Duration Of Antipsychotic Treatment Research Articles

Clinical Characteristics of Asymptomatic Thromboembolism in Psychiatric Inpatients: A Retrospective Study.

Venous thromboembolism (VTE) poses a significant threat to individuals' health, yet its correlation with mental disorders remains underappreciated. Here, we conducted a retrospective analysis to explore the characteristics of psychiatric patients presenting with VTE. We retrospectively analyzed psychiatric inpatients with elevated plasma D-dimer levels at the Mental Health Center, First Affiliated Hospital, Zhejiang University School of Medicine, from January 2014 to January 2022. The inclusion criteria comprised comprehensive demographic and clinical profiles, including laboratory and imaging findings. A cohort of 33 eligible patients was included, with plasma D-dimer levels ranging from 880 to 10,700 μg/L FEU. Significantly higher D-dimer levels were observed in patients diagnosed with severe mental disorders (SMD), such as schizophrenia and bipolar disorder, compared to those with mild mental disorders (MMD), including depression and anxiety disorders (p = 0.007). Furthermore, individuals receiving antipsychotic medications for less than one year exhibited elevated D-dimer levels compared to those on treatment for over one year (p = 0.005). However, normalization of D-dimer levels did not demonstrate a significant association with psychiatric diagnosis or treatment duration (p > 0.05). Our findings suggest that patients diagnosed with SMD or those undergoing antipsychotic treatment for less than one year may have elevated D-dimer levels, indicating a potential predisposition to VTE severity. This underscores the importance of recognizing VTE risk in individuals with severe mental disorders and warrants further investigation into the impact of antipsychotic treatment duration on thrombotic risk.

Predictors of hospitalisation and recovery following full antipsychotic discontinuation in first episode psychosis. A naturalistic retrospective cohort study.

Whilst antipsychotic medication reduces risk of relapse following a first episode of psychosis (FEP), some individuals can discontinue medication and remain relapse free. We aimed to identify patient and service-specific factors which influence clinical outcome following antipsychotic discontinuation. The outcomes 'admission to hospital' and 'remaining free from psychotic symptoms', both within one year from discontinuation, were explored retrospectively in an established naturalistic cohort of 354 patients with FEP. Logistic regression analysis was used to explore influence of routinely available baseline and treatment course variables on these outcomes. Seventy-seven individuals (22%) fully discontinued antipsychotic treatment within a year, at mean 102days from initiation. Only antipsychotic type had significant association with discontinuation; aripiprazole was discontinued more than olanzapine (p=0.028). Seventeen individuals required admission to hospital; significantly associated with prior admission at first illness onset (p=0.004), and prior legal detention to hospital (p=0.001). Admission was less likely in those discontinuing aripiprazole vs olanzapine (p=0.044). Twenty-four patients remained psychosis symptom free and were most significantly likely to have received clinician support in discontinuation; this group had no association with either initial duration of untreated psychosis or prior duration of antipsychotic treatment. Future studies exploring outcomes following antipsychotic discontinuation require consistency of choice of outcome measures and sample stratification by vulnerability factors including severity of first illness episode, whether remaining symptom free after first episode, which medication switched from and baseline functioning. The impact and nature of clinician support to discontinue requires further exploration alongside its association with abruptness of discontinuation.

Up-regulation of the Trace Amine Receptor, TAAR-1, in the Prefrontal Cortex of Individuals Affected by Schizophrenia.

Type-1 trace amine-associated receptors (TAAR1) modulate dopaminergic and glutamatergic neurotransmission and are targeted by novel antipsychotic drugs. We hypothesized that schizophrenia (SCZ) causes adaptive changes in TAAR1 expression in the prefrontal cortex. We measured TAAR1 mRNA and protein levels by quantitative PCR and immunoblotting in post-mortem prefrontal cortical samples obtained from 23 individuals affected by SCZ and 23 non-schizophrenic controls (CTRL). Data were correlated with a number of variables in both groups. TAAR1 mRNA levels were largely increased in the SCZ prefrontal cortex, and did not correlate with age, age at onset and duration of SCZ, or duration of antipsychotic treatment. For the analysis of TAAR1 protein levels, CTRL and SCZ were divided into 2 subgroups, distinguished by the extent of neuropathological burden. CTRL with low neuropathological burden (LNB) had lower TAAR1 protein levels than CTRL with high neuropathological burden (HNB), whereas no changes were found between LNB and HNB in the SCZ group. TAAR1 protein levels were lower in CTRL with LNB with respect to all SCZ samples or to SCZ samples with LNB. In the SCZ group, levels showed an inverse correlation with the duration of antipsychotic treatment and were higher in individuals treated with second-generation antipsychotics as compared with those treated with first-generation antipsychotics. The up-regulation of TAAR1 observed in the SCZ prefrontal cortex supports the development of TAAR1 agonists as new promising drugs in the treatment of SCZ.

Association of Tumor Necrosis Factor-Alpha with Psychopathology in Patients with Schizophrenia.

We investigated the relationship between serum tumor necrosis factor-alpha (TNF-α) levels and psychopathological symptoms, clinical and socio-demographic characteristics and antipsychotic therapy in individuals with schizophrenia. TNF-α levels were measured in 90 patients with schizophrenia and 90 healthy controls matched by age, gender, smoking status, and body mass index. The Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of psychopathology in patients. No significant differences in TNF-α levels were detected between the patients and controls (p=0.736). TNF-α levels were not correlated with total, positive, negative, general, or composite PANSS scores (all p>0.05). A significant negative correlation was observed between TNF-α levels and the PANSS cognitive factor (ρ=-0.222, p=0.035). A hierarchical regression analysis identified the cognitive factor as a significant predictor of the TNF-α level (beta=-0.258, t=-2.257, p=0.027). There were no significant differences in TNF-α levels among patients treated with different types of antipsychotics (p=0.596). TNF-α levels correlated positively with the age of onset (ρ=0.233, p=0.027) and negatively with illness duration (ρ=-0.247, p=0.019) and antipsychotic treatment duration (ρ=-0.256, p=0.015). These results indicate that TNF-α may be involved in cognitive impairment in schizophrenia, and would be a potential clinical-state marker in schizophrenia.

Predicting psychotic relapse following randomised discontinuation of paliperidone in individuals with schizophrenia or schizoaffective disorder: an individual participant data analysis

Predicting relapse for individuals with psychotic disorders is not well established, especially after discontinuation of antipsychotic treatment. We aimed to identify general prognostic factors of relapse for all participants (irrespective of treatment continuation or discontinuation) and specific predictors of relapse for treatment discontinuation, using machine learning. For this individual participant data analysis, we searched the Yale University Open Data Access Project's database for placebo-controlled, randomised antipsychotic discontinuation trials with participants with schizophrenia or schizoaffective disorder (aged ≥18 years). We included studies in which participants were treated with any antipsychotic study drug and randomly assigned to continue the same antipsychotic drug or to discontinue it and receive placebo. We assessed 36 prespecified baseline variables at randomisation to predict time to relapse, using univariate and multivariate proportional hazard regression models (including multivariate treatment group by variable interactions) with machine learning to categorise the variables as general prognostic factors of relapse, specific predictors of relapse, or both. We identified 414 trials, of which five trials with 700 participants (304 [43%] women and 396 [57%] men) were eligible for the continuation group and 692 participants (292 [42%] women and 400 [58%] men) were eligible for the discontinuation group (median age 37 [IQR 28-47] years for continuation group and 38 [28-47] years for discontinuation group). Out of the 36 baseline variables, general prognostic factors of increased risk of relapse for all participants were drug-positive urine; paranoid, disorganised, and undifferentiated types of schizophrenia (lower risk for schizoaffective disorder); psychiatric and neurological adverse events; higher severity of akathisia (ie, difficulty or inability to sit still); antipsychotic discontinuation; lower social performance; younger age; lower glomerular filtration rate; benzodiazepine comedication (lower risk for anti-epileptic comedication). Out of the 36 baseline variables, predictors of increased risk specifically after antipsychotic discontinuation were increased prolactin concentration, higher number of hospitalisations, and smoking. Both prognostic factors and predictors with increased risk after discontinuation were oral antipsychotic treatment (lower risk for long-acting injectables), higher last dosage of the antipsychotic study drug, shorter duration of antipsychotic treatment, and higher score on the Clinical Global Impression (CGI) severity scale The predictive performance (concordance index) for participants who were not used to train the model was 0·707 (chance level is 0·5). Routinely available general prognostic factors of psychotic relapse and predictors specific for treatment discontinuation could be used to support personalised treatment. Abrupt discontinuation of higher dosages of oral antipsychotics, especially for individuals with recurring hospitalisations, higher scores on the CGI severity scale, and increased prolactin concentrations, should be avoided to reduce the risk of relapse. German Research Foundation and Berlin Institute of Health.

Association of the First Antipsychotic Treatment Duration With the Re-Initiation of Treatment in Schizophrenia: A National Health Insurance Data-Based Study

Objectives: The optimal duration of maintenance treatment for patients with first-episode schizophrenia (FES) remains unclear. We examined the first antipsychotic treatment duration and its association with re-initiation of treatment using a nationwide claim database.Methods: Data from the Health Insurance Review and Assessment Service database in South Korea for 2007–2016 were used. Linear regression analysis and Cox proportional hazard models were used to evaluate the associations between the duration of the first antipsychotic treatment, time to re-initiation of treatment, and occurrence of treatment re-initiation.Results: Of 30,143 patients with FES, 80.4% (n=24,231) received <2 years of the first antipsychotic treatment. In patients who discontinued treatment (n=23,030), the rate of treatment re-initiation was 74.2% (n=17,086). As the duration of the first antipsychotic treatment increased, the time to re-initiation of treatment decreased (β=-0.146, p<0.001); however, the rate of treatment re-initiation was relatively constant (hazard ratio=1.001, p<0.001).Conclusion: Long-term antipsychotic treatment was not significantly associated with the rate of treatment re-initiation but showed a negative association with the time to re-initiation of treatment. Further research is needed to better understand the optimal treatment duration for FES.

Continuity of antipsychotic medication use among migrant and Finnish-born populations with a psychotic disorder: a register-based study.

Higher incidence of psychotic disorders and underuse of mental health services have been reported among many migrant populations. This study examines the initiation and continuity of antipsychotic treatment among migrants and non-migrants with a non-affective psychosis during a new treatment episode. This study is based on a nationwide sample of migrants and Finnish-born controls. Participants who were diagnosed with a psychotic disorder in 2011-2014 were identified from the Care Register for Health Care (n = 1693). Information on purchases of antipsychotic drugs in 2011-2015 was collected from the National Prescription Register. The duration of antipsychotic treatment since diagnosis was estimated using the PRE2DUP model. Cox regression analysis was used to study factors that are associated with discontinuing the use of medication. There were fewer initiators of antipsychotic treatment after being diagnosed with psychosis among migrants (68.1%) than among Finnish-born patients (73.6%). After controlling for sociodemographic background and factors related to the type of disorder and treatment, migrants were more likely to discontinue medication (adjusted hazard ratio 1.28, 95% confidence interval 1.08-1.52). The risk of discontinuation was highest among migrants from North Africa and the Middle East and Sub-Saharan Africa and among recent migrants. Non-use of antipsychotic treatment before being diagnosed with psychosis, involuntary hospitalization and diagnosis other than schizophrenia were associated with earlier discontinuation both among migrants and non-migrants. Migrants with a psychotic disorder are less likely to continue antipsychotic treatment than non-migrants. The needs of migrant patients have to be addressed to improve adherence.

Monitoring side-effects of antipsychotics using the glasgow antipsychotic side-effect scale

AimsAntipsychotic drugs frequently produce side-effects which represent common reasons for noncompliance. National guidelines, published by the National Institute of Care and Health Excellence, the Royal College of Psychiatrists, and the Maudsley Prescribing Guidelines in Psychiatry, stipulate that patients prescribed antipsychotic drugs should be reviewed for side-effects on a weekly basis. This completed audit cycle, conducted on a mixed acute general adult psychiatric ward, examined whether patients were being assessed for side-effects of antipsychotic drugs using a standardised, self-reporting scale – the Glasgow Antipsychotic Side-effect Scale (GASS) – as per national guidelines. As identification of side-effects is important in tailoring treatment to improve compliance, auditing monitoring practice was important in realising these outcomes.MethodRetrospectively, 26 inpatients were identified over a two-month period who were prescribed antipsychotic drugs. Their notes were reviewed for documented weekly GASS scores for the duration of antipsychotic treatment. Initial data demonstrated 0% compliance with guidelines, as no patients completed a weekly GASS. The intervention to improve compliance was a training session for ward staff on implementing the GASS. Data were subsequently collected prospectively over three weeks for 15 patients.ResultSeven patients completed the GASS weekly over three weeks, representing 47% compliance. Two patients (13%) completed two forms, three (20%) completed one form, and three (20%) completed no forms. There was a positive correlation between being offered the GASS and completing it – only one patient declined to complete it and was not offered it during the third week. Of the remaining 14 patients, if the GASS was offered there was 100% rate of completion. Staff did not offer the GASS to every patient each week, which accounted for most cases of non-completion. Some patients with pre-existing symptoms of physical illnesses included these on the GASS, which complicated interpretation. Future interventions could include further staff education, and involving a ward pharmacist to review results during medication reviews to optimise treatment compliance, as no medication changes resulted directly from patients completing the GASS.ConclusionCompliance with completing the GASS weekly improved following staff education, identifying the main factor affecting compliance as staff not offering the GASS to patients. Patients generally engaged well with side-effect monitoring, as most completed the GASS when offered. Further staff education may produce even greater compliance with guidelines, and involving pharmacy staff to review GASS scores and inform medication choices may lead to use of the GASS resulting in more tolerable and effective treatment plans.

Antipsychotic Treatment Duration in Children and Adolescents: A Register-Based Nationwide Study.

Objective: Despite the increasing use of antipsychotic drugs in children and adolescents in many countries, little is known about the treatment duration in this vulnerable population. The present nationwide study investigated the duration of antipsychotic treatment and factors associated with treatment discontinuation in Finnish children and adolescents. Methods: All subjects aged 1-17 years who had started a second-generation antipsychotic (SGA) drug (risperidone, quetiapine, aripiprazole, or olanzapine) between January 2008 and December 2016 (n = 20,932) were extracted from the Finnish Prescription Registry and followed up until December 31, 2017. Treatment duration was calculated as the time between the initial purchase of medication and treatment discontinuation. Treatment was considered discontinued if the treatment-free gap was more than 270 days. The associations between explanatory factors and treatment discontinuation were analyzed with the Cox proportional hazards models. Results: The mean and median treatment durations were 509 days (95% confidence interval [95% CI]: 500-517 days) and 317 days (95% CI: 306-325 days), respectively. The duration was shorter in girls than in boys (p < 0.001). Of all SGA users, 35.1% used antipsychotics less than 50 days and 16.0% used more than 600 days. Shorter treatment duration was associated with age groups of 7-12 and 13-15 years compared with 1-6 years (hazard ratio [HR]:1.23 [95% CI: 1.11-1.36]; HR: 1.35 [95% CI: 1.21-1.51], respectively) and initiating treatment with quetiapine or olanzapine compared with risperidone (HR: 1.18 [95% CI: 1.12-1.25]; HR: 1.66 [95% CI 1.46-1.88], respectively). Switching of SGA drug during treatment was associated with longer treatment duration (HR: 0.40 [95% CI: 0.38-0.43]). Conclusions: In children and adolescents, the mean treatment duration of SGAs was relatively long given that the majority of SGA use was off-label. Older age and initiating treatment with quetiapine were associated with earlier treatment discontinuation, whereas switching of antipsychotic drug during therapy increased the possibility of longer SGA use.

Relationship of Long Acting Injectable Antipsychotics with Caregiver Burden, Quality of Life, Symptom Severity and Treatment Discontinuation in Schizophrenia.

Regarding the patients using long acting injectable (LAI) antipsychotic treatment; we aimed to investigate the effect of attitude towards drugs, antipsychotic type and side effects on quality of life, caregiver burden and continuation of treatment. Our study sample consisted of 110 patients in the age range of 18-65 using LAI antipsychotics for at least 12 weeks with the diagnosis of schizophrenia according to DSM-5 criteria. Sociodemographic and Clinical Data Form, Drug Attitude Inventory 10 (DAI-10), Positive and Negative Syndrome Scale (PANSS), UKU Side Effect Rating Scale, Quality of Life for Schizophrenia Scale were used for evaluation of patients. Sociodemographic Data Form, Zarit Caregiver Burden Scale (ZCBS) were used for the caregivers. It is observed that the patients with positive attitude against the treatment had longer antipsychotic treatment duration (13.7+9.1 years) compared to patients with negative attitude (7.7 + 6.6 years) (p<0.001). PANSS total scores of patients who were considering about treatment discontinuation (44.0+14.3) were higher than the other patients (38.6+9.0) (p=0.03) and DAI-10 scores of patients who were considering about treatment discontinuation were lower (1.4+4.9; 5.2+3.4; p<0.001). Duration of illness were also shorter (10.3+9.3 year) for the patients who were considering about treatment discontinuation than the other group (15.7 + 9.0 year) (p=0.01). There was no significant difference in caregiver burden, side effects, quality of life and reasons for treatment discontinuation between typical and atypical antipsychotics. According to the regression analysis results, PANSS score (β=0.553, p<0.001) and male gender (β= 0.225, p=0.003) were positive predictors of ZCBS scores. It is observed that the attitude towards drugs and psychotic symptom severity were the most important factors for treatment discontinuation in patients with schizophrenia using LAI antipsychotics. Atypical and typical antipsychotics were not different with respect to quality of life and caregiver burden for the patients on regular treatment with LAI antipsychotics.

Identification of risk factors and metabolic monitoring practices in patients on antipsychotic drugs in South India.

The objectives of this study were to identify the risk factors for metabolic syndrome in patients on antipsychotics and to compare the frequency of metabolic monitoring with evidence-based guidelines. We conducted a retrospective cohort study in a tertiary care health institution of South India. The study included patients with schizophrenia, bipolar disorder, and schizoaffective disorders prescribed with antipsychotic drugs. Data was collected from the medical records department. American Diabetic Association/American Psychiatric Association (ADA/APA) guidelines were used as a reference standard to assess the monitoring for metabolic parameters. Diagnosis of metabolic syndrome was done according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) guidelines. Risk factors for metabolic syndrome and frequency of metabolic monitoring were analyzed. A total of 668 patients were included for clinical audit. About 16.5 % of the patients were diagnosed with metabolic syndrome. Age >50 years (Odds Ratio (OR) 2.00; p value <0.001) and duration of antipsychotic treatment>5 years (OR 1.55; p value< 0.05) were recognized as the independent risk factors for metabolic syndrome using multiple logistic regression. Blood pressure (BP) and fasting blood sugar (FBS) levels were documented in 99.7 % and 47 % of cases at baseline respectively, however, subsequent annual data on BP and FBS monitoring was reduced to 72.7 % and 46 % respectively. Weight was documented in 60 % of the cases at baseline, whereas the subsequent data on four times the annual assessment of weight was reduced to 9.8 %. The extent of documentation of metabolic monitoring parameters was inadequate.

Delaying clozapine: how long is too long?

BackgroundAlthough clozapine is the most effective drug for treatment-resistant schizophrenia, its use remains restricted in clinical practice in India. The delay in initiating treatment with clozapine and its impact on...

Pharmacological management of delusions associated with dementia

We searched PubMed using the words 'delusion', 'dementia' and 'treatment' from January 2007 till November 2017. Non-pharmacologic interventions are first-line treatment. Acetyl-cholinesterase inhibitors have shown conflicting results in the treatment of delusions in dementia patients. However, donepezil may be particularly useful in the treatment of psychotic symptoms in Lewy body dementia (LBD). Antipsychotics are reserved for the treatment of severe symptoms. The highest level of evidence exists for risperidone, followed by olanzapine and quetiapine. Clozapine and pimavenserine are therapeutic options for Parkinson disease dementia and LBD. The duration of antipsychotic treatment should not exceed 6 weeks as per the French recommendations (Agence nationale pour la sécurité du médicament) and 4 months as per the American psychiatric association recommendations. In the event of failure to respond to the aforementioned treatments or as an alternative, antidepressants, in particularly citalopram can be considered. There is not enough evidence to recommend melatonine for the treatment of delusions in dementia patients, although it has been shown to improve behavioral symptoms of dementia in general. The choice of medication for the treatment of delusions in dementia patients should be tailored to each patient. The severity of the symptom and its related danger should be considered along with the patient's co-morbidities and the medication's potential adverse effect.

Is Antipsychotic Treatment Associated With Risk of Pneumonia in People With Serious Mental Illness?: The Roles of Severity of Psychiatric Symptoms and Global Functioning.

Most pneumonia-related researches in people with severe mental illness were based on insurance claims data. This study aimed for a comprehensive analysis of factors potentially associated with risk of pneumonia in psychiatric inpatients. Inpatients at a large psychiatric hospital diagnosed with pneumonia during the course of hospitalization were enrolled as cases. Controls were matched by ward and date. The diagnosis of pneumonia was confirmed by physicians based on clinical features, chest radiographs, and blood tests. A stepwise conditional logistic regression model was used to identify potential risk factors for pneumonia. Seventy-five pneumonia cases and 436 matched controls were enrolled. Conditional logistic regression revealed 3 variables significantly associated with an increased risk of pneumonia: a higher score on the Clinical Global Impression-Severity scale (adjusted odds ratio [aOR], 3.7; 95% confidence interval [CI]. 1.5-9.1), a higher score on the Charlson comorbidity index (aOR, 2.2; 95% CI, 1.5-3.2), and a longer duration of antipsychotic treatment (aOR, 1.0; 95% CI, 1.0-1.0). Two variables were significantly associated with a decreased risk of pneumonia: a higher score on the Global Assessment of Functioning scale (aOR, 0.9; 95% CI, 0.8-0.9) and an older age of onset (aOR, 0.9; 95% CI, 0.9-1.0). After adjusting for potential confounders, use of antipsychotic or other psychotropic medications was not found to be a significant risk factor for pneumonia. Physical comorbidities, long duration of antipsychotic treatment, early onset, severe psychiatric symptoms, and poor global functioning are associated with pneumonia in people with serious mental illness.

Association of Tourette Syndrome and Chronic Tic Disorder With Metabolic and Cardiovascular Disorders

ImportanceThere are limited data concerning the risk of metabolic and cardiovascular disorders among individuals with Tourette syndrome (TS) or chronic tic disorder (CTD).ObjectiveTo investigate the risk of metabolic and cardiovascular disorders among individuals with TS or CTD over a period of 40 years.Design, Settings, and ParticipantsThis longitudinal population-based cohort study included all individuals living in Sweden between January 1, 1973, and December 31, 2013. Families with clusters of full siblings discordant for TS or CTD were further identified. Data analyses were conducted from August 1, 2017, to October 11, 2018.ExposuresPreviously validated International Classification of Diseases diagnoses of TS or CTD in the Swedish National Patient Register.Main Outcomes and MeasuresRegistered diagnoses of obesity, dyslipidemia, hypertension, type 2 diabetes, and cardiovascular diseases (including ischemic heart diseases, arrhythmia, cerebrovascular diseases and transient ischemic attack, and arteriosclerosis).ResultsOf the 14 045 026 individuals in the cohort, 7804 individuals (5964 males [76.4%]; median age at first diagnosis, 13.3 years [interquartile range, 9.9-21.3 years]) had a registered diagnosis of TS or CTD in specialist care. Of 2 675 482 families with at least 2 singleton full siblings, 5141 families included siblings who were discordant for these disorders. Individuals with TS or CTD had a higher risk of any metabolic or cardiovascular disorders compared with the general population (hazard ratio adjusted by sex and birth year [aHR], 1.99; 95% CI, 1.90-2.09) and sibling controls (aHR for any disorder, 1.37; 95% CI, 1.24-1.51). Specifically, individuals with TS or CTD had higher risks for obesity (aHR, 2.76; 95% CI, 2.47-3.09), type 2 diabetes (aHR, 1.67; 95% CI, 1.42-1.96), and circulatory system diseases (aHR, 1.76; 95% CI, 1.67-1.86). The risk of any cardiometabolic disorder was significantly greater in males than in females (aHR, 2.13; 95% CI, 2.01-2.26 vs aHR, 1.79; 95% CI, 1.64-1.96), as was the risk of obesity (aHR, 3.24; 95% CI, 2.83-3.70 vs aHR, 1.97; 95% CI, 1.59-2.44). The risks were already evident from childhood (the groups were significantly different by age 8 years) and were significantly reduced with the exclusion of individuals with comorbid attention-deficit/hyperactivity disorder (aHR, 1.52; 95% CI, 1.42-1.62), while excluding other comorbidities did not significantly affect the results. Compared with patients with TS or CTD who were not taking antipsychotics, patients with a longer duration of antipsychotic treatment (>1 year) had significantly lower risks of metabolic and cardiovascular disorders.Conclusions and RelevanceThe findings of this study suggest that TS and CTD are associated with a substantial risk of metabolic and cardiovascular disorders. The results highlight the importance of carefully monitoring cardiometabolic health in patients with TS or CTD across the lifespan, particularly in those with comorbid attention-deficit/hyperactivity disorder.

Duration of antipsychotic treatment and doses/receptor profile modulate early gene expression throughout rat brain regions

Duration of antipsychotic treatment and doses/receptor profile modulate early gene expression throughout rat brain regions

Orexin-A Levels in Relation to the Risk of Metabolic Syndrome in Patients with Schizophrenia Taking Antipsychotics.

BackgroundThe role of orexin-A in regulating metabolic homeostasis has been recognized, but its association with antipsychotic-induced metabolic abnormalities remains unclear. We investigated the association between orexin-A levels and metabolic syndrome in patients with schizophrenia treated with clozapine or less obesogenic antipsychotics compared with nonpsychiatric controls.MethodsPlasma orexin-A levels and metabolic parameters were determined in 159 patients with schizophrenia: 109 taking clozapine; 50 taking aripiprazole, amisulpride, ziprasidone, or haloperidol; and 60 nonpsychiatric controls.ResultsOrexin-A levels were significantly higher in the group taking less obesogenic antipsychotics, followed by the clozapine group and the controls (F=104.6, P<.01). Higher orexin-A levels were correlated with better metabolic profiles in the patient groups but not in the controls. Regression analyses revealed that the patients with higher orexin-A levels had significantly lower risk of metabolic syndrome (adjusted odds ratio [OR]=0.04, 95% CI: 0.01–0.38 for the 2nd tertile; OR=0.04, 95% CI: 0.01–0.36 for the 3rd tertile, compared with the first tertile), after adjustment for age, sex, smoking history, types of antipsychotics (clozapine vs less obesogenic antipsychotics), duration of antipsychotic treatment, and disease severity.ConclusionsOur results revealed that the orexin-A level was upregulated in patients with schizophrenia treated with antipsychotics, especially for the group taking less obesogenic antipsychotics. Furthermore, higher orexin-A levels were independently associated with better metabolic profiles. These observations suggest that an upregulation of orexin-A has a protective effect against the development of metabolic abnormalities in patients with schizophrenia receiving antipsychotic treatment.

Risk factors for early circulatory mortality in patients with schizophrenia

Patients with schizophrenia have higher mortality and shortened life expectancy than the general population, and cardiovascular disease (CVD) accounts for up to 50% cases of early mortality in schizophrenia. We determined risk factors, particularly pathophysiological changes, for early circulatory mortality in schizophrenia. In this multi-institutional, nested, case–control study, we enrolled consecutive inpatients with schizophrenia admitted to three psychiatric hospitals in the northern Taiwan. Seventy-nine patients who died of CVD before 65 years of age were identified as cases through record linkage, and 158 controls were randomly selected in a 2:1 ratio through risk-set density sampling, after matching for age (±2 years), sex, and index admission (±3 years). Data were obtained through medical record reviews. At the time of death, the mean age of the patients was 47.5 years (standard deviation = 10.3). Conditional logistic regression revealed that the duration of antipsychotic treatment was significantly associated with a lower risk of early circulatory mortality, and leukocyte counts at index hospitalization were significantly associated with a higher risk. Systemic inflammation may be a risk factor for early circulatory mortality in schizophrenia, but antipsychotic treatment, in particular typical antipsychotic treatment, could be a protective factor.

F181. CHANGE IN PREFRONTAL-LIMBIC MORPHOLOGY AND COGNITION IN DRUG-NAïVE FIRST-EPISODE PSYCHOSIS PATIENTS FOLLOWING ATYPICAL ANTIPSYCHOTIC TREATMENT: A BRIEF LONGITUDINAL STUDY

BackgroundAtypical antipsychotics are thought to normalize structural morphology in subcortical regions, however their effect on cortical volume remains equivocal.1,2 Studying the impact of atypical antipsychotic treatment on cortical structure in drug-naïve first-episode psychosis (FEP) patients is an opportunity to elucidate the effects of illness chronicity and treatment. Previous work has indicated the potential for short-term atypical antipsychotic treatment to increase cortical thickness in FEP patients, particularly the rostral and caudal middle frontal cortices.3 Both entorhinal and orbitofrontal cortices are decreased in patients with schizophrenia and impairment in prefrontal-limbic circuitry has been linked with cognitive impairment in patients.4,5 We examined the ability of an eight-week atypical antipsychotic treatment to increase entorhinal cortex (ERC) and orbitofrontal cortex (OFC) volume and thickness and improve symptom severity in drug-naïve FEP patients.MethodsTwenty-three FEP patients treated with risperidone or quetiapine and 28 healthy volunteers completed structural 3T magnetic resonance imaging, neurocognitive testing and clinical assessments at baseline, four weeks and eight weeks. Volumetric segmentation of the cortical regions of interest was performed with Freesurfer 5.3 software. Baseline and eight-week follow-up assessments were used to calculate change scores for clinical, cognitive and structural variables to compare between groups. Change in volume, clinical and cognitive scores were analyzed with ANCOVA with age, antipsychotic dose and total brain volume entered as covariates.ResultsFEP patients and healthy volunteers did not differ significantly in volume or thickness for both ERC and OFC regions at baseline. FEP patients demonstrated a significant increase in OFC volume (F(22,1)=5.23, p=0.34) and an increase in ERC thickness (F(22,1)=12.80, p=0.002) following treatment. Healthy volunteers had an increase in ERC volume (F(27, 1)=4.99, p=0.35). Cognitive switching, an indicator of executive functioning, was not predicted by our brain measures of interest at baseline. Following treatment, increased OFC volume predicted a worse performance on the cognitive switching task for patients (β(22,1)=0.770, p=0.017) but a better score for healthy volunteers (β(23,1)=-0.712, p=0.044). Symptom severity scores were not significantly related to our brain regions of interest.DiscussionFEP patients have increase entorhinal cortical thickness and orbitofrontal cortical volume following an 8-week treatment of atypical antipsychotics. Increased OFC volume is associated with a decreased proficiency at cognitive switching for FEP patients but an increased proficiency for healthy volunteers. This difference may be due to underlying neurodevelopmental differences between psychosis patients and healthy controls and improvement in neurocognitive tasks may occur given a longer duration of antipsychotic treatment. These findings demonstrate the impact of atypical antipsychotics on cortical morphology in key regions associated with psychosis-spectrum disorders.

Undiagnosed Diabetes Mellitus and Associated Factors among Psychiatric Patients Receiving Antipsychotic Drugs at The University of Gondar Hospital, Northwest Ethiopia.

Undiagnosed diabetes mellitus cases are at higher risk for diabetic related complications. In low-income African countries, patients with undiagnosed diabetes mellitus account for 75% of diabetes cases. Psychiatric disorders have a greater impact on the global burden of diseases and disability associated with chronic diseases like diabetes mellitus and cardiovascular diseases. Institution based cross-sectional study was conducted at the University of Gondar Hospital from February to April 2016. A total of 205 psychiatric patients aged above 15 years that were taking antipsychotic were included by the simple random sampling method. Fasting blood glucose, triglycerides and cholesterol level were determined from venous blood samples to evaluate diabetes mellitus based on WHO criteria. Among 205 psychiatric patients taking antipsychotics, 15(7.3%) had undiagnosed diabetes mellitus. Duration of antipsychotic treatment and sex had a statistically significant association with the prevalence of undiagnosed diabetes mellitus. As the duration of antipsychotic drug treatment increased by one year, the risk of having a diabetes mellitus increase by 1.47 times (AOR: 1.47 CI: 1.021-2.125). The prevalence of undiagnosed diabetes mellitus among psychiatry patients taking antipsychotics was higher than the estimated diabetes national prevalence of Ethiopia. Screening of diabetes mellitus in particular, patients having a longer duration of antipsychotic treatment is mandatory to bring more undiagnosed cases for medical attention.