DOCSLIB.ORG

Prescribing Psychotropics Management of Psychosis in Primary Care Learning Outcomes

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Prescribing Psychotropics Management of Psychosis in Primary Care Learning Outcomes Prescribing psychotropics Management of Psychosis in Primary Care Learning Outcomes • Pathophysiology • Mode of action of antipsychotics • Side‐effects • Management of some of the challenges Introduction • Psychosis – Includes schizophrenia, schizoaffective disorder, delusional disorder • 0.7% ‐ 1% • Reduced lifespan – metabolic disorder, suicide, • M:F • Lifelong • Suicide – 15% • Symptoms –+ve, ‐ve – quality of life • Cost >20 bn Aetiology • Genetic • Structural • Biochemical • Social –low socioeconomic status, poor housing, social isolation, loss of cultural identity and discrimination • Environmental • Psychological –stressful life events Genetics of Schizophrenia A heterogeneous disorder or set of disorders. Often triggered by stress at puberty / early adulthood Behavioural effects of disordered brain development then become manifest Neurodevelopmental structural changes Symptoms Positive Negative • Hallucination • Social withdrawal • Delusion • Avolition/Apathy • Thought disorder • Blunted affect • Poverty of speech Dopamine hypothesis of schizophrenia Schizophrenia is associated with impaired dopaminergic neurotransmission in the brain Hypoactivity in Hyperactivity in the mesocortical pathway mesolimbic pathway - Negative symptoms -Positive symptoms - Impaired learning and memory Normal dopamine Normal dopamine activity in activity in tuberoinfundibular nigrostriatal pathway pathway (involved in prolactin (involved in regulation movement regulation) Dopamine hypothesis of schizophrenia The Dopamine Theory • DA‐ergic hyperactivity in Mesolimbic forebrain areas D‐amphetamine causes paranoia, delusions & auditory hallucinations at high doses Stimulants can exacerbate psychosis All typical neuroleptics block D2receptors & alleviate positive symptoms • Structural changes – limbic forebrain smaller and disorganised • Risk factors –stress, alcohol, drugs, smoking cannabis • Reduction in Mesocortical DA activity is known to be responsible for negative symptoms Effects of Dopamine agonism and antagonism Mesocortical Mesolimbic Nigrostriatal pathway pathway pathway Dopamine Increased Positive mood1 Motor activity2 receptor attention and Euphoria/mania concentration1 agonism Psychoses Dopamine Decreased Negative mood1 Extrapyramidal receptor attention and symptoms2 antagonism concentration1 1. Nutt DJ et al. J Psychopharmacol 2007;21:461–71; 2. Shiloh R, et al. Atlas of Psychiatric Pharmacotherapy. Second edition. Oxford: Taylor & Francis; 2007. More than dopamine! Effects of serotonin agonism and antagonism at main 5HT receptor subtypes in the brain Effect at 5HT1A 5HT2A 5HT2C receptor Agonist Anxiolytic Psychosis3 Insomnia5 1,2 effect Hallucinations4 Anxiety2 Antidepressant Satiety3 effect1,2 Antagonist Turns off Antidepressant Possible autoreceptor effect2,6 increased 3 4 activity Possible appetite/weight antipsychotic effect2,3 Can counteract EPS effect of D2 blockade3 1. Blier P et al. Biol Psychiatry 2003;53(3):193–236; 2. Hardman JG et al. (eds) Goodman and Gillman’s The Pharmacological Basis of Therapeutics. New York: McGraw Hill; 2001; 3. Correll C et al. J Clin Psych 2008; 69 (Suppl 4): 26–36; 4. Gouzoulis-Mayfrank, E. Neuropsychopharmacology. 2006 Feb;31(2):431–41; 5. Quintin P et al. Encephale 2004;30:583–9; 6. Mann N. Engl J Med 2005;353:1819–34. • Serotonergic projections to prefrontal cortex mediate cognitive effects • Mediates inhibition of DA release from dopaminergic pre‐synaptic neurones • Second generation antipsychotics have mixed 5‐HT profiles – Reduced extrapyramidal side profile –Some serotonergic side effects (weight gain‐5HT2C) Other receptor activitites affected by antipsychotics and effects Receptor Noradrenaline Noradrenaline Histamine ACh ACh type Alpha 1 (α1) Alpha 2 (α2) H1 M1 M2-M4 Effect at (central) (peripheral) receptor Agonism Anxiety1 Memory2 Arousal 3 Arousal4 Nausea3 Anti- Attention2 Insomnia3 Memory4 Diarrhoea3 1 depressant 5 Seizures Bradycardia Antagonism Postural Anti-depressant Sedation Amnesia Blurred vision 3 hypotension Increased Anxiolytic Decreased Constipation Dizziness alertness Weight cognition Urinary Tachycardia Increased blood gain Dry mouth retention Syncope pressure Anti-EPS Tachycardia Hypertension Antipsychotics Typical Atypical Partial pharmacology pharmacology agonist 5HT2 dopamine dopamine dopamine Haloperidol Clozapine Amisulpride Aripiprazole Zuclopenthixol Olanzapine Lurasidone Flupenthixol Quetiapine Sulpiride Risperidone First-generation (“typical”) AP Side Effect Profiles Usual Sedation Movement Weight Anticho- Sexual Drug daily problems gain linergic problems dose Chlorpromazine 75-300mg • • • • • • • • • • • • Haloperidol 5-20mg • • • • • • • • • • Levomepromazine 100-200mg • • • • • • • • • • • • 5-20mg Pericyazine • • • • • • • • • • • • Perphenazine 12-24mg • • • • • • • • • • • 400- Sulpiride 1,600mg • • • • • • • • • Trifluoperazine 5-15mg • • • • • • • • • • Second-generation (“atypical”) AP Side Effect Profiles Usual daily Sedation Movement Weight Antichol Sexual Drug dose problems gain inergic problems Amisulpride 400-800mg (Solian®) •• •• ••• • • Aripiprazole 15-30mg (Abilify®) ••††† Clozapine Usually (Clozaril®, Denzapine®, • • • • • • • • • • • 300-600mg Zaponex®) Olanzapine 10-20mg (Zyprexa®) • • • • • • • • • Paliperidone 6mg (Invega®) •• •• •• • • Risperidone 4-6mg (Risperdal®) •• •• ••• • Quetiapine Around (Seroquel®) 600mg • • • • • • • • Zotepine Up to 300mg (Zoleptil®) • • • • • • • • • • • NICE CG187 guidance Primary care • Referral from primary care • Monitoring and follow up • Promote wellbeing and relapse prevention 19 November, 2019 20 Management of Challenges in Clinical Practice Non‐adherence Shared decision, Reasons explored, Depot, Psychological intervention, Increased follow up, CBT Physical monitoring Q‐RISK (Intervention –smoking, Yearly –ECG, Lipids, Weight, BP, Pulse, HbA1c, diabetes, obesity, lipids) Side‐effect: GASS, clozapineGASS Weight gain & Metabolic Diet & exercise, CBT disorder Movement disorders Dose adjustment, procyclidine, second generation AP Sexual dysfunction Prolactin level, management of mental condition Sedation Dose adjustment and time of administration Constipation Laxatives prophylaxis, diet and lifestyle Management of Challenges in Clinical Practice Information PILs Off label prescribing Information, discussion, consent, documentation Interaction: Smoking Smoking cessation, monitoring Other medication ‐ carbamazepine Avoid with clozapine, dose adjustment 19 November, 2019 22 Management of Depression in Primary Care Introduction • Increasing prevalence • High risk of mortality • 21% suicide rate • F>M • Social, economic, ethnic factors • Associated with increased comorbidity of psychiatric and medical conditions • Worsens outcome of general medical conditions Morbidity/mortality post‐myocardial infarction Risk of mortality in nursing home patients Morbidity post‐stroke May worsen outcomes in cancer and HIV Pathophysiology • Genetic – altered neurotransmitter Risk Factors: and receptor activity in response to triggers. • Family history, early life adverse experience, life events such as divorce, • The two hypothesis are high level of pregnancy, physical conditions e.g. cortisol and functional deficit of Diabetes, CVD, other mental condition, noradrenaline, serotonin, GABA and changes in sleep patter, social isolation, dopamine transmission in the central abuse, medication e.g. isotretinoin, nervous system. alcohol, personality traits, social circumstances. • Structural brain changes have been noted in severe depression: ventricular enlargement; reduced grey matter in left hippocampus, basal ganglia and thalamus. Role of Serotonin and Noradrenaline in Mental & Physical Processes Present in many mental and physical processes: • Anxiety • Pain perception • Vasoconstriction • Urethral sphincter contraction • Bladder wall relaxation • Gastrointestinal motility • Pilomotor contraction Symptom classification for depression – more than feeling sad! Emotional Cognitive Behavioural Physical Symptoms Symptoms Symptoms Symptoms Low Mood Reduced Attention Anhedonia Low Energy Guilt Reduced Tearfulness Reduced Sleep Worthlessness Concentration Irritability Reduced Appetite Suicidal Thoughts, Anxiety Reduced Libido Ideas or Actions Social Withdrawal Painful Symptoms Reduced Confidence 19 November, 2019 27 Diagnosis • NICE recommends PHQ‐9, BDl‐ll, HADS Symptoms: when examining mental state through observation and direct questioning, against • A: Depressed mood present most of the DSM‐5 or ICD11 criteria. Five or more of day and almost every day these symptoms must have been present • B: Loss of interest or pleasure in usual during the same two‐week period and activities represent a change from previous • C: Decreased energy or increased functioning. fatigability • D: Loss of confidence or self‐esteem • Differential diagnosis such as • E: Unreasonable feelings of guilt hypothyroidism, low folate as well as other • prescribed medication e.g steroids should F: Recurrent thoughts of death or be considered, investigated and managed. suicide • G: Complaints of diminished ability to think or concentrate • The severity of the depression is based on • H: Change in psychomotor activity, the number of symptoms the patient has in with agitation or retardation addition to the two core symptoms of low mood and lack of interest or enjoyment as • I: Sleep disturbance well as loss of daily living functions • J: Change in appetite 19 November, 2019 28 NICE CG90 Depression 19 November, 2019 29 Management: Treatment Aim • Pharmacological
Load more

Recommended publications
  • 2D6 Substrates 2D6 Inhibitors 2D6 Inducers
    Physician Guidelines: Drugs Metabolized by Cytochrome P450’s 1 2D6 Substrates Acetaminophen Captopril Dextroamphetamine Fluphenazine Methoxyphenamine Paroxetine Tacrine Ajmaline Carteolol Dextromethorphan Fluvoxamine Metoclopramide Perhexiline Tamoxifen Alprenolol Carvedilol Diazinon Galantamine Metoprolol Perphenazine Tamsulosin Amiflamine Cevimeline Dihydrocodeine Guanoxan Mexiletine Phenacetin Thioridazine Amitriptyline Chloropromazine Diltiazem Haloperidol Mianserin Phenformin Timolol Amphetamine Chlorpheniramine Diprafenone Hydrocodone Minaprine Procainamide Tolterodine Amprenavir Chlorpyrifos Dolasetron Ibogaine Mirtazapine Promethazine Tradodone Aprindine Cinnarizine Donepezil Iloperidone Nefazodone Propafenone Tramadol Aripiprazole Citalopram Doxepin Imipramine Nifedipine Propranolol Trimipramine Atomoxetine Clomipramine Encainide Indoramin Nisoldipine Quanoxan Tropisetron Benztropine Clozapine Ethylmorphine Lidocaine Norcodeine Quetiapine Venlafaxine Bisoprolol Codeine Ezlopitant Loratidine Nortriptyline Ranitidine Verapamil Brofaramine Debrisoquine Flecainide Maprotline olanzapine Remoxipride Zotepine Bufuralol Delavirdine Flunarizine Mequitazine Ondansetron Risperidone Zuclopenthixol Bunitrolol Desipramine Fluoxetine Methadone Oxycodone Sertraline Butylamphetamine Dexfenfluramine Fluperlapine Methamphetamine Parathion Sparteine 2D6 Inhibitors Ajmaline Chlorpromazine Diphenhydramine Indinavir Mibefradil Pimozide Terfenadine Amiodarone Cimetidine Doxorubicin Lasoprazole Moclobemide Quinidine Thioridazine Amitriptyline Cisapride
    [Show full text]
  • Reference 8 Huang Repurposing Psychiatric Drugs for Cancer 18
    Cancer Letters 419 (2018) 257e265 Contents lists available at ScienceDirect Cancer Letters journal homepage: www.elsevier.com/locate/canlet Mini-review Repurposing psychiatric drugs as anti-cancer agents * Jing Huang a, b, c, d, Danwei Zhao e, Zhixiong Liu a, Fangkun Liu a, a Department of Neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China b Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China c Mental Health Institute of the Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center for Mental Disorders (Xiangya), Changsha, Hunan, 410011, China d Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, 410011, China e Xiangya Medical School, Central South University, Changsha, Hunan, China article info abstract Article history: Cancer is a major public health problem and one of the leading contributors to the global disease burden. Received 10 November 2017 The high cost of development of new drugs and the increasingly severe burden of cancer globally have Received in revised form led to increased interest in the search and development of novel, affordable anti-neoplastic medications. 17 January 2018 Antipsychotic drugs have a long history of clinical use and tolerable safety; they have been used as good Accepted 19 January 2018 targets for drug repurposing. Being used for various psychiatric diseases for decades, antipsychotic drugs are now reported to have potent anti-cancer properties against a wide variety of malignancies in addition Keywords: to their antipsychotic effects. In this review, an overview of repurposing various psychiatric drugs for Antipsychotic drugs Drug repurposing cancer treatment is presented, and the putative mechanisms for the anti-neoplastic actions of these Cancer treatment antipsychotic drugs are reviewed.
    [Show full text]
  • Drug Class Review on Atypical Antipsychotic Drugs
    Drug Class Review on Atypical Antipsychotic Drugs Final Report April 2006 The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports. Marian S. McDonagh, PharmD Kim Peterson, MS Susan Carson, MPH Oregon Evidence-based Practice Center Oregon Health & Science University Mark Helfand, MD, MPH, Director Copyright © 2006 by Oregon Health & Science University Portland, Oregon 97201. All rights reserved. Final Report Update 1 Drug Effectiveness Review Project TABLE OF CONTENTS INTRODUCTION............................................................................................................. 5 Scope and Key Questions ......................................................................................................13 METHODS .................................................................................................................... 15 Literature Search ....................................................................................................................15 Study Selection .......................................................................................................................15 Data Abstraction .....................................................................................................................15
    [Show full text]
  • How CATIE Brought Us Back to Kansas: a Critical Re-Evaluation of the Concept of Atypical Antipsychotics and Their Place In
    Advances in Psychiatric Treatment (2008), vol. 14, 17–28 doi: 10.1192/apt.bp.107.003970 How CATIE brought us back to Kansas: a critical re-evaluation of the concept of atypical antipsychotics and their place in the treatment of schizophrenia David Cunningham Owens Abstract The subdivision of the class of antipsychotic drugs into two discrete groups – ‘conventional’ (or first generation) and ‘atypical’ (or second generation) – has been adopted as standard, with the latter generally accepted as ‘better’ and widely recommended as automatic first-line choices. However, this perception has been thrown into confusion with the results of large pragmatic trials that failed to identify advantages with the new, more expensive drugs, while identifying worrying tolerability issues. This article explores the origins of ‘atypicality’, its construction on the back of a confusing and weak clinical validator (diminished liability to promote parkinsonism) and how even in relation to the archetypical atypical, clozapine, the uncertain boundaries of drug-induced extrapyramidal dysfunction may be contributing to confusion about ‘efficacy’ and ‘tolerability’. It argues that abandoning atypicality would open up clinical practice to all drugs of a single class of ‘antipsychotics’ and allow for individualised risk/benefit appraisal as a basis for truly tailored treatment recommendations. Sometimes, the best way forward is back – to take This article raises fundamental questions about stock, appraise anew, admit mistakes. This is never our understanding of the clinical pharmacology easy, especially if shadows haunt the way but, if of antipsychotic drugs – so fundamental that (as necessary, is better undertaken sooner than later – numerous publication rejections attest) they were and with honesty.
    [Show full text]
  • Antipsychotics
    © Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 | Fax 503-947-1119 Class Update with New Drug Evaluations: Antipsychotics Date of Review: May 2016 End Date of Literature Search: February 2016 New Drugs: brexpiprazole Brand Names (Manufacturer): Rexulti® (Otsuka) cariprazine Vraylar™ (Actavis) Dossiers Received: yes PDL Classes: Antipsychotics, First generation Antipsychotics, Second generation Antipsychotics, Parenteral Current Status of PDL Class: See Appendix 1. Purpose for Class Update: Several new antipsychotic drug products have been approved by the U.S. Food and Drug Administration since these drug classes were last reviewed by the Oregon Health Plan (OHP) Pharmacy and Therapeutics Committee. Research Questions: 1. Is there new comparative evidence of meaningful difference in efficacy or effectiveness outcomes for schizophrenia, bipolar mania or major depressive disorders (MDD) between oral antipsychotic agents (first‐ or second‐generation) or between parenteral antipsychotic agents (first‐ or second‐generation)? 2. Is there new comparative evidence of meaningful difference in harms between oral antipsychotic agents (first‐ or second‐generation) or between parenteral antipsychotic agents (first‐ or second‐generation)? 3. Is there new comparative evidence of meaningful difference in effectiveness or harms in certain subpopulations based on demographic characteristics? Conclusions: There is insufficient evidence of clinically meaningful differences between antipsychotic agents in efficacy or effectiveness or harms between antipsychotic agents for schizophrenia, bipolar mania or MDD. There is insufficient evidence to determine if brexpiprazole and cariprazine offer superior efficacy or safety to other antipsychotic agents for schizophrenia. There is insufficient evidence to determine if brexpiprazole offers superior efficacy or safety to other antipsychotic agents for MDD.
    [Show full text]
  • United States Patent (10 ) Patent No.: US 10,660,887 B2 Javitt (45 ) Date of Patent: *May 26 , 2020
    US010660887B2 United States Patent (10 ) Patent No.: US 10,660,887 B2 Javitt (45 ) Date of Patent : *May 26 , 2020 (54 ) COMPOSITION AND METHOD FOR (56 ) References Cited TREATMENT OF DEPRESSION AND PSYCHOSIS IN HUMANS U.S. PATENT DOCUMENTS 6,228,875 B1 5/2001 Tsai et al. ( 71 ) Applicant : Glytech , LLC , Ft. Lee , NJ (US ) 2004/0157926 A1 * 8/2004 Heresco - Levy A61K 31/198 514/561 (72 ) Inventor: Daniel C. Javitt , Ft. Lee , NJ (US ) 2005/0261340 Al 11/2005 Weiner 2006/0204486 Al 9/2006 Pyke et al . 2008/0194631 Al 8/2008 Trovero et al. ( 73 ) Assignee : GLYTECH , LLC , Ft. Lee , NJ (US ) 2008/0194698 A1 8/2008 Hermanussen et al . 2010/0069399 A1 * 3/2010 Gant CO7D 401/12 ( * ) Notice : Subject to any disclaimer, the term of this 514 / 253.07 patent is extended or adjusted under 35 2010/0216805 Al 8/2010 Barlow 2011/0207776 Al 8/2011 Buntinx U.S.C. 154 ( b ) by 95 days . 2011/0237602 A1 9/2011 Meltzer This patent is subject to a terminal dis 2011/0306586 Al 12/2011 Khan claimer . 2012/0041026 A1 2/2012 Waizumi ( 21 ) Appl. No.: 15 /650,912 FOREIGN PATENT DOCUMENTS CN 101090721 12/2007 ( 22 ) Filed : Jul. 16 , 17 KR 2007 0017136 2/2007 WO 2005/065308 7/2005 (65 ) Prior Publication Data WO 2005/079756 9/2005 WO 2011044089 4/2011 US 2017/0312275 A1 Nov. 2 , 2017 WO 2012/104852 8/2012 WO 2005/000216 9/2013 WO 2013138322 9/2013 Related U.S. Application Data (63 ) Continuation of application No.
    [Show full text]
  • Effects of Subchronic Administrations of Vortioxetine, Lurasidone, And
    International Journal of Molecular Sciences Article Effects of Subchronic Administrations of Vortioxetine, Lurasidone, and Escitalopram on Thalamocortical Glutamatergic Transmission Associated with Serotonin 5-HT7 Receptor Motohiro Okada * , Ryusuke Matsumoto, Yoshimasa Yamamoto and Kouji Fukuyama Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan; [email protected] (R.M.); [email protected] (Y.Y.); [email protected] (K.F.) * Correspondence: [email protected]; Tel.: +81-59-231-5018 Abstract: The functional suppression of serotonin (5-HT) type 7 receptor (5-HT7R) is forming a basis for scientific discussion in psychopharmacology due to its rapid-acting antidepressant-like action. A novel mood-stabilizing atypical antipsychotic agent, lurasidone, exhibits a unique receptor-binding profile, including a high affinity for 5-HT7R antagonism. A member of a novel class of antidepres- sants, vortioxetine, which is a serotonin partial agonist reuptake inhibitor (SPARI), also exhibits a higher affinity for serotonin transporter, serotonin receptors type 1A (5-HT1AR) and type 3 (5-HT3R), and 5-HT7R. However, the effects of chronic administration of lurasidone, vortioxetine, and the selec- Citation: Okada, M.; Matsumoto, R.; tive serotonin reuptake inhibitor (SSRI), escitalopram, on 5-HT7R function remained to be clarified. Yamamoto, Y.; Fukuyama, K. Effects Thus, to explore the mechanisms underlying the clinical effects of vortioxetine, escitalopram, and of Subchronic Administrations of lurasidone, the present study determined the effects of these agents on thalamocortical glutamatergic Vortioxetine, Lurasidone, and transmission, which contributes to emotional/mood perception, using multiprobe microdialysis Escitalopram on Thalamocortical and 5-HT7R expression using capillary immunoblotting.
    [Show full text]
  • Assessment Report
    19 September 2013 EMA/737723/2013 Committee for Medicinal Products for Human Use (CHMP) Assessment report ABILIFY MAINTENA International non-proprietary name: ARIPIPRAZOLE Procedure No. EMEA/H/C/002755/0000 Note Assessment report as adopted by the CHMP with all information of a commercially confidential nature deleted. 7 Westferry Circus ● Canary Wharf ● London E14 4HB ● United Kingdom Telephone +44 (0)20 7418 8400 Facsimile +44 (0)20 7418 8613 E -mail [email protected] Website www.ema.europa.eu An agency of the European Union © European Medicines Agency, 2013. Reproduction is authorised provided the source is acknowledged. Table of contents 1.1. Submission of the dossier .................................................................................... 6 1.2. Manufacturers ................................................................................................... 6 1.3. Steps taken for the assessment of the product ....................................................... 7 2. Scientific discussion ................................................................................ 7 2.1. Introduction ...................................................................................................... 7 2.2. Quality aspects .................................................................................................. 9 2.2.1. Introduction ................................................................................................... 9 2.2.2. Active Substance ..........................................................................................
    [Show full text]
  • Schizophrenia Or Bipolar Disorder
    Appendix D- NICE’s response to consultee and commentator comments on the draft scope and provisional matrix National Institute for Health and Clinical Excellence Proposed Single Technology Appraisal (STA) Loxapine inhalation for the treatment of acute agitation and disturbed behaviours associated with schizophrenia or bipolar disorder Response to consultee and commentator comments on the draft remit and draft scope (pre-referral) Comment 1: the draft remit Section Consultees Comments Action Appropriateness Alexza Yes as this topic is relevant to New Horizons: A Shared Vision for Mental Health Comment noted. No Pharmaceuticals (2009)1 and to The National Service Framework for Mental Health: Modern action required. Standards and Service Models (1999).2 Royal College of The appraisal of use of alternative matrices for drug delivery is important. It is Comment noted. No Pathologists particularly important in situation where there may be difficulties in administering action required. traditional drugs via intramuscular or intravenous routes. Therefore this worthy of NICE appraisal. Royal College of It is appropriate to consider novel methods to administer medications for this Comment noted. No Nursing condition. action required. Wording Alexza Revise to: Comment noted. Pharmaceuticals To appraise the clinical and cost effectiveness of Staccato® loxapine within the Consultees agreed that licensed indication for the rapid control of agitation and disturbed behaviors in the draft remit should patients with schizophrenia or in patients with bipolar
    [Show full text]
  • A Systematic Review of Atypical Antipsychotics for Schizophrenia
    A systematic review of atypical antipsychotics for schizophrenia AM Bagnall, L Jones, J Kleijnen. NHS Centre for Reviews and Dissemination, University of York, UK. This work was funded by the NHS R&D HTA programme. The views and opinions expressed do not necessarily reflect those of the NHS Executive Purpose: A systematic review on the effectiveness and safety of atypical Side effects antipsychotics in the treatment of people with schizophrenia and related All atypical antipsychotics caused fewer movement disorder side effects disorders was commissioned by the UK National Institute of Clinical than typical drugs. Excellence (NICE).1 Serious and potentially fatal cardiac side effects were noted with two Methods: Literature searches ran from database inception to March 2001. 1 atypical drugs (sertindole and clozapine) and two typical drugs (pimozide A list of databases searched is available from the full report. and thioridazine). Study inclusion criteria: More somnolence occurred in clozapine than in those given typical drugs. • People with the diagnosis of schizophrenia, schizoaffective disorder, Olanzapine, amisulpride, sertindole and perhaps risperidone may cause schizophreniform disorder or ‘psychotic illness’, treated with less somnolence than typical drugs. More autonomic side effects occurred amisulpride, clozapine, olanzapine, quetiapine, risperidone, sertindole, with clozapine and sertindole and less with quetiapine and olanzapine ziprasidone or zotepine. than with typical drugs. • Randomised controlled trials (RCTs) or systematic reviews for Amisulpride, risperidone and sertindole caused more weight gain than effectiveness data. For data on long term or rare adverse events and typical drugs. The evidence for clozapine and olanzapine was equivocal. suicide or other mortality, studies with a case-control design, >2yrs Attrition follow-up or >2000 participants.
    [Show full text]
  • Pharmaceuticals and Medical Devices Safety Information No
    Pharmaceuticals and Medical Devices Safety Information No. 260 August 2009 Table of Contents 1. Tricyclic and tetracyclic antidepressants, associated with aggression ................................................................................................... 3 2. Important Safety Information .................................................................. 9 .1. Telmisartan ··························································································· 9 .2. Phenytoin, Phenytoin/Phenobarbital, Phenytoin/Phenobarbital/ Caffeine and Sodium Benzoate, Phenytoin Sodium ··························· 13 3. Revision of PRECAUTIONS (No. 208) Lamotrigine (and 9 others) ············································································ 17 4. List of products subject to Early Post-marketing Phase Vigilance ..................................................... 21 This Pharmaceuticals and Medical Devices Safety Information (PMDSI) is issued based on safety information collected by the Ministry of Health, Labour and Welfare. It is intended to facilitate safer use of pharmaceuticals and medical devices by healthcare providers. PMDSI is available on the Pharmaceuticals and Medical Devices Agency website (http://www.pmda.go.jp/english/index.html) and on the MHLW website (http://www.mhlw.go.jp/, Japanese only). Published by Translated by Pharmaceutical and Food Safety Bureau, Pharmaceuticals and Medical Devices Agency Ministry of Health, Labour and Welfare Pharmaceutical and Food Safety Bureau, Office of Safety I, Ministry of
    [Show full text]
  • Hippocampal Plasticity in Response to Exercise in Schizophrenia
    ORIGINAL ARTICLE Hippocampal Plasticity in Response to Exercise in Schizophrenia Frank-Gerald Pajonk, MD; Thomas Wobrock, MD; Oliver Gruber, MD; Harald Scherk, MD; Dorothea Berner, MD; Inge Kaizl, MD; Astrid Kierer, cand.med; Stephanie Müller, cand.med; Martin Oest, MD; Tim Meyer, MD; Martin Backens, MD; Thomas Schneider-Axmann, PhD; Allen E. Thornton, PhD; William G. Honer, MD; Peter Falkai, MD Context: Hippocampal volume is lower than expected (Rey Auditory Verbal Learning Test, Corsi block- in patients with schizophrenia; however, whether this rep- tapping test), and clinical (Positive and Negative Syn- resents a fixed deficit is uncertain. Exercise is a stimu- drome Scale) features. lus to hippocampal plasticity. Results: Following exercise training, relative hippocam- Objective: To determine whether hippocampal vol- pal volume increased significantly in patients (12%) and ume would increase with exercise in humans and whether healthy subjects (16%), with no change in the nonexer- this effect would be related to improved aerobic fitness. cise group of patients (−1%). Changes in hippocampal volume in the exercise group were correlated with im- Design: Randomized controlled study. provements in aerobic fitness measured by change in maximum oxygen consumption (r=0.71; P=.003). In the Setting: Patients attending a day hospital program or schizophrenia exercise group (but not the controls), an outpatient clinic. change in hippocampal volume was associated with a 35% increase in the N-acetylaspartate to creatine ratio in the Patients or Other Participants: Male patients with hippocampus. Finally, improvement in test scores for chronic schizophrenia and matched healthy subjects. short-term memory in the combined exercise and non- exercise schizophrenia group was correlated with change Interventions: Aerobic exercise training (cycling) and in hippocampal volume (r=0.51; PϽ.05).
    [Show full text]