A symptom profile analysis of antipsychotic drug treatment: Nonparametric multidimensional technique

Thirty-six schizoaffective patients were treated with haloperidol plus lithium or haloperidol plus placebo. Standard statistical analysis showed greater improvement in those treated with lithium plus haloperidol, as published previously. The Brief Psychiatric Rating Scale (BPRS) scores were reanalyzed in the present study using a nonparametric technique for multidimensional scaling of symptom profiles. The differential outcome after haloperidol with or without added lithium is determined both by symptom dimension and by type of drug. Added lithium prevents a depressive shift after haloperidol treatment on the dimension of “cognitive disorganization—depressive preoccupation.”     

Weight gain and antipsychotic drug treatment

Like the classical neuroleptic drugs, most of the new antipsychotic agents can cause weight gain in patients receiving long-term treatment. However, it remains difficult to rank the different compounds according to their propensity to cause this unwanted side-effect. Recent data suggest that weight gain appears to be essentially related to an increase in appetite in these patients. Thus, it is a fact that the patients' diet represents the main predictive factor for weight gain, independently of the antipsychotic compound prescribed. In contrast to the other and often more disabling side-effects of these treatments, overweight can be effectively prevented by simple hygienic and dietetic measures. It would therefore be advisable to discuss the possibility of this side-effect of antipsychotic treatment with the patient, and to suggest appropriate preventive measures, as part of the therapeutic partnership.     

Antipsychotic type and correlates of antipsychotic treatment discontinuation in the outpatient treatment of schizophrenia.

Antipsychotic medication maintenance and the factors influencing it were analyzed using data from the SOHO study, a large observational study of the outcomes of antipsychotic treatment for schizophrenia in Europe. A total of 7186 adult patients in the outpatient setting who were initiating or changing their antipsychotic medication and who were prescribed only one antipsychotic after the baseline visit were analyzed. Medication maintenance at 12 months varied with the type of antipsychotic prescribed, being highest with clozapine (79.5%) and olanzapine (77.0%), and lowest with quetiapine (51.4%) and amisulpride (58.2%). Multiple logistic regression analysis demonstrated that the type of antipsychotic prescribed at baseline was the most important predictor of medication maintenance. Alcohol dependency, taking mood stabilizers, compulsory admission or arrest in the previous 6 months, greater clinical severity, and changing antipsychotic medication due to lack of effectiveness at baseline predicted a higher frequency of medication discontinuation in the subsequent 12 months. In contrast, medication maintenance was higher among patients who were treatment naïve at baseline, socially active or who had loss of libido at baseline. The findings from this study should be interpreted conservatively because of its non-randomized observational design.     

Multiple versus single antipsychotic drug treatment in chronic psychosis

Fourteen patients receiving multiple antipsychotic drugs in a state mental hospital long-term unit comprised the study sample. They completed a 1-year clinical trial to reduce such drugs to a single antipsychotic agent. Six of the 14 patients were successfully converted to a single antipsychotic drug without clinical deterioration. Eight patients showed marked psychiatric decompensation when converted to single antipsychotic therapy. Factors that may have contributed to this difference are discussed.     

青少年抑郁症患者药物治疗后认知功能障碍的影响因素研究

目的 探讨青少年抑郁症患者药物治疗后认知功能障碍的影响因素。方法 回顾性分析 2019 年 1 月至 2022 年 4 月在阜阳市第三人民医院住院治疗的 212 例青少年抑郁症患者的临床资料,将治 疗后蒙特利尔认知评估量表（MoCA）评分≥ 26 分的患者纳入认知功能无障碍组（n=141）,评分＜ 26 分的 患者纳入认知功能障碍组（n=71）。比较两组患者的年龄、性别、体重指数（BMI）、病程、吸烟、家族史、饮酒、 社会支持评定量表（SSRS）评分、17 项汉密尔顿抑郁量表（HAMD-17）评分、文化程度、抑郁程度。采用 受试者工作特征（ROC）曲线分析年龄和 SSRS 评分预测青少年抑郁症患者治疗后认知功能障碍的价值。 采用多因素 Logistic 回归分析青少年抑郁症患者治疗后认知功能障碍的危险因素。结果 两组患者性 别、BMI、病程、有无家族史、HAMD-17 评分、抑郁程度比较,差异无统计学意义（P＞ 0.05）。认知功能障 碍组患者的年龄及吸烟、饮酒、初中文化程度患者占比高于认知功能无障碍组,SSRS 评分低于认知功 能无障碍组,差异有统计学意义（P＜ 0.05）。年龄、SSRS 评分预测青少年抑郁症患者治疗后认知功能障 碍的ROC曲线下面积分别为0.896、0.964 （P＜0.05）。多因素Logistic回归分析显示,14～18岁（OR=1.571, 95%CI=1.251～1.973）、吸烟（OR=1.457,95%CI=1.187～1.788）、饮酒（OR=1.254,95%CI=1.093～1.439）、初 中文化程度（OR=1.513,95%CI=1.178～1.943）、SSRS 评分＜ 20 分（OR=1.593,95%CI=1.251～2.028）为青 少年抑郁症患者治疗后认知功能障碍的危险因素（P＜ 0.05）。结论 青少年抑郁症患者治疗后认知功 能障碍受年龄、吸烟、饮酒、文化程度、社会支持度的影响,临床中应该给予密切关注,预防患者认知功 能的损害。     

抗精神病药过量对心电图的影响

目的：探讨抗精神病药过量对心电图的影响。方法：对吞服过量抗精神病药自杀患者和服用常规剂量抗精神病药患者的心电图进行对照分析。结果：抗精神病药过量组患者的心电图异常的严重程度显著高于常规剂量组。药物过量所致心电图异常率高低和严重程度与服药后至开始抢救的间隔时间长短密切相关。结论：抗精神病药过量导致心电图异常严重程度较高,应引起重视。     

Combination antipsychotic therapy in psychiatric outpatient clinics in Taiwan

OBJECTIVE: The purpose of this study is to survey the use of combination antipsychotic therapy (CAT) in the psychiatric outpatient clinic of a general hospital. METHODS: Patients who received at least 2 antipsychotics in the psychiatric outpatient clinic of a general hospital in 1 month (August 1-31, 2003) were identified, and their retrospective chart review was performed. Using a questionnaire, we surveyed the clinicians on why 2 antipsychotics were prescribed, why long-term CAT was used, and whether the problems were solved by CAT. RESULTS: We studied 957 patients diagnosed with schizophrenia and related disorders in 1 month. A total of 119 patients (12%) were prescribed at least 2 antipsychotics. Among these 119 patients, 91 (76%) were prescribed 2 types of first-generation antipsychotics (FGAs), and 15 patients (16%) were prescribed a second-generation antipsychotic medication and a low-dose FGA medication. The clinicians' main reasons for CAT were to treat insomnia (84%) and psychotic symptoms (83%). CONCLUSIONS: The results of this study revealed that 12% of the patients received CAT in the clinical practice. Most patients were prescribed 2 FGAs. The clinicians' reasons for prescribing CAT in Taiwan were to treat insomnia and psychotic symptoms.     

Aripiprazole: a new atypical antipsychotic drug

Aripiprazole is an atypical antipsychotic agent with an intrinsic dopamineagonist activity of 30 %. Aripiprazole exerts additional partial agonist action on 5-HT (1A) receptors and has antagonist properties at 5-HT (2A) receptors. Controlled studies demonstrated an effectiveness in acute relapse of schizophrenic psychosis, chronical schizophrenic and schizoaffective disorders. Aripiprazole was effective in the treatment of productive psychotic and negative symptoms. Compared to other antipsychotics aripiprazole demonstrated a favourable profile of side effects: only slight changes of body weight, mild extrapyramidal symptoms, no prolactin elevation and no significant changes in QTc interval. The efficacy in the long term treatment of schizophrenia seems to be similar to other antipsychotics (e. g. olanzapine). The first evaluations of studies with patients with bipolar disorders showed a significant efficacy in the treatment of mania.     

Social phobia in an outpatient alcohol and drug treatment sample

OBJECTIVE: To examine characteristics of patients with social phobia (SP) in alcohol and drug treatment settings and to identify features distinguishing this group from patients with and without other psychiatric conditions. METHOD: A random sample of 105 patients completing an initial assessment at two outpatient alcohol and drug treatment services were assessed and agreed to a 9 month follow-up interview, completed by n=102 (97%). At baseline the Composite International Diagnostic Interview (CIDI) was administered. Current diagnoses at baseline were used to separate the sample into those with SP (n=33), other current psychiatric disorders (OPD, n=40), and those with no current psychiatric diagnosis other than a substance use disorder (NPD, n=29). The novel methodology used in this study compared the SP group first to the NPD group to see if SP was associated with a different presentation, and then compared the SP group to the OPD group to see if any identified differences were associated with SP per se or psychopathology generally. The three groups were compared on demographic, current clinical, and past treatment utilization variables at baseline, while follow-up data were used to compare the groups on treatment outcome and treatment utilization. RESULTS: The SP group did not differ from either group in a systematic way. What differences did emerge tended to show a difference between OPD and NPD, with SP intermediate between the two, or that SP and OPD together were different from NPD. CONCLUSIONS: Despite the relatively small sample size, these findings suggest that in substance use disorder treatment settings, patients with coexisting SP do not represent a distinctly high-needs or at-risk group in the broader context of patient populations, for which coexisting psychiatric diagnoses are the norm rather than the exception.     

Self-reported motivation to smoke in schizophrenia is related to antipsychotic drug treatment

PURPOSE: The prevalence of smoking in schizophrenia has reliably been reported as being higher than for any other psychiatric disorder. While a number of theories have been proposed to account for such high rates of smoking, little is known about the subjective motivation for why schizophrenia patients smoke in comparison with those without the disease. OBJECTIVES: The aim of the present study was to evaluate and compare smoking motivation in control subjects and schizophrenia patients, and determine if factors such as type of medication or access to cigarettes could contribute to self-reported motivation for smoking. METHODS: We assessed motivation to smoke in 61 schizophrenia inpatients and 33 non-psychiatric health worker controls at a tertiary care psychiatric facility in a cross-sectional study. Nicotine dependency and smoking behavior were evaluated using the Fagerstrom Test for Nicotine Dependence and a validated questionnaire that assesses motivation for smoking along seven different dimensions. RESULTS: Schizophrenia patients reported a stronger motivation to smoke than controls for reasons related to pleasure from the act of smoking, as well as a need for psychomotor stimulation. Scores on both these factors were significantly associated with daily antipsychotic drug dose. The sedative and anxiolytic effects of smoking were related to anticholinergic load of psychiatric medications. CONCLUSION: The findings highlight important differences in self-reported motivation to smoke between schizophrenia patients and normals. Antipsychotic drugs may also influence aspects of motivation to smoke.     

Pharmacological specificity of the increase in neurotensin concentrations after antipsychotic drug treatment.

Neurotensin is an endogenous neuropeptide that produces many CNS effects that are similar to the behavioral and physiological alterations seen after administration of antipsychotic drugs to laboratory animals. As previously reported, sub-chronic (3 week) and acute (single injection) treatment with haloperidol (1 mg/kg), a clinically effective antipsychotic drug increases neurotensin concentrations in the nucleus accumbens and the caudate nucleus. In contrast, a tricyclic antidepressant (desipramine, 10 mg/kg), an anxiolytic (chlordiazepoxide, 25 mg/kg) and a histamine H1 receptor antagonist (diphenhydramine, 20 mg/kg) did not alter neurotensin concentrations in these brain regions after sub-chronic or acute treatment. These data demonstrate pharmacologic specificity to the antipsychotic drug-induced increases in regional brain neurotensin concentrations, and support the hypothesis that these changes may contribute to the clinical efficacy of these drugs.     

Maintenance antipsychotic medication patterns in outpatient schizophrenia patients: a naturalistic cohort study

OBJECTIVE: Newer antipsychotics are increasingly used in schizophrenia maintenance. The UK change has been slow with little known on switching patterns. We aimed to investigate antipsychotic prescribing patterns in schizophrenia patients. METHOD: A naturalistic six-site cohort sample of 600 patients were interviewed by researchers at 6-monthly intervals for 2 years to record their clinical and social functioning; use of services and medication for the preceding 6 months was obtained by structured extraction from clinical case notes. RESULTS: Alterations in antipsychotic medication were frequent in this group, mainly during periods of inpatient care. Atypical prescribing increased steadily, though slowly, across the period. Polypharmacy was less than anticipated. CONCLUSION: Inpatient care remains the main forum for switching of antipsychotics. The UK maintains a slow shift to atypical antipsychotics.