Antipsychotic Medicine Research Articles

Unlocking treatment success: predicting atypical antipsychotic continuation in youth with mania

PurposeThis study aimed to create and validate robust machine-learning-based prediction models for antipsychotic drug (risperidone) continuation in children and teenagers suffering from mania over one year and to discover potential variables for clinical treatment.MethodThe study population was collected from the national claims database in China. A total of 4,532 patients aged 4–18 who began risperidone therapy for mania between September 2013 and October 2019 were identified. The data were randomly divided into two datasets: training (80%) and testing (20%). Five regularly used machine learning methods were employed, in addition to the SuperLearner (SL) algorithm, to develop prediction models for the continuation of atypical antipsychotic therapy. The area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI) was utilized.ResultsIn terms of discrimination and robustness in predicting risperidone treatment continuation, the generalized linear model (GLM) performed the best (AUC: 0.823, 95% CI: 0.792–0.854, intercept near 0, slope close to 1.0). The SL model (AUC: 0.823, 95% CI: 0.791–0.853, intercept near 0, slope close to 1.0) also exhibited significant performance. Furthermore, the present findings emphasize the significance of several unique clinical and socioeconomic variables, such as the frequency of emergency room visits for nonmental health disorders.ConclusionsThe GLM and SL models provided accurate predictions regarding risperidone treatment continuation in children and adolescents with episodes of mania and hypomania. Consequently, applying prediction models in atypical antipsychotic medicine may aid in evidence-based decision-making.

Adherence to Antipsychotics among Patients with Schizophrenia at Selected Tertiary Level Hospitals

Background: Schizophrenia is a severe mental disorder where nonadherence is present in patients so that relapse, rehospitalization and treatment resistant can occur. Objectives: To identify the level of adherence to antipsychotics among patients with schizophrenia and to find its association with socio-demographic variables. Materials and method: A descriptive, cross-sectional study design was used for the study. 422 samples were collected using the purposive sampling technique Data was collected by the face-to-face interview technique during March, April, and May 2023. Questionnaire related to Socio-demographic information, standard valid tool Drug Attitude Inventory (DAI-10) was used as instrument. Data were analyzed using descriptive and inferential statistics with SPSS version 20. Results: The mean age of the respondents was 41.02, ±12.77. More than half52 (12.3%) of respondents were taking antipsychotics for more than 15 years. Majority of respondents 342 (81.0%) were taking atypical types of antipsychotics. Only 220 (52.1%) of respondents has moderate level of adherence towards antipsychotic medicine. Significant association was found between duration of illness and adherence level where p=0.006. There is mean difference found p=<0.001 from nonadherent group to moderate adherent and adherent group and from moderate adherent-to-adherent group. Conclusion: Nonadherence was found important factor low Quality of life among schizophrenia patient. Implementation of community mental health program is necessary to reduce treatment gap and decrease nonadherence. It is essential to improve adherence on antipsychotic for better quality of life among schizophrenia patient.

Development of an Automated Morphometric Approach to Assess Vascular Outcomes following Exposure to Environmental Chemicals in Zebrafish.

Disruptions in vascular formation attributable to chemical insults is a pivotal risk factor or potential etiology of developmental defects and various disease settings. Among the thousands of chemicals threatening human health, the highly concerning groups prevalent in the environment and detected in biological monitoring in the general population ought to be prioritized because of their high exposure risks. However, the impacts of a large number of environmental chemicals on vasculature are far from understood. The angioarchitecture complexity and technical limitations make it challenging to analyze the entire vasculature efficiently and identify subtle changes through a high-throughput in vivo assay. We aimed to develop an automated morphometric approach for the vascular profile and assess the vascular morphology of health-concerning environmental chemicals. High-resolution images of the entire vasculature in Tg(fli1a:eGFP) zebrafish were collected using a high-content imaging platform. We established a deep learning-based quantitative framework, ECA-ResXUnet, combined with MATLAB to segment the vascular networks and extract features. Vessel scores based on the rates of morphological changes were calculated to rank vascular toxicity. Potential biomarkers were identified by vessel-endothelium-gene-disease integrative analysis. Whole-trunk blood vessels and the cerebral vasculature in larvae exposed to 150 representative chemicals were automatically segmented as comparable to human-level accuracy, with sensitivity and specificity of 95.56% and 95.81%, respectively. Chemical treatments led to heterogeneous vascular patterns manifested by 31 architecture indexes, and the common cardinal vein (CCV) was the most affected vessel. The antipsychotic medicine haloperidol, flame retardant 2,2-bis(chloromethyl)trimethylenebis[bis(2-chloroethyl) phosphate], and tert-butylphenyl diphenyl phosphate ranked as the top three in vessel scores. Pesticides accounted for the largest group, with a vessel score of , characterized by a remarkable inhibition of subintestinal venous plexus and delayed development of CCV. Multiple-concentration evaluation of nine per- and polyfluoroalkyl substances (PFAS) indicated a low-concentration effect on vascular impairment and a positive association between carbon chain length and benchmark concentration. Target vessel-directed single-cell RNA sequencing of cells from larvae treated with , perfluorohexanesulfonic acid, or benzylbutyl phthalate, along with vessel-endothelium-gene-disease integrative analysis, uncovered potential associations with vascular disorders and identified biomarker candidates. This study provides a novel paradigm for phenotype-driven screenings of vascular-disrupting chemicals by converging morphological and transcriptomic profiles at a high-resolution level, serving as a powerful tool for large-scale toxicity tests. Our approach and the high-quality morphometric data facilitate the precise evaluation of vascular effects caused by environmental chemicals. https://doi.org/10.1289/EHP13214.

Awakening on antipsychotic medication: A call to action.

Explore a lived experience perspective on using antipsychotic medicine and call to action for psychiatric rehabilitation practitioners to get involved in preparing people diagnosed with serious mental illness (SMI) to have a voice and choice in antipsychotic medication treatment. A first-person account of awakening on an antipsychotic medication for the first time is used to understand the lived experience and challenges of using it. Lessons learned are amplified through de-identified queries of the CommonGround database capturing concerns about antipsychotic medication of people diagnosed with SMI in public sector mental health clinics in the United States. Lived experience of "me-on-medicine" included embodied and perceptual changes to self when taking antipsychotic medications. Discordance between the team's goal and personal goals for medication treatment interfered with recovery. Analysis of more than 100,000 concerns about antipsychotic medications expressed by 57,370 CommonGround users showed the most frequent concerns are that medication is perceived as unhelpful (21%), side effects (13%), impact on health (12%), and concerns about feeling unmotivated to use medication (8%). Among CommonGround users below age 30, low motivation to take antipsychotics was the third most prevalent concern. Among CommonGround users over age 30, concerns about the impact on health were the third most dominant. Psychiatric rehabilitation practitioners can support people diagnosed with SMI getting prepared to participate in decision making about antipsychotic medications with psychiatric care providers by identifying concerns and building skills and strategies to negotiate the new "me-on-medicine." (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Manic Episode Due to Steroid Use in Pemphigus Vulgaris Patient: Case Report

Corticosteroids are used in the treatment of numerous diseases, primarily in the treatment of autoimmune diseases. They have various side-effects. Although the pathophysiology of psychiatric side-effects have not clearly been revealed, the various risk factors leading to these have been defined. In the treatment of psychiatric symptoms which emerge after steroid treatments, it is firstly advised to discontinue the use of the steroid and initiate the use of an antipsychotic medicine together with a mood regulator or single-handedly. It is aimed at discussing the manic attack which took place after corticosteroid use in our patient diagnosed with pemphigus vulgaris, the risk factors leading to this situation and the course of the disease only with olanzapine.

Staff knowledge, attitudes and confidence levels for fall preventions in older person long-term care facilities: a cross-sectional study

BackgroundFalls are the most common health problem affecting older people in long-term care facilities (LTCFs), with well-recognised adverse psychological and physical resident outcomes, and high staff burden and financial cost. LTCF staff knowledge and skills can play a vital role in providing and promoting fall prevention care.MethodsA descriptive cross-sectional survey study was conducted across 13 LTCF sites in the Southwest of Ireland; a sampling frame facilitated inclusion of a range of provider types and facility sizes. An existing questionnaire, based on fall prevention guidance, and examining staff knowledge, skills and attitudes, was distributed in physical and online formats.ResultThe response rate was 15% (n = 155), predominantly healthcare assistants, staff nurses and senior nurses. Almost 90% expressed high confidence levels for delivering fall prevention interventions and being aware of how falls affect LTCFs. However, over half underestimated the fall rate in LTCFs, and only 60% had adequate knowledge. Longer experience in working with older people in healthcare services was associated with greater knowledge (p = .001) and confidence in fall prevention interventions (p = .01), while senior nurses had more knowledge than others (p = .01). LTCF staff had lowest knowledge about “identification systems for residents at high risk of falling”, “keeping confused residents near nursing stations”, “the effect of using antipsychotic medicine on falls”, “using a toileting regimen” and “staff responsibility regarding fall prevention efforts”. Despite their knowledge gaps, nearly 50% thought they had enough fall prevention training; their main preference for any further fall education training was face-to-face education.ConclusionThe results, with the caveat of a low response rate, show the need for interdisciplinary fall prevention training that is tailored to both the perceived learning needs and actual knowledge gap of LTCF staff and their preferences for learning delivery, as part of an overall approach to reducing fall-related adverse outcomes.

Application of a nucleophilic substitution reaction for spectrofluorimetric determination of aripiprazole in pharmaceutical dosage form and plasma matrix; greenness assessment

Aripiprazole is an antipsychotic medicine used to treat a variety of mental disorders, including irritability linked with autism disorder in children. Herein, a green and highly sensitive spectrofluorimetric method was developed for the determination of aripiprazole in pharmaceutical dosage form and plasma matrix. The method based on the formation of a fluorescent adduct from the nucleophilic substitution reaction of 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole (NBD-chloride) with aripiprazole, which can be detected at 542 nm following excitation at 481 nm. Factors that affect the development and fluorescence sensitivity of the reaction product were investigated and optimized. The reaction yielded the most optimal fluorescence responses when it was performed using 1.5 mL of 0.2 % w/v NBD-chloride, 1.5 mL of borate buffer pH 9, heating at 80 °C for 20 min, and ethanol as a diluting solvent. The method was validated as per ICH guidelines for analytical and bioanalytical procedures. Good linearity was established between the fluorescence responses of the reaction product and aripiprazole concentrations in the range of 100–1200 ng/mL with adequate accuracy and precision results. The applied method was very sensitive and selectively determined aripiprazole in pharmaceutical and plasma matrices with no interferences. Furthermore, the compliance of the proposed method with the principles of green analytical chemistry was evaluated in comparison with the reported method using analytical eco-scale and AGREE metrics. The outputs proved that the proposed method complied more with the principles of green analytical chemistry than the reported method.

Advancing nanomedicine production via green thermal supercritical processing: Laboratory measurement and thermodynamic modeling

Chlorpromazine is an antipsychotic medicine which is used to treat psychotic disorders, nausea and vomiting. Based on the Biopharmaceutical Classification System (BCS), this medicine is categorized in the IV class because of its low solubility and bioavailability. In this regard, the required dosage, and hence the consequent side effects, can be decremented by enhancing the drug solubility. The particles size reduction of Chlorpromazine by various approaches based on supercritical carbon dioxide (scCO2) can efficiently enhance the bioavailability and therapeutic efficiency of the medicine. The proper design of a supercritical micronization/nanonization method requires the precise measurement of supercritical solubility of Chlorpromazine. Here, the supercritical solubility of this medicine was founded under diverse conditions (308–348 K, and 170–410 bar). The solubility of Chlorpromazine in scCO2 varied between 3.21 × 10-5 to 5.25 × 10-5 mol·mole−1 (mole fraction). Also, the determined solubility values were correlated by six empirical models (Chrastil, Bartle, Sung-Shim, Jafari Nejad, Khansary, and Keshmiri). The Jafari Nejad model offered the highest fitting precision with the experimental data with an AARD% of 1.05 and Radj of 0.992. Additionally, the extrapolative capability of these models for predicting the Chlorpromazine solubility beyond the studied range was also explored.

Construction of a hydrophobic-hydrophilic open-droplet microfluidic chemosensor towards colorimetric/spectrophotometric recognition of quetiapine fumarate: a cost-benefit method for biomedical analysis using a smartphone.

Quetiapine fumarate (QF) is used to treat a number of mental/emotional diseases, including schizophrenia, bipolar disorder, and abrupt bouts of mania or depression linked to bipolar disorder. This antipsychotic medicine can be deadly if an overdose is given to a person. Therefore, the sensitive identification of QF in bodily fluids is very important. In this study, an innovative low-cost colorimetric chemosensor based on silver nanoprism transfiguration in a phosphate-buffered saline (PBS)/Cl- matrix was developed and successfully tested for the recognition of QF in human-exhaled breath condensate. Using this non-invasive colorimetric chemosensor, a broad linearity range of 0.001-1000 μM and a low limit of quantification of 0.001 μM for QF were attained. Notably, the proposed optical chemosensor is capable of detecting QF from a minimum amount of sample [500 μM in PBS and 0.001 μM in exhaled breath condensate] in the first few seconds of reaction by the naked eye. So, a rapid colorimetric assay for the on-site analysis of QF was developed and validated. Moreover, for the first time, a semi-analytical method was introduced that can provide a rough estimation of the QF concentration. This colorimetric system was, for the first time, integrated in an optimized microfluidic paper-based colorimetric device (μPCD), promising the development of an engineered colorimetric opto-sensor toward real-time and therapeutic drug monitoring (TDM) assay of drugs in real-world samples.

Haloperidol Versus Atypical Antipsychotics for Treating Delirium in Intensive Care Unit Patients: A Systematic Review.

Delirium is a severe and variable neuropsychiatric illness that causes cognitive and behavioral problems as well as abrupt impairment in consciousness and focus.Due to the complex, dynamic, and multifaceted interactions between several risk factors, the etiology of delirium is unclear. Although its efficacy has not been thoroughly studied, haloperidol, a common antipsychotic medicine, is frequently used to prevent delirium in critically ill patients. When evaluating the atypical antipsychotic response rates for treating delirium, only a few trials have taken age into account. Articles were searched for from PubMed, PubMed Central (PMC), and Science Direct, and reviewed systematically. A complete 225 articles were identified after applying the search strategy to these databases. Out of these, 12 were finalized for review. We reviewed the efficacy and safety of haloperidol with atypical antipsychotics for treating delirium in intensive care unit patients.

Olanzapine abuse: A case report

Olanzapine is a 2nd generation or atypical antipsychotic medicine belongs to thienobenzodiazepine group that blocks the serontonin (5-Hydroxytryptamine [5-HT]) 5-HT2A and the Dopamine (D2) receptors in particular, and also blocks Muscarinic (M1), Histamine (H1), 5-HT2C, 5-HT3 to 5-HT6, adrenergic (αl), and D4 receptors. The olanzapine has greater affinity for blocking 5-HT2A receptors in comparison with D2 receptors in comparison to other antipsychotics except Clozapine and Quetiapine. Olanzapine is most commonly prescribed for treatment of overall positive and negative symptoms of schizophrenia, for acute, management of mania, and as Olanzapine- fluoxetine combination in bipolar depression. It is shown to possess antidepressant activity without destabilizing the mood. It is usually well tolerated But most common side effects of the drug is sedation. The patient stated that he was suffering from sleep problem and was facing problem in procuring Benzodiazepines. On suggestion of his friend, he started taking Olanzapine as sleeping pill. Soon he discovered that it would make him feel cloudiness of mind “get stoned”, to which he liked most. It was a prime motivation for abusing olanzapine.

Stress among medical students and its impact on academic performance

Introduction and Aim: Stress is the response given by the human body to various changes which needs physical, mental or physiological adaptation. The inordinate stress during medical education incline students in solving social conflicts, dropped attention, reduced mindfulness, decreased neutrality, increased errors and misconduct like negligence which leads to decrease in academic performance. Hence, this study was undertaken to know the prevalence and impact of stress in medical students’ academic performance. Materials and Methods: This was a cross sectional study organized by the Department of Physiology, Great Eastern Medical School and Hospital, Srikakulam (AP). All medical students pursuing their 2nd and 3rd MBBS were included in the study. Students on any antipsychotic medicine; not willing to participate were excluded. Informed written consent was taken from subjects. Approval was taken from the Institutional Ethical Committee prior to the study. Data were collected using K-10 questionnaire for stress and academic performance. Results: The prevalence of stress was mild, moderate, severe among 12%, 69%, 19% subjects respectively. Statistically significant negative association was found between stress and academic performance (p<0.05). Conclusion: A high prevalence of stress was found amongst medical students. Poor academic performance was seen in students associated with higher level of stress.

The inhibitory effect and mechanism of quetiapine on tumor progression in hepatocellular carcinoma in vivo.

Hepatocellular carcinoma (HCC) is the primary tumor of the liver and the fourth leading cause of cancer‐related death. Recently, several studies indicated the anti‐tumor potential of antipsychotic medicine. Quetiapine, an atypical antipsychotic, is used to treat schizophrenia, bipolar disorder, and major depressive disorder since 1997. However, whether quetiapine may show potential to suppress HCC progression and its underlying mechanism is persisting unclear. Quetiapine has been shown to induce apoptosis and inhibit invasion ability in HCC in vitro. Here, we established two different HCC (Hep3B, SK‐Hep1) bearing animals to identify the treatment efficacy of quetiapine. Tumor growth, signaling transduction, and normal tissue pathology after quetiapine treatment were validated by caliper, bioluminescence image, immunohistochemistry (IHC), and hematoxylin and eosin staining, respectively. Quetiapine suppressed HCC progression in a dose‐dependent manner. Extracellular signal‐regulated kinases (ERKs) and Nuclear factor‐κB (NF‐κB) mediated downstream proteins, such as myeloid leukemia cell differentiation protein (MCL‐1), cellular FLICE‐inhibitory protein (C‐FLIP), X‐linked inhibitor of apoptosis protein (XIAP), Cyclin‐D1, matrix metallopeptidase 9 (MMP‐9), vascular endothelial growth factor‐A (VEGF‐A) and indoleamine 2,3‐dioxygenase (IDO) which involved in proliferation, survival, angiogenesis, invasion and anti‐tumor immunity were all decreased by quetiapine. In addition, extrinsic/intrinsic caspase‐dependent and caspase‐independent pathways, including cleaved caspase‐3, −8, and − 9 were increased by quetiapine. In sum, the tumor inhibition that results from quetiapine may associate with ERK and NF‐κB inactivation.

Using data linkage for national surveillance of clinical quality indicators for dementia care among Australian aged care users

Care quality has important implications for people with dementia. We examined trends and geographical variation of four clinical quality indicators (CQIs) in Australia. This retrospective cohort study included all people with dementia using Australian government-subsidised aged care in 2008–2016 (n = 373,695). Quality indicator data were derived from linked national aged care, health, and pharmaceutical datasets. Negative binomial regression modelling assessed trends in CQI performance over time (2011–2016) and funnel plots examined geographical variation in performance. The incidence rate of antipsychotic medicine dispensing decreased slightly from 1.17/1000 person-days to 1.07/1000 person-days (adjusted incidence rate ratio (aIRR) = 0.98, 95%CI 0.98–0.99). Cholinesterase inhibitors and memantine dispensing did not change (aIRR = 1.02, 95%CI 1.00–1.04), while exposure to high sedative load increased slightly from 1.39/1000 person-days to 1.44/1000 person-days (aIRR = 1.01, 95%CI 1.00–1.01). Dementia and delirium-related hospitalisations increased slightly from 0.17/1000 person-days to 0.18/1000 person-days (aIRR = 1.02, 95%CI 1.01–1.03). There was marked variation in cholinesterase inhibitor and memantine dispensing by geographical area (0–41%). There has been little change in four indicators of dementia care quality in Australian aged care users over time. Cholinesterase inhibitor and memantine dispensing varied substantially by geographical region. Existing strategies to improve national performance on these indicators appear to be insufficient, despite the significant impact of these indicators on outcomes for people with dementia.

Self-assembled ruthenium decorated electrochemical platform for sensitive and selective determination of amisulpride in presence of co-administered drugs using safranin as a mediator

A wholly new electroanalytical protocol for the sensitive determination of Amisulpride (AMS) has been developed. AMS is an antipsychotic and antiemetic medicine that is prescribed at lower dosages intravenously to stop and cure vomiting and postoperative nausea; and at higher orally dosages and intramuscularly for treatment of schizophrenia and serious psychotic seizures. AMS detection is proposed here for the first-time using Ruthenium nanoparticles (Ru) and Safranin (Saf) as a modifier through carbon paste electrochemical sensor platform. The Ruthenium - Safranin sensor was found to possess good electrocatalytic activity and selectivity for simultaneous determination of AMS in the presence of co-administered drug citalopram (CIT). The Ru-Saf/CPE modified sensor exhibited a wide linear response range for electrochemical sensing of AMS (9.8 × 10−8–7.0 × 10−5 M) with LOD of 8.80 × 10−9 M.

Comparative Study on the Chemical Components and Gastrointestinal Function on Rats of the Raw Product and Licorice-Simmered Product of Polygala tenuifolia

The root of Polygala tenuifolia Willd. (Polygalaceae) (PT) has been listed as a nootropic, anti-inflammatory, and antipsychotic medicine that can cure insomnia. Raw PT (RPT) is toxic and must be processed before clinical use. Licorice-simmered PT (LPT) is one of the most common processed products. We conducted this study in order to investigate the differences in chemical components and gastrointestinal function between RPT and LPT. We used principal component analysis (PCA) and quantitative analysis to study the differences in the chemical components. Animal experiments were conducted to evaluate the effects of PT on the gastrointestinal function of rats before and after simmering. Pathological sections of gastrointestinal tissues, serum hormone levels, and inflammatory cytokines were observed. The PCA results demonstrated that obvious separation was achieved between the RPT and LPT samples. Tenuifoliside B (TFSB), 3,6'-disinapoyl sucrose (DSS), tenuifoliose A (TFOA), tenuifoliose H (TFOH), onjisaponin B (OJB), onjisaponin Z (OJZ), and total saponins levels were decreased after licorice processing, while glomeratose A (GA) and 3,4,5-trimethoxycinnamic acid (TMCA) levels were markedly increased. Compared to the control group, the RPT groups exhibited dramatically lower levels of gastrin (GAS), motilin (MTL), and substance P (SP) and markedly higher levels of vasoactive intestinal peptide (VIP) and somatostatin (SS), but the LPT groups exhibited no significant differences in the above indexes. The levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) in gastrointestinal tissue were markedly increased in the low RPT (L-RPT), high RPT (H-RPT), and H-LPT groups, showing a certain inflammatory effect, but the inflammatory effect in the L-LPT group was relatively weak. Licorice simmering can effectively reduce the inhibitory effect of RPT on gastrointestinal function in rats and reduce damage to gastrointestinal tissue. This study provides a scientific basis for research on the processing mechanism and clinical application of PT.

Combination of Antipsychotic Medication and Crisis Intervention on Outcomes of Acute Mental Illness Patients Scale

Background: The Crisis intervention program is very crucial to reduce the violence of emergency and acute mental illness. In the present research, an adjusted violence scale instrument through the implementation of a crisis intervention program that was combined with antipsychotic medicine was proposed for acute mental illness patients. Methods and Material: The Brøset’s violence risk scale instrument was utilized to measure the patients' behavior with intervention; after that, it was refined (mixed method with concurrent embedded strategy) to adapt the measuring scales. Each patient was given a crisis intervention program and received similar antipsychotic medication that comprised of Chlorpromazine 300 mg/day, Haloperidol 15 mg/day, and Trihexyphenidyl 6 mg/day; then, the response was recorded for 7 to 12 days in an acute inpatient psychiatric unit. The instrument was adjusted to satisfy the changes in patients' behaviors throughout an intervention. Then, a trial procedure, verification, and validation were performed on the content of the instrument. Results: The results revealed that a paired-samples t-test comparison of the panic level of 72 patients' violence was t=-7617 and probability 0.000. The proportion of agreement Cohen's kappa (κ) can range from -1 to +1. It means that the kappa (κ) equal to 0.667 represents a moderate agreement. Furthermore, since Probability was very low ( P < 0.05). Conclusions: It can be concluded that there was different levels of patients' violence before and after the crisis intervention. The interrater statistical results confirmed that the majority of nurses had similar perceptions towards items of modified Brøset’s violence risk scales.

Effect of risperidone on prepulse inhibition of the startle reflex and P50 deficit in patients with first-episode and chronic schizophrenia

Objective: To investigate the effect of antipsychotic medicine risperidone on prepulse inhibition of the startle reflex (PPI) and P50 deficit in patients with first-episode and chronic. Methods: Thirty-eight patients with first-episode schizophrenia and 36 patients with chronic schizophrenia, both in acute stage, were enrolled in the study. All patients were treated with risperidone of different doses (2 to 6mg/d). All patients fulfilled the evaluation of PPI and P50 before treatment and 8 weeks after treatment. The psychotic symptoms were assessed with Positive and Negative Syndrome Scale (PANSS), and the therapeutic effects were evaluated with PANSS reduction rate. Results: (1) There was no significant difference in PPI and P50 parameters between the two groups before treatment (PPI ratio: first group 43%±29%, chronic group 42%±27%, P>0.05; P50 S2/S1 ratio: first group 83%±33%, chronic group 82%±24%, P>0.05). (2) There was no significant correlation between PPI and P50 inhibition parameters and disease course, psychotic episodes and psychiatric symptoms (PANSS total score, positive symptoms score, negative symptoms score and general psychopathology symptoms score) of schizophrenia (P>0.05). (3) Except the group main effect for S2 amplitude (F=5.75, P=0.019), there was no significant change for main effect and interaction of the other P50 and PPI inhibition ratio parameters after treatment (P50 S2/S1 ratio: first group before treatment 83%±33%, after treatment 85%±49%, P>0.05; chronic group before treatment 82%±44%, after treatment 84%±35%, P>0.05. PPI ratio: first group before treatment 43%±29%, after treatment 42%±27%; chronic group before treatment 42%±27%, after treatment 41%±28%,P>0.05). The effect of risperidone on P50 and PPI parameters was not related to the therapeutic effect. Conclusion: Deficit in sensory gating inhibition exists in both first-episode schizophrenia and chronic schizophrenia, and risperidone is not effective in treating the deficit in sensory gating (PPI and P50) inhibition of schizophrenia.

Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis.

Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis.

Predicting medication noncompliance among patients with schizophrenia after hospital discharge

Background: Medication noncompliance(NC) after hospital discharge is the main reason for poor outcomes of the clinical course of the schizophrenics subjects. In the present study we assess the patients with diagnosis of schizophrenia and predict the reason for medication noncompliance after hospital discharge on follow up period. Methods: A total of 70 patients (C=35, NC=35) with schizophrenia at 1month follow-up were interviewed using self-designed tools to assess sociodemographic data, insight, clinical symptoms, attitudes, therapeutic alliance, side-effects experienced and substance use disorder were assessed at baseline and 6month follow-up. Results: Mean age with ± SD in compliance(C) and noncompliance(NC) group is 32.45 ± 11.07 and 35.29 ± 13.45 respectively. Significant correlation between C and NC group in education level, SES (p = 0.011). Majority of patients in both groups are male (C=72.7%, NC=70.3%). NC is higher in illiterate, unmarried, joint family and Low SES. At 1month follow up, in NC group most patients are need of treatment (45.9%), reports of difficulty relabeling their symptoms (18.9%). Clinical symptoms in Mean ± SD, BPRS Score differ in C and NC group(p=0.052). At 6month follow up, 66 no’s of subjects came (C=35, NC=31). Significant reduction in the severity of the psychopathology BPRS score(P=0.000) and perceived side-effects (P=0.015). Improved quality of therapeutic relationship. Substance abuse, lack of awareness, attitudes and belief system, social isolation are reason for noncompliance. Discussion: As inpatient care, medication taking behavior is closely supervised by hospital staff, so compliance is high. Post-discharge follow-up is important for continued medication compliance in schizophrenic patients.NC increase the risk of relapse, rehospitalization, self-harm, lower quality of life. Conclusion: Public awareness concerning stigma to illness and antipsychotic medicine noncompliance should be further studied. With the current available pharmacological and psychological approaches that lowers risk of medication noncompliance should be encouraged in every patient, family members and medical personnel.