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- Long-acting antipsychotic treatments: focus on women with schizophrenia
Authors: Sofia Brissos, Vicent Balanzá-Martínez Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Effective management of schizophrenia (SZ) requires long-term treatment with antipsychotics (APs) to prevent clinical relapse, attain remission and improve patients’ personal and social functioning, and quality of life. Although APs remain the cornerstone treatment for patients with SZ, despite their potential benefits, long-acting injectable APs (LAI-APs) remain underused, most notably in women with SZ. The efficacy and tolerability of APs differ significantly between men and women, and some of these differences are more noticeable depending on the patient’s age and the stage of the disorder. Although sex differences may influence treatment outcomes in SZ, their pertinence has been insufficiently addressed, especially regarding the use of LAI-APs. Some biological and social experiences, such as pregnancy, lactation, contraception and menopause, are specific to women, but these remain under-researched issues. Implications of this disorder in parenting are also of special pertinence regarding women; therefore, taking sex differences into account when treating SZ patients is now recommended, and improving personalized approaches has been proposed as a priority in the management of psychosis. In this narrative, critical review, we address some aspects specific to sex and their implications for the clinical management of women with SZ, with a special focus on the potential role of LAI-AP treatments.Plain language summary (OPTION 1)• Schizophrenia is a chronic mental illness, and patients often need to take antipsychotic medications in the long-run in order to stay well, avoid re-occurrence of symptoms and improve their everyday functioning and quality of life.• Antipsychotics are available in both pill and injection form. The latter is known as long-acting injectable antipsychotics (LAI-APs) and can be administered from weekly to twice a year.• Despite their effectiveness and practicality due to less frequent administration, LAI-APs remain largely underused, especially in women with schizophrenia.• The efficacy and tolerability of antipsychotics can be very different between men and women, and some of these differences may be more pronounced depending on the patient’s age and the phase of the illness.• Notably, physical and social aspects such as pregnancy, lactation, contraception, parenting and menopause and their effects on the treatment with antipsychotics and particularly LAI-APs in women with schizophrenia are under-studied.• Nevertheless, we have now become more aware of the importance of these sex differences, and it is recommended to take them routinely into consideration when treating patients with schizophrenia in clinical practice.• In this article, we discuss how factors specific to sex can influence the treatment of women with schizophrenia and focus on the potential role of LAI-AP medications. Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-07-31T08:50:36Z DOI: 10.1177/20451253241263715 Issue No: Vol. 14 (2024)
- Sublingual asenapine for agitation in malabsorptive states: three patient
cases Authors: Bradley G. Burk, Kyle Humphreys, Jim Waites, Bentley Adams, Badari Birur, Pamela E. Parker Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Gastric malabsorptive conditions may prevent patients from deriving benefit from orally administered medications intended for enteric absorption. While malabsorption is an increasingly common issue, current data on alternative oral options for agitation in these patients are very sparse. Sublingual (SL) asenapine is absorbed transmucosally, bypassing gut absorption, making it a viable consideration. We report on three patients, one with short bowel syndrome, one with viral gastritis, and one with aortic dissection who were trialed on SL asenapine for agitation after failing alternative antipsychotics. Two of these patients had an extensive history of psychiatric admissions for bipolar disorder and substance-induced psychosis. All three patients had significant reductions in agitation within 1–5 days, with no reported adverse effects. However, benefit of SL asenapine was hindered in two of these patients as they began inappropriately swallowing the medication, reducing bioavailability to nil. Clinicians should consider the use of SL asenapine for medically complex agitated patients where gastric absorption is questionable. There is an urgent need for guidelines on this matter, as well as more, alternative dosage forms for various medications that may help with agitation in this population. Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-07-25T08:16:26Z DOI: 10.1177/20451253241263714 Issue No: Vol. 14 (2024)
- Efficacy and safety of long-acting injectable versus oral antipsychotics
in the treatment of patients with early-phase schizophrenia-spectrum disorders: a systematic review and meta-analysis Authors: Giovanni Vita, Angelantonio Tavella, Giovanni Ostuzzi, Federico Tedeschi, Michele De Prisco, Rafael Segarra, Marco Solmi, Corrado Barbui, Christoph U. Correll Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Background:Long-acting injectable antipsychotics (LAIs) have advantages over oral antipsychotics (OAPs) in preventing relapse and hospitalization in chronically ill patients with schizophrenia-spectrum disorders (SSDs), but evidence in patients with first-episode/recent-onset, that is, early-phase-SSDs is less clear.Objectives:To assess the relative medium- and long-term efficacy and safety of LAIs versus OAPs in the maintenance treatment of patients with early-phase SSDs.Method:We searched major electronic databases for head-to-head randomized controlled trials (RCTs) comparing LAIs and OAPs for the maintenance treatment of patients with early-phase-SSDs.Design:Pairwise, random-effects meta-analysis. Relapse/hospitalization and acceptability (all-cause discontinuation) measured at study-endpoint were co-primary outcomes, calculating risk ratios (RRs) with their 95% confidence intervals (CIs). Subgroup analyses sought to identify factors moderating differences in efficacy or acceptability between LAIs and OAPs.Results:Across 11 head-to-head RCTs (n = 2374, median age = 25.2 years, males = 68.4%, median illness duration = 45.8 weeks) lasting 13–104 (median = 78) weeks, no significant differences emerged between LAIs and OAPs for relapse/hospitalization prevention (RR = 0.79, 95%CI = 0.58–1.06, p = 0.13) and acceptability (RR = 0.92, 95%CI = 0.80–1.05, p = 0.20). The included trials were highly heterogeneous regarding methodology and patient populations. LAIs outperformed OAPs in preventing relapse/hospitalization in studies with stable patients (RR = 0.65, 95%CI = 0.45–0.92), pragmatic design (RR = 0.67, 95%CI = 0.54–0.82), and strict intent-to-treat approach (RR = 0.64, 95%CI = 0.52–0.80). Furthermore, LAIs were associated with better acceptability in studies with schizophrenia patients only (RR = 0.87, 95%CI = 0.79–0.95), longer illness duration (RR = 0.88, 95%CI = 0.80–0.97), unstable patients (RR = 0.89, 95%CI = 0.81–0.99) and allowed OAP supplementation of LAIs (RR = 0.90, 95%CI = 0.81–0.99).Conclusion:LAIs and OAPs did not differ significantly regarding relapse prevention/hospitalization and acceptability. However, in nine subgroup analyses, LAIs were superior to OAPs in patients with EP-SSDs with indicators of higher quality and/or pragmatic design regarding relapse/hospitalization prevention (four subgroup analyses) and/or reduced all-cause discontinuation (five subgroup analyses), without any instance of OAP superiority versus LAIs. More high-quality pragmatic trials comparing LAIs with OAPs in EP-SSDs are needed.Trial registration:CRD42023407120 (PROSPERO).Plain language summaryComparing long-acting injections and pills for early schizophrenia: a study review and combined analysisBackground: We explored whether antipsychotics long-acting injections (LAIs) might outperform regular antipsychotics pills for people dealing with early-stage conditions like schizophrenia. While LAIs have clear benefits for those with long-term challenges, their effectiveness for those just starting to grapple with these issues is less certain. Objective: We aimed to uncover whether LAIs or regular antipsychotic pills demonstrate better outcomes over the medium and long term for individuals in the early stages of schizophrenia. Method: We scrutinized several studies comparing LAIs to regular pills in treating early-stage schizophrenia. Employing a combined analysis, we assessed factors such as preventing relapses and hospitalizations, as well as patient treatment adherence. Design: We combined different study results in one unique analysis. We delved into whether LAIs surpassed regular pills in preventing relapses and hospitalizations and in patient treatment adherence. Results: In our study of 11 trials involving over 2000 participants, we observed that LAIs and regular antipsychotic pills were generally comparable regarding preventing relapses, hospitalizations, and treatment adherence. However, on closer inspection, LAIs appeared slightly more effective for specific groups in the early stages of schizophrenia. Conclusion: While LAIs and regular antipsychotic pills showed similar results for most individuals in the early stages of schizophrenia, our findings hint at the possibility that LAIs might have a slight edge for certain groups. Nevertheless, we emphasize the need for more high-quality studies to gain a clearer understanding. Registration: This study is registered under CRD42023407120 (PROSPERO). Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-06-03T06:28:28Z DOI: 10.1177/20451253241257062 Issue No: Vol. 14 (2024)
- Paralytic ileus in a patient on clozapine therapy showing an inverted
clozapine/norclozapine ratio after switching valproic acid to carbamazepine: a case report Authors: Geke van Weringh, Leonieke van Koolwijk, Lieuwe de Haan, Daan J. Touw, Mariken B. de Koning Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. This case report examines the possible correlation between the clozapine/norclozapine ratio and the occurrence of constipation and paralytic ileus. We present the case of a 42-year-old patient diagnosed with schizoaffective disorder undergoing clozapine therapy. Despite intensive treatment with clozapine, haloperidol, valproic acid and biweekly electroconvulsive therapy sessions for over a year, florid psychotic symptoms and fluctuating mood swings persisted. Therefore, valproic acid was replaced by carbamazepine, a potent inducer of several CYP450-enzymes. To maintain clozapine plasma levels, fluvoxamine, a CYP1A2-inhibitor, was introduced at a dose of 25 mg before this switch. After addition of carbamazepine, there was a significant decline in clozapine levels, necessitating an increase in fluvoxamine dosage to 50 mg. Five weeks later the patient was admitted to a general hospital with a diagnosis of paralytic ileus. Treatment with enemas proved effective. Drug concentration analysis revealed a 2.5-fold increase in norclozapine levels in the weeks preceding hospital admission, resulting in an inverted clozapine/norclozapine ratio. Treatment with clozapine, carbamazepine and fluvoxamine was continued as the patient demonstrated clinical improvement on carbamazepine. Concurrently, an intensive laxative regimen was initiated. Two weeks later, the patient was readmitted to the general hospital due to suspected paralytic ileus and faecal vomiting, once again displaying an inverted clozapine/norclozapine ratio. We discuss potential mechanisms contributing to the occurrence of the paralytic ileus in this patient, including the antagonism of muscarinic M3 receptors by both clozapine and norclozapine, as well as the agonism of delta-opioid receptors by norclozapine. This case highlights the potential significance of both the clozapine/norclozapine ratio and absolute norclozapine levels as risk factors for constipation and paralytic ileus in patients on clozapine therapy. Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-05-31T10:48:41Z DOI: 10.1177/20451253241255487 Issue No: Vol. 14 (2024)
- Metformin co-commencement at time of antipsychotic initiation for
attenuation of weight gain: a systematic review and meta-analysis Authors: Ou Yu, Mengyao Lu, Terence K. Y. Lai, Margaret Hahn, Sri Mahavir Agarwal, Brian O’Donoghue, Bjørn H. Ebdrup, Dan Siskind Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Background:Antipsychotic medications are associated with weight gain and metabolic derangement. However, comprehensive evidence for the efficacy of co-commenced pharmacological treatments to mitigate initial weight gain is limited. Metformin has been shown to be effective in reducing weight among people on antipsychotic medications who are already overweight, but the potential benefits of metformin co-commencement in mitigating antipsychotic-induced weight gain has not been systematically reviewed.Method:We conducted a systematic review of PubMed, EMBASE, PsychInfo, CINAHL, the Cochrane database, and China National Knowledge Infrastructure from inception to 18 November 2023. We undertook a meta-analysis of concomitant commencement of metformin versus placebo for attenuation of weight gain and metabolic syndrome for people with schizophrenia commencing a new antipsychotic.Results:Fourteen studies from Australia, United States, Venezuela, and China with 1126 participants were included. We found that metformin was superior to placebo in terms of attenuating weight gain (−3.12 kg, 95% CI −4.22 to −2.01 kg). Metformin also significantly attenuated derangement of fasting glucose levels, total cholesterol, and total triglyceride levels. Sensitivity analysis on study quality, duration, and antipsychotic agent did not impact the results. Meta-analysis was also conducted on adverse drug reactions (ADR) reported in each study which showed no significant difference in ADR incidence between metformin and placebo groups. Subgroup analysis on antipsychotic-naïve participants and participants switching to new antipsychotic did not impact the results.Conclusion:Metformin led to statistically significant and clinically meaningful attenuation of weight gain as well as attenuation of several other metabolic parameters when commenced concomitantly with antipsychotic medications. Co-commencement of metformin with antipsychotic medications, where tolerated, should be considered in the clinical setting with aim to improve long-term cardiometabolic outcomes for patients with long-term need of antipsychotic treatments. Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-05-30T12:29:46Z DOI: 10.1177/20451253241255476 Issue No: Vol. 14 (2024)
- The cardiovascular safety of tricyclic antidepressants in overdose and in
clinical use Authors: David Taylor, Sofia Poulou, Ivana Clark Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Tricyclic antidepressants (TCAs) remain widely prescribed for depression and many other conditions. There may be important differences between individual TCA in regard to their overdose toxicity and their cardiac toxicity in clinical use. We conducted a systematic review to compare the toxicity of individual TCA in overdose and the risk of serious adverse cardiac events occurring with therapeutic doses. We used the fatal toxicity index (FTI) and case fatality ratio as markers of fatality in overdose, and hazard ratios or odds ratios for the risk of cardiovascular adverse events during normal clinical use. In all, 30 reports of mortality in overdose and 14 observational studies assessing the risk of cardiovascular adverse events in clinical use were included. FTI values were of the same order of magnitude (101–102) for all TCAs except lofepramine. Desipramine appears to be somewhat more likely than other TCAs to lead to death in overdose. Amitriptyline, clomipramine, dothiepin/dosulepin, doxepin, trimipramine and imipramine showed broadly similar toxicity and were usually reported to be less toxic than desipramine. Data on nortriptyline were contradictory. Lofepramine had the lowest risk of death in overdose. The rank order of overdose toxicity was broadly consistent between different FTI definitions and between markers used. With respect to the risk of cardiovascular events at clinically relevant exposure, amitriptyline, nortriptyline and lofepramine were associated with a greater risk of in-use cardiotoxicity. All measures of overdose toxicity were subject to external influences and confounding. The continued use of TCAs in depression and other conditions should be minimized when considering their undoubted toxicity in overdose and possible toxicity in normal clinical use.Plain language summaryOlder tricyclic antidepressants and their toxicity in overdose and in clinical useTricyclic antidepressants were first used in the 1950s. Their use for depression has gone down in the past 20 or so years. This is because newer antidepressants are better tolerated and less toxic in overdose. Certain tricyclics - dosulepin and amitriptyline - have been identified as being particularly toxic tricyclics and their use has been restricted. However many other tricyclics remain widely used for depression and many other conditions. We examined all the evidence we could find on tricyclic toxicity. We found that, with one exception, all tricyclics are toxic and dangerous when taken in overdose. The exception is lofepramine - a tricyclic used in the UK and some other countries. When looking at toxicity in clinical use, we found no consistent evidence of difference between individual tricyclics. It is possible that most or all tricyclics do not increase the risk of heart attack or sudden cardiac death when used at normal clinical doses. Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-05-30T12:01:40Z DOI: 10.1177/20451253241243297 Issue No: Vol. 14 (2024)
- Corrigendum to “Semaglutide for the treatment of
antipsychotic-associated weight gain in patients not responding to metformin – a case series” Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024.
Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-05-28T08:27:28Z DOI: 10.1177/20451253241258536 Issue No: Vol. 14 (2024)
- Clozapine-induced cholinergic urticaria: a case report
Authors: Nadia El Ouni Amami, Husen Ali-Diabacte, Sarra Ateb, Hamadi Ben Rejeb, Avicenne Bellis, Reza Bellis, Dominique Januel, Noomane Bouaziz Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Clozapine, renowned for its efficacy in treatment-resistant schizophrenia, is associated with rare yet potentially severe side effects, including hematological disorders, myocarditis, seizures and gastrointestinal obstruction. Dermatological adverse effects, though less serious, can profoundly impact patients’ quality of life. We present the first reported case of cholinergic urticaria induced by clozapine, in a 25-year-old male with treatment-resistant schizophrenia. Four months into clozapine therapy, the patient developed intensely pruritic erythematous lesions triggered by sweating, significantly impairing his daily activities. Despite attempts at management, including dose reduction and antihistamine therapy, the urticaria persisted. However, a favorable outcome was achieved upon switching to quetiapine. This case underscores the importance of recognizing and managing treatment-related adverse effects, even when they arise late in treatment, and highlights the need for individualized therapeutic approaches.We discuss potential mechanisms underlying clozapine-induced cholinergic urticaria and emphasize the significance of patient-centered care in optimizing treatment outcomes in schizophrenia.Plain language summaryItchy rash from sweating with clozapineDespite its undisputed efficacy, clozapine has attracted a great deal of attention for its rare but potentially serious side effects, such as hematological disorders (in particular, low white blood cell counts), seizures and inflammation of the heart muscle. Other effects, notably cutaneous, have also been reported, and although they are not serious, they can have a considerable impact on the patient’s quality of life. Such is the case of our patient who became allergic to his own sweat while taking clozapine. To our knowledge, this is the first case described in the literature.The patient was a 25-year-old man suffering from resistant schizophrenia, i.e. who had failed to respond to successive use of two different antipsychotics. Four months after starting treatment with clozapine, he developed a generalized cutaneous eruption characterized by intensely pruritic erythematous punctiform lesions which appeared with each episode of perspiration. The lesions considerably disrupted the patient’s daily activities, making it necessary to refrain from physical effort and avoid exposure to heat. Despite attempts to manage symptoms, by treatment with antihistamines and clozapine dose reduction, the urticaria persisted. However, a favorable and durable outcome was observed after switching to quetiapine rather than olanzapine.This case highlights the importance of recognizing and managing treatment-related undesirable side effects, even if they appear late in the course of treatment, and of not neglecting their impact on the patient’s daily life. In this report, we have also tried to outline the hypothetical mechanisms that could explain this unusual side effect.This case encourages clinicians to always seek the optimal antipsychotic for their patients, even after several therapeutic failures and/or episodes of intolerance. Trial and error can lead to more effective, personalized treatment. Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-05-14T07:21:03Z DOI: 10.1177/20451253241241056 Issue No: Vol. 14 (2024)
- Neuroimaging features of cognitive impairments in schizophrenia and major
depressive disorder Authors: Yu-Ting Li, Chi Zhang, Jia-Cheng Han, Yu-Xuan Shang, Zhu-Hong Chen, Guang-Bin Cui, Wen Wang Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Cognitive dysfunctions are one of the key symptoms of schizophrenia (SZ) and major depressive disorder (MDD), which exist not only during the onset of diseases but also before the onset, even after the remission of psychiatric symptoms. With the development of neuroimaging techniques, these non-invasive approaches provide valuable insights into the underlying pathogenesis of psychiatric disorders and information of cognitive remediation interventions. This review synthesizes existing neuroimaging studies to examine domains of cognitive impairment, particularly processing speed, memory, attention, and executive function in SZ and MDD patients. First, white matter (WM) abnormalities are observed in processing speed deficits in both SZ and MDD, with distinct neuroimaging findings highlighting WM connectivity abnormalities in SZ and WM hyperintensity caused by small vessel disease in MDD. Additionally, the abnormal functions of prefrontal cortex and medial temporal lobe are found in both SZ and MDD patients during various memory tasks, while aberrant amygdala activity potentially contributes to a preference to negative memories in MDD. Furthermore, impaired large-scale networks including frontoparietal network, dorsal attention network, and ventral attention network are related to attention deficits, both in SZ and MDD patients. Finally, abnormal activity and volume of the dorsolateral prefrontal cortex (DLPFC) and abnormal functional connections between the DLPFC and the cerebellum are associated with executive dysfunction in both SZ and MDD. Despite these insights, longitudinal neuroimaging studies are lacking, impeding a comprehensive understanding of cognitive changes and the development of early intervention strategies for SZ and MDD. Addressing this gap is critical for advancing our knowledge and improving patient prognosis. Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-05-04T12:15:31Z DOI: 10.1177/20451253241243290 Issue No: Vol. 14 (2024)
- Psychedelic skepticism: back to the sixties'
Authors: Eduardo Ekman Schenberg Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024.
Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-04-25T11:57:58Z DOI: 10.1177/20451253241243242 Issue No: Vol. 14 (2024)
- Network analysis of the comorbidity between post-traumatic stress,
depression and anxiety symptoms among frontline healthcare workers during the COVID-19 pandemic Authors: Hui Ouyang, Lili Wu, Wenjie Yan, Keyi Si, Hongli Lv, Jingye Zhan, Jing Wang, Yanpu Jia, Zhilei Shang, Wenfang Chen, Weizhi Liu Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Background:Coronavirus disease 2019 pandemic pointed out significant mental symptoms of frontline healthcare workers (HCWs).Objective:We aimed to estimate the prevalence and comorbidity of post-traumatic stress symptoms (PTSS), depression and anxiety symptoms in HCWs from Fangcang shelter hospitals during the pandemic.Design:Demographic information, post-traumatic stress disorder checklist for DSM-5 (PCL-5), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Questionnaire (GAD-7) were obtained online based on stratified random sampling design during April 2022, with 284 eligible responses.Method:Hierarchical regression analyses were applied to investigate independent variables associated with psychological status outcomes (PHQ-9, GAD-7 and PCL-5), and the network analyses were applied to explore the comorbidity using all items of PCL-5, PHQ-9 and GAD-7.Results:(1) 10.56%, 13.03% and 8.10% of HCWs reported PTSS, depression and anxiety symptoms. Fifty-three (18.66%) HCWs experienced at least one mental health disorder, among which 26.42–37.74% HCWs had comorbidity of two or three mental disorders; (2) several influence factors of mental health were identified, including medical professions, working hours, contacted patients (p Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-04-20T08:32:39Z DOI: 10.1177/20451253241243292 Issue No: Vol. 14 (2024)
- Effect of long-acting antipsychotic treatment on psychiatric
hospitalization rate in early psychosis patients: a naturalistic study Authors: Raúl Sancho-Echeverria, Claudia Aymerich, José Manuel Rodríguez-Sánchez, Patxi Gil, Borja Pedruzo, Miguel Ángel González-Torres, Paolo Fusar-Poli, Celso Arango, Ana Catalan Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Background:The effectiveness of long-acting injectable (LAI) antipsychotics in preventing relapses of first-episode psychosis is currently debated.Objectives:The study aimed to investigate the number of psychiatric hospitalizations comparing the LAI cohort versus the oral cohort during different phases of the illness, pre-LAI treatment, during LAI treatment, and after LAI treatment.Design:A naturalistic study was conducted on two independent cohorts of early psychosis patients receiving treatment from a specific early intervention service. The first cohort comprised 228 patients who received LAIs, while the second cohort comprised 667 patients who had never received LAIs.Methods:This study was designed as a longitudinal observational study conducted within a naturalistic clinical setting in two cohorts of early psychosis patients. Repeated series ANCOVA (ANCOVA-r) was used to study the number of hospitalizations in the different study periods (T1 = from the date of the first psychiatric record to the beginning of the mirror period; T2 = the mirror period; T3 = from the LAI implementation to the LAI discontinuation; and T4 = from the LAI discontinuation to the end). In all cases, discontinuation of LAI involved the return to oral treatment. In all, 35 patients had not T4 as they were still on LAI treatment at the time of database closing (September 2020), and their data were not included in the analysis of the effect of the LAI discontinuation.Results:The patients in the LAI cohort were younger, more frequently males, presented more schizophrenia diagnoses, and had a higher number of hospitalizations (2.50 ± 2.61 versus 1.19 ± 1.69; p Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-04-20T05:46:57Z DOI: 10.1177/20451253241243273 Issue No: Vol. 14 (2024)
- Attentional bias modification and attention control training in PTSD: a
systematic review and meta-analysis Authors: Fan Zhang, Chenwei Huang, Wenjie Yan, Hui Ouyang, Weizhi Liu Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Background:Cognitive models of post-traumatic stress disorder (PTSD) highlighted the effect of maladaptive cognitive processing in the development and maintenance of PTSD. PTSD is related to attentional bias (AB) toward threatening stimuli and greater attentional bias variability (ABV). Attentional bias modification (ABM) and attention control training (ACT) have demonstrated the effect of improving PTSD, but the results of randomized controlled trials (RCTs) are controversial.Objectives:The current study aimed to evaluate the extent of evidence supporting the efficacy of ABM in the treatment of PTSD.Design:Systematic review and meta-analysis.Methods:We searched PUBMED, PsycINFO, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for articles published between 1980 and 2022. RCTs of ABM for adult participants with PTSD symptoms were identified. The primary outcome was changes in PTSD severity, and the second outcome was changes in AB and ABV. Trial quality was assessed using the Cochrane Risk of Bias Tool. Publication bias was assessed using the Doi plot and Luis Furuya-Kanamori (LFK) index.Results:Eight RCTs comparing the effect of ABM to ACT were included in the review, and six studies were meta-analyzed. Meta-analysis favored ACT in improving PTSD symptoms and ABV, and the effect size was large. ABM and ACT demonstrated similar effects in improving AB.Conclusion:ACT should not only be seen as a control training condition but also has therapeutic values. However, since the current meta-analysis only included a limited number of studies, further research was still needed to examine the clinical value of ACT in PTSD treatment.Plain language summaryAttentional bias modification and attention control training in PTSDWe summarized and analyzed studies on attentional bias modification (ABM) and attention control training (ACT) in PTSD. Our findings indicated that ACT was a more effective treatment condition. This study highlights the therapeutic value of ACT. Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-04-16T10:38:41Z DOI: 10.1177/20451253241243260 Issue No: Vol. 14 (2024)
- Patient-reported outcomes on sleep quality and circadian rhythm during
treatment with intravenous ketamine for treatment-resistant depression Authors: Raymond Yan, Tyler Marshall, Atul Khullar, Travis Nagle, Jake Knowles, Mai Malkin, Brittany Chubbs, Jennifer Swainson Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Background:Intravenous (IV) ketamine is a rapid acting antidepressant used primarily for treatment-resistant depression (TRD). It has been suggested that IV ketamine’s rapid antidepressant effects may be partially mediated via improved sleep and changes to the circadian rhythm.Objectives:This study explores IV ketamine’s association with changes in patient-reported sleep quality and circadian rhythm in an adult population with TRD.Methods:Adult patients (18–64 years) with TRD scheduled for IV ketamine treatment were recruited to complete patient rated outcomes measures on sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and circadian rhythm using the Morningness–Eveningness Questionnaire (MEQ). Over a 4-week course of eight ketamine infusions, reports were obtained at baseline (T0), prior to second treatment (T1), prior to fifth treatment (T2), and 1 week after eighth treatment (T3).Results:Forty participants with TRD (mean age = 42.8, 45% male) were enrolled. Twenty-nine (72.5%) had complete follow-up data. Paired t tests revealed statistically significant improvements at the end of treatment in sleep quality (PSQI) (p = 0.003) and depressive symptoms (Clinically Useful Depression Outcome Scale-Depression, p Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-03-04T09:30:10Z DOI: 10.1177/20451253241231264 Issue No: Vol. 14 (2024)
- Drug safety in older patients with alcohol use disorder: a retrospective
cohort study Authors: Sebastian Schröder, Martin Schulze Westhoff, Tabea Pfister, Johanna Seifert, Stefan Bleich, Felix Koop, Phileas Johannes Proskynitopoulos, Alexander Glahn, Johannes Heck Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Background:Older patients with alcohol use disorder are at particular risk of developing adverse drug reactions due to multimorbidity, polypharmacy, and altered organ function.Objectives:In this study, we investigated the frequency and characteristics of potentially serious alcohol–medication interactions, potentially inappropriate medications (PIMs) for older adults, and potential drug–drug interactions (pDDIs) in a population of older patients with alcohol use disorder over a 10-year period.Design:Retrospective monocentric cohort study.Methods:Prescribed medications were screened for potentially serious alcohol–medication interactions, PIMs, and pDDIs using the POSAMINO (POtentially Serious Alcohol–Medication INteractions in Older adults) criteria, the PRISCUS 2.0 list, the FORTA (Fit fOR The Aged) classification, and the drug interaction program AiDKlinik®.Results:We enrolled 114 patients aged ⩾65 years with alcohol use disorder, who were treated in an addiction unit of a university hospital in Germany. About 80.7% of the study population had at least one potentially serious alcohol–medication interaction. Potentially serious alcohol–medication interactions most commonly affected the cardiovascular (57.7%) and the central nervous system (32.3%). A total of 71.1% of the study population received at least one prescription of a FORTA C or D drug, compared with 42.1% who received at least one PIM prescription according to the PRISCUS 2.0 list. A total of 113 moderate and 72 severe pDDIs were identified in the study population.Conclusion:Older patients with alcohol use disorders are frequently exposed to potentially serious alcohol–medication interactions, PIMs, and pDDIs. Improvements in the quality of prescribing should primarily target the use of cardiovascular and psychotropic drugs. Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-02-21T09:05:51Z DOI: 10.1177/20451253241232563 Issue No: Vol. 14 (2024)
- Patients’ awareness of recovery mediates the link between clinical and
level of functional remission in schizophrenia to a larger extent in those treated with long-acting antipsychotics Authors: Jasmina Mallet, Clément Dondé, Caroline Dubertret, Philip Gorwood Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Background:Clinical remission is a step towards functional remission for subjects with schizophrenia. While recovery is both a subjective personal journey and a clinical outcome to be targeted, data on patient self-rated outcomes are scarce.Objectives:(i) To determine the extent to which the association between clinical and functional remission is mediated by the subjective experience of recovery as reported by patients versus their relatives or their psychiatrist and (ii) to assess differences according to treatment, specifically with oral antipsychotics only versus long-acting injectable antipsychotics (LAIs).Design:Clinical observational study.Methods:Community-dwelling participants with schizophrenia enrolled in the EGOFORS cohort (N = 198) were included. Clinical symptoms and remission were assessed using the Positive and Negative Syndrome Scale. Functional remission was assessed with the Functional Remission of General Schizophrenia Scale. Awareness of recovery was assessed with one question ‘What percentage of recovery do you think you have now (from 0% – no recovery – to 100% – full recovery)'’, asked of the patient, also of the patient’s close relative, and the psychiatrist. We used mediation analyses, taking into account the type of pharmacological treatment.Results:Remission criteria and perceived remission measures were significantly correlated, both within and between groups (r > 0.330). The patient’s awareness of recovery mediated the relationship between clinical remission and level of functional remission, while the level of recovery according to psychiatrists or close relatives did not. The direct effect of clinical remission on the level of functional remission became non-significant when taking into account the mediator (patients’ awareness of recovery) in the group of patients with LAI (t = 1.5, p = 0.150) but not in the group of patients with other treatments (t = 3.1, p = 0.003).Conclusion:Patients with LAIs may be more efficient in reporting their level of functional remission. Higher patient awareness could be an interesting candidate to explain this. However, as the study was cross-sectional, such a proposal should be tested with a more specifically designed protocol, such as a long-term cohort. Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-02-16T12:02:53Z DOI: 10.1177/20451253241231269 Issue No: Vol. 14 (2024)
- Monoclonal antibody precision therapy targeting inflammation for bipolar
disorder: a narrative review Authors: Shijin Wu, Yuyang Zhou Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024. Bipolar disorder (BD) is a severe mental disorder with various hypotheses regarding its pathogenesis. This article provides a summary of numerous studies on the variations in inflammatory cytokine levels in patients with BD and the effects of treatment with antipsychotics, mood stabilizers, and antidepressants on these levels. In addition, patients with autoimmune diseases who use anti-inflammatory monoclonal antibodies experience symptoms, such as depression, anxiety, and insomnia. These pieces of evidence suggest a potential association between immune inflammation and BD and offer new possibilities for therapy. Building upon this relationship, the authors propose an innovative approach for treating BD through individualized and precise therapy using anti-inflammatory monoclonal antibody drugs. To support this proposal, the authors compile information on pharmacological effects and relevant studies, including trials of various anti-inflammatory therapeutic monoclonal antibody drugs (e.g. infliximab, tocilizumab, and canakinumab) for the potential treatment of BD and its associated side effects in psychiatry. The authors categorize these anti-inflammatory monoclonal antibody drugs into levels I–IV through a comprehensive analysis of their advantages and disadvantages. Their potential is examined, and the need for further exploration of their pharmaceutical effects is established. Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-02-06T09:12:26Z DOI: 10.1177/20451253241227772 Issue No: Vol. 14 (2024)
- Corrigendum to “Managing medical and psychiatric multimorbidity in
older patients” Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024.
Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-01-18T11:57:24Z DOI: 10.1177/20451253241227940 Issue No: Vol. 14 (2024)
- Erratum to “History repeating: guidelines to address common problems in
psychedelic science” Abstract: Therapeutic Advances in Psychopharmacology, Volume 14, Issue , January-December 2024.
Citation: Therapeutic Advances in Psychopharmacology PubDate: 2024-01-10T11:16:26Z DOI: 10.1177/20451253231223609 Issue No: Vol. 14 (2024)
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