • Elsevier – Honoraria (medical editing) • Global Medical Education – Honoraria (CME speaker and content developer) • Medscape – Honoraria (CME speaker) • Wolters-Kluwer – Royalties (content developer) • UpToDate – Royalties, honoraria (content developer and editor) • American Psychiatric Association – Consultant honoraria (SMI Adviser) www.mghcme.org Outline • Antipsychotic side effect summary • Critical side effect management – NMS – Cardiac side effects – Gastrointestinal side effects – Clozapine black box warnings • Routine side effect management – Metabolic side effects – Motor side effects – Prolactin elevation • The man-in-the-arena algorithm www.mghcme.org Receptor profile and side effects • Alpha-1 – Hypotension: slow titration • Dopamine-2 – Dystonia: prophylactic anticholinergic – Akathisia, parkinsonism, tardive dyskinesia – Hyperprolactinemia • Histamine-1 – Sedation – Weight gain -
Sex-Specific Cannabidiol- and Iloperidone-Induced Neuronal Activity Changes in an in Vitro MAM Model System of Schizophrenia
International Journal of Molecular Sciences Article Sex-Specific Cannabidiol- and Iloperidone-Induced Neuronal Activity Changes in an In Vitro MAM Model System of Schizophrenia Rachel-Karson Thériault 1,2,†, Myles St-Denis 1,†, Tristen Hewitt 1,2, Jibran Y. Khokhar 2,3 , Jasmin Lalonde 1,2 and Melissa L. Perreault 2,3,* 1 Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON N1G 2W1, Canada; [email protected] (R.-K.T.); [email protected] (M.S.-D.); [email protected] (T.H.); [email protected] (J.L.) 2 Collaborative Program in Neuroscience, University of Guelph, Guelph, ON N1G 2W1, Canada; [email protected] 3 Department of Biomedical Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada * Correspondence: [email protected]; Tel.: +1-(519)-824-4120 (ext. 52013) † These authors contributed equally to this work. Abstract: Cortical circuit dysfunction is thought to be an underlying mechanism of schizophrenia (SZ) pathophysiology with normalization of aberrant circuit activity proposed as a biomarker for antipsychotic efficacy. Cannabidiol (CBD) shows potential as an adjunctive antipsychotic therapy; however, potential sex effects in these drug interactions remain unknown. In the present study, we sought to elucidate sex effects of CBD coadministration with the atypical antipsychotic iloperidone (ILO) on the activity of primary cortical neuron cultures derived from the rat methylazoxymethanol Citation: Thériault, R.-K.; St-Denis, acetate (MAM) model used for the study of SZ. Spontaneous network activity measurements were M.; Hewitt, T.; Khokhar, J.Y.; Lalonde, J.; Perreault, M.L. Sex-Specific obtained using a multielectrode array at baseline and following administration of CBD or ILO Cannabidiol- and Iloperidone- alone, or combined. -
Revision of Precautions Asenapine Maleate, Aripiprazole, Olanzapine
Published by Translated by Ministry of Health, Labour and Welfare Pharmaceuticals and Medical Devices Agency This English version is intended to be a reference material to provide convenience for users. In the event of inconsistency between the Japanese original and this English translation, the former shall prevail. Revision of Precautions Asenapine maleate, aripiprazole, olanzapine, quetiapine fumarate, clocapramine hydrochloride hydrate, chlorpromazine hydrochloride, chlorpromazine hydrochloride/promethazine hydrochloride/phenobarbital, chlorpromazine phenolphthalinate, spiperone, zotepine, timiperone, haloperidol, paliperidone, pipamperone hydrochloride, fluphenazine decanoate, fluphenazine maleate, brexpiprazole, prochlorperazine maleate, prochlorperazine mesilate, Pharmaceuticals and Medical Devices Agency Office of Safety I 3-3-2 Kasumigaseki, Chiyoda-ku, Tokyo 100-0013 Japan E-mail: [email protected] Published by Translated by Ministry of Health, Labour and Welfare Pharmaceuticals and Medical Devices Agency This English version is intended to be a reference material to provide convenience for users. In the event of inconsistency between the Japanese original and this English translation, the former shall prevail. propericiazine, bromperidol, perphenazine, perphenazine hydrochloride, perphenazine fendizoate, perphenazine maleate, perospirone hydrochloride hydrate, mosapramine hydrochloride, risperidone (oral drug), levomepromazine hydrochloride, levomepromazine maleate March 27, 2018 Non-proprietary name Asenapine maleate, -
Washington State Health Care Authority
Washington State Health Care Authority Prescription Drug Program 626 8th Ave SE, Olympia, WA 98501 ● 206-521-2029 https://www.hca.wa.gov/about-hca/prescription-drug-program February 17, 2021 Dear Interested Party, Based on recommendations by the Washington State Pharmacy and Therapeutics Committee, the Health Care Authority, Uniform Medical Plan (UMP), and the Department of Labor & Industries (L&I) have named the following drugs as preferred in their respective therapeutic classes on the Washington State Preferred Drug List (PDL), effective immediately: Antiplatelet reviewed 8/15/2018 Agency Coverage Ingredient Name Label Name of Preferred Product L&I UMP clopidogrel bisulfate clopidogrel tablet Not participating Yes The effect of this recommendation is no change to the Washington PDL. Second Generation Antipsychotics reviewed 12/18/2019 Agency Coverage Ingredient Name Label Name of Preferred Products L&I UMP aripiprazole Abilify Maintena® suspension reconstituted No Yes aripiprazole solution Yes Yes aripiprazole tablet Yes Yes aripiprazole ODT tablet dispersible Yes Yes aripiprazole lauroxil Aristada® injectable No Yes Aristada Initio® injectable No Yes asenapine maleate Saphris® sublingual Yes Yes brexpiprazole Rexulti® tablet Yes Yes cariprazine HCL Vraylar® capsule Yes Yes clozapine clozapine tablet Yes Yes clozapine ODT tablet dispersible Yes Yes iloperidone Fanapt® tablet Yes Yes Fanapt Titration Pack® tablet Yes Yes lurasidone HCL Latuda® tablet Yes Yes olanzapine olanzapine injectable No Yes olanzapine tablet Yes Yes olanzapine -
New Zealand Data Sheet 1. Product Name
NEW ZEALAND DATA SHEET 1. PRODUCT NAME Norvir 100 mg tablets. 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each film-coated tablet contains 100 mg ritonavir. For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM White film-coated oval tablets debossed with the corporate Abbott "A" logo and the Abbott-Code “NK”. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications NORVIR is indicated for use in combination with appropriate antiretroviral agents or as monotherapy if combination therapy is inappropriate, for the treatment of HIV-1 infection in adults and children aged 12 years and older. For persons with advanced HIV disease, the indication for ritonavir is based on the results for one study that showed a reduction in both mortality and AIDS defining clinical events for patients who received ritonavir. Median duration of follow-up in this study was 6 months. The clinical benefit from ritonavir for longer periods of treatment is unknown. For persons with less advanced disease, the indication is based on changes in surrogate markers in controlled trials of up to 16 weeks duration (see section 5.1 Pharmacodynamic properties). 4.2 Dose and method of administration General Dosing Guidelines Prescribers should consult the full product information and clinical study information of protease inhibitors if they are co-administered with a reduced dose of ritonavir. The recommended dose of NORVIR is 600 mg (six tablets) twice daily by mouth, and should be given with food. NORVIR tablets should be swallowed whole and not chewed, broken or crushed. NORVIR DS 29 April 2020 Page 1 of 37 Version 35 Paediatric population Ritonavir has not been studied in patients below the age of 12 years; hence the safety and efficacy of ritonavir in children below the age of 12 have not been established. -
How to Identify and Manage Non-Response to Clozapine? T ⁎ Mujeeb U
Asian Journal of Psychiatry 45 (2019) 50–52 Contents lists available at ScienceDirect Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp Short communication How to identify and manage non-response to clozapine? T ⁎ Mujeeb U. Shada,b,c, , Emma Felziena, Kamalika Roya,b, Simrat Sethib a School of Medicine, Oregon Health & Science University, Portland, Oregon, United States b Department of Psychiatry, Oregon State Hospital, Salem, Oregon, United States c Samaritan Mental Healthcare System, Corvallis, Oregon, United States ARTICLE INFO ABSTRACT Keywords: Clozapine is the only approved treatment for Treatment-Refractory Schizophrenia. Here we describe a case series Clozapine of three hospitalized patients with clozapine nonresponse. One of them responded to clozapine after dose ad- Non-response justments were made for an interaction between clozapine and ciprofloxacin. The other two cases remained Identify clozapine nonresponders despite optimizing clozapine treatment. However, both these patients responded to Manage other antipsychotic medications (APMs) with better tolerability than observed with clozapine treatment. This case series focuses on diagnosing a genuine from a pseudo-nonresponse to clozapine and to consider other APMs in genuine nonresponse before switching to invasive interventions, such as ECT. 1. Introduction medications (APMs), except in situations where bone marrow toxicity warrants clozapine discontinuation. Although augmentation strategies Since clozapine provides the only evidence-based treatment for with APMs, glutamate modulators and mood stabilizers have been patients with treatment-refractory schizophrenia (TRS) (Manu and proposed in ultra-treatment resistant schizophrenia (Naguy and Grudnikoff, 2016; Mukku et al., 2018), optimal efforts are warranted to Alamiri, 2019), a recent metanalysis reported a low quality of sup- confirm a true clozapine non-response before giving up on clozapine porting evidence for these clozapine augmentation strategies with the treatment. -
Antipsychotics
The Fut ure of Antipsychotic Therapy (page 7 in syllabus) Stepp,,hen M. Stahl, MD, PhD Adjunct Professor, Department of Psychiatry Universityyg of California, San Diego School of Medicine Honorary Visiting Senior Fellow, Cambridge University, UK Sppyonsored by the Neuroscience Education Institute Additionally sponsored by the American Society for the Advancement of Pharmacotherapy This activity is supported by an educational grant from Sunovion Pharmaceuticals Inc. Copyright © 2011 Neuroscience Education Institute. All rights reserved. Individual Disclosure Statement Faculty Editor / Presenter Stephen M. Stahl, MD, PhD, is an adjunct professor in the department of psychiatry at the University of California, San Diego School of Medicine, and an honorary visiting senior fellow at the University of Cambridge in the UK. Grant/Research: AstraZeneca, BioMarin, Dainippon Sumitomo, Dey, Forest, Genomind, Lilly, Merck, Pamlab, Pfizer, PGxHealth/Trovis, Schering-Plough, Sepracor/Sunovion, Servier, Shire, Torrent Consultant/Advisor: Advent, Alkermes, Arena, AstraZeneca, AVANIR, BioMarin, Biovail, Boehringer Ingelheim, Bristol-Myers Squibb, CeNeRx, Cypress, Dainippon Sumitomo, Dey, Forest, Genomind, Janssen, Jazz, Labopharm, Lilly, Lundbeck, Merck, Neuronetics, Novartis, Ono, Orexigen, Otsuka, Pamlab, Pfizer, PGxHealth/Trovis, Rexahn, Roche, Royalty, Schering-Plough, Servier, Shire, Solvay/Abbott, Sunovion/Sepracor, Valeant, VIVUS, Speakers Bureau: Dainippon Sumitomo, Forest, Lilly, Merck, Pamlab, Pfizer, Sepracor/Sunovion, Servier, Wyeth Copyright © 2011 Neuroscience Education Institute. All rights reserved. Learninggj Objectives • Differentiate antipsychotic drugs from each other on the basis of their pharmacological mechanisms and their associated therapeutic and side effects • Integrate novel treatment approaches into clinical practice according to best practices guidelines • Identify novel therapeutic options currently being researched for the treatment of schizophrenia Copyright © 2011 Neuroscience Education Institute. -
A Study on the Efficacy and Safety of Blonanserin in Indian Patients in Ahmedabad: a Randomized, Active Controlled, Phase III Clinical Trial
Lakdawala et al. : Efficacy and Safety of Blonanserin 359 Original Research Article A study on the efficacy and safety of Blonanserin in Indian patients in Ahmedabad: a randomized, active controlled, phase III clinical trial Bhavesh Lakdawala1, Mahemubin S. Lahori2, Ganpat K. Vankar3 1Associate Professor, Dept. of Psychiatry, AMC-MET Medical College and Sheth L.G. General Hospital, Ahmedabad, Gujarat, India. 2Assistant Professor, Dept. of Psychiatry, GMERS Medical College and General Hospital, Sola, Gujarat, India. 3Professor, Dept. of Psychiatry, Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital Wardha, Maharashtra Corresponding author: Dr. Mahemubin Lahori Email – [email protected] ABSTRACT Introduction: Blonanserin is a novel atypical antipsychotic with higher dopamine D2 receptor occupancy and lower serotonin 5-HT2A receptor blocking activity as compared to the other atypical antipsychotics. The objective of this study was to compare the efficacy and safety of blonanserin with haloperidol in Indian patients with schizophrenia. Methodology: This was an 8 week, randomized, open label, active controlled, multicentre study. Patients diagnosed with schizophrenia according to the DSM-IV criteria were enrolled in the study. Patients were randomized to receive either blonanserin (16 mg/day) or haloperidol (4.5 mg/day). Patients were assessed on an out-patient basis after every 2 weeks for clinical efficacy [Positive and Negative Syndrome Scale (PANSS) total and factor scores], Clinical Global Impressions–severity CGI-S, Clinical Global Impressions–Improvement (CGI-I), Global Assessment of Efficacy (CGI-C), adverse events and drug compliance. Results: At our centre, total 60 patients were randomized in the study with 30 patients each in Blonanserin and Haloperidol group. -
Prolactin Levels in Schizophrenic Patients Receiving Perospirone in Comparison to Risperidone
J Pharmacol Sci 91, 259 – 262 (2003) Journal of Pharmacological Sciences ©2003 The Japanese Pharmacological Society Short Communication Prolactin Levels in Schizophrenic Patients Receiving Perospirone in Comparison to Risperidone Takashi Togo1,2,*, Eizo Iseki2, Mika Shoji1, Ikuo Oyama1, Akihiko Kase1, Hirotake Uchikado2, Omi Katsuse2 and Kenji Kosaka2 1Yokohama Maioka Hospital, Yokohama 244-0813, Japan 2Department of Psychiatry, Yokohama City University School of Medicine, Yokohama 236-0004, Japan Received November 21, 2002; Accepted January 9, 2003 Abstract. Serum prolactin levels were investigated in 41 patients with schizophrenia who were receiving clinically effective doses of perospirone or risperidone for more than 4 weeks. In order to determine baseline prolactin levels, blood samples were obtained in the morning, 10 – 14 h after antipsychotic medication. Median levels were within normal limits in both female and male patients receiving perospirone, while risperidone induced significant elevation. These results suggest that in contrast to risperidone, where baseline prolactin levels were elevated 5.3-fold in female and 4.2-fold in male patients, baseline prolactin levels are not elevated after treatment with perospirone. However, these results should be cautiously interpreted, because drug-by-time interaction has previously been reported in antipsychotic-induced hyperprolactinemia. Keywords: prolactin, perospirone, schizophrenia Hyperprolactinemia is a common side effect that may well as the adverse effects of perospirone have not been arise from the use of antipsychotic agents (1, 2). Before fully investigated. In the present study, we have investi- the introduction of clozapine, it was assumed that all gated the baseline serum prolactin levels in patients antipsychotics cause extrapyramidal side effects and treated with clinically effective doses of perospirone in elevate prolactin levels by antagonizing dopamine D2 comparison to risperidone.