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  Subjects -> PHARMACY AND PHARMACOLOGY (Total: 575 journals)
Showing 1 - 200 of 253 Journals sorted by number of followers
Nature Reviews Drug Discovery     Full-text available via subscription   (Followers: 324)
International Journal of Drug Policy     Hybrid Journal   (Followers: 253)
Journal of Clinical Oncology     Hybrid Journal   (Followers: 240)
Journal of Medicinal Chemistry     Hybrid Journal   (Followers: 154)
Journal of Pharmaceutical Sciences     Hybrid Journal   (Followers: 152)
Drugs     Full-text available via subscription   (Followers: 144)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 94)
Pharmaceutical Research     Hybrid Journal   (Followers: 93)
European Journal of Pharmaceutical Sciences     Hybrid Journal   (Followers: 85)
Drug Safety     Full-text available via subscription   (Followers: 82)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 56)
Biomaterials     Hybrid Journal   (Followers: 55)
Clinical Pharmacology & Therapeutics     Hybrid Journal   (Followers: 45)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 41)
Annual Review of Pharmacology and Toxicology     Full-text available via subscription   (Followers: 38)
Journal of Controlled Release     Hybrid Journal   (Followers: 37)
International Journal of Pharmaceutics     Hybrid Journal   (Followers: 37)
Clinical Therapeutics     Hybrid Journal   (Followers: 34)
European Journal of Pharmaceutics and Biopharmaceutics     Hybrid Journal   (Followers: 34)
Pharmacoepidemiology and Drug Safety     Hybrid Journal   (Followers: 33)
British Journal of Clinical Pharmacology     Hybrid Journal   (Followers: 31)
Journal of Pharmacy and Pharmacology     Full-text available via subscription   (Followers: 31)
Drug Development and Industrial Pharmacy     Hybrid Journal   (Followers: 29)
Clinical Pharmacokinetics     Full-text available via subscription   (Followers: 28)
PharmacoEconomics     Full-text available via subscription   (Followers: 26)
Critical Reviews in Toxicology     Hybrid Journal   (Followers: 25)
AAPS Journal     Hybrid Journal   (Followers: 25)
Journal of Clinical Psychopharmacology     Hybrid Journal   (Followers: 24)
International Journal of Pharmacy Practice     Full-text available via subscription   (Followers: 24)
Toxicology and Applied Pharmacology     Hybrid Journal   (Followers: 24)
Chemical Research in Toxicology     Hybrid Journal   (Followers: 22)
Journal of Pharmacokinetics and Pharmacodynamics     Hybrid Journal   (Followers: 22)
Journal of Pain & Palliative Care Pharmacotherapy     Hybrid Journal   (Followers: 21)
Trends in Pharmacological Sciences     Full-text available via subscription   (Followers: 20)
Journal of Clinical Pharmacology     Hybrid Journal   (Followers: 20)
Journal of Applied Toxicology     Hybrid Journal   (Followers: 19)
Pharmaceutical Development and Technology     Hybrid Journal   (Followers: 19)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 19)
Clinical Trials     Hybrid Journal   (Followers: 18)
Toxicology     Hybrid Journal   (Followers: 18)
Journal of Pharmaceutical and Biomedical Analysis     Hybrid Journal   (Followers: 18)
Clinical Toxicology     Hybrid Journal   (Followers: 18)
International Journal of Toxicology     Hybrid Journal   (Followers: 17)
Journal of Clinical Pharmacy and Therapeutics     Hybrid Journal   (Followers: 17)
Critical Reviews in Clinical Laboratory Sciences     Hybrid Journal   (Followers: 16)
Journal of Natural Products     Hybrid Journal   (Followers: 16)
Pharmaceutical Statistics     Hybrid Journal   (Followers: 15)
Toxicology Letters     Hybrid Journal   (Followers: 15)
Journal of Pharmacy Practice     Hybrid Journal   (Followers: 15)
Psychopharmacology     Hybrid Journal   (Followers: 15)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 14)
Cardiovascular Drugs and Therapy     Hybrid Journal   (Followers: 14)
European Journal of Clinical Pharmacology     Hybrid Journal   (Followers: 14)
Current Medicinal Chemistry     Hybrid Journal   (Followers: 13)
American Journal of Therapeutics     Hybrid Journal   (Followers: 13)
Drug and Chemical Toxicology     Hybrid Journal   (Followers: 13)
Journal of the American Pharmacists Association     Full-text available via subscription   (Followers: 13)
Drug Metabolism and Disposition     Hybrid Journal   (Followers: 13)
Clinical Research and Regulatory Affairs     Hybrid Journal   (Followers: 12)
Drug Discovery Today: Technologies     Full-text available via subscription   (Followers: 12)
Seminars in Hematology     Hybrid Journal   (Followers: 12)
Journal of Oncology Pharmacy Practice     Hybrid Journal   (Followers: 12)
Journal of Psychopharmacology     Hybrid Journal   (Followers: 11)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 11)
Current Pharmaceutical Design     Hybrid Journal   (Followers: 11)
Drug Development Research     Hybrid Journal   (Followers: 11)
Toxicology in Vitro     Hybrid Journal   (Followers: 11)
Seminars in Oncology Nursing     Full-text available via subscription   (Followers: 10)
Biochemical Pharmacology     Hybrid Journal   (Followers: 10)
Journal of Pharmacology and Experimental Therapeutics     Hybrid Journal   (Followers: 10)
Journal of Separation Science     Hybrid Journal   (Followers: 10)
CNS Drugs     Full-text available via subscription   (Followers: 10)
Current Pharmaceutical Biotechnology     Hybrid Journal   (Followers: 10)
Journal of Medical Marketing     Hybrid Journal   (Followers: 10)
Drugs & Aging     Full-text available via subscription   (Followers: 10)
European Neuropsychopharmacology     Hybrid Journal   (Followers: 9)
Food Additives & Contaminants Part A     Hybrid Journal   (Followers: 9)
Environmental Toxicology and Pharmacology     Hybrid Journal   (Followers: 9)
Medicinal Chemistry     Hybrid Journal   (Followers: 9)
Biometrical Journal     Hybrid Journal   (Followers: 9)
Drugs & Therapy Perspectives     Full-text available via subscription   (Followers: 9)
Prescriber     Hybrid Journal   (Followers: 9)
ChemMedChem     Hybrid Journal   (Followers: 9)
Current Opinion in Pharmacology     Hybrid Journal   (Followers: 9)
European Journal of Pharmacology     Hybrid Journal   (Followers: 8)
Clinical Drug Investigation     Full-text available via subscription   (Followers: 8)
Inhalation Toxicology     Hybrid Journal   (Followers: 8)
Antiviral Research     Hybrid Journal   (Followers: 8)
Drug Metabolism Reviews     Hybrid Journal   (Followers: 8)
Progress in Neuro-Psychopharmacology and Biological Psychiatry     Hybrid Journal   (Followers: 8)
Human & Experimental Toxicology     Hybrid Journal   (Followers: 8)
Drug Delivery     Open Access   (Followers: 8)
BioDrugs     Full-text available via subscription   (Followers: 8)
Frontiers in Drug Design & Discovery     Hybrid Journal   (Followers: 8)
Expert Review of Pharmacoeconomics & Outcomes Research     Full-text available via subscription   (Followers: 8)
Experimental and Clinical Psychopharmacology     Full-text available via subscription   (Followers: 7)
Toxicology Mechanisms and Methods     Hybrid Journal   (Followers: 7)
Journal of Pharmacological and Toxicological Methods     Hybrid Journal   (Followers: 7)
Clinical and Experimental Pharmacology and Physiology     Hybrid Journal   (Followers: 7)
Scandinavian Journal of Clinical and Laboratory Investigation     Hybrid Journal   (Followers: 7)
Epilepsy Research     Hybrid Journal   (Followers: 7)
Toxicology and Industrial Health     Hybrid Journal   (Followers: 6)
Journal of Veterinary Pharmacology and Therapeutics     Hybrid Journal   (Followers: 6)
Skin Pharmacology and Physiology     Full-text available via subscription   (Followers: 6)
Journal of Cardiovascular Pharmacology     Hybrid Journal   (Followers: 6)
AAPS PharmSciTech     Hybrid Journal   (Followers: 6)
Current Drug Discovery Technologies     Hybrid Journal   (Followers: 6)
Current Drug Delivery     Hybrid Journal   (Followers: 6)
Current Therapeutic Research     Open Access   (Followers: 6)
Expert Review of Cardiovascular Therapy     Full-text available via subscription   (Followers: 6)
Neuropharmacology     Hybrid Journal   (Followers: 5)
Current Drug Metabolism     Hybrid Journal   (Followers: 5)
Fitoterapia     Hybrid Journal   (Followers: 5)
Expert Review of Molecular Diagnostics     Full-text available via subscription   (Followers: 5)
Expert Review of Anti-infective Therapy     Full-text available via subscription   (Followers: 5)
Anti-Infective Agents     Hybrid Journal   (Followers: 5)
Toxicon     Hybrid Journal   (Followers: 5)
Medicinal Research Reviews     Hybrid Journal   (Followers: 5)
Investigational New Drugs     Hybrid Journal   (Followers: 5)
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry     Hybrid Journal   (Followers: 5)
Current Cancer Therapy Reviews     Hybrid Journal   (Followers: 5)
Reviews of Physiology, Biochemistry and Pharmacology     Hybrid Journal   (Followers: 4)
Planta Medica     Hybrid Journal   (Followers: 4)
Current Vascular Pharmacology     Hybrid Journal   (Followers: 4)
Pharmaceutical Medicine     Full-text available via subscription   (Followers: 4)
Journal of Child and Adolescent Psychopharmacology     Hybrid Journal   (Followers: 4)
CNS Drug Reviews     Open Access   (Followers: 4)
Inpharma Weekly     Full-text available via subscription   (Followers: 4)
Journal of Labelled Compounds and Radiopharmaceuticals     Hybrid Journal   (Followers: 4)
Immunopharmacology and Immunotoxicology     Hybrid Journal   (Followers: 4)
International Journal of Pharmaceutical and Healthcare Marketing     Hybrid Journal   (Followers: 4)
Inflammation Research     Hybrid Journal   (Followers: 4)
Cancer Chemotherapy and Pharmacology     Hybrid Journal   (Followers: 4)
International Journal of Neuropsychopharmacology     Open Access   (Followers: 3)
Pharmacology & Therapeutics     Hybrid Journal   (Followers: 3)
Physiology International     Full-text available via subscription   (Followers: 3)
Cardiovascular Therapeutics     Open Access   (Followers: 3)
ASSAY and Drug Development Technologies     Hybrid Journal   (Followers: 3)
Pharmacopsychiatry     Hybrid Journal   (Followers: 3)
Chemotherapy     Full-text available via subscription   (Followers: 3)
Therapeutic Drug Monitoring     Hybrid Journal   (Followers: 3)
Current Drug Therapy     Hybrid Journal   (Followers: 3)
Research in Social and Administrative Pharmacy     Hybrid Journal   (Followers: 3)
PharmacoEconomics & Outcomes News     Full-text available via subscription   (Followers: 3)
Journal of Aerosol Medicine and Pulmonary Drug Delivery     Hybrid Journal   (Followers: 3)
Journal of Ethnopharmacology     Hybrid Journal   (Followers: 3)
Drug Resistance Updates     Hybrid Journal   (Followers: 3)
Journal of Infection and Chemotherapy     Hybrid Journal   (Followers: 3)
Journal of Cardiovascular Pharmacology and Therapeutics     Hybrid Journal   (Followers: 3)
Current Pharmacogenomics and Personalized Medicine     Hybrid Journal   (Followers: 3)
Acta Pharmacologica Sinica     Hybrid Journal   (Followers: 3)
Microbial Drug Resistance     Hybrid Journal   (Followers: 3)
Frontiers in Medicinal Chemistry     Hybrid Journal   (Followers: 3)
Human Psychopharmacology Clinical and Experimental     Hybrid Journal   (Followers: 3)
Journal of Pain Management & Medicine     Open Access   (Followers: 2)
BMC Pharmacology     Open Access   (Followers: 2)
The Brown University Psychopharmacology Update     Hybrid Journal   (Followers: 2)
International Clinical Psychopharmacology     Hybrid Journal   (Followers: 2)
Canadian Journal of Physiology and Pharmacology     Hybrid Journal   (Followers: 2)
Journal of Drug Targeting     Hybrid Journal   (Followers: 2)
Inflammopharmacology     Hybrid Journal   (Followers: 2)
Journal of Inflammation     Open Access   (Followers: 2)
Fundamental & Clinical Pharmacology     Hybrid Journal   (Followers: 2)
Behavioural Pharmacology     Hybrid Journal   (Followers: 2)
Vascular Pharmacology     Hybrid Journal   (Followers: 2)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Biomedicine & Pharmacotherapy     Full-text available via subscription   (Followers: 2)
Clinical Neuropharmacology     Hybrid Journal   (Followers: 2)
Drugs in R & D     Full-text available via subscription   (Followers: 2)
International Immunopharmacology     Hybrid Journal   (Followers: 2)
Pharmacology Biochemistry and Behavior     Hybrid Journal   (Followers: 2)
Letters in Drug Design & Discovery     Hybrid Journal   (Followers: 2)
Archiv der Pharmazie     Hybrid Journal   (Followers: 2)
Pharmacological Reviews     Hybrid Journal   (Followers: 2)
Molecular Pharmacology     Hybrid Journal   (Followers: 2)
Journal of Microencapsulation: Microcapsules, Liposomes, Nanoparticles, Microcells, Microspheres     Hybrid Journal   (Followers: 2)
Toxicological & Environmental Chemistry     Hybrid Journal   (Followers: 2)
Particulate Science and Technology: An International Journal     Hybrid Journal   (Followers: 1)
Pharmacological Research     Hybrid Journal   (Followers: 1)
Current Enzyme Inhibition     Hybrid Journal   (Followers: 1)
Journal of Neuroimmune Pharmacology     Hybrid Journal   (Followers: 1)
Current Pharmaceutical Analysis     Hybrid Journal   (Followers: 1)
Current Neuropharmacology     Hybrid Journal   (Followers: 1)
Pharmacogenetics and Genomics     Hybrid Journal   (Followers: 1)
Journal of Texture Studies     Hybrid Journal   (Followers: 1)
Pharmaceutical Biology     Open Access  
Journal of Liposome Research     Hybrid Journal  
Toxin Reviews     Hybrid Journal  
Kaohsiung Journal of Medical Sciences     Open Access  
Redox Report     Open Access  
Pharmacology     Full-text available via subscription  
Pharmaceutical Chemistry Journal     Hybrid Journal  
NeuroMolecular Medicine     Hybrid Journal  
Journal of Ocular Pharmacology and Therapeutics     Hybrid Journal  
Harm Reduction Journal     Open Access  
Current Nanoscience     Hybrid Journal  
Infectious Disorders - Drug Targets     Hybrid Journal  
Current Bioactive Compounds     Hybrid Journal  
Cancer Biotherapy & Radiopharmaceuticals     Hybrid Journal  
Autonomic & Autacoid Pharmacology     Hybrid Journal  

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Journal Cover
Therapeutic Advances in Psychopharmacology
Number of Followers: 4  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2045-1253 - ISSN (Online) 2045-1261
Published by Sage Publications Homepage  [1174 journals]
  • Clinical outcome analysis of patients with autism spectrum disorder:
           analysis from the UK Medical Cannabis Registry

    • Authors: Simon Erridge, Jess Kerr-Gaffney, Carl Holvey, Ross Coomber, Daniela A. Riano Barros, Urmila Bhoskar, Gracia Mwimba, Kavita Praveen, Chris Symeon, Simmi Sachdeva-Mohan, Mikael H. Sodergren, James J. Rucker
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Introduction:Cannabis-based medicinal products (CBMPs) have been identified as a promising novel therapeutic for symptoms and comorbidities related to autism spectrum disorder (ASD). However, there is a paucity of clinical evidence of their efficacy and safety. Objective: This case series aims to assess changes to health-related quality of life and the incidence of adverse events in patients treated with CBMPs for associated symptoms of ASD enrolled on the UK Medical Cannabis Registry (UKMCR).Methods:Patients treated with CBMPs for ASD-related symptoms for a minimum of 1 month were identified from the UKMCR. Primary outcomes were changes in validated patient-reported outcome measures [Generalised Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), 5-level version of the EQ-5D (EQ-5D-5L) index values] at 1, 3 and 6 months compared with baseline. Adverse events were recorded and analysed. Statistical significance was determined by p 
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-09-20T12:33:17Z
      DOI: 10.1177/20451253221116240
      Issue No: Vol. 12 (2022)
  • Risperidone-induced priapism: a case report and literature review

    • Authors: Sarra Ateb, Taoufik Fourati, Hammadi Ben Rejeb, Dominique Januel, Noomane Bouaziz
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Priapism is a rare pathological condition defined as painful and persistent penile erection that is unrelated to sexual stimulation. It can be classified as ischaemic or non-ischaemic. Many causes have been attributed to ischaemic priapism, including the use of some medications such as antipsychotics. The mechanism of priapism associated with antipsychotics is thought to be related to alpha-adrenergic blockage that is mediated by the alpha receptors in the corpora cavernosa of the penis. In this paper, we describe a case of a patient who suffered from Risperidone-induced priapism, and how this adverse effect was resolved by switching to olanzapine followed by olanzapine pamoate. A literature search on PubMed/Medline up to 2011 was conducted by some doctors from London and found 30 cases of priapism associated with risperidone. Based on this work, we searched PubMed through 2021, using the keywords ‘priapism’ and ‘risperidone’ and found a total of 43 cases of priapism involving risperidone. Priapism is not correlated with the dosage of this psychotropic drug, and has also occasionally occurred when risperidone has been used in conjunction with another drug. The question of choosing a replacement antipsychotic after the first one has induced priapism, remains problematic. It would be preferable to switch to a drug with less marked alpha1-blocking properties, but no consensus has been reached as to the best choice of medication. Finally, any prescription of an antipsychotic treatment must be preceded by a careful interrogation in search of risk factors for priapism, and the patient should be made aware of the possible occurrence of this side effect and the need to then seek urgent medical advice.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-08-24T11:38:59Z
      DOI: 10.1177/20451253221113246
      Issue No: Vol. 12 (2022)
  • Antipsychotic polypharmacy and clozapine prescribing patterns: evolution
           and correlates before and after a psychiatric hospitalisation

    • Authors: Juliette Lagreula, Philippe de Timary, Laure Elens, Olivia Dalleur
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Antipsychotic polypharmacy (APP) prescribing and clozapine underuse are considered inappropriate prescribing in schizophrenia. Psychiatric hospitalisations may be suitable occasions to re-evaluate patient pharmacotherapy and to switch to monotherapy.Objectives:To explore the evolution of APP and other psychotropic prescribing patterns during psychiatric hospitalisations, to detect characteristics associated with APP on admission and at discharge, and to examine clozapine prescribing patterns.Design:We performed a retrospective observational study based on electronic health records.Methods:Data on adult inpatients diagnosed with schizophrenia spectrum disorders were collected retrospectively from 6 Belgian hospitals in 2020-2021.Results:Of the 516 patients included, APP prescribing increased significantly from 47.9% on hospital admission to 59.1% at discharge. On admission and at discharge, APP was associated with prior clozapine use (ORadmission = 2.53, CI = 1.1–5.84, ORdischarge = 11.01, CI = 4.45–27.28), treatment with a first-generation antipsychotic (ORadmission = 26.79, CI = 13.08–54.86, ORdischarge = 25.2, CI = 12.2–52.04), increased antipsychotic exposure (ORadmission = 8.93, CI = 5.13–15.56, ORdischarge = 19.89, CI = 10–39.54), and a greater number of hypno-sedatives (ORadmission = 1.88, CI = 1.23–2.88, ORdischarge = 4.18, CI = 2.53–6.91). APP was negatively associated with involuntary admission (ORadmission = 0.31, CI = 0.14–0.7, ORdischarge = 0.3, CI = 0.13–0.68). When using an alternative definition of monotherapy (i.e. including patients with an add-on low-dose antipsychotic for sleep disorders), alcohol use disorder (ORadmission = 0.26, CI = 0.13–0.54) and higher age (ORdischarge = 0.53, CI = 0.29–0.95) were negatively associated with APP, and living in a residential facility (ORdischarge = 2.39 CI = 1.21–4.71) and a higher daily dosage of benzodiazepines during the stay (ORdischarge = 1.32 CI = 1.03–1.69) increased the odds of being discharged on APP. On admission, 9.3% of patients were being treated with clozapine. Although 28.1% of patients were eligible for clozapine treatment, only 11% of patients were discharged with a clozapine prescription. For 7 of the 10 patients with a new clozapine prescription, it was directly prescribed in combination with another antipsychotic, without a prior trial of clozapine monotherapy.Conclusion:Suboptimal prescriptions of antipsychotics in patients with schizophrenia persist after psychiatric hospitalisations and are associated with identifiable characteristics.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-08-23T11:21:52Z
      DOI: 10.1177/20451253221112587
      Issue No: Vol. 12 (2022)
  • Who is prescribed valproate and how carefully is this treatment reviewed
           in UK mental health services' Data from a clinical audit

    • Authors: Carol Paton, Leslie Citrome, Emilio Fernandez-Egea, Olivia Rendora, Thomas R.E. Barnes
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:The licensed indications for valproate are narrow, yet this medication is commonly prescribed in mental health services.Objectives:To explore the target symptoms/behaviours for which valproate is prescribed and how well the efficacy and tolerability of this treatment are monitored in routine clinical practice.Design:An audit-based quality improvement (QI) programme in UK mental health services.Methods:Information on valproate prescribing was collected from clinical records using a bespoke data collection tool.Results:Sixty-four NHS mental health Trusts/healthcare organisations submitted data on valproate treatment for 5320 patients. Valproate was clearly prescribed for a licensed indication in 1995 (38%) patients, off-label in 1987 (37%) while the indication was uncertain/not available in 1338 (25%). Of the 919 patients started on valproate treatment within the past year, between a half and two-thirds had each of the relevant baseline physical health checks documented. In 539 (59%) of these patients, valproate was prescribed for an unlicensed indication; the prescription was recognised as off-label in 363 (67%), 20 (6%) of whom were documented as having had this explained to them. Of 631 patients prescribed valproate for between 3 months and a year, early on-treatment assessments of response and side effects were documented in 441 (70%) and 332 (53%), respectively. Of 4401 patients treated for more than a year, annual on-treatment reviews of clinical response and side effects were documented in 2771 (63%) and 2140 (49%), respectively.Conclusion:Our data suggest the majority of prescriptions for valproate in mental health services are not for a licensed indication. Furthermore, patients rarely receive an explanation that their valproate prescription is off-label, perhaps partly because the licensed indications are not widely understood by prescribers. Given the very limited evidence for efficacy for the off-label uses of valproate, failure to routinely conduct early on-treatment and annual reviews of the benefits and side effects of this medication may result in patients remaining on ineffective and poorly tolerated treatment by default.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-08-23T11:19:14Z
      DOI: 10.1177/20451253221110016
      Issue No: Vol. 12 (2022)
  • Plasma levels of interleukin-6 and 3-methoxy-4-hydroxyphenylglycol and
           treatment with milnacipran in major depression

    • Authors: Reiji Yoshimura, Naomichi Okamoto, Atsuko Ikenouchi
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.

      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-08-06T11:37:11Z
      DOI: 10.1177/20451253221116238
      Issue No: Vol. 12 (2022)
  • Dose-response analysis of aripiprazole in patients with schizophrenia in

    • Authors: Yun Tien, Hsiang-Ping Huang, Ding-Lieh Liao, Shang-Chien Huang
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Aripiprazole is a third-generation antipsychotic agent with acceptable efficacy and a good safety profile. Previous studies have indicated the therapeutic serum concentration of aripiprazole to be 100 to 350 ng/ml; however, most of these studies examined a Western population. Patients with schizophrenia from Tungs’ Taichung MetroHarbor Hospital in central Taiwan were recruited to analyze the dose–response relationship of aripiprazole in the Chinese population.Objective:We aimed to investigate whether a serum concentration of aripiprazole higher than the current suggested range leads to higher response rates.Design:A prospective cohort study was designed to investigate the response rates in different studied cohorts grouped by serum concentration of aripiprazole.Data Sources and Methods:Data of 64 patients who presented to a single medical center in central Taiwan and who received therapeutic drug monitoring (TDM) were obtained. Serum concentrations of aripiprazole were correlated with the clinical response of patients by using the Clinical Global Impressions (CGI) scores.Results:The mean concentration of aripiprazole was 432.1 ± 275.1 ng/ml in the study cohort. Among the much-improved patients, the mean serum concentration of aripiprazole was 494 ± 273 ng/ml (25th–75th percentiles 264–666 ng/ml), which was higher than the current recommended therapeutic target of 100–350 ng/ml for aripiprazole. The response rate in the severe group (baseline CGI score of 6 or 7) was significantly higher than in the moderate group (baseline CGI score of 4 or 5; 86.7% versus 55.9%, p = 0.007).Conclusion:A significantly higher response rate was observed in the study cohort with serum aripiprazole concentrations over 300 ng/ml. Therefore, dosing higher than the current recommended range may potentially improve the treatment efficacy in the Chinese population. Because the serum concentration varies among patients due to multiple intrinsic and extrinsic factors, TDM, especially in outpatients, is recommended if the clinical response is limited.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-07-30T11:09:26Z
      DOI: 10.1177/20451253221113238
      Issue No: Vol. 12 (2022)
  • Comment on: Treatment strategies for clozapine-induced hypotension: A
           systematic review

    • Authors: Patrick M. Wieruszewski, Erica D. Wittwer, Sarah B. Leung, Jonathan G. Leung
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.

      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-07-19T07:34:42Z
      DOI: 10.1177/20451253221111682
      Issue No: Vol. 12 (2022)
  • Olanzapine long-acting injection, discontinuation rates and reasons for
           discontinuation: 10 years’ experience at a UK high-secure hospital

    • Authors: Azizah Attard, John Wakelam, Josephine Broyd, David Taylor, Jonathan Hafferty
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Olanzapine pamoate has been shown to be an effective second-generation long-acting injection. Its popularity has possibly been adversely affected by the rare incidence of post-injection syndrome (PIS) and the associated requirement to monitor for 3 h after each injection.Objective:This study aimed to collect and present data on the use of olanzapine long-acting injection (OLAI) over a 10-year period in a high-security forensic hospital in South East England.Design:This was a non-interventional retrospective study collecting information from anonymised electronic patient and prescription records. As per hospital Trust guidelines, patient consent to access of hospital records was presumed unless explicitly withdrawn.Method:All patients prescribed OLAI between the years 2009 and 2019 were identified. Data collected included date that OLAI was started, stopped, dose range, side effects and concomitant medication.Results:Of 88 patients who were started OLAI, 45 (51%) continued at month 24. At 60 months, 22 of 70 (31%) patients for whom data were available continued with OLAI. Over 60% of continuers were on higher than recommended doses. Of almost 5000 injections administered, there was 1 episode of PIS.Conclusion:OLAI is an effective treatment for schizophrenia and schizoaffective disorder, especially when used in patients have been able to tolerate the drug and were stabilised on it for 24 months. In over half the patients who continued OLAI, the doses were higher than that recommended by the manufacturer. The incidence of PIS in this study was very low in comparison with other studies.Registration code:2049
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-07-19T06:41:35Z
      DOI: 10.1177/20451253221113093
      Issue No: Vol. 12 (2022)
  • Exercise interventions to reduce anxiety in mid-life and late-life anxiety
           disorders and subthreshold anxiety disorder: a systematic review

    • Authors: Terence W.H. Chong, Scherazad Kootar, Helen Wilding, Sarah Berriman, Eleanor Curran, Kay L. Cox, Alex Bahar-Fuchs, Ruth Peters, Kaarin J. Anstey, Christina Bryant, Nicola T. Lautenschlager
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Anxiety disorders are highly prevalent and cause significant distress, disability, and cost. Medication adverse effects and interactions increase in mid-life and late-life, highlighting the need for effective non-pharmacological interventions.Objectives:We aimed to evaluate the extent of evidence supporting exercise interventions for anxiety and subthreshold anxiety disorders in mid-life and late-life.Design:Systematic review.Data Sources and Methods:We searched MEDLINE, PsycINFO, Embase, Emcare, Ovid Nursing, CINAHL Plus, Cochrane Library, Health Collection, Humanities & Social Sciences Collection, and https://clinicaltrials.gov databases for trials published January 1994–May 2019. Randomised controlled trials of exercise interventions involving aerobic exercise or resistance training for adults aged 40 years and above with anxiety or subthreshold anxiety disorders in residential or health settings were identified. The primary outcome was change in anxiety. We excluded trials including participants aged below 40 years, participants with diagnosis of separation anxiety, selective mutism, obsessive-compulsive disorder, acute stress disorder and post-traumatic stress disorder, and head-to-head comparisons of interventions. Trial quality was assessed using the Cochrane Risk of Bias Tool and evidence synthesised in narrative form.Results:Four trials totalling 132 participants met inclusion criteria, although some had methodological limitations. Interventions included a home-based resistance training intervention, supervised group-based aerobic intervention, Tai Chi intervention, and supervised group-based aerobic and strength intervention. Three trials included late-life participants and the fourth mid-life. Three trials demonstrated greater reductions in anxiety in the intervention group compared with control. The fourth trial showed pre–post reductions in anxiety in both groups, with between-group difference not reaching statistical significance.Conclusion:There is limited supportive evidence suggesting that exercise interventions have potential to be effective, feasible and safe non-pharmacological interventions for anxiety and subthreshold anxiety disorders in mid-life and late-life. The heterogeneity, limited number and high risk of bias of some trials meant that we were not able to conduct a meta-analysis. Tailoring of interventions may improve uptake and reduce dropout. The paucity of research in this area with only four included trials demonstrates the urgent need for future and larger trials to provide proof of concept, data about effective types and doses of exercise interventions, and guidance to community, clinical, and public health services.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-07-07T10:33:31Z
      DOI: 10.1177/20451253221104958
      Issue No: Vol. 12 (2022)
  • Vortioxetine as adjunctive therapy in the treatment of schizophrenia

    • Authors: Sofia Redaelli, Lilla Porffy, Ebenezer Oloyede, Olubanke Dzahini, Gabriella Lewis, Maria Lobo, Eromona Whiskey, Sukhi S. Shergill
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:The evidence for safe and effective interventions to treat the negative and cognitive symptoms of schizophrenia is lacking.Objectives:Vortioxetine is a novel antidepressant that has been used as adjunctive therapy for the treatment of psychosis; however, its effectiveness in clinical practice is relatively unknown. In this study, we aimed to determine the potential clinical effectiveness and safety and tolerability of vortioxetine in psychosis.Design:This is a non-interventional, retrospective study on the add-on use of vortioxetine in a group of people with schizophrenia-spectrum disorders in a large UK NHS mental health trust.Methods:Clinical effectiveness of vortioxetine was retrospectively assessed through the Clinical Global Impression – Severity (CGI-S) scale at 3 months. Safety and tolerability were evaluated through treatment discontinuation rates at 3, 6, and 12 months, and clinical reasons were evaluated at the primary endpoint of 3 months.Results:Data were available for 40 subjects with a diagnosis of schizophrenia or schizoaffective disorder–prescribed vortioxetine treatment; 30 (75%) remained on treatment at 3 months. At CGI-S assessment, 15 of the 35 evaluated subjects reported at least a 1-point improvement, from 5 at baseline to 4 after 3 months of treatment. Twenty-six (65%) remained on treatment at 1-year follow-up. The main reasons for those discontinuing treatment were inadequate response (10%) and manic switch (7.5%), while one subject refused treatment. Tolerability to treatment was good, and 36 subjects (90%) reported no adverse events specific to vortioxetine treatment.Conclusion:Schizophrenia is a complex illness, and there is insufficient treatment response in many individuals. A significant proportion of whom may require adjunctive treatments depending on the nature of the residual symptoms. Vortioxetine could be a potentially safe and effective option in such people, but further controlled studies are required.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-07-06T06:25:39Z
      DOI: 10.1177/20451253221110014
      Issue No: Vol. 12 (2022)
  • Agomelatine for the treatment of generalized anxiety disorder: focus on
           its distinctive mechanism of action

    • Authors: Mark J. Millan
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Generalized anxiety disorder (GAD), the most frequently diagnosed form of anxiety, is usually treated by cognitive-behavioural approaches or medication; in particular, benzodiazepines (acutely) and serotonin or serotonin/noradrenaline reuptake inhibitors (long term). Efficacy, compliance, and acceptability are, however, far from ideal, reinforcing interest in alternative options. Agomelatine, clinically employed in the treatment of major depression, expresses anxiolytic properties in rodents and was effective in the treatment of GAD (including severely ill patients) in several double-blind, short-term (12 weeks) and relapse-prevention (6 months) studies. At active doses, the incidence of adverse effects was no higher than for placebo. Agomelatine possesses a unique binding profile, behaving as a melatonin (MT1/MT2) receptor agonist and 5-HT2C receptor antagonist, yet recognizing neither monoamine transporters nor GABAA receptors. Extensive evidence supports a role for 5-HT2C receptors in the induction of anxious states, and their blockade likely plays a primary role in mediating the anxiolytic actions of agomelatine, including populations in the amygdala and bed nucleus of stria terminalis, as well as the hippocampus. Recruitment of MT receptors in the suprachiasmatic nucleus, thalamic reticular nucleus, and hippocampus appears to fulfil a complimentary role. Downstream of 5-HT2C and MT receptors, modulation of stress-sensitive glutamatergic circuits and altered release of the anxiogenic neuropeptides, corticotrophin-releasing factor, and vasopressin, may be implicated in the actions of agomelatine. To summarize, agomelatine exerts its anxiolytic actions by mechanisms clearly distinct from those of other agents currently employed for the management of GAD.Plain Language SummaryHow agomelatine helps in the treatment of anxiety disordersIntroduction:• Anxiety disorders have a significant negative impact on quality of life.• The most common type of anxiety disorder, called generalized anxiety disorder (GAD), is associated with nervousness and excessive worry.• These symptoms can lead to additional symptoms like tiredness, sleeplessness, irritability, and poor attention.• GAD is generally treated through either cognitive-behavioural therapy or medication. However, widely used drugs like benzodiazepines and serotonin reuptake inhibitors have adverse effects.• Agomelatine, a well-established antidepressant drug, has shown anxiety-lowering (‘anxiolytic’) properties in rats and has been shown to effectively treat GAD with minimal side effects.• However, exactly how it acts on the brain to manage GAD is not yet clear.• Thus, this review aims to shed light on agomelatine’s mechanism of action in treating GAD.Methods:• The authors reviewed studies on how agomelatine treats anxiety in animals.• They also looked at clinical studies on the effects of agomelatine in people with GAD.Results:• The study showed that agomelatine ‘blocks’ a receptor in nerve cells, which plays a role in causing anxiety, called the 5-HT2C receptor.• Blocking this receptor, especially in specific brain regions such as nerve cells of the amygdala, bed nucleus of stria terminalis, and hippocampus, produced the anxiety reduction seen during agomelatine treatment.• Agomelatine also activates the melatonin (MT) receptor, which is known to keep anxiety in check, promote sleep, and maintain the sleep cycle.• Agomelatine should thus tackle sleep disturbances commonly seen in patients with GAD.• Beyond 5-HT2C and MT receptors, signalling molecules in nerve cells that are known to be involved in anxiety disorders (called ‘neurotransmitters’ and ‘neuropeptides’) are also affected by agomelatine.Conclusion:• Agomelatine’s anxiolytic effects are caused by mechanisms that are distinct from those of other medications currently used to treat GAD.• This explains its therapeutic success and minimal adverse side effects.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-06-30T10:48:10Z
      DOI: 10.1177/20451253221105128
      Issue No: Vol. 12 (2022)
  • Effects of antipsychotics on heart rate in treatment of schizophrenia: a
           systematic review and meta-analysis

    • Authors: Maximilian Huhn, Thomas Arndt, Johannes Schneider-Thoma, Stefan Leucht
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Antipsychotics are the treatment of choice in the therapy of schizophrenia. These drugs can be associated with changes in heart rate, but this question has never been examined systematically.Objective:We aimed to analyse changes in heart rate during treatment with antipsychotics using the frequency of tachycardia and bradycardia events.Design:For this systematic review and meta-analysis, we included all randomized controlled trials for the acute treatment of schizophrenia comparing antipsychotics head-to-head or with placebo.Data Sources and Methods:We searched Embase, MEDLINE, PsycINFO, PubMed, BIOSIS, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry Platform and ClinicalTrials.gov (last search June 2021). Two authors independently selected studies and extracted data. We conducted pairwise meta-analyses using a random-effects model. Outcomes were tachycardia and bradycardia events.Results:We found 469 trials meeting the inclusion criteria. Seventy-seven studies with 16,907 participants provided data on tachycardia or bradycardia events. We found no significant differences between antipsychotics and placebo or between antipsychotics for bradycardia events based on sparse data. Antipsychotics had a higher risk for tachycardia events compared with placebo [N = 37, n = 7827, risk ratio (RR) = 1.83, 95% confidence interval (CI) = 1.40–2.41], with large differences between the individual substances (iloperidone RR = 14.05, chlorpromazine RR = 4.84, loxapine RR = 4.52, risperidone RR = 3.38, quetiapine RR = 2.64, paliperidone RR = 1.65). Some head-to-head comparisons were also significantly different: olanzapine versus haloperidol RR = 2.87, chlorpromazine versus thiothixene RR = 2.92, quetiapine versus lurasidone RR = 3.22, risperidone versus aripiprazole RR = 4.37, iloperidone versus ziprasidone RR = 4.65).Conclusion:Many studies do not report data for cardiac outcomes, but the available evidence indicates that treatment with antipsychotics raises the risk for tachycardia. Therefore, especially patients with cardiac risk factors should be monitored closely during antipsychotic treatment.Registration:PROSPERO: CRD42014014919
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-06-24T09:46:56Z
      DOI: 10.1177/20451253221097261
      Issue No: Vol. 12 (2022)
  • Duration of prior psychotic illness and clozapine response: a
           retrospective observational study using electronic health records

    • Authors: Rowena Jones, Rachel Upthegrove, Malcolm J. Price, Megan Pritchard, Joht Singh Chandan, Sophie Legge, James H. MacCabe
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Clozapine is the gold-standard medication for treatment-resistant schizophrenia (TRS) yet its initiation is often delayed.Objective:To examine whether earlier initiation of clozapine in TRS is associated with lower Clinical Global Impression – Severity (CGI-S) scores at 2 years.Methods:This was a retrospective cohort study from electronic health records of patients with first adequate trial of clozapine at the South London and Maudsley mental health service between 1 January 2007 and 31 December 2016. Dates of illness onset and clozapine commencement were manually extracted from anonymised case notes. CGI-S scores were rated blind to illness duration. Ordinal logistic regression was used to describe the association between illness duration at baseline and CGI-S outcome score at 2 years, following adjustment for CGI-S start score and other key covariates.Results:Among the 401 patients included, there was an association between illness duration and CGI-S outcome score with a 4% increase in the odds of a higher (worse) outcome CGI-S score per year of illness [adjusted odds ratio (AOR) = 1.04; 95% confidence interval (CI): 1.01–1.06]. The association between illness duration and clozapine response was most marked at less than 4 years illness duration. There were too few clozapine initiations within the first 2 years of illness to draw any conclusions about early clozapine initiation.Conclusion:Initiation of clozapine within 2–4 years of psychotic illness onset offers the best outcome for TRS, but the advantage, if any, of earlier initiation is unclear from these data.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-06-20T01:49:47Z
      DOI: 10.1177/20451253221103353
      Issue No: Vol. 12 (2022)
  • Estimation of cardiac QTc intervals in people prescribed antipsychotics: a
           comparison of correction factors

    • Authors: Teodora Andric, Karl Winckel, Timothy David Tanzer, Samantha Hollingworth, Lesley Smith, Katherine Isoardi, Olivier Tan, Dan Siskind
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:A prolonged electrocardiogram (ECG) QT interval is associated with cardiac events and increased mortality. Antipsychotics can prolong the QT interval. The QT interval requires correction (QTc) for heart rate using a formula or QT-nomogram. The QT and QTc can be calculated automatically by the ECG machine or manually; however, machine-measured QT(c) intervals may be inaccurate.Objective:We aimed to investigate the mean QTc and proportion of prolonged QTc intervals in people taking antipsychotic medicines.Methods:We conducted an observational retrospective chart review and data analysis of all consecutive patients taking antipsychotics, with an ECG record, admitted to the psychiatric unit of a large tertiary hospital in Brisbane, Australia, between 1 January 2017 and 30 January 2019. We investigated the mean QTc of people taking antipsychotics to determine differences using (a) machine versus manual QT interval measurement and (b) QTc correction formulae (Bazett, Fridericia, Framingham, Hodges and Rautaharju) and the QT-nomogram. We also determined the number of people with a prolonged QTc using different methods and compared rates of prolonged QTc with antipsychotic monotherapy and polypharmacy.Results:Of 920 included people, the mean (±SD) machine-measured, Bazett-corrected QT interval (recorded from the ECG) was 435 ms (±27), significantly longer (p 
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-06-17T06:17:33Z
      DOI: 10.1177/20451253221104947
      Issue No: Vol. 12 (2022)
  • Clozapine blood level assessment using a point-of-care device: feasibility
           and reliability

    • Authors: Shiri Kamhi-Nesher, Sharon Taub, Shikma Halimi, Maria Frenkel, Mahmud Azam, Gil Bormant, Helena Isakov, Dikla Radzinsky, Abraham Weizman, Amir Krivoy
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Therapeutic drug monitoring (TDM) is useful to assess clozapine adherence and optimize treatment. However, analysis of venous blood levels by liquid chromatography tandem mass spectrometry (LC-MS/MS) is often logistically complicated and process time is prolonged.Objective:To assess the feasibility and reliability of a new point-of-care device, (MyCare™ Insite), using capillary blood for clozapine therapeutic monitoring.Methods:Matched venous and capillary blood samples were collected from patients treated with clozapine on a stable dose. Samples were analyzed by LC-MS/MS and MyCare Insite Clozapine Test. Clozapine plasma levels were compared between methods using linear regression model. Both patients and treatment team completed questionnaires about the feasibility of blood sampling.Results:Of the total sample (44 patients, 61% males, mean age 43 ± 12 years), mean daily clozapine dose was 293 ± 134 mg/day. Linear regression model demonstrated high correlation with R2 = 0.83 (p 
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-06-14T08:57:27Z
      DOI: 10.1177/20451253221094435
      Issue No: Vol. 12 (2022)
  • Treatment strategies for clozapine-induced hypotension: a systematic

    • Authors: Timothy David Tanzer, Thomas Brouard, Samuel Dal Pra, Nicola Warren, Michael Barras, Steve Kisely, Emily Brooks, Dan Siskind
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Clozapine is the most effective medication for treatment–refractory schizophrenia but is associated with significant adverse drug effects, including hypotension and dizziness, which have a negative impact on quality of life and treatment compliance. Available evidence for the management of clozapine-induced hypotension is scant.Objectives:Due to limited guidance on the safety and efficacy of pharmacological treatments for clozapine-induced hypotension, we set out to systematically review and assess the evidence for the management of clozapine-induced hypotension and provide guidance to clinicians, patients, and carers.Design:We undertook a systematic review of the safety and efficacy of interventions for clozapine-induced hypotension given the limited available evidence.Data Sources and Methods:PubMed, Embase, PsycINFO, CINAHL, and the Cochrane trial Registry were searched from inception to November 2021 for literature on the treatment strategies for clozapine-induced hypotension and dizziness using a PROSPERO pre-registered search strategy. For orthostatic hypotension, we developed a management framework to assist in the choice of intervention.Results:We identified nine case studies and four case series describing interventions in 15 patients. Hypotension interventions included temporary clozapine dose reduction, non-pharmacological treatments, and pharmacological treatments. Midodrine, fludrocortisone, moclobemide and Bovril® combination, and etilefrine were associated with improvement in symptoms or reduction in orthostatic hypotension. Angiotensin II, arginine vasopressin, and noradrenaline successfully restored and maintained mean arterial pressure in critical care situations. A paradoxical reaction of severe hypotension was reported with adrenaline use.Conclusion:Orthostatic hypotension is a common side effect during clozapine titration. Following an assessment of the titration schedule, salt and fluid intake, and review of hypertensive and nonselective α1-adrenergic agents, first-line treatment should be a temporary reduction in clozapine dose or non-pharmacological interventions. If orthostatic hypotension persists, fludrocortisone should be trialled with monitoring of potassium levels and sodium and fluid intake. Midodrine may be considered second-line or where fludrocortisone is contraindicated or poorly tolerated. For patients on clozapine with hypotension in critical care settings, the use of adrenaline to maintain mean arterial pressure should be avoided.Registration:PROSPERO (Registration No. CRD42020191530)
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-05-25T06:44:37Z
      DOI: 10.1177/20451253221092931
      Issue No: Vol. 12 (2022)
  • The efficacy of antipsychotics in the treatment of physical aggressive
           behavior in patients with dementia in nursing homes

    • Authors: Sina Nawzad, Wiepke Cahn, Heshu Abdullah-Koolmees
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Patients with dementia often suffer from behavioral changes. A common behavioral change is acute physical aggressive behavior which is the most distressing change. This can lead to harm, which is especially problematic in nursing homes. Despite the serious safety concerns, antipsychotics are often prescribed to combat this problem. This article is aimed to review the evidence of the efficacy of utilizing antipsychotics in acutely treating physical aggressive behavior in patients with dementia in nursing homes. Therefore, a systematic literature search was performed. The results demonstrated that a meta-analysis confirmed statistically significant reduction in physical aggression when risperidone was compared to placebo. However, a randomized controlled trial showed no change in physical aggressive behavior between quetiapine and placebo. More research is needed to fully investigate the benefits of physical aggressive behavior and safety concerns of all the antipsychotics in patients with dementia in nursing homes.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-05-16T07:00:09Z
      DOI: 10.1177/20451253221097452
      Issue No: Vol. 12 (2022)
  • Gut microbiome in schizophrenia and antipsychotic-induced metabolic
           alterations: a scoping review

    • Authors: Raghunath Singh, Nicolette Stogios, Emily Smith, Jiwon Lee, Kateryna Maksyutynsk, Emily Au, David C. Wright, Giada De Palma, Ariel Graff-Guerrero, Philip Gerretsen, Daniel J. Müller, Gary Remington, Margaret Hahn, Sri Mahavir Agarwal
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Schizophrenia (SCZ) is a severe mental disorder with high morbidity and lifetime disability rates. Patients with SCZ have a higher risk of developing metabolic comorbidities such as obesity and diabetes mellitus, leading to increased mortality. Antipsychotics (APs), which are the mainstay in the treatment of SCZ, increase the risk of these metabolic perturbations. Despite extensive research, the mechanism underlying SCZ pathophysiology and associated metabolic comorbidities remains unclear. In recent years, gut microbiota (GMB) has been regarded as a ‘chamber of secrets’, particularly in the context of severe mental illnesses such as SCZ, depression, and bipolar disorder. In this scoping review, we aimed to investigate the underlying role of GMB in the pathophysiology of SCZ and metabolic alterations associated with APs. Furthermore, we also explored the therapeutic benefits of prebiotic and probiotic formulations in managing SCZ and AP-induced metabolic alterations. A systematic literature search yielded 46 studies from both preclinical and clinical settings that met inclusion criteria for qualitative synthesis. Preliminary evidence from preclinical and clinical studies indicates that GMB composition changes are associated with SCZ pathogenesis and AP-induced metabolic perturbations. Fecal microbiota transplantation from SCZ patients to mice has been shown to induce SCZ-like behavioral phenotypes, further supporting the plausible role of GMB in SCZ pathogenesis. This scoping review recapitulates the preclinical and clinical evidence suggesting the role of GMB in SCZ symptomatology and metabolic adverse effects associated with APs. Moreover, this scoping review also discusses the therapeutic potentials of prebiotic/probiotic formulations in improving SCZ symptoms and attenuating metabolic alterations related to APs.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-05-16T06:58:48Z
      DOI: 10.1177/20451253221096525
      Issue No: Vol. 12 (2022)
  • Risperidone-induced neuroleptic malignant syndrome: a case report

    • Authors: Ling Deng, Zhi-Xin Qiu, Mao-Yun Wang
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Neuroleptic malignant syndrome (NMS) is a rare illness that results from reactions to antipsychotics. However, the diagnosis of NMS is challenging due to its atypical clinical presentation and unclear pathogenesis. We report the case of a patient with NMS induced by irregular use of antipsychotics, especially risperidone (RSP). He had typical hyperthermia, muscle rigidity and rhabdomyolysis, which led to renal impairment. We carefully analysed the mechanism by which NMS occurred in this patient. An interesting aspect of the case is the synergistic involvement of risperidone, antidepressants, opioids and stress. Because of these complex predisposing factors, it is difficult to completely rule out the diagnosis of malignant hyperthermia (MH). In addition, the rare phenomenon of elevated lipase and amylase was observed in this patient.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-05-14T08:40:12Z
      DOI: 10.1177/20451253221094960
      Issue No: Vol. 12 (2022)
  • Population pharmacokinetic model and limited sampling strategy for
           clozapine using plasma and dried blood spot samples

    • Authors: Lisanne M. Geers, Dan Cohen, Laura M. Wehkamp, Hans J. van Wattum, Jos G.W. Kosterink, Anton J.M. Loonen, Daan J. Touw
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:To improve efficacy, therapeutic drug monitoring is often used in clozapine therapy. Trough level monitoring is regular, but trough levels provide limited information about the pharmacokinetics of clozapine and exposure in time. The area under the concentration time curve (AUC) is generally valued as better marker of drug exposure in time but calculating AUC needs multiple sampling. An alternative approach is a limited sampling scheme in combination with a population pharmacokinetic model meant for Bayesian forecasting. Furthermore, multiple venepunctions can be a burden for the patient, whereas collecting samples by means of dried blood spot (DBS) sampling can facilitate AUC-monitoring, making it more patient friendly.Objective:Development of a population pharmacokinetic model and limited sampling strategy for estimating AUC0-12h (a twice-daily dosage regimen) and AUC0-24h (a once-daily dosage regimen) of clozapine, using a combination of results from venepunctions and DBS sampling.Method:From 15 schizophrenia patients, plasma and DBS samples were obtained before administration and 2, 4, 6, and 8 h after clozapine intake. MwPharm® pharmacokinetic software was used to parameterize a population pharmacokinetic model and calculate limited sampling schemes.Results:A three-point sampling strategy with samples at 2, 6, and 8 h after clozapine intake gave the best estimation of the clozapine AUC0-12h and at 4, 10, and 11 h for the AUC0-24h. For clinical practice, however, a two-point sampling strategy with sampling points at 2 and 6 h was sufficient to estimate AUC0-12h and at 4 and 11 h for AUC0-24h.Conclusion:A pharmacokinetic model with a two–time point limited sampling strategy meant for Bayesian forecasting using DBS sampling gives a better prediction of the clozapine exposure in time, expressed as AUC, compared to trough level monitoring. This limited sampling strategy might therefore provide a more accurate prediction of effectiveness and occurrence of side effects compared to trough level monitoring. The use of DBS samples also makes the collection of clozapine samples easier and wider applicable.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-05-02T02:24:19Z
      DOI: 10.1177/20451253211065857
      Issue No: Vol. 12 (2022)
  • The clinical effectiveness and cost effectiveness of clozapine for
           inpatients with severe borderline personality disorder (CALMED study): a
           randomised placebo-controlled trial

    • Authors: Mike J. Crawford, Verity C. Leeson, Rachel Evans, Barbara Barrett, Aisling McQuaid, Jack Cheshire, Rahil Sanatinia, Gary Lamph, Piyal Sen, Katina Anagnostakis, Louise Millard, Inti Qurashi, Fintan Larkin, Nusrat Husain, Paul Moran, Thomas R.E. Barnes, Carol Paton, Zoe Hoare, Marco Picchioni, Simon Gibbon
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Data from case series suggest that clozapine may benefit inpatients with borderline personality disorder (BPD), but randomised trials have not been conducted.Methods:Multicentre, double-blind, placebo-controlled trial. We aimed to recruit 222 inpatients with severe BPD aged 18 or over, who had failed to respond to other antipsychotic medications. We randomly allocated participants on a 1:1 ratio to receive up to 400 mg of clozapine per day or an inert placebo using a remote web-based randomisation service. The primary outcome was total score on the Zanarini Rating scale for Borderline Personality Disorder (ZAN-BPD) at 6 months. Secondary outcomes included self-harm, aggression, resource use and costs, side effects and adverse events. We used a modified intention to treat analysis (mITT) restricted to those who took one or more dose of trial medication, using a general linear model fitted at 6 months adjusted for baseline score, allocation group and site.Results:The study closed early due to poor recruitment and the impact of the COVID-19 pandemic. Of 29 study participants, 24 (83%) were followed up at 6 months, of whom 21 (72%) were included in the mITT analysis. At 6 months, 11 (73%) participants assigned to clozapine and 6 (43%) of those assigned to placebo were still taking trial medication. Adjusted difference in mean total ZAN-BPD score at 6 months was -3.86 (95% Confidence Intervals = -10.04 to 2.32). There were 14 serious adverse events; 6 in the clozapine arm and 8 in the placebo arm of the trial. There was little difference in the cost of care between groups.Interpretation:We recruited insufficient participants to test the primary hypothesis. The study findings highlight problems in conducting placebo-controlled trials of clozapine and in using clozapine for people with BPD, outside specialist inpatient mental health units.Trial registrationISRCTN18352058. https://doi.org/10.1186/ISRCTN18352058
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-04-30T04:21:08Z
      DOI: 10.1177/20451253221090832
      Issue No: Vol. 12 (2022)
  • Analysis of the clinical characteristics of olanzapine-induced acute

    • Authors: Yang He, Weijin Fang, Zuojun Li, Linli Sun, Yulu Zhou, Cuifang Wu, Wei Sun, Chunjiang Wang
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Numerous case reports of acute pancreatitis (AP) induced by olanzapine have been published. Little is, however, known about the clinical features of olanzapine-induced AP. The aim of the study was to explore the clinical characteristics of olanzapine-induced AP. We collected literature on AP cases induced by olanzapine from 1996 to April 2021 for retrospective analysis in Chinese and English. The median time to onset of olanzapine-induced acute pancreatic symptoms was 12 (range = 0.86–216) weeks in 25 patients. The clinical features of AP range from asymptomatic elevation of blood amylase/lipase levels to digestive system symptoms (abdominal pain, vomiting, and nausea) and even death in a small number of patients. Laboratory tests showed varying degrees of elevated serum amylase and lipase levels, along with high blood sugar and high triglyceride levels in some patients. Computed tomography showed acute edematous pancreatitis, acute hemorrhagic pancreatitis, and acute necrotizing pancreatitis in the patients. The patients’ symptoms were completely relieved and high triglyceride levels gradually returned to normal levels after olanzapine was stopped. Some patients with hyperglycemia still needed hypoglycemic therapy. AP is a rare adverse effect of olanzapine. Clinicians should be aware of such complications and monitor pancreatin.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-04-30T04:19:09Z
      DOI: 10.1177/20451253221079971
      Issue No: Vol. 12 (2022)
  • Experiences with benzodiazepine use, tapering, and discontinuation: an
           Internet survey

    • Authors: Alistair J. Reid Finlayson, Jane Macoubrie, Christy Huff, Darren E. Foster, Peter R. Martin
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Over 92 million prescriptions for benzodiazepines are dispensed in the United States annually, yet little is known about the experiences of those taking and discontinuing them.Objective:The aim of this study is to assess the experiences of those taking, tapering, or having discontinued benzodiazepines.Methods:An online survey (n = 1207) elicited information about benzodiazepine use, including long-term use, tapering, discontinuation, and withdrawal symptoms.Results:Symptoms associated with benzodiazepine use, tapering, and discontinuation were numerous and ranged from symptoms such as anxiety, insomnia, and nervousness to digestive problems, irregular heart rhythms, uncontrollable anger, photosensitivity, balance problems, and others. When asked how benzodiazepine symptoms affected their lives, 82.9% reported work problems, 86.3% had problems with social interactions and friendships, and 88.8% had problems with fun, recreation, and hobbies. Suicidal thoughts or attempted suicide was reported by 54.4%, and 46.8% said benzodiazepines caused lost employment. Most of the respondents for whom benzodiazepines were prescribed (76.2%) stated they had not been informed that benzodiazepines were indicated for short-term use only and that discontinuation might be difficult. About a third (31.5%) reported food allergies and/or seasonal allergies that occurred only after benzodiazepine use.Conclusion:The trajectory of those who taper or discontinue benzodiazepines is unpredictable, and many patients experience a range of protracted and severe symptoms, even years after benzodiazepines were completely discontinued. Greater awareness is needed for both prescribers and patients about the potential for a difficult withdrawal from benzodiazepines.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-04-25T07:19:16Z
      DOI: 10.1177/20451253221082386
      Issue No: Vol. 12 (2022)
  • Will psilocybin lose its magic in the clinical setting'

    • Authors: Caroline Hayes, Mourad Wahba, Stuart Watson
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Psilocybin as a novel treatment for depression is garnering a lot of attention from both the mainstream media and the academic community. Although phase 3 trials are only just beginning, we feel that it is important for clinicians to consider what psilocybin-assisted psychotherapy might look like in the clinical setting. In this narrative review article we have considered the difficulties that may arise as psilocybin emerges from the research setting, which may hamper its progress towards becoming a licenced medication. Psilocybin has its own unique challenges: the expectation patients come to dosing with having read overwhelmingly positive media; patient suggestibility under the influence of psilocybin and requirement for specialised therapists to name a few. We have also made some recommendations for measures that should be taken in both the phase 3 trials and with clinicians to try and minimise some of the issues raised. In doing so our hope is that psilocybin will continue towards becoming a licenced medication that suitable patients are able to access with relative ease. Practicing psychiatrists need to have an awareness of the potential pitfalls of psilocybin as they will be responsible for prescribing it in the future.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-04-23T06:51:01Z
      DOI: 10.1177/20451253221090822
      Issue No: Vol. 12 (2022)
  • Time to rehospitalization in involuntarily hospitalized individuals
           suffering from schizophrenia discharged on long-acting injectable
           antipsychotics or oral antipsychotics

    • Authors: Ching-Hua Lin, Hung-Yu Chan, Fu-Chiang Wang, Chun-Chi Hsu
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Involuntarily hospitalized individuals suffering from schizophrenia often have a poorer prognosis after discharge.Objective:This study aimed to analyze time to rehospitalization within 6 months of discharge in involuntarily hospitalized individuals suffering from schizophrenia discharged on long-acting injectable antipsychotics (LAIs) or oral antipsychotics (OAPs). In addition, temporal trends in LAI use at discharge were explored.Methods:Involuntarily hospitalized individuals suffering from schizophrenia discharged from the study hospital between 2006 and 2019 (n = 806) were included in the analysis. Survival analysis was used to compare time to rehospitalization within 6 months of discharge between individuals discharged on LAIs and OAPs, and between first-generation antipsychotic (FGA) LAIs and second-generation antipsychotic (SGA) LAIs. The Cochran–Armitage trend test was used to test whether a temporal trend existed for LAIs use at discharge during the study period.Results:The LAIs group (n = 231) had a significantly lower rate of rehospitalization and a significantly longer time to rehospitalization than the OAPs group (n = 575). Rehospitalization rate and time to rehospitalization were not significantly different between individuals discharged on FGA-LAIs and SGA-LAIs. LAIs use at discharge grew significantly from 16.77% in 2006 to 50.00% in 2019 (Z = 6.81, p 
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-03-23T09:59:40Z
      DOI: 10.1177/20451253221079165
      Issue No: Vol. 12 (2022)
  • Clozapine- and non-clozapine-associated neutropenia in patients with
           schizophrenia: a retrospective cohort study

    • Authors: Claas-Frederik Johannsen, Tonny Studsgaard Petersen, Jimmi Nielsen, Anders Jørgensen, Espen Jimenez-Solem, Anders Fink-Jensen
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Introduction:The antipsychotic drug clozapine remains underutilized partly because of the risk of life-threatening adverse effects, such as neutropenia. Therefore, an extensive hematological monitoring program was set up to detect neutropenia.Methods:In this retrospective cohort study, we used registry-based data from the Capital Region of Denmark to investigate incidence rates of neutropenia among patients with a diagnosis of schizophrenia or other psychotic disorders and treated with clozapine for the first time. In a within-subject design, we compared rates of neutropenia in time periods where patients were exposed to clozapine versus time periods, where they were not exposed to clozapine. We also investigated whether the lengths of clozapine-associated neutropenia (CAN) were related to discontinuation of clozapine treatment.Results:Data from 520 clozapine users were included. The incidence rate of CAN was 3.2 cases per 100 person-years (95% confidence interval [CI]: 2.1–4.8) throughout the entire study. There was no significant difference in incidence rates of neutropenia during clozapine exposure and non-clozapine exposure, with an incidence rate ratio of 0.7 (95% CI: 0.4–1.3). One episode of severe neutropenia was detected. Episodes of CAN with only one sub-threshold neutrophil count were not associated with higher clozapine discontinuation (26%) than CAN episodes of more than one sub-threshold neutrophil count (28%).Conclusion:In the present study, we could not confirm that clozapine treatment was associated with neutropenia.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-03-05T09:16:35Z
      DOI: 10.1177/20451253211072341
      Issue No: Vol. 12 (2022)
  • Can the use of long-acting injectable antipsychotic preparations be
           increased in routine clinical practice and the benefits realised'

    • Authors: Carol Paton, Chike I. Okocha, Maxine X. Patel
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:The use of continuing antipsychotic medication is an established evidence-based strategy for preventing relapse in people with schizophrenia, but medication adherence is known to be suboptimal. Covert non-adherence can be eliminated by the use of long-acting injectable (LAI) formulations. We sought to (1) raise awareness among clinicians of the potential benefits of LAI antipsychotic formulations, (2) increase use of these formulations for the treatment of schizophrenia in routine clinical practice and thereby (3) reduce the number of relapses requiring hospitalisation in patients with schizophrenia under our care.Method:Educational initiatives, promotion of reflective practice and patient-specific reminders were used to prompt increased use of LAI antipsychotic medication for patients with schizophrenia. Data relating to the use of these medications and the number of acute admissions for schizophrenia spectrum disorders (F20-29, ICD-10) over time were extracted from existing clinical information systems.Results:Over the 3-year time frame of our local initiative, the use of LAI antipsychotic preparations increased by 11%, the number of acute admissions for schizophrenia/schizoaffective disorder (F20 and F25) decreased by 26% and the number of acute bed days occupied by patients with these diagnoses decreased by 8%. The number of admissions for other psychosis diagnoses (F21-24 and F28-29) did not show the same pattern of improvement.Conclusion:In our health care organisation, raising clinicians’ awareness of the evidence base relating to the potentially favourable benefit–risk balance for LAI antipsychotic medication compared with oral formulations resulted in more use of the former. There were accompanying reductions in acute admissions and occupied bed days for patients with schizophrenia.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-02-15T08:02:44Z
      DOI: 10.1177/20451253211072347
      Issue No: Vol. 12 (2022)
  • Clinical practice guideline recommendations on tapering and discontinuing
           antidepressants for depression: a systematic review

    • Authors: Anders Sørensen, Karsten Juhl Jørgensen, Klaus Munkholm
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Tapering and discontinuing antidepressants are important aspects of the management of patients with depression and should therefore be considered in clinical practice guidelines.Objectives:We aimed to assess the extent and content, and appraise the quality, of guidance on tapering and discontinuing antidepressants in major clinical practice guidelines on depression.Methods:Systematic review of clinical practice guidelines on depression issued by national health authorities and major national or international professional organisations in the United Kingdom, the United States, Canada, Australia, Singapore, Ireland and New Zealand (PROSPERO CRD42020220682). We searched PubMed, 14 guideline registries and the websites of relevant organisations (last search 25 May 2021). The clinical practice guidelines were assessed for recommendations and information relevant to tapering and discontinuing antidepressants. The quality of the clinical practice guidelines as they pertained to tapering and discontinuation was assessed using the AGREE II tool.Results:Of the 21 included clinical practice guidelines, 15 (71%) recommended that antidepressants are tapered gradually or slowly, but none provided guidance on dose reductions, how to distinguish withdrawal symptoms from relapse or how to manage withdrawal symptoms. Psychological challenges were not addressed in any clinical practice guideline, and the treatment algorithms and flow charts did not include discontinuation. The quality of the clinical practice guidelines was overall low.Conclusion:Current major clinical practice guidelines provide little support for clinicians wishing to help patients discontinue or taper antidepressants in terms of mitigating and managing withdrawal symptoms. Patients who have deteriorated upon following current guidance on tapering and discontinuing antidepressants thus cannot be concluded to have experienced a relapse. Better guidance requires better randomised trials investigating interventions for discontinuing or tapering antidepressants.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-02-11T10:36:58Z
      DOI: 10.1177/20451253211067656
      Issue No: Vol. 12 (2022)
  • Clinical outcomes following switching antipsychotic treatment due to
           market withdrawal: a retrospective naturalistic cohort study of
           pipotiazine palmitate injection (Piportil Depot) discontinuation,
           subsequent acute care use and effectiveness of medication to which
           patients switched

    • Authors: Rollo J.G. Sheldon, Marco Pereira, George Aldersley, Tim Sales, Jed Hewitt, Ray Lyon, Richard Whale
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Introduction:Pipotiazine palmitate depot injection (Piportil) was withdrawn from the UK marketplace in 2015. Few studies exist on the clinical impact of such market withdrawal. Purpose: We aimed to identify a cohort of patients switching from pipotiazine following this withdrawal and explore factors associated with effectiveness of the medication switched to and subsequent acute service use.Methods:A naturalistic retrospective cohort study was conducted in Sussex, United Kingdom. Those discontinuing pipotiazine solely due to market withdrawal were identified from electronic patient database and manual searching. Multivariate logistic regression analyses and survival analyses were performed to explore associations between available baseline variables and dichotomous all-cause discontinuation of the next prescribed medication and admission to acute mental health services over the subsequent year.Results:Of 205 patients identified as receiving pipotiazine in October 2014, 137 switched from this due to market withdrawal. Over the subsequent year, 31.5% discontinued the medication to which they were switched and 19% required acute care. Drug class switched to (typical depot vs atypical long acting injection (LAI) vs atypical oral) had no significant association with discontinuation. Switch to atypical LAI was significantly associated with acute care in comparison to typical depot. Those with a schizophrenia diagnosis were significantly less likely to discontinue switched medication or to receive acute care in comparison to those with schizoaffective disorder. Women were significantly more likely to discontinue switched medication than men. Of those requiring acute care, only 38% had required this in the previous 2 years.Conclusions:Antipsychotic market withdrawal has demonstrable negative clinical implications and requires careful clinical management. Increased acute care rates in those receiving an atypical LAI versus a typical depot following pipotiazine suggests lower effectiveness or possible withdrawal effects. No significant difference between depots, LAIs and oral medications on discontinuation supports the importance of a collaborative, fully informed approach when deciding next treatment options.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-01-31T04:40:05Z
      DOI: 10.1177/20451253211067042
      Issue No: Vol. 12 (2022)
  • Clozapine augmentation with cariprazine for negative symptoms: a case
           series and literature review

    • Authors: Ebenezer Oloyede, Ivana Clark, Shubhra Mace, Eromona Whiskey, David Taylor
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Only about 50% of patients with treatment-resistant schizophrenia respond to clozapine, and many more patients continue to experience ongoing and prominent negative symptoms. These negative symptoms, for which there are limited pharmacological options, may represent the greatest barrier to functional recovery. Cariprazine is a novel antipsychotic drug that is a partial agonist at dopamine D2 and D3 receptors with preferential binding to the D3 receptor, antagonism of 5HT2B receptors, and partial agonism at 5HT1A receptors. Cariprazine is currently licenced for the treatment of schizophrenia in Europe and the United States and has also been approved for bipolar disorder in the United States. There is a limited body of evidence to suggest clinical effectiveness as an augmentation strategy for negative symptoms in those treated with clozapine. In this case series, we present five cases of successful treatment of negative symptoms by clozapine combined with cariprazine in treatment-resistant psychosis.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-01-28T12:21:33Z
      DOI: 10.1177/20451253211066642
      Issue No: Vol. 12 (2022)
  • Brugada syndrome: should we be screening patients before prescribing
           psychotropic medication'

    • Authors: Azizah Attard, Claire Stanniland, Stephen Attard, Andrew Iles, Kim Rajappan
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Brugada syndrome (BrS) presents with a characteristic electrocardiogram (ECG) and is associated with sudden cardiac death. Until now, prolongation of QTc interval and its association with Torsade de Pointe and possible fatal arrhythmia have been the focus of routine baseline ECGs before prescribing psychotropic medication. A semi-systematic literature review was conducted using PubMed. The terms ‘Brugada’, ‘Brugada Syndrome’ AND ‘psychotropic’ ‘antipsychotic’ ‘antidepressant’ ‘mood stabilisers’ ‘clozapine’ ‘Tricyclic Antidepressants’ ‘Lithium’ were searched. From a search that delivered over 200 articles, 82 articles were included. Those that included details around causative medication, doses of medication and where clear timeline on drug cause were included. Where clarification was needed, the manufacturer of the medication was contacted directly. Psychotropic medication can be associated with BrS, Brugada phenocopy or unmasking of BrS, in overdose or in normal doses. Our results include a table summarising a number of psychotropic overdoses that led to BrS unmasking. Routine screening for BrS in patients before prescribing psychotropic medication is a natural extension of the baseline ECG currently routinely done to rule out QTc prolongation. Psychiatrists need to invest in ensuring better skills in interpreting ECGs and work closer with cardiologists in interpreting ECGs.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-01-28T10:16:12Z
      DOI: 10.1177/20451253211067017
      Issue No: Vol. 12 (2022)
  • Advances in pharmacotherapy for postpartum depression: a structured review
           of standard-of-care antidepressants and novel neuroactive steroid

    • Authors: Yardana Kaufman, Sara V. Carlini, Kristina M. Deligiannidis
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Postpartum depression is one of the most common morbidities of childbearing, yet it is underdiagnosed and undertreated with negative consequences for mother and offspring. Despite the widespread use of standard-of-care antidepressants as the mainstay of treatment for postpartum depression, there is limited evidence on their safety and efficacy due to their slow onset of action and suboptimal outcomes. The emergence of gamma-aminobutyric acidergic neuroactive steroids may offer faster response and remission times and improved patient outcomes. This article reviews the evidence base for the efficacy of standard-of-care antidepressants, hormonal therapeutics including progestins and estradiol, and gamma-aminobutyric acidergic neuroactive steroids in the treatment of postpartum depression, as well as the safety of infant exposure to these agents during lactation.
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-01-28T10:14:32Z
      DOI: 10.1177/20451253211065859
      Issue No: Vol. 12 (2022)
  • Identifying dopamine supersensitivity through a randomized controlled
           study of switching to aripiprazole from other antipsychotic agents in
           patients with schizophrenia

    • Authors: Chia-Hao Ma, Hung-Yu Chan, Ming H. Hsieh, Chen-Chung Liu, Chih-Min Liu, Hai-Gwo Hwu, Ching-Hua Kuo, Wei J. Chen, Tzung-Jeng Hwang
      Abstract: Therapeutic Advances in Psychopharmacology, Volume 12, Issue , January-December 2022.
      Background:Aripiprazole has been reported to worsen psychotic symptoms when switching from other antipsychotics, possibly due to dopamine supersensitivity psychosis.Objective:This study aimed to explore the predictors and possible underlying mechanisms of aripiprazole-related psychotic exacerbation.Methods:We conducted an 8-week, open-label, randomized controlled study from October 2007 to September 2009, assigning patients with a primary diagnosis of schizophrenia or schizoaffective disorder to switch from other antipsychotics to aripiprazole with 2-week dual administration, and then to taper off the original agents in fast (n = 38, within 1 week) or slow (n = 41, within 4 weeks) strategies. Positive and Negative Syndrome Scale (PANSS) was examined at day 0, 7, 14, 28, 56. Aripiprazole-related exacerbation (ARE) was defined positive as a 2-point increase in delusion/hallucination dimension score within 28 days compared with baseline. Baseline demographic, clinical and intervention-related variables were compared between the ARE+ and ARE- groups.Results:Of the 79 randomized patients, 21 fulfilled the criteria of ARE+ , and 46 were classified as ARE-. Fourteen patients in the ARE+ group had worsening psychotic symptoms in the first and second weeks. Compared with the ARE- group, the ARE+ group had a higher baseline chlorpromazine equivalent dose (405.8 ± 225.8 mg vs 268.1 ± 165.4 mg, p = 0.007) and was associated with prescription of first-generation antipsychotics (p = 0.038).Conclusions:A higher dose of original antipsychotics and prescription of first-generation antipsychotics may be associated with a higher risk of ARE. The underlying mechanism might be covert dopamine supersensitivity psychosis. These findings may help to identify high-risk patients and guide appropriate treatment strategies.Trial Registration:ClinicalTrials.gov, identifier: NCT00545467
      Citation: Therapeutic Advances in Psychopharmacology
      PubDate: 2022-01-28T10:12:46Z
      DOI: 10.1177/20451253211064396
      Issue No: Vol. 12 (2022)
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