Combination Of Antipsychotics Research Articles

Real world clinical outcomes of treatment of cannabis-induced psychosis and prevalence of cannabis-related primary psychosis: a retrospective study

BackgroundCurrent treatment of cannabis-induced psychosis (CIP) focus on the presenting symptoms of individual patient. Therefore, the objective of this study was to investigate the efficacy of pharmacological treatment for CIP in a retrospective manner.MethodsA retrospective chart review study was conducted at the Princess Mother National Institute on Drug Abuse Treatment (PMNIDAT), Thailand. Patients aged more than 12 years who met the International Classification of Disease-10 (ICD-10) criteria of CIP, had recorded of cannabis use in medical chart, and had positive urine test of cannabis on the first day of admission from October 2013 to September 2019 were enrolled. The primary outcome was the efficacy of pharmacological treatment of CIP. Brief Psychotic Rating Scale (BPRS) on the first day and weekly after receiving treatment were used to assess the primary outcome.ResultsFour hundred and three medical charts with diagnosis of CIP were enrolled into the study and only 317 charts were analyzed. Most of them were male with an average aged of 21.0 (19.0–24.0) years old. All of them used smoked cannabis from dried leaves and flowers of cannabis plant. The presented symptoms on admission were psychosis, mood symptoms, sleep problems, weight loss, and cognitive problems (100%, 64%, 61%, 11%, and 7%, respectively). Baseline BPRS score of the first day of admission was 55.2 ± 9.6. Majority of patients received antipsychotic (98.7%) followed by the combination of antipsychotics with benzodiazepines (34.5.%), antipsychotics with antidepressants (14.4%) and antipsychotics treatment with antidepressants and benzodiazepines (25.9%). Only few patients received antipsychotic monotherapy (17.9%). Risperidone was the most frequently prescribed antipsychotics (83.6%). Mean equivalence dose of risperidone was 8.0 ± 5.9 mg/day. The average hospital length of stay was 28 days (range 22-31). BPRS at 22 days significantly improved compared to the first day of admission (p < 0.001). Schizophrenia was diagnosed in 7% at 1.3 years of follow up.ConclusionAntipsychotics was still a key psychotropic drug for treatment of CIP. The symptoms were decreased rapidly and sustained among the treatment period. However, antidepressants and benzodiazepines were commonly used for treatment of other symptoms beyond psychosis.Trial registrationClinicalTrials.gov ID: NCT04945031 (Registration Date: 30 June, 2021).

Examine the Effects of Atomoxtine Alone Versus Atomoxtine Combined with Risperidone at Sample of Egyptian Children Suffering from ADHD.

Background: An estimated 7% of elementary school children suffer from Attention Deficit Hyperactivity Disorder (ADHD), a mental neuro-developmental condition marked by impulsivity, hyperactivity, and lack of attention. Atomoxetine is one of the most important medications for ADHD however Risperidone has been used as a label for the treatment of ADHD. Aim: To study the Efficacy of Atomoxetine alone vs. Atomoxtine with Antipsychotic (Risperidone) in ADHD children. Subjects and Methods: 54 Egyptian children with ADHD, ranging in age from 6 to 18. They meet the DSM-IV criteria for ADHD and have been receiving therapy at Al Hussian Hospital's psychiatry clinic. Conner's 2 scale was used to evaluate each patient for ADHD. Between January and June of 2024, a study was carried out on all children receiving therapy for all forms of ADHD using either Atomoxetine alone or in combination with an antipsychotic (Risperidone). Results: When Atomoxetine was administered to 27 children, it demonstrated a moderate level of efficacy in 12 of 27 patients (44.4%) for all children with ADHD, regardless of type, but it significantly improved the inattention type of ADHD in 4 from 4 patients (100%). Given to 27 children, the combination of Atomoxetine and Risperidone demonstrated a greater effect on 24 of 27 patients with (88.9%) for all ADHD children, and it showed a discernible improvement on 9 out of 9 with (100%) for ADHD hyperactivity type. Conclusion: Patients with Attention deficit variant responded well to Atomoxetine., Patients with attentiondeficit/hyperactivity variant responded well to Atomoxetine/Antipsychotic (Risperidone) combination., Patients with Hyperactivity variants show good responses to Antipsychotics (Risperidone)., All types of ADHD are responsive to Atomoxetine or Atomoxetine / Antipsychotic (Risperidone) combination, But the Atomoxetine effect is more on the Attention deficit variant than other variants, while Antipsychotic (Risperidone) is more effective on hyperactivity and aggression.

Maintenance Doses of Antipsychotics in Schizophrenia: Experience of the HMIMV Psychiatry Department

Introduction: Various research studies have looked at average maintenance doses in the treatment of schizophrenia, with the observation that these doses are likely to be influenced by multiple variables. The objective of this study is to examine the maintenance doses of antipsychotics in a sample of patients with schizophrenia who are stabilized and who are followed in our department. We will also seek to evaluate the relative impact of the various variables mentioned in the literature on these doses. Material and Method: This cross-sectional study was conducted among patients with schizophrenia who had been on stable treatment for at least three months, during the period from November 1, 2021 to November 1, 2022. Data were collected from medical records, and in total, 37 patients were included in the study. Results: The average dose of antipsychotics prescribed to the patients in our sample during their last hospitalizations was 509.45 mg. Maintenance doses of antipsychotics in our sample had a mean of 340.54 mg CPZ eq. The average maintenance dose in patients with a combination of antipsychotics was 384.6 mg CPZ eq, and that in patients with a single antipsychotic was 236.36 mg CPZ eq. 29.7% of our patients had only one antipsychotic prescribed. Conclusion: The aim of this work was to try to study as many factors as possible identified in the literature likely to influence the maintenance dosages of neuroleptics in schizophrenia and to compare them to the experience of our psychiatry department.

Antipsychotic prescription patterns among schizophrenia patients in Guangdong Province, China’s 686 program: A retrospective study

Schizophrenia is a severe mental disorder. However, there is limited data on the prescribing patterns of patients under China’s Central Government Support for the Local Management and Treatment of Severe Mental Illnesses Program, known as the “686 program.” This study aimed to investigate the use of antipsychotic medications and associated factors among discharged schizophrenia patients in Guangdong Province, within the 686 Program. This study encompassed schizophrenia patients who were discharged from the Affiliated Brain Hospital, Guangzhou Medical University and enrolled in the 686 Program between January 2019 and December 2019. A total of 1645 hospitalized schizophrenia patients were included in the analysis. Clinical and sociodemographic data were acquired from medical records upon discharge. A total of 15 unique antipsychotic medications were utilized, comprising 4 first-generation (FGAs) and 11 second-generation (SGAs) options. FGAs were prescribed at a rate of 8.3%, while SGAs dominated at 98.8%. Risperidone (40.8%), olanzapine (30.2%), clozapine (24.6%), and amisulpride (15.4%) emerged as the top 4 prescribed medications. Additionally, mood stabilizers were used by 20.4%, antidepressants by 14.8%, sedative-hypnotics by 33.6%, anticholinergics by 26.9%, and other internal medicine drugs by 46.4%. Notably, 60.5% received antipsychotic monotherapy (AMT), while 39.5% underwent antipsychotic polypharmacy (APP). Predictors of polypharmacy included multiple hospital admissions, longer hospital stays, and undergoing modified Electroconvulsive Therapy (mECT) during hospitalization. In Guangdong Province, China’s 686 Program, hospitalized patients commonly receive multiple antipsychotic medications simultaneously. Due to the varying outcomes in current studies on the benefits and risks of polypharmacy, it’s vital to educate psychiatrists about the importance of AMT to reduce APP. Additionally, randomized, controlled trials are essential to identify the safest and most effective antipsychotic combinations, as well as to understand which patient profiles may benefit from these combinations.

Pharmacovigilance of drug-drug interactions: A pharmacokinetic study on the combined oral administration of lurasidone and clozapine in rats by using LC-MS/MS

In recent years, the expanding array of psychotropic medications has led to an increase in drug-drug interactions, particularly with combinations of different antipsychotics or psychotropic medications in clinical practice. However, the potential pharmacokinetic interactions between Lurasidone and Clozapine have not been extensively studied. Thus, this study aims to investigate these potential interactions by analyzing their pharmacokinetics in rat plasma after single oral administrations using developed LC-MS/MS methods. The study revealed notable changes in Lurasidone's pharmacokinetic parameters between single and combination administrations. Specifically, there were significant reductions in t1/2 and Vd by 3.3 and 1.5-fold (p < 0.05) respectively, while Cmax and AUC0-t proved a significant increase by 1.8 and 1.6-fold (p < 0.05) respectively following the combination administration. Furthermore, separate co-administration markedly decreased Clozapine's Cmax and AUC 0-t by 1.6 and 1.3-fold (p < 0.05) respectively, after the combination administration. Moreover, the AUC ratio for Lurasidone was 0.2, indicating a diminished therapeutic effect, whereas the AUC ratio for Clozapine suggested an elevated risk of adverse effects. These findings confirm the presence of drug-drug interactions between Lurasidone and Clozapine, suggesting potential implications for treatment efficacy. Recommendations for future clinical research include conducting pharmacodynamic studies to evaluate the impact of Lurasidone and Clozapine combination therapy. This underscores the importance of thoroughly assessing these interactions for clinical relevance and provides a scientific foundation for future evaluations of this drug combination.

Association of antipsychotic formulations with sudden cardiac death in patients with schizophrenia: A nationwide population-based case–control study

The aim of this study was to clarify the association between various antipsychotic formulations—oral-daily antipsychotics (OAPs), long-acting injectable antipsychotics (LAIs), and their combination—and the risk of sudden cardiac death (SCD). We conducted a nationwide population-based case–control study using data from 2011 to 2020 from the National Health Insurance Research Database and multiple-cause-of-death data from Taiwan. The study included patients with a new diagnosis of schizophrenia who were followed for SCD occurrence until 2020. Cases and controls were frequency-matched at a 1:4 ratio by age, sex, and year of new schizophrenia diagnosis. Compared with the use of OAP monotherapy, the use of LAI and OAP combination (OR = 1.91) and LAI monotherapy (OR = 1.45) were associated with an increased risk of SCD. Additionally, cardiovascular comorbidities (adjusted OR = 11.15) were identified as a significant risk factor for SCD. This study revealed the following hierarchy of SCD risk associated with antipsychotic formulations (listed from lowest to highest risk): nonuse of antipsychotics, OAP monotherapy, LAI monotherapy, and their combination. These findings underscore the importance of assessing cardiovascular disease history before LAIs are prescribed to patients with schizophrenia and indicate that physicians should avoid prescribing combined antipsychotics when using LAIs.

Acute treatment residual depression symptoms and functional impairment among depressive patients of different age groups and education levels in China: A prospective, multicenter, randomized study.

A prospective, multicenter, randomized study evaluated the efficacy of major depressive disorder (MDD) patients after 2-3 months of acute treatment based on the dual factors of education and age. This study classified the included patients into four groups using two classification parameters: age (≤45 years, vs.>45 years) and education years (≤12vs.>12). We analyzed age, gender, marital status, personal income, depression onset history, medication use, and follow-up across various groups. We evaluated residual somatic symptoms and social functioning in depression patients was conducted using the 16-item Quick Inventory of Depressive Symptomatology Self-report (QIDS-SR16), the Patient Health Questionnaire-15 (PHQ15), and the Sheehan Disability Scale (SDS). In China, 16 hospitals, 553 depression patients, and 428 fulfilled the inclusion criteria. Baseline patient data revealed significant differences among the different age groups in gender, marital status, income, first onset age, physical illness, combination of antipsychotics, and benzodiazepines use (all p<.05). Statistically significant differences were observed in overall comparisons among the four groups, encompassing the QIDS-SR16 score, PHQ15 score, and various SDS parameters (all p<.05). However, no statistically significant differences (all p>.05) were found in residual somatic symptoms and social functioning parameters between different education levels (≤12 years vs.>12 years) at baseline, 3 months, and 6 months, based on total scores on the scale. Repeated measures mixed model indicates that the QIDS-SR16 assessment indicates statistical differences among various marital statuses, income levels, medical histories, and antipsychotic medication use (p<.05). Furthermore, PHQ-15 and SDS assessments reveal statistical differences between single and married/cohabiting statuses, physical comorbidities, 3 and 6 months follow-ups compared to baseline (p<.05). This study indicates that compared to depressive patients>45 years old, those ≤45 years old often exhibit more residual depression, somatic symptoms, and severe social functional impairment; patients' education levels less influence this trend.

Atypical Antipsychotics and Lithium Induced Neuroleptic Malignant Syndrome associated with Acute Kidney Injury: A Case Report

Neuroleptic Malignant Syndrome (NMS) is a rare but serious adverse reaction to antipsychotic medications. This case report presents a 56-year-old male with bipolar disorder on a regimen of Olanzapine, Clozapine and Lithium carbonate, who developed typical NMS. He had muscle rigidity, hyperthermia, rhabdomyolysis which led to acute kidney injury. Prompt withdrawal of psychotropic medications and administration of supportive therapies was done, yet the patient's condition deteriorated, leading to Multiple Organ Dysfunction Syndrome (MODS) and eventually mortality. This case shows the complexity of managing NMS in the context of polypharmacy emphasizing the need for vigilance when prescribing antipsychotic combinations and the challenges faced in treating NMS, especially when there are associated complications.

Pharmacological treatments for psychotic depression

Despite the overall efficacy of antidepressant and antipsychotic combination therapy for the treatment of psychotic depression, data on the most appropriate choice of individual drugs for the combination treatment are limited. Researchers recently conducted a network meta‐analysis to compare the efficacy and safety of various pharmacological treatment options for patients who had major depressive episodes with psychotic features (Oliva et al., 2024).

Reaching the limits of antipsychotic treatment: the upper end of severe schizophrenia in forensic institutions - a case report

IntroductionSevere schizophrenia is often closely related to delinquency resulting in relative overrepresentation of these manifestations of disease in forensic institutions.ObjectivesThe aim of the present work is to report the therapeutic challenges in a case of severe schizophrenia in a forensic institution from a clinical viewpoint as a basis for discussion.MethodsThe case report is based on the available clinical documentation, exploratory interviews as well as a structured clinical interview (PANSS).ResultsPresenting a case of a 41-year-old, male Caucasian inpatient suffering from a catatonic schizophrenia, we report the challenges in treatment of chronic, major schizophrenic disease resistant to antipsychotic medication. Without any previous criminal convictions, he has been instutionalized in a forensic psychiatry after a bodily harm to a random stranger about three years ago. Regarding medical history, information is limited to a few inpatient admissions prior to detention documenting intravenous opioid and cocaine abuse. Initially, the patient presented sexual disinhibition and ongoing endangerment of others with frequent assaults to other patients and prison guards. From a psychopathological viewpoint several phenomenona such as delusional intuition, acoustic, tactile and coenaesthetic hallucinations, echolalia, mannerisms and thought diffusions reflect the severe course of the disease (PANSS: P 34/49, N 38/49, G 73/112; total 145/210). Therapeutic attempts with an antipsychotic combination of risperidone, olanzapine and quetiapine as well as valproic acid resulted in insufficient recovery with persistent physical assaults and florid psychosis. In reaction to that zuclopenthixol for impulse control was added. As from the beginning of this year a switch of medication by gradually replacing risperidone and zuclopenthixol with haloperidol and clozapine showed modest success. Under the current medication and therapeutic drug levels the patient does not pose endangerment to others. However, regular tonic-eye fits require supplementary treatment with biperiden, and the patient still presents frequent periods of self-harm punching himself, verbal lack of impulse control and the psychopathological phenomenona described before. In addition to pharmacological treatment the patient receives psychotherapeutic one-on-one conversations. Despite approaching all limits of the available antipsychotic repertoire, psychopathology is only insufficiently controlled leading considerations to electroconvulsive therapy as a treatment of last resort.ConclusionsCertainly, the present case is exemplary for a severely ill population of patients reaching – after a long and untreated course of disease - a chronic stage that does not sufficiently respond to a multitude of treatment attempts despite proper compliance raising the urgent need for further treatment options.Disclosure of InterestNone Declared

Cognitive behavioural therapy without medication for schizophrenia.

Cognitive behavioural therapy (CBT) can be effective in people with schizophrenia when provided in combination with antipsychotic medication. It remains unclear whether CBT could be safely and effectively offered in the absence of concomitant antipsychotic therapy. To investigate the effects of CBT for schizophrenia when administered without concomitant pharmacological treatment with antipsychotics. We conducted a systematic search on 6 March 2022 in the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ClinicalTrials.gov, and WHO ICTRP. We included randomised controlled trials (RCTs) in people with schizophrenia comparing CBT without antipsychotics to standard care, standard care without antipsychotics, or the combination of CBT and antipsychotics. Two review authors independently screened references for inclusion, extracted data from eligible studies, and assessed risk of bias using Cochrane's RoB 2 tool. We contacted study authors for missing data and additional information. Our primary outcome was general mental state measured with a validated rating scale. Key secondary outcomes were specific symptoms of schizophrenia, relapse, service use, number of participants leaving the study early, functioning, quality of life, and number of participants actually receiving antipsychotics during the trial. We also assessed behaviour, adverse effects, and mortality. We included 4 studies providing data for 300 participants (average age 21.94 years). The mean sample size was 75 participants (range 61 to 90 participants). Study duration was between 26 and 39 weeks for the intervention period and 26 to 104 weeks for the follow-up period. Three studies employed a blind rater, while one study was triple-blind. All analyses included data from a maximum of three studies. The certainty of the evidence was low or very low for all outcomes. For the primary outcome overall symptoms of schizophrenia, results showed a difference favouring CBT without antipsychotics when compared to no specific treatment at long term (> 1 year mean difference measured with the Positive and Negative Syndrome Scale (PANSS MD) -14.77, 95% confidence interval (CI) -27.75 to -1.79, 1 RCT, n = 34). There was no difference between CBT without antipsychotics compared with antipsychotics (up to 12 months PANSS MD 3.38, 95% CI -2.38 to 9.14, 2 RCTs, n = 63) (very low-certainty evidence) or compared with CBT in combination with antipsychotics (up to 12 months standardised mean difference (SMD) 0.30, 95% CI -0.06 to 0.65, 3 RCTs, n = 125). Compared with no specific treatment, CBT without antipsychotics was associated with a reduction in overall symptoms (as described above) and negative symptoms (PANSS negative MD -4.06, 95% CI -7.50 to -0.62, 1 RCT, n = 34) at longer than 12 months. It was also associated with a lower duration of hospital stay (number of days in hospital MD -22.45, 95% CI -28.82 to -16.08, 1 RCT, n = 74) and better functioning (Personal and Social Performance Scale MD -12.42, 95% CI -22.75 to -2.09, 1 RCT, n = 40, low-certainty evidence) at up to 12 months. We did not find a difference between CBT and antipsychotics in any of the investigated outcomes, with the exception of adverse events measured with the Antipsychotic Non-Neurological Side-Effects Rating Scale (ANNSERS) at both 6 and 12 months (MD -4.94, 95% CI -8.60 to -1.28, 2 RCTs, n = 48; MD -6.96, 95% CI -11.55 to -2.37, 2 RCTs, n = 42). CBT without antipsychotics was less effective than CBT combined with antipsychotics in reducing positive symptoms at up to 12 months (SMD 0.40, 95% CI 0.05 to 0.76, 3 RCTs, n = 126). CBT without antipsychotics was associated with a lower number of participants experiencing at least one adverse event in comparison with CBT combined with antipsychotics at up to 12 months (risk ratio 0.36, 95% CI 0.17 to 0.80, 1 RCT, n = 39, low-certainty evidence). This review is the first attempt to systematically synthesise the evidence about CBT delivered without medication to people with schizophrenia. The limited number of studies and low to very low certainty of the evidence prevented any strong conclusions. An important limitation in the available studies was that participants in the CBT without medication group (about 35% on average) received antipsychotic treatment, highlighting the challenges of this approach. Further high-quality RCTs are needed to provide additional data on the feasibility and efficacy of CBT without antipsychotics.

Challenges in the Treatment of Psychotic Bipolar Depression.

Psychotic bipolar depression (PBD) is a prevalent yet understudied psychiatric illness, and there are no specific guidelines or Food and Drug Administration-approved medications for its treatment. Recent studies suggest that some antipsychotics and mood stabilizers may be effective in managing bipolar depression; however, their effectiveness for PBD remains unclear. Given the urgent need for more focused research for managing PBD, we conducted a literature review to summarize the existing literature on PBD. We conducted an electronic literature search from the 1960s to 2023, utilizing PubMed, MEDLINE, EMBASE, and Google, and selected studies based on their relevance to PBD. PBD is a complex disorder, with 50%-75% of patients with bipolar disorder exhibiting psychotic features. This likelihood increases among those with a history of psychotic mania. Treatment guidelines often recommend a combination of mood stabilizers, antipsychotics, or electroconvulsive therapy, but they do not specify a first-line treatment. PBD symptoms can be masked by mixed high mood and energy feelings, potentially delaying diagnosis and treatment while increasing suicide risk. Limited research has evaluated outcomes of various treatments for PBD, and despite the lack of evidence for superior efficacy, in clinical practice, antipsychotics are frequently prescribed. Notably, combining an antipsychotic with selective noradrenaline reuptake inhibitors or tricyclic antidepressants may be effective, but including a mood stabilizer is necessary. PBD poses a significant challenge in mental health due to its severity and the lack of consensus on optimal treatment approaches. There is a critical need for more dedicated clinical trials and research to answer key questions about the effective treatment of acute PBD, ideal follow-up care, traits of responders to different therapies, and decision models for subsequent treatments.

ANALISIS EFEKTIVITAS BIAYA (Cost Effectiveness Analysis) PENGGUNAAN ANTIPSIKOTIK MONOTERAPI ATIPIKAL DENGAN KOMBINASI ATIPIKAL DAN TIPIKAL PADA PASIEN RAWAT INAP SKIZOFRENIA DI RUMAH SAKIT JIWA GRHASIA YOGYAKARTA

Schizophrenia is a serious mental disorder characterized by impaired thinking, hallucinations and social behavior. Yogyakarta Special Region (DIY) ranks 2nd with a prevalence of schizophrenia reaching 10.4 per 1,000 population. The high number of people suffering from mental disorders can lead to increasingly expensive costs. To reduce the problem of health financing, a cost-effectiveness analysis is needed by calculating the cost of antipsychotic drugs and calculating the Average Cost Effectiveness Ratio value. The aim of this study was to determine the cost-effectiveness of using atypical antipsychotic monotherapy with atypical and typical combinations in schizophrenia patients at RSJ Grhasia Yogyakarta. The research method was carried out descriptively and retrospectively using medical record data for the period January-December 2022, with a proportional sampling technique. Results: research shows that atypical monotherapy antipsychotics are more cost-effective with an Average Cost Effectiveness Ratio value of IDR 204.4/week of therapeutic treatment compared to atypical-typical combination antipsychotics with a greater value of IDR 343.2/week of therapeutic treatment. Conclusion: The antipsychotics used by inpatient schizophrenia patients at RSJ Grhasia Yogyakarta had the highest effectiveness, namely in the atypical monotherapy therapy group, amounting to (93.02%).

Efficacy and safety of clozapine combination with different antipsychotics in schizophrenia: a systematic review

Schizophrenia is a severe and chronic mental disorder, where antipsychotics are used as the main therapy. Antipsychotics are commonly used in combination, especially in refractory patients. Clozapine is one of antipsychotics that is often used in combination with other antipsychotic to achieve more effective treatment. However, the effectiveness and safety of the clozapine combination are still inconclusive. This review aimed to evaluate the efficacy and safety evidence of clozapine combination therapy with different other antipsychotics. Relevant articles were collected from Google Scholar, Scopus, and PubMed, and published in 2000-2020. Five studies concerning the effectiveness and safety of clozapine in combination with different other antipsychotics were evaluated. No significant difference in the effectiveness of clozapine in combination with other antipsychotics was observed in 4 studies. No significant difference in the safety of all clozapine combinations was observed in 3 studies. Only 2 studies reported that the clozapine-atypical antipsychotic combination (clozapine-aripiprazole) is more tolerable compared to the clozapine-typical antipsychotic. In conclusion, the efficacy and safety of clozapine in combination with different other antipsychotics have not been definitively conclusive, yet.

Analysis of risk factors for hospital-acquired pneumonia in schizophrenia.

Hospital-acquired pneumonia is one of the most important causes of recurrent illness, disease progression, and even death during hospitalization. Patients with schizophrenia have the special characteristics of their disease, and at the same time, the occurrence of hospital-acquired pneumonia is more common among patients with schizophrenia due to the prolonged stay in closed wards, accompanied by various factors such as age, gender, and nutritional status. The PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and China Biomedical Literature Database (CBM) databases were searched with a timeframe of build to February 2024 to collect studies on factors influencing hospital-acquired pneumonia in patients with schizophrenia. Two researchers independently screened the literature, extracted data, and analyzed them. A total of 5 papers including 85246 patients were included in the literature, which suggested that benzodiazepines (especially the use of clozapine), combination of antipsychotics, mood stabilizers, modified electroconvulsive therapy (MECT), duration of hospitalization, underlying diseases, hyperglycemia, and salivation/dysphagia were important risk factors for hospital-acquired pneumonia in schizophrenia patients, and that advanced age, smoking and alcohol drinking Older age, smoking and drinking habits, malnutrition, and underlying diseases are also risk factors for hospital-acquired pneumonia. Patients with schizophrenia are at a higher risk of developing hospital-acquired pneumonia, so identifying the risk factors associated with hospital-acquired pneumonia and evaluating them comprehensively and promptly during hospitalization facilitates the development of early interventions, which are essential for improving the prognosis of patients with schizophrenia.

Postpartum Psychosis: A Proposed Treatment Algorithm.

Postpartum psychosis (PPP) is a psychiatric emergency that generally warrants acute inpatient care. PPP is marked by the sudden onset of affective and psychotic symptoms with a rapid deterioration in mental state. Evidence suggests that PPP is a discrete disorder on the bipolar disorder spectrum with a distinct treatment profile and prognosis. We conducted a PubMed database search for various terms involving PPP and its treatment and included peer-reviewed articles published in English. To provide a treatment algorithm for the management of PPP based on available evidence. Pharmacological therapy is the mainstay of PPP management in the acute phase. Evidence points to a combination of antipsychotics and lithium in the acute treatment of PPP. Electroconvulsive therapy can offer a rapid treatment response where required. Lithium appears to have the best evidence for relapse prevention and prophylaxis in PPP. Psychoeducation is essential and psychosocial interventions used in bipolar disorder may be effective in PPP. Early detection and prompt treatment with antipsychotics and lithium, followed by maintenance treatment with lithium, is associated with a favourable prognosis in PPP.Reprinted from J Psychopharmacol 2023; 37:960-970, with permission from Sage Journals. Copyright © 2023.

Antipsychotics in the maintenance phase for psychotic depression.

This study aimed to associate antidepressants with versus without antipsychotics with readmission and suicide in patients with psychotic unipolar depression. Swedish national registers were used to identify inpatients with psychotic unipolar depression, treated 2007-2016. The participants collected antidepressants with or without antipsychotics from a pharmacy within 14 days after discharge and were followed up for 2 years. The primary outcome was hospital readmission due to any psychiatric disorder, suicide attempt, or completed suicide. Cox regression was used to analyze the data, which were adjusted for sex, age, prior admissions, comorbidity, electroconvulsive therapy, and other pharmacological treatments. We identified 4391 patients, of which 2972 were in the antidepressant + antipsychotic combination therapy group, and 1419 were in the antidepressant monotherapy group. After 2 years, 42.3% and 36.6% of patients were readmitted or committed suicide in the combination therapy and monotherapy group, respectively. Monotherapy was significantly associated with a lower risk of reaching the outcome in the main analysis (hazard ratio = 0.86; 95% confidence interval: 0.77-0.95). The results went in the same direction in all sensitivity analyses. Our findings do not indicate any advantage of adding antipsychotics as adjunctive to antidepressants as maintenance treatment. Considering the wide use, known side effects, and the current lack of evidence supporting the benefit, further studies on the effect of antipsychotics in the maintenance phase of psychotic unipolar depression are urgently warranted.

Frequency of sexual dysfunction in outpatients with severe mental illness in Greece.

Patients with psychosis can develop sexual dysfunction, which may be related to the disease itself, psychosocial factors, somatic comorbidities, and the use of psychotropic medication. We aimed to investigate the type and frequency of sexual dysfunction in patients diagnosed with schizophrenia or bipolar disorder in order to assess the side effects of antipsychotics in sexual function. This is a multicenter, cross-sectional study, involving patients diagnosed with schizophrenia (79.3%) or bipolar disorder (20.7%) treated in the Department of Psychiatry and Community Mental Health Centers from November 2018 to December 2019. Patients were enrolled in the study after signed informed consent. Demographic and clinical data were collected from patients through a semi-structured interview. The Antipsychotics and Sexual Functioning Questionnaire (ASFQ) was administered to assess sexual function. A total of 87 outpatients on antipsychotics were recruited in the study. The mean age was 43.6 years, while the mean duration of the disease was 16.9 years. Overall, only 9.1% of patients spontaneously reported sexual dysfunction. Patients treated with oral first-generation antipsychotics had more difficulties in achieving orgasm and decreased erection capacity. In contrast, patients treated with oral second-generation antipsychotics had decreased ejaculation capacity. Patients on antipsychotic combination therapy were associated with higher rates of sexual anhedonia. These results suggest that sexual dysfunction is a side effect of antipsychotic treatment, which was spontaneously rarely reported by patients. It seems essential to obtain a psychosexual clinical history before initiating antipsychotic treatment to evaluate following changes and adopt an individualized strategy to manage sexual dysfunction induced by antipsychotics.

Potential benefits of combining two long-acting injectable antipsychotic: a retrospective study.

The aim of this study was to evaluate the efficacy and tolerability of the combination of two long-acting injectable antipsychotics (LAIA) in psychiatric disorders, especially in schizophrenia. Eighty-three patients treated with dual LAIA were included in the study by retrospective screening from the hospital registration system. The present study was designed as an observational, retrospective, naturalistic mirror-image study. The number of hospitalizations before and after switching to dual LAIA was compared in patients who received oral antipsychotics and single LAIA during the study period. In addition, it was analyzed which was the preferred dual antipsychotic combination. Of the patients, 44.6% had schizophrenia, 41.0% had schizoaffective disorder, and 14.4% had other psychiatric disorders. The number of patients receiving oral treatment prior to dual LAIA use was 80 (96.4%). Data on dual LAIA regimens showed that 31.3% were receiving paliperidone and aripiprazole, 24.1% were receiving paliperidone and flupenthixol, 18.1% were receiving paliperidone and zuclopenthixol, and 26.5% were receiving the other combinations. After dual LAIA treatment, there was a significant decrease in the number of hospitalizations compared to before (from 5.95 to 0.99, p<0.001). In addition, while the number of patients who did not require hospitalization in the pre-treatment period was 10.8%, it reached 48.1% in the post-treatment period (p<0.001). No significant adverse effect related to the use of dual LAIA was observed in any patient during the treatment period. The use of dual LAIA instead of oral antipsychotics or single LAIA in chronic psychotic patients with poor social support and irregular medication use is thought to reduce hospitalization and related treatment costs and regularize medication use.

Real-world use of pharmacological treatments for incident bipolar disorder: A Finnish nationwide cohort study

BackgroundPharmacotherapy remains crucial for treating bipolar disorder (BD), but knowledge on the treatments actually used by newly diagnosed patients in real-world settings is sparse. MethodsIndividuals newly diagnosed with BD during 1996–2018, aged 15–65 years, were identified from national Finnish registers. The patients' use of different drug classes (mood stabilizers, antipsychotics and antidepressants) or combinations of these drug classes were followed from initial pharmacotherapy (first line) after BD diagnosis until the fifth line of treatment or until the two-year follow-up time ended. Clinical and sociodemographic factors associated with antidepressants-only as the first treatment line were assessed with logistic regression. Results82.6 % of all patients used BD medication during the follow-up. 33.9 % had antidepressants-only as the first, 22.9 % as the second and 19.7 % as the third treatment line. Use of combinations of mood stabilizers, antipsychotics and antidepressants increased by successive treatment lines. Factors associated with antidepressants-only as the first treatment line included older age (>45 years aOR 2.20, 95% CI: 2.01–2.40, 25–45 years: 1.55, 1.42–1.68, compared with those aged <25), diabetes (1.35, 1.17–1.55) and female sex (1.29, 1.21–1.37). BD diagnosis registered in 2016–2018 (0.48, 0.42–0.55) and substance abuse (0.77, 0.71–0.83) were associated with decreased odds. LimitationsDue to the register-based nature of this study, not all potentially important clinical factors influencing medication use could be controlled for. ConclusionsA large proportion of patients with bipolar disorder are not treated according to treatment guidelines, as use of antidepressants alone is common. Reasons for not following evidence-based recommendations need to be further researched.