Benefits Of Antipsychotic Medications Research Articles

Antipsychotic Medications and Cognitive Behavior Therapy in Pregnant Women with Bipolar Disorder

One of the most difficult clinical tasks is treating pregnant women with bipolar disorder. Decisions that patients and physicians make are challenging, and no strategy is without risks nor prevents potential malpractice litigation. There is debate about whether to continue or discontinue antipsychotic medications during pregnancy. While discontinuation of antipsychotics may increase the risk of relapse, continued use of these medications may lead to fetal and maternal adverse outcomes. Some antipsychotics effectively treat symptoms related to bipolar disorder, including manic episodes and mood swings between mania and depression. Though antipsychotics may be useful for the treatment and management of bipolar disorder, the medications are not always favorable and are associated with adverse effects which have influenced some medical professionals to practice defensive medicine for decades that, in some cases, may coincide or conflict with medical ethics. While antipsychotics have a less safe yet effective impact on bipolar disorder in pregnant women, an alternative therapeutic approach such as Cognitive Behavior Therapy (CBT) should be considered. CBT psychotherapy is an evidence-based practice approach that can be beneficial in the treatment of bipolar disorder in pregnant women while bypassing the associated adverse reactions of antipsychotics. Attention is needed to explore the use and associated risks and benefits of antipsychotic medications during prenatal and postnatal, the debate of whether to continue or discontinue antipsychotic medication during pregnancy, and the role of CBT in the treatment of pregnant women with bipolar disorder. While antipsychotics may have beneficial effects that should not be underscored, the risks associated with the usage of antipsychotics during pregnancy cannot be minimized.

Treatment patterns and appropriateness of antipsychotic prescriptions in patients with schizophrenia

Schizophrenia is a chronic mental condition presenting a wide range of symptoms. Although it has a low prevalence compared to other mental conditions, it has a negative impact on social and occupational functions. This study aimed to assess the appropriateness of antipsychotic medications administered to schizophrenic patients and describe current treatment patterns for schizophrenia. A retrospective cohort study was conducted in all patients over the age of 15 with an active diagnosis of schizophrenia and treated with antipsychotics between 2008 and 2013 in the Valencia region. A total of 19,718 patients were eligible for inclusion. The main outcome assessed was inappropriateness of the pharmacotherapeutic management, including polypharmacy use. Altogether, 30.4% of patients received antipsychotic polypharmacy, and 6.8% were prescribed three or more antipsychotics. Overdosage affected 318 individuals (1.6%), and 21.5% used concomitant psychotropics without an associated psychiatric diagnosis. Women and people with a comorbid condition like anxiety or depression were less likely to receive antipsychotic polypharmacy. In contrast, increased polypharmacy was associated with concomitant treatment with other psychoactive drugs, and only in user on maintenance therapy, with more visits to the mental health hospital. Overall, we observed a high level of inappropriateness in antipsychotic prescriptions. Greater adherence to guidelines could maximize the benefits of antipsychotic medications while minimizing risk of adverse effects.

Sustaining Remission of Psychotic Depression: The STOP-PD II Study Treatment Risks and Benefits in Late Life

Psychotic depression (PD) is a severe disorder that may be more common among the older vs. younger adults. The significant morbidity and disability associated with acute episodes of PD can be especially prominent in the elderly. Treatment guidelines recommend either electroconvulsive therapy or the combination of antidepressant and antipsychotic medications for the acute treatment of PD. However, little is known about the risks and benefits of antipsychotic medication during continuation and maintenance treatment. Premature discontinuation of antipsychotic medication carries the potential risk of early relapse of a severe and potentially lethal disorder. Conversely, the continuation of antipsychotic medication can expose a patient to known adverse effects, such as weight gain and metabolic disturbance, extrapyramidal symptoms and potential impact on brain structure and connectivity. For this symposium, we will first review the epidemiology of PD, its clinical presentation, diagnostic challenges, as well as controversies in treatment with special emphasize on the difference between older vs. younger patients. Then, we will report the results of a NIMH-funded, multicenter randomized placebo-controlled trial (STOP-PD II) that assessed the risks and benefits of continuing antipsychotic medication in 126 adults with PD once the episode of depression had responded to treatment with an antidepressant (sertraline) and an antipsychotic (olanzapine). Notably, 42.9% (n=54) of study participants were aged 60+ years. Finally, we will present the findings of a separate NIMH-funded study that examined the effects of olanzapine vs. placebo on brain structure and connectivity in a subset of STOP-PD II participants using magnetic resonance imaging – this is the first placebo-controlled RCT to examine the effects of antipsychotic medication on brain structure and connectivity in humans. For both studies, differences in outcomes between older adults and younger adults will be highlighted.

SUSTAINING REMISSION OF PSYCHOTIC DEPRESSION: THE STOP-PD II STUDY TREATMENT RISKS AND BENEFITS IN LATE LIFE

Psychotic depression (PD) is a severe disorder that may be more common among the older vs. younger adults. The significant morbidity and disability associated with acute episodes of PD can be especially prominent in the elderly. Treatment guidelines recommend either electroconvulsive therapy or the combination of antidepressant and antipsychotic medications for the acute treatment of PD. However, little is known about the risks and benefits of antipsychotic medication during continuation and maintenance treatment. Premature discontinuation of antipsychotic medication carries the potential risk of early relapse of a severe and potentially lethal disorder. Conversely, the continuation of antipsychotic medication can expose a patient to known adverse effects, such as weight gain and metabolic disturbance, extrapyramidal symptoms and potential impact on brain structure and connectivity. For this symposium, we will first review the epidemiology of PD, its clinical presentation, diagnostic challenges, as well as controversies in treatment with special emphasize on the difference between older vs. younger patients. Then, we will report the results of a NIMH-funded, multicenter randomized placebo-controlled trial (STOP-PD II) that assessed the risks and benefits of continuing antipsychotic medication in 126 adults with PD once the episode of depression had responded to treatment with an antidepressant (sertraline) and an antipsychotic (olanzapine). Notably, 42.9% (n=54) of study participants were aged 60+ years. Finally, we will present the findings of a separate NIMH-funded study that examined the effects of olanzapine vs. placebo on brain structure and connectivity in a subset of STOP-PD II participants using magnetic resonance imaging – this is the first placebo-controlled RCT to examine the effects of antipsychotic medication on brain structure and connectivity in humans. For both studies, differences in outcomes between older adults and younger adults will be highlighted.

Management of common adverse effects of antipsychotic medications.

The benefits of antipsychotic medications are sometimes obscured by their adverse effects. These effects range from relatively minor tolerability issues (e.g., mild sedation or dry mouth) to very unpleasant (e.g., constipation, akathisia, sexual dysfunction) to painful (e.g., acute dystonias) to disfiguring (e.g., weight gain, tardive dyskinesia) to life-threatening (e.g., myocarditis, agranulocytosis). Importantly, adverse effect profiles are specific to each antipsychotic medication and do not neatly fit into first- and second-generation classifications. This paper reviews management strategies for the most frequent side effects and identifies common principles intended to optimize net antipsychotic benefits. Only use antipsychotics if the indication is clear; only continue antipsychotics if a benefit is discernible. If an antipsychotic is providing substantial benefit, and the adverse effect is not life-threatening, then the first management choice is to lower the dose or adjust the dosing schedule. The next option is to change the antipsychotic; this is often reasonable unless the risk of relapse is high. In some instances, behavioral interventions can be tried. Finally, concomitant medications, though generally not desirable, are necessary in many instances and can provide considerable relief. Among concomitant medication strategies, anticholinergic medications for dystonias and parkinsonism are often effective; beta-blockers and anticholinergic medications are useful for akathisia; and metformin may lead to slight to moderate weight loss. Anticholinergic drops applied sublingually reduce sialorrhea. Usual medications are effective for constipation or dyslipidemias. The clinical utility of recently approved treatments for tardive dyskinesia, valbenazine and deutetrabenazine, is unclear.

Development and pilot testing of a decision aid for the initiation of antipsychotic medications in persons with dementia in long-term care using a systematic approach: a study protocol

IntroductionAntipsychotic medications are commonly used in long-term care to treat neuropsychiatric symptoms of dementia despite concerns that their risks (eg, infection, falls, death) may outweigh their benefits. This study protocol...

One Facility’s Route to Eliminate Antipsychotic Use

One Facility’s Route to Eliminate Antipsychotic Use

A Risk-Benefit Analysis of Antipsychotic Medication and Contingent Skin Shock for the Treatment of Destructive Behaviors

Antipsychotic medications are commonly used to address destructive behaviors in people with developmental disabilities. Contingent skin shock is less commonly employed. Here, the risks and the benefits of antipsychotic medications and contingent skin shock are enumerated and compared. First, the major untoward effects of antipsychotic medications and contingent skin shock are summarized. Second, an efficacy analysis was conducted consisting of the following components: a brief description of the conclusions of a 1991 review of antipsychotic medications; a complete analysis of the effect of first generation and second generation antipsychotics on the irritability subscale of the Aberrant Behavior Checklist; a complete analysis of first generation and second generation antipsychotics on the Clinical Global Impression – Improvement Scale; a complete analysis of the effect of first generation antipsychotics, second generation antipsychotics, and contingent skin shock on destructive behavior frequency. The results of the analysis suggest that contingent skin shock is by far the most effective procedure and has the most favorable side effect profile.

The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia.

(Reprinted with permission from American Journal of Psychiatry 2016; 173:543-546).

Illness self-management for individuals in acute psychiatric care settings in Japan: Cross-cultural adaptation of an American program.

To examine whether the challenges of a cross-national adaptation of an American, evidence-based, illness self-management module for people with serious mental illnesses could be met. The UCLA Medication Management Module was adapted for use in Japan with individuals experiencing short-stay, acute care in an inpatient setting. Two evaluations were conducted with 37 and 63 persons diagnosed as having schizophrenia and bipolar disorder, respectively, to test the feasibility and impact of the module as an intervention for illness self- management in an academic, Japanese psychiatric unit. The short-term feasibility was demonstrated by consumers' enhanced comprehension of the value and benefits of antipsychotic medication as well as their gaining positive, therapeutic attitudes toward use of medication. A second evaluation of the module revealed that consumers who participated in the skills training developed better understanding of the purposes of medication, more positive attitudes toward medication, and superior coping skills in dealing with medication side effects than their counterparts who received standard treatment. The greater benefits achieved from participating in the module persisted for 7 months postdischarge. While preliminary, these studies suggest the applicability of the Medication Management Module for illness management for Japanese hospital practice.

Anorexia Nervosa and Antipsychotics: How to Apply Research Findings to the Adolescent Population

The physical and psychological symptoms of anorexia nervosa (AN) are intertwined, each affecting each other and each a focus of recovery. Although no FDA approved pharmacotherapy exists for AN, the use of second generation antipsychotics (SGAs) in AN treatment has exponentially increased in the past decade (Fazeli et al., 2012). Frequently, clinicians use SGAs in an attempt to capitalize on the side effects of increased appetite and weight gain often seen with this class of medication. Although it is possible that medication might improve treatment outcomes as part of a multidisciplinary approach initiated during nutritional rehabilitation, there is a lack of data to support pharmacotherapies in this patient population. Recent research has attempted to examine whether (SGAs) are effi cacious for weight restoration in AN. However, the results of research studies thus far are inconsistent and randomized trials looking at outcomes beyond weight increase might better demonstrate the benefi ts of using antipsychotic medication. We will discuss options for future trial designs to test the benefi ts of antipsychotic medications as part of a multidimensional treatment plan.

Predictors of antipsychotic medication adherence in patients recovering from a first psychotic episode

Background Many patients recovering from a first psychotic episode will discontinue medication against medical advice, even before a 1-year treatment course is completed. Factors associated with treatment adherence in patients with chronic schizophrenia include beliefs about severity of illness and need for treatment, treatment with typical versus atypical antipsychotic and medication side effects. Method In this 2-year prospective study of 254 patients recovering from a first episode of schizophrenia, schizophreniform, or schizoaffective disorder we examined the relationship between antipsychotic medication non-adherence and patient beliefs about: need for treatment, antipsychotic medication benefits, and negative aspects of antipsychotic medication treatment. We also examined the relationship between medication non-adherence and treatment with either haloperidol or olanzapine, and objective measures of symptom response and side effects. Results The likelihood of becoming medication non-adherent for 1 week or longer was greater in subjects whose belief in need for treatment was less (HR = 1.75, 95% CI 1.16, 2.65, p = 0.0077) or who believed medications were of low benefit (HR = 2.88, 95 CI 1.79–4.65, p < 0.0001). Subjects randomized to haloperidol were more likely to become medication non-adherent for ≥ 1 week than subjects randomized to olanzapine (HR-1.51, 95% CI 1.01, 2.27, p = 0.045). Conclusion Beliefs about need for treatment and the benefits of antipsychotic medication may be intervention targets to improve likelihood of long-term medication adherence in patients recovering from a first episode of schizophrenia, schizoaffective, or schizophreniform disorder.