Antipsychotic Choice Research Articles

Choice of antipsychotics for dementia doesn't affect risk of stroke

Choice of antipsychotics for dementia doesn't affect risk of stroke

Pharmacogenetics as a tool in the therapy of schizophrenia

This review summarises the present knowledge of associations between pharmacogenetics and therapeutic efficacy and side effects of antipsychotics to enable pharmacists to judge the applicability for a more tailor made therapy in patients with schizophrenia. Polymorphisms of Cytochrome P450 isoenzymes and neurotransmitter receptors involved in the efficacy and side effects of antipsychotics are highlighted in this review. A search was performed in Medline and EMBASE for the period 1995-August 2002. Also relevant references from the selected papers were incorporated. Poor metabolism with respect to CYP2D6 seems to be related with more pronounced extrapyramidal symptoms and more specifically with a higher incidence of tardive dyskinesia. The C/C-genotype for CYP1A2 results in smokers in a reduction of enzyme activity, but an effect on the incidence of tardive dyskinesia is controversial. For dopamine D2 receptors the effect of the -141C Ins/Del polymorphism on efficacy is not clear yet, although the Taq I polymorphism is associated with greater improvement of positive, but not negative symptoms in acute psychosis. The Gly9-allele of the dopamine D3 receptor is associated with the response to clozapine, but in studies in which the choice of antipsychotics is not restricted, the role of this polymorphism is unclear. The reverse is applicable to the dopamine D(4.2/4.7) polymorphism. For the 5-HT2A receptor the His452Tyr polymorphism is associated with response to clozapine, the 102 T/C polymorphism leads to equivocal results. The polymorphism studied for 5-HT5A, 5-HT6, alpha1A- and alpha2A-receptors give no clear associations with the response to clozapine. The polymorphism studied of the dopamine D2 and D4 receptor are not related to extrapyramidal adverse effects and side effects, respectively. The 9Gly-variant of the dopamine D3 receptor, the 102C-variant, but not the His452Tyr polymorphism of the 5-HT2A-receptor and the 23Ser-variant (for females only) of the 5-HT2C receptor seem to increase the susceptibility to tardive dyskinesia. Weight gain induced by antipsychotics seems to be associated with the -759C-allele of the 5-HT2C receptor. The results show the first careful steps toward application of pharmacogenetics in a more individualised, tailor-made, pharmacotherapy. A pre-condition seems to be a multifactorial approach, as can be expected for multifactorial processes.

P.2.047 Shared decision making on antipsychotic drug choice for inpatients with schizophrenia

P.2.047 Shared decision making on antipsychotic drug choice for inpatients with schizophrenia

Diabetes and its prevention: pragmatic solutions for people with schizophrenia.

Patients with schizophrenia have an increased risk of developing diabetes. However, no pragmatic pathway of care has ever been proposed in order to identify individuals at risk and manage that risk effectively. To develop practical recommendations for the screening and management of diabetes in schizophrenia. Staged review of evidence for the under recognition of diabetes in people with schizophrenia and of the applicability of current screening strategies to this population. Recommendations for pragmatic pathways of care were developed. All patients with schizophrenia should be screened and managed as a high-risk group for the development of diabetes. Psychiatrists should be responsible for screening and diabetes risk management; primary care physicians and/or diabetologists should be responsible for managing diabetes. Choice of antipsychotics should be based on achieving good control of schizophrenia, which may improve compliance with diabetes risk reduction strategies. Effective multidisciplinary team working should reduce the burden of diabetes in schizophrenia.

The role of atypical antipsychotic drugs in schizophrenia

This issue of the Bulletin contains a series of thought-provoking articles concerning the choice of antipsychotics in schizophrenia (Adams & Gilbody, this issue; Bebbington, this issue; Healy, this issue; Hogman, this issue; Mortimer, this issue). In other words, atypicals or not and if so when.

Antipsychotic medication and the elderly

The administration of neuroleptics in the treatment of psychosis and nonspecific behavioral disorders associated with psychotic symptoms in elderly patients is not without consequences. The potential side effects (e.g., dystonia, parkinsonian syndrome, and akathisia) of medications used in treating delirium, dementia, or confusional states are discussed. General guidelines are presented regarding choice of sedatives and antipsychotics and dosage, with attention to management of the individual elderly patient with psychosis.