Increased risk of extrapyramidal side-effect treatment associated with atypical antipsychotic polytherapy

OBJECTIVE: To determine whether atypical antipsychotic polytherapy is a risk factor for drug treatment for extrapyramidal side-effects (anti-EPS drugs) and whether the risk is attributable to antipsychotic dose. METHOD: We studied Iowa Medicaid beneficiaries aged 18-64 years with an active atypical and no conventional antipsychotic on January 1, 2001. The association of atypical antipsychotic polytherapy with anti-EPS drug treatment was determined. Multiple logistic regression was utilized to adjust for covariates in two models, the first adjusting for age, sex and the specific antipsychotic(s) prescribed, and the second also adjusting for doses. RESULTS: Among 4400 patients, the unadjusted odds of anti-EPS treatment were increased two-fold with polytherapy. Polytherapy remained a risk factor in the first model (OR 1.5, 95% CI 1.1-2.0), but not after adjusting for doses (OR 1.0, 95% CI 0.7-1.4). CONCLUSION: Atypical antipsychotic polytherapy is a risk factor for anti-EPS drug treatment, apparently because of higher cumulative doses.     

Clinical correlates of antipsychotic polytherapy in patients with schizophrenia in Singapore

The purpose of the present study wa to determine the prevalence of antipsychotic polytherapy (use of more than one antipsychotic drug at one time) and its clinical correlates among 300 hospitalized psychotic Asian patients diagnosed with schizophrenia. It was hypothesized that such treatment would be associated with more severe illness than in comparable monotherapy patients, and with higher chlorpromazine-equivalent (CPZ) total daily doses. Clinical and demographic details were obtained from the medical records and direct clinical examinations. Polytherapy was encountered in 215 of the 300 patients (71.7%), with an average number of 1.8 antipsychotics (range 1-4) prescribed at a mean CPZ daily dose of 612 +/- 528 mg (median: 464 mg, range: 25-2500 mg). The 215 patients prescribed more than one antipsychotic agents were younger, ill longer, more likely to be taking at least one high-potency agent, in receipt of higher average daily CPZ doses, and more likely to be prescribed anticholinergic agents but with similar admission illness severity rating (Brief Psychiatric Rating Scale) scores compared to the 85 patients given only one antipsychotic drug at one time. The high rate of antipsychotic polytherapy that appeared to be unrelated to current illness severity suggests that this practice may not consistently be based on rational therapeutic principles.     

Primary care use of antipsychotic drugs: an audit and intervention study

Background  

Concerns regarding the use of antipsychotic medication in secondary care suggested an examination of primary care prescribing.     

长期抗精神病药治疗撤药时的运动障碍

目的：调查撤药出现的运动障碍（ＷＥ－Ｄ）是否为迟发性运动障碍（ＴＤ）的早期征象。方法：７１例精神分裂症病人停药２周,于停药前及停药后第２周末评定迟发性运动障碍量表（Ｓｉｍｐ－ｓｏｎ量表）及阴性症状量表,收集临床资料,并随访半年。结果：无ＴＤ组病人年龄、病程显著低于ＷＥ－Ｄ组及ＴＤ组病人;ＷＥ－Ｄ组与ＴＤ组病人间年龄、病程、抗精神病药治疗持续时间、平均剂量及阴性症状间无显著差异。结论：ＷＥ－Ｄ可能是ＴＤ的一个早期表现或为一隐匿性运动障碍     

Atypical antipsychotic drugs: Part 1

This column on atypical antipsychotics is the first of two parts. Part I consists of a review of foundational information and a discussion on clozapine and risperidone. Part II will address olanzapine, quetiapine, and ziprasidone.     

Atypical antipsychotic drugs: Part II

This is the second of two columns on atypical antipsychotic drugs. Part II discusses olanzapine, quetiapine, and ziprasidone.     

Legal fallacies of antipsychotic drugs

Advances in the biological sciences have dramatically improved the understanding of schizophrenia and related psychotic illnesses. One of the most compelling findings is the substantial degree to which cognition is impaired in these illnesses and the remedial effects that antipsychotic drugs have in treating these cognitive impairments. Despite these promising discoveries, legal cases and scholarship remain replete with pejorative associations with antipsychotic drug action. References to antipsychotic medications as mind-altering drugs and their effects as "synthetic sanity" misconstrue the beneficial effects these medicines have on cognition. We review the prevailing legal attitude of antipsychotic medications and contrast these views with prevailing scientific knowledge. We conclude that legal opinion is misinformed about the effects of antipsychotic medications on cognition.     

Extrapyramidal effects of antipsychotic drugs

Conventional antipsychotics have been used for many years to treat psychiatric and neurological disorders. Nevertheless, their effectiveness is often associated with a high incidence of side effects, especially extrapyramidal ones (EPS). With the entrance of the socalled atypical neuroleptics, this risk has been considerably, although not completely, reduced. Thus, clinicians should have good knowledge about the pharmacological characteristics of the newer anti-psychotics and their associated risk of worsening or developing motor disturbances. This article reviews these drugs, their pharmacological characteristics as well as the phenomenology of the extrapyramidal syndromes ans treatment of the EPS recommended.     

Long-acting antipsychotic drugs for the treatment of schizophrenia: use in daily practice from naturalistic observations

ABSTRACT: BACKGROUND: Current guidelines suggest specific criteria for oral or long-acting injectable antipsychotic drugs (LAIs). This review aims to describe the demographic and clinical characteristics of the ideal profile of the patient with schizophrenia treated with LAIs, through the analysis of nonrandomized studies. METHODS: A systematic review of nonrandomized studies in English was performed attempting to analyze the factors related to the choice and use of LAIs in daily practice. The contents were outlined using the Cochrane methods for nonrandomized studies and the variables included demographic as well as clinical characteristics. The available literature did not allow any statistical analysis that could be used to identify the ideal profile of patients with schizophrenia to be treated with LAIs. RESULTS: Eighty publications were selected and reviewed. Prevalence of LAI use ranged from 4.8% to 66%. The only demographic characteristics that were consistently assessed through retrieved studies were age (38.5 years in the 1970's, 35.8 years in the 1980's, 39.3 years in the 1990's, to 39.5 years in the 2000's) and gender (male > female). Efficacy was assessed through the use of various symptom scales and other indirect measurements; safety was assessed through extrapyramidal symptoms and the use of anticholinergic drugs, but these data were inconsistent and impossible to pool. Efficacy and safety results reported in the different studies yielded a good therapeutic profile with a maximum of 74% decrease in hospital admissions and the prevalence of extrapyramidal symptoms with LAIs consistently increased at 6, 12, 18, and 24 months (35.4%, 37.1%, 36.9%, and 41.3%, respectively). CONCLUSIONS: This analysis of the available literature strongly suggests that further observational studies on patients with schizophrenia treated with LAIs are needed to systematically assess their demographic and clinical characteristics and the relationships between them and patient outcome. Besides the good efficacy and safety profile of LAIs, health care staff must also take into account the importance of establishing a therapeutic alliance with the patient and his/her relatives when selecting the most appropriate treatment. LAIs seem to be a good choice not only because of their good safety and efficacy profile, but also because they improve compliance, a key factor to improving adherence and to establishing a therapeutic alliance between patients with schizophrenia, their relatives, and their health care providers.     

Sudden death and antipsychotic drugs

Antipsychotic drug use may be associated with clinically significant cardiovascular side effects and rare instances of sudden death. The authors review case reports of patients who suddenly died while taking these drugs and examine possible mechanisms involved. Clinical recommendations for prevention are made and include attention to predisposing medical factors and avoidance of risky drug combinations.