DOCSLIB.ORG

(PANSS) in First-Episoderecent-Onset Psychosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
(PANSS) in First-Episoderecent-Onset Psychosis View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Stellenbosch University SUNScholar Repository Studies in the psychopathology, neurobiology and psychopharmacology of schizophrenia. Dissertation presented for the Degree of Doctor of Science (D.Sc.) at the University of Stellenbosch. Promoter: Dan Stein Professor and Head Department of Psychiatry and Mental Health University of Cape Town March 2008 1 Declaration I, the undersigned, declare that the work contained in this dissertation is my own original work, and has not previously been submitted for a degree in its entirety or in part at any other University for a degree …………………………. Robin Emsley December 2007 Copyright © 2008 Stellenbosch University All rights reserved. 2 Summary The overall aim of these studies was to investigate selected aspects of psychopathology, neurobiological abnormalities and treatment in schizophrenia. The following topics were researched: 1. Psychopathology: We explored the symptom structure of schizophrenia by means of principal components and factor analysis in two separate samples. a. The first study investigated the nature of symptoms in patients with a first-episode of schizophrenia, in a large cohort of patients who were participating in a multinational clinical trial. We compared our findings with similar analyses previously conducted in multi-episode schizophrenia patients. b. We then assessed the influence of culture on the symptom structure of schizophrenia by conducting a principal components and factor analysis of the symptom ratings in a large sample of South African Xhosa patients with schizophrenia, and comparing the results with those in other parts of the world. c. We investigated the occurrence of co-morbid depressive and anxiety symptoms, and their demographic and clinical correlates. The sample for this study comprised acutely psychotic patients who were participants in clinical drug trials conducted at our centre. d. To explore the relationships between obsessive-compulsive disorder and schizophrenia, we conducted a review of the relevant literature. 2. Neurobiological abnormalities: a. We performed a series of studies to investigate disorders of water homeostasis and vasopressin secretion in schizophrenia. To test the hypothesis that acutely psychotic patients have disordered regulation of water homeostasis, we applied a dynamic suppression test - a water loading test, with assessment of excretory capacity (including arginine vasopressin assay) in acutely psychotic patients. To evaluate whether a subset of patients with schizophrenia and co-morbid disordered water homeostasis sustained cerebral damage as a consequence of water intoxication we did the following experiment: We identified a cohort of subjects with schizophrenia and disordered water homeostasis and compared them with patients with schizophrenia without disordered water homeostasis in terms of cerebral ventricular size and cognitive function. To assess the prevalence of disordered water homeostasis in a long-term inpatient sample of psychiatric patients we conducted serum sodium screening tests. Those subjects with dilutional hyponatraemia were then further investigated for dysregulation of water homeostatic mechanisms. b. We studied neurological soft signs in a sample of subjects with first-episode schizophrenia followed up over a two year period. We investigated their occurrence, relationships to psychiatric symptoms and medication effects, their 3 temporal stability and their outcome correlates. We also investigated their potential to predict outcome in schizophrenia 3. Treatment aspects A great deal of our work has focussed on the pharmacological treatment of schizophrenia. The following aspects of treatment are included in this thesis: a. Treatment effects on psychiatric symptoms: i. To assess the effects of ethnicity on treatment outcome in schizophrenia we compared the acute response to antipsychotic treatment in 3 ethnic groups, namely blacks, coloureds and whites. We included patients in this analysis who had participated in clinical trials in our department as well as the Department of Psychiatry in the University of the Free Sate. Patients had been treated under blinded conditions over a 6-week period. ii. After discussions with the late Dr David Horrobin, who had pioneered possible applications of the omega-3 fatty acids in the treatment of various psychiatric disorders, we became interested in further investigating the potential of this group of compounds as an affordable adjunct to treating schizophrenia. We assessed the antipsychotic potential of the omega-3 fatty acid, ethyl-eicosapentaenoic-acid (e-EPA) supplementation versus placebo supplementation in a small sample of subjects with schizophrenia who had been only partially responsive to antipsychotic treatment previously. We also conducted a review of the literature to evaluate the evidence for efficacy for the omega-3 fatty acids in schizophrenia according to published studies. b. Treatment effects on neurological abnormalities: i. In a single-blinded controlled study we compared a new generation antipsychotic to a conventional antipsychotic in the treatment of tardive dyskinesia (TD). This was a long-term (1 yr) study in patients with chronic schizophrenia and established tardive dyskinesia. ii. We also assessed the effect of omega-3 fatty acid (e-EPA) supplementation in treating TD. This was conducted in a larger sample (n=84) of patients with chronic schizophrenia and established TD. The blinded, placebo-controlled phase was 12 weeks. This was followed by an open-label extension for 40 weeks. c. Conventional versus new generation antipsychotic agents. Several evidence-based literature reviews of the efficacy and tolerability of the new generation of antipsychotics compared to the conventional agents were conducted. Some multinational, randomised, controlled clinical trials in which the author was principal investigator, are included in this thesis. Also, studies addressing patients with partial treatment refractoriness are included, as well as studies of the effects of antipsychotics on depressive symptoms, 4 body mass and glycaemic control. Finally, we have included a pharmaco- economic study comparing a conventional antipsychotic (haloperidol) with a new generation antipsychotic (quetiapine) in partially refractory patients in a South African setting. Findings and conclusions: 1. Psychopathology: Our studies demonstrated that the factor structure for the symptoms of schizophrenia is replicable across samples, and is not greatly influenced by ethnic and cultural factors. However, changes in the factor structures do occur over time. There are symptom domains that are present in first-episode schizophrenia but disappear as a distinct entity as the illness becomes chronic. Particularly, a motor component is evident in untreated patients, but disappears after initiation of treatment. We found that depression and anxiety are common co-morbid symptoms in schizophrenia, and have important clinical and outcome correlates. Depressive symptoms in the acute psychotic phase of schizophrenia are associated with a favourable prognosis and diminish as the symptoms of psychosis improve in response to antipsychotic treatment. However, persistent depressive symptoms are associated with a poorer prognosis, and require additional therapeutic intervention. 2. Neurobiological abnormalities: We investigated the occurrence of disordered water regulation in a population of psychiatric inpatients, and conducted further investigations on those identified, in order to establish mechanisms involved. Polydipsia and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) were found to occur in a subset of patients with schizophrenia, and are associated with acute psychosis, as well as with some psychotropic medications. These patients are characterised by more severe cognitive impairment and evidence of cerebral atrophy. The condition can become life-threatening in the presence of other factors impeding water excretion, particularly thiazide diuretics. Neurological soft signs were investigated in a sample of patients with a first-episode of schizophrenia. These soft signs appear to be trait-like (present early in the illness, and stable over time), except for a motor sequencing factor. Patients performing poorly on this latter group of tests have a longer duration of untreated psychosis, and are at significant risk for developing TD. 3. Treatment aspects: Our studies suggest that there are important ethnic differences in antipsychotic treatment response, but that these differences could be explained by a number of environmental and biological factors. As was found with many studies worldwide, we found that the new 5 generation antipsychotics have important efficacy and safety advantages over their predecessors. Risperidone was as effective as haloperidol in first-episode psychosis, but with a more favourable side-effect profile in terms of reduced extrapyramidal symptoms. Quetiapine treatment in partially refractory patients resulted in more responders compared to haloperidol, and fewer extrapyramidal symptoms. However, evidence of a different side-effect profile is emerging. Of particular concern is the finding that some of the new antispychotics cause weight gain, glucose intolerance and dyslipidaemias. We found that one novel antipsychotic, quetiapine, was not associated with significantly more weight gain or disordered glucose metabolism that a conventional
Load more

Recommended publications
  • The In¯Uence of Medication on Erectile Function
    International Journal of Impotence Research (1997) 9, 17±26 ß 1997 Stockton Press All rights reserved 0955-9930/97 $12.00 The in¯uence of medication on erectile function W Meinhardt1, RF Kropman2, P Vermeij3, AAB Lycklama aÁ Nijeholt4 and J Zwartendijk4 1Department of Urology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; 2Department of Urology, Leyenburg Hospital, Leyweg 275, 2545 CH The Hague, The Netherlands; 3Pharmacy; and 4Department of Urology, Leiden University Hospital, P.O. Box 9600, 2300 RC Leiden, The Netherlands Keywords: impotence; side-effect; antipsychotic; antihypertensive; physiology; erectile function Introduction stopped their antihypertensive treatment over a ®ve year period, because of side-effects on sexual function.5 In the drug registration procedures sexual Several physiological mechanisms are involved in function is not a major issue. This means that erectile function. A negative in¯uence of prescrip- knowledge of the problem is mainly dependent on tion-drugs on these mechanisms will not always case reports and the lists from side effect registries.6±8 come to the attention of the clinician, whereas a Another way of looking at the problem is drug causing priapism will rarely escape the atten- combining available data on mechanisms of action tion. of drugs with the knowledge of the physiological When erectile function is in¯uenced in a negative mechanisms involved in erectile function. The way compensation may occur. For example, age- advantage of this approach is that remedies may related penile sensory disorders may be compen- evolve from it. sated for by extra stimulation.1 Diminished in¯ux of In this paper we will discuss the subject in the blood will lead to a slower onset of the erection, but following order: may be accepted.
    [Show full text]
  • The Effects of Antipsychotic Treatment on Metabolic Function: a Systematic Review and Network Meta-Analysis
    The effects of antipsychotic treatment on metabolic function: a systematic review and network meta-analysis Toby Pillinger, Robert McCutcheon, Luke Vano, Katherine Beck, Guy Hindley, Atheeshaan Arumuham, Yuya Mizuno, Sridhar Natesan, Orestis Efthimiou, Andrea Cipriani, Oliver Howes ****PROTOCOL**** Review questions 1. What is the magnitude of metabolic dysregulation (defined as alterations in fasting glucose, total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, and triglyceride levels) and alterations in body weight and body mass index associated with short-term (‘acute’) antipsychotic treatment in individuals with schizophrenia? 2. Does baseline physiology (e.g. body weight) and demographics (e.g. age) of patients predict magnitude of antipsychotic-associated metabolic dysregulation? 3. Are alterations in metabolic parameters over time associated with alterations in degree of psychopathology? 1 Searches We plan to search EMBASE, PsycINFO, and MEDLINE from inception using the following terms: 1 (Acepromazine or Acetophenazine or Amisulpride or Aripiprazole or Asenapine or Benperidol or Blonanserin or Bromperidol or Butaperazine or Carpipramine or Chlorproethazine or Chlorpromazine or Chlorprothixene or Clocapramine or Clopenthixol or Clopentixol or Clothiapine or Clotiapine or Clozapine or Cyamemazine or Cyamepromazine or Dixyrazine or Droperidol or Fluanisone or Flupehenazine or Flupenthixol or Flupentixol or Fluphenazine or Fluspirilen or Fluspirilene or Haloperidol or Iloperidone
    [Show full text]
  • Clozapine and Gastrointestinal Adverse Effects – a Pain in the Gut? Graylands Hospital Drug Bulletin 2004 Vol
    Clozapine and Gastrointestinal Adverse Effects – A Pain in the Gut? Graylands Hospital Drug Bulletin 2004 Vol. 12 No. 3 September ISSN 1323-1251 Gastrointestinal adverse effects of clozapine impaction5. The patient died three weeks after are very common and include nausea, presentation from refractory shock and vomiting and constipation. Other troublesome progressive multi-system organ failure, unwanted effects include dry mouth and despite maximal care. hypersalivation, which involve the autonomic nervous system. A further case involved a 29 year old man who had only been taking clozapine for 36 Constipation is a particularly common days2. He died after aspiration of vomitus adverse effect that has been reported to occur secondary to bowel obstruction. in 14-60% of patients1,2. The management of clozapine-induced constipation has been the Intestinal Obstruction/Occlusion subject of a past Drug Bulletin3. Clozapine’s association with constipation could be There is a French report of three cases of intestinal occlusion in clozapine treated explained by its potent anticholinergic 6 properties. patients, one of which was fatal . Another report describes two cases of Rarely, clozapine-induced constipation has 7 lead to serious complications including ileus, clozapine-induced intestinal obstruction . bowel obstruction and necrotising colitis. A One of these involved a 51 year old man with review was conducted to determine what no past history of constipation, who had been serious gastrointestinal adverse effects have taking clozapine for two months. He suffered been reported in the literature and these are from an intestinal obstruction, from which he discussed below. fully recovered and clozapine was recommenced. The other case involved a 35 Faecal Impaction year old woman who had been taking clozapine for four months when she There are three reported cases of death developed abdominal symptoms.
    [Show full text]
  • Evaluating the Evidence|J Clin Psychiatry
    THE JOURNAL OF CLINICALCLINICAL PSYCHIATRYPSYCHIATRY This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions. See letters by Stip and Stip and reply by Correll et al The Use of Long-Acting Injectable Antipsychotics in Schizophrenia: Evaluating the Evidence Christoph U. Correll, MD (Chair); Leslie Citrome, MD, MPH; Peter M. Haddad, MD; John Lauriello, MD; Mark Olfson, MD, MPH; Stephen M. Calloway; and John M. Kane, MD Long-acting injectable antipsychotics (LAIs) are among the most effective treatments in psychiatry, yet they remain underutilized in clinical practice. Although LAIs are typically used to maintain treatment adherence in patients with chronic schizophrenia, recent research has suggested that they may also provide an effective treatment strategy for patients with early- phase or first-episode disease. In October 2015, a group of 8 experts on the management of schizophrenia and LAIs met to evaluate the evidence surrounding the efficacy, safety, and cost-effectiveness of LAIs and to develop practical recommendations regarding the clinical use, education, and unmet needs related to LAIs. Participants were also asked to rate the importance of several patient characteristics when choosing an LAI versus an oral antipsychotic, from the perspectives of 4 different stakeholder groups: patients, health care professionals, families, and payers. The evidence review demonstrated that LAIs are superior to placebo for acute and maintenance treatment of schizophrenia and, in general, appear to be similar to one another in terms of schizophrenia relapse prevention. Study design impacts the demonstrated efficacy of LAIs versus oral antipsychotics, but recent database and randomized controlled studies favor the use of LAIs in early-phase schizophrenia patients.
    [Show full text]
  • N-Alkylamino Derivates of Aromatic, Tricyclic Compounds in the Treatment of Drug-Resistant Protozoal Infections
    Europaisches Patentamt 0 338 532 European Patent Office Qv Publication number: A2 Office europeen des brevets EUROPEAN PATENT APPLICATION 31/54 © Application number: 89107027.8 © mt.ci.4.A61K 31/38 , A61K @ Date of filing: 19.04.89 © Priority: 20.04.88 US 183858 © Applicant: MERRELL DOW 12.09.88 US 243524 PHARMACEUTICALS INC. 2110 East Galbraith Road @. Date of publication of application: Cincinnati Ohio 45215-6300(US) 25.10.89 Bulletin 89/43 © Inventor: Bitonti, Alan J. © Designated Contracting States: 7854 Carraway Court AT BE CH DE ES FR GB GR IT LI LU NL SE Maineville Ohio 45039(US) Inventor: McCann, Peter P. 3782 Cooper Road Cincinnati Ohio 45241 (US) Inventor: Sjoerdsma, Albert 5475 Waring Drive Cincinnati Ohio 45243(US) © Representative: Vossius & Partner Siebertstrasse 4 P.O. Box 86 07 67 D-8000 Munchen 86(DE) © N-alkylamino derivates of aromatic, tricyclic compounds in the treatment of drug-resistant protozoal infections. © Drug-resistant protozoal infection, particularly, drug-resistant malarial infection in humans, can be effectively treated with standard antiprotozoal agents if administered in conjunction with a tricyclic N-aminoalkyi iminodiben- zyl, dibenzylcycloheptane and cycloheptene, phenothiazine, dibenzoxazepine, dibenzoxepine, or thioxanthene derivative. CM < CM CO in oo CO CO LU Xerox Copy Centre EP 0 338 532 A2 N-ALKYLAMINO DERIVATIVES OF AROMATIC, TRICYCLIC COMPOUNDS IN THE TREATMENT OF DRUG- RESISTANT PROTOZOAL INFECTIONS This invention relates to the use of certain N-(aminoalkyl) derivatives of iminodibenzyl, dibenzyl- cycioheptane and cycloheptene, phenothiazine, dibenzoxazepine, dibenzoxepine, and thioxanthene in the treatment of drug-resistant malaria and in the treatment of other drug-resistant protozoal infections.
    [Show full text]
  • The Effect of the Process Variables on the HPLC Separation of Tricyclic Neuroleptics on a Calixarene-Bonded Stationary Phase
    ORIGINAL ARTICLES Institute of Pharmacy, Pharmaceutical/Medicinal Chemistry, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany The effect of the process variables on the HPLC separation of tricyclic neuroleptics on a calixarene-bonded stationary phase H. Hashem, Th. Jira Received March 15, 2004, accepted May 25, 2004 Priv.-Doz. Dr. Thomas Jira, Ernst-Moritz-Arndt-University Greifswald, Institute of Pharmacy, Pharmaceu- tical/Medicinal Chemistry, F.-L.-Jahnstr. 17, D-17487 Greifswald, Germany [email protected] Pharmazie 60: 186–192 (2005) The chromatographic behavior of a new HPLC-stationary phase with supramolecular selectors on the basis of calixarenes is described for the separation of nine tricyclic neuroleptics. The effects of differ- ent chromatographic conditions (buffer system, pH-value, type and content of organic modifier, injec- tion volume) on the separation of the analytes were studied. Additionally, the effect of structural differ- ences of the neuroleptic analytes was studied. The chemical structure and pKa of the neuroleptics highly influenced their separation on the calix[8]arene phase. The separation of all analytes on the investigated calixarene-bonded stationary phase was possible with a mobile phase of acetonitrile with 30 mM ammonium acetate buffer (pH 3.5) 30 : 70(v/v) using 1 ml/min flow rate. 1. Introduction Neuroleptics which are widely used for the treatment of CH3 psychological problems are basic compounds, mainly thiox- CH3 anthene and phenothiazine derivatives. Many papers de- N N CH3 scribe the separation of this pharmacological group of ana- N N CH3 lytes on the usual RP-stationary phases (Goldstein and Van S CH3 S O Vunakis 1981; Kountourellis and Markopoulou 1991; Trac- CH3 qui et al.
    [Show full text]
  • (12) United States Patent (10) Patent No.: US 6,197,764 B1 Bradley Et Al
    USOO6197764B1 (12) United States Patent (10) Patent No.: US 6,197,764 B1 Bradley et al. (45) Date of Patent: *Mar. 6, 2001 (54) CLOZAPINE COMPOSITIONS AND USES FOREIGN PATENT DOCUMENTS THEREOF 0599 576A1 1/1994 (EP). (75) Inventors: Matthews O. Bradley, Laytonsville, 693498 1/1996 (EP). MD (US); Victor E. Shashoua, 61204136 11/1984 (JP). Belmont, MA (US); Charles S. 06-072868 3/1994 (JP). Swindell, Merion; Nigel L. Webb, 6072868 3/1994 (JP). Bryn Mawr, both of PA (US) 7082146 3/1996 (JP). 8151334 6/1996 (JP). (73) Assignee: Protarga, Inc., Conshohocken, PA (US) 9030963 2/1997 (JP). (*) Notice: Subject to any disclaimer, the term of this WO 89/07938 9/1989 (WO). patent is extended or adjusted under 35 WO 96/04001 2/1996 (WO). U.S.C. 154(b) by 0 days. WO 96/22303 7/1996 (WO). WO 96/27380 9/1996 (WO). This patent is Subject to a terminal dis WO98/17325 4/1998 (WO). claimer. OTHER PUBLICATIONS (21) Appl. No.: 08/978,541 (22) Filed: Nov. 26, 1997 Bourat, et al., "Long Chain Esters of Pipotiazine as Lon g-Acting Psychotropic Pro-Drug, Med. Chem. Proc. Int. (51) Int. Cl. .............................................. A61K 31/00 Symp. 5th (1976) pp. 105-114. (52) U.S. Cl. ........................... 514/218; 514/219; 514/220 Lohr, et al., “Neuroleptic-Induced Movement Disorders . (58) Field of Search ..................................... 514/218, 219, ..", Psychiatry, vol. 3, (1989). 514/220 Makino, et al., Chemical Abstracts, vol. 106, No. 12, (56) References Cited (90.177x) issued Mar. 23, 1987, “Pharmaceuticals Permeable to Blood-Brain Barrier'.
    [Show full text]
  • Product Monograph
    PRODUCT MONOGRAPH PrCLOPIXOL® Zuclopenthixol Tablets Lundbeck Std. (10 mg and 25 mg zuclopenthixol as zuclopenthixol hydrochloride) Lundbeck standard PrCLOPIXOL-ACUPHASE® 50 mg/mL Zuclopenthixol Intramuscular Injection (45.25 mg/mL zuclopenthixol as zuclopenthixol acetate) Lundbeck standard PrCLOPIXOL® DEPOT 200 mg/mL Zuclopenthixol Intramuscular Injection (144.4 mg/mL zuclopenthixol as zuclopenthixol decanoate) Lundbeck standard Antipsychotic Agent Lundbeck Canada Inc. Date of Revision: 2600 Alfred-Nobel October 16th, 2020 Suite 400 St-Laurent, QC H4S 0A9 Submission Control No : 171198 Page 1 of 34 Table of Contents PART I: HEALTH PROFESSIONAL INFORMATION .........................................................3 SUMMARY PRODUCT INFORMATION ........................................................................3 INDICATIONS AND CLINICAL USE ..............................................................................3 CONTRAINDICATIONS ...................................................................................................4 WARNINGS AND PRECAUTIONS ..................................................................................4 ADVERSE REACTIONS ....................................................................................................9 DRUG INTERACTIONS ..................................................................................................13 DOSAGE AND ADMINISTRATION ..............................................................................14 OVERDOSAGE ................................................................................................................18
    [Show full text]
  • ABC Ofpoisoning PSYCHOACTIVE DRUGS
    Br Med J (Clin Res Ed): first published as 10.1136/bmj.289.6454.1291 on 10 November 1984. Downloaded from BRITISH MEDICAL JOURNAL VOLUME 289 10 NOVEMBER 1984 1291 0 ~~~~~~~~JOHNHENRY ABC ofPoisoning GLYN VOLANS PSYCHOACTIVE DRUGS Tricyclic antidepressants ofthe drugs used to treat psychiatric disorders are relatively toxic, and Amitriptyhgne &3O AmXrijyD IMostsince suicidal behaviour is often a feature ofthese conditions the risk of CHCH2CH2N ICH3)2 overdose, often with potentially serious consequences, is real. Those Related tricyclic antidepressants: prescribing psychoactive drugs should ensure not only that the diagnosis is correct and the treatment but that use Butriptylie X appropriate the proper and possible Bothiepiline side effects of the medication are carefully explained to the patient. If Doxepin suicide IS thought to be a risk th leat toxic ofthe available drugs should be Nortriptyline ucchosen. Protriptylire Ilmipramine CH2CH2CH2N (CH3 )2 Related tricyclic antidepressants: Clomipramine Desipbamine Tricyclic antidepressants have a three ring structure, Dibeozepin hence their name. Opipramol iL- Trimipramine http://www.bmj.com/ Clinical features Selfpoisoning with tricyclic antidepressants accounts for about 300 SymTptoms of tricyclic antidepressant deaths a year in adults in England and Wales. Patients prescribed tricyclic poisoning antidepressants should be told that the drug will not fully reverse their Anticholinergic: depression for some weeks and that they should persevere with their on 24 September 2021 by guest. Protected copyright. Sinus tachycardia treatment. These drugs are also the major cause offatal accidental poisoning Mydriasis in children in the United Kingdom, causing about 5 deaths a year. Urinary retention Although the antidepressant activity ofthese drugs probably relates to Central nervous effects.
    [Show full text]
  • List of Different Groups of Medications
    LIST OF DIFFERENT GROUPS OF MEDICATIONS 1.beta blockers Dichloroisoprenaline, the first beta blocker. Non-selective agents • Alprenolol • Bucindolol • Carteolol • Carvedilol (has additional α-blocking activity) • Labetalol (has additional α-blocking activity) • Nadolol • Penbutolol (has intrinsic sympathomimetic activity) • Pindolol (has intrinsic sympathomimetic activity) • Propranolol • Sotalol • Timolol β1-Selective agents • Acebutolol (has intrinsic sympathomimetic activity) • Atenolol • Betaxolol • Bisoprolol • Celiprolol [39] • Esmolol • Metoprolol • Nebivolol 2.Antiarrhythmic classification + • Class I agents interfere with the sodium (Na ) channel. • Class II agents are anti-sympathetic nervous system agents. Most agents in this class are beta blockers. + • Class III agents affect potassium (K ) efflux. • Class IV agents affect calcium channels and the AV node. • Class V agents work by other or unknown mechanisms. • Overview table Clas Known as Examples s • Quinidine • Procainamide Ia fast-channel blockers • Disopyramide • Lidocaine • Phenytoin Ib • Mexiletine Flecainide Ic • • Propafenone • Moricizine • Propranolol • Esmolol • Timolol Metoprolol II Beta-blockers • • Atenolol • Bisoprolol • Amiodarone • Sotalol III IV slow-channel • Verapamil blockers • Diltiazem • Adenosine V • Digoxin 3.Antidepressants Selective serotonin reuptake inhibitors (SSRIs • Celexa): usual dosing is 20 mg initially; maintenance 40 mg per day; maximum dose 60 mg per day. • Escitalopram (Lexapro, Cipralex): usual dosing is 10 mg and shown to be as effective as 20 mg in most cases. Maximum dose 20 mg. Also helps with anxiety. • Paroxetine (Paxil, Seroxat): Also used to treat panic disorder, OCD, social anxiety disorder, generalized anxiety disorder and PTSD. Usual dose 25 mg per day; may be increased to 40 mg per day. Available in controlled release 12.5 to 37.5 mg per day; controlled release dose maximum 50 mg per day.
    [Show full text]
  • Antipsychotics-Children-Surveillance
    AHRQ Comparative Effectiveness Review Surveillance Program CER #39: First & second generation antipsychotics for children and young adults Original Release Date: February, 2012 Surveillance Report: November, 2012 Surveillance Report: October, 2014 Summary of Key Findings from Surveillance Reports: • For Key Question 1, studies were identified suggesting that conclusions related to the effectiveness of Second Generation Antidepressants (SGA) for anorexia nervosa are out of date, that conclusions related to the comparative effectiveness of First Generation Antidepressants (FGA) and SGAs are possibly out of date, that the conclusion of no difference between SGAs and placebo for aggression is possibly out of date, that the strength of evidence (SOE) for SGAs and improvement on mania scales may possibly increase from low to moderate, and the SOE regarding risperidone and reduction in problem behavior may have increased. • For Key Question 2, conclusions related to cardiovascular events and weight gain, and the tolerability of molidone hydrochloride are possibly out of date, and the SOE for additional adverse events may possibly increase from moderate to high. • For Key Question 3, the conclusion on the safety and tolerability of FGAs vs. SGAs is possibly out of date. • For Key Question 4, conclusions related to individuals with comorbid disorders are possibly out of date. Signal Assessment: The signals examined in this surveillance assessment suggest that the original CER is possibly out of date. i Authors: Karli Kondo Maya O’Neil Shammarie Mathis Ryan McKenna Kelly Vander Ley Johanna Anderson Mark Helfand Conflict of Interest: None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.
    [Show full text]
  • An Open Trial of Zuclopenthixol in Management of Acute Psychoses : a Multicentered Study
    Indian Journal of Psychiatry, 1999, 41 (3), 242-248 AN OPEN TRIAL OF ZUCLOPENTHIXOL IN MANAGEMENT OF ACUTE PSYCHOSES : A MULTICENTERED STUDY JOHN FERNANDES, P.V. PRADHAN, PARTHA CHOUDHURY, SOMNATH CHATTERJI, J. PEREIRA, HENAL SHAH, HOZEFA A. BHINDERWALA, DUSHYANT M. BHADLIKAR & R. RADHAKRISHANAN ABSTRACT In an open trial, patients with ICD-10 diagnosis of acute functional psychoses were administered injection Zuclopenthixol acetate (Acuphase) in the initial phase. Patients were rated with CGI, BPRS -24 item and UKU side effect rating scale at baseJine, 24 hours and 72 hours. Of the 120 patients recruited, 119 finished this part of the trial. The most common side effect was sedation, which was preferable as most of the patients were in the acute state. The issues concerning less dosing efficacy and the rapid onset of antipsychotic activity are discussed. Patients who had been administered zuclopenthixol acetate in the acute phase were maintained with injection zuclopenthixol decanoate (depot) starting at 72 hours over the baseline. Patients were assessed at 72 hours, one week, 2 weeks, 3 vseeks, 4 weeks and 8 weeks using the same instruments. The issues concerning the dosage and therapeutic efficacy are discussed. Key words : Zuclopenthixol acetate, acute psychoses, zuclopenthixol decanoate, depot. Violence and aggression constitute a major neuroleptics such as haloperidol have a problem in psychiatry. For a psychiatrist the main disadvantages as their duration of action is short. concern when working with such severely ill The long-acting depot preparation of patients is to limit or prevent physical violence zuclopenthixol is in the form of decanoate in and disruptive behaviour.
    [Show full text]