First-generation Antipsychotic Medications Research Articles

Evaluation of droperidol use in the emergency department: a retrospective analysis of QTc prolongation and adverse events

BackgroundDroperidol is a first-generation antipsychotic medication that has been used for various indications in the emergency department (ED); however, its use has been controversial due to reports of QT prolongation and the risk of torsades de pointes (TdP). The aim of the study is to evaluate the safety of droperidol administration in the ED.MethodsThis was a retrospective study, conducted at an academic level I trauma center. System-generated reports were used to identify all droperidol administrations in the ED from the time that droperidol was reintroduced to the institutional formulary on July 1, 2019 through January 31, 2023. The major safety endpoint was a composite of the incidence of QTc interval prolongation, incidence of TdP, ventricular arrhythmia, or hypotension.ResultsA total of 327 administrations of droperidol were identified in 245 patients in the ED. The composite safety endpoint occurred in 30 (9.1%) administrations. None of these events were classified as “probable” or “definite” on the Naranjo adverse drug reaction probability scale. No episodes of TdP or serious ventricular arrhythmia were reported. Higher cumulative droperidol dose and creatinine clearance < 60 mL/min were associated with an increased odds of developing QTc prolongation (OR 1.27 [CI 1.04–1.56]) and (OR 1.01 [CI 1.0-1.02]), respectively.ConclusionsThe study supports the use of low dose droperidol for various indications in the ED. There were no serious adverse events reported that could be directly attributed to droperidol use; however, it is crucial to consider the potential dose dependent impact on QTc prolongation.

Haloperidol May Be Safely Administered Intravenously in the Emergency Department

Haloperidol is a first-generation antipsychotic medication approved for treating schizophrenia and psychotic disorders; however, it also treats several other challenging conditions commonly encountered in the emergency department (ED).1 Haloperidol has demonstrated efficacy in acute behavior control, cannabinoid hyperemesis syndrome, and abdominal pain.2-4 Intravenous (IV) administration allows a rapid onset of action without the delay, pain, and risk of exacerbating agitation associated with intramuscular (IM) administration.

Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases.

Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases.

Antipsychotic medication exposure, clozapine, and pneumonia: results from a self-controlled study.

By using a self-controlled design, we investigated whether antipsychotic medication exposure was associated with increased pneumonia risk and whether patients receiving clozapine were more likely to develop pneumonia than patients receiving other antipsychotic medications. Through nationwide health registers, we identified all out-patients with schizophrenia initiating antipsychotic treatment. First, we estimated whether antipsychotic-naïve patients with schizophrenia increased their risk of pneumonia after initiation of either a first- or second-generation antipsychotic medication using a one-year mirror-image model. Afterward, similar analyses were made for individual second-generation antipsychotics. Lastly, the rate of pneumonia for patients initiated on clozapine was compared to patients commenced on other second-generation antipsychotics. In total, 8355 antipsychotic-naïve patients with schizophrenia were initiated on a first-generation antipsychotic medication; 0.95% of the patients had developed pneumonia before exposure, compared to 0.68% after exposure (P=0.057). Similar findings were made for the 8001 antipsychotic-naïve patients with schizophrenia initiated on second-generation antipsychotic medications, with 0.56% developing pneumonia before exposure compared to 0.55% after exposure (P=1.00). Second-generation antipsychotic medications did not increase the pneumonia risk, except for risperidone (increased by 0.32%; P=0.007) and clozapine, which gave the largest absolute increase in pneumonia risk although not significant (increased by 0.64%; P=0.10). The rate of pneumonia was higher after initiation of clozapine than for other second-generation antipsychotic medications. Most antipsychotic medications were not found to increase the risk of pneumonia. Clozapine exposure might be associated with increased risk of developing pneumonia.

Comparison of therapeutic effects of monotherapy of chlorpromazine, risperidone and their combination in newly diagnosed schizophrenic patients

Background: This study evaluates and compares how negative and positive symptoms of schizophrenia were influenced with monotherapy with a first-generation anti-psychotic medication (Chlorpromazine) and a second generation anti-psychotic medication (Risperidone) and by their combination, both of which are commonly used in clinical psychiatric practice.Methods: It was randomized, double-blind, controlled clinical study performed in Indian newly diagnosed schizophrenic patients in the Department of psychiatry from Feb 2003 to March 2004. Patients 18 (eighteen) patients aged 20 to 60 years diagnosed schizophrenics according to ICD-10 Criteria who visited in outpatient department of psychiatry during study period. Three groups of 6 Patient each, group-1 - was treated with oral Chlorpromazine 100 mg 12 hly, group -2 - was treated with oral Risperidone 2mg 12 hly group 3 -was treated with combination of oral Chlorpromazine 100mg 12 hly + oral Risperidone 2 mg 12 hly. How symptomatology in schizophrenic patients affected, is measured by applying various validated psychiatric scales like Brief psychiatric Rating Score (BPRS), Scale for assessment of positive symptom(SAPS), and Scale for Assessment of Negative Symptoms (SANS).Results: the study showed that the combination therapy of oral Chlorpromazine 100 mg 12 hly + Risperidone 2mg 12 hly had reduced the overall beneficial effects which were achieved with monotherapy of both the drugs.Conclusions: In this study, the therapeutic effects of combination of oral Chlorpromazine 100 mg 12 hly + Risperidone 2 mg 12 hly found to be reduced on positive symptoms and negative symptoms of schizophrenia, assessed on SAPS and SANS scoring scales when compared with beneficial effects which were achieved with monotherapy of both the drugs.

Olanzapine-induced Cataract in a Teenage Girl

Cataract, defined as cloudiness of the lens, is a common adverse effect of first-generation antipsychotic medications. Newer generation antipsychotics, also known as atypical antipsychotics, are less commonly associated with cataract. A 19-year-old girl with underlying schizophrenia on olanzapine for the past two years complained of gradual blurring of vision in both eyes for four months prior to presentation. On examination, the best corrected visual acuity was counting finger in both eyes. The anterior segment examination showed bilateral diffuse cortical cataract precluding fundus examination. Systemic examination was unremarkable. Blood investigations revealed a high random blood sugar, which normalised after she was initiated on oral hypoglycemic medication. After bilateral lens aspiration, her visual acuity was 6/6 bilaterally. Olanzapine may be cataractogenic via its action as a serotonin antagonist, which results in reduced glucose responsiveness of the pancreatic beta-cells. Patients on anti-psychotic medication are at risk of developing diabetes mellitus and cataract compared to the general population. Screening for diabetes mellitus should be part of the follow-up of these patients. Ophthalmological evaluation is warranted in the presence of visual complaints.

Short term effectiveness of haloperidol versus risperidone in first-episode schizophrenia

Aim: The supposed superiority of second-generation antipsychotic medication over first-generation antipsychotic medication has been challenged recently by several studies. This naturalistic retrospective study aims to compare outcomes between patients admitted for the first time with first-episode schizophrenia-spectrum disorders who were started on either haloperidol or risperidone. Would choice of antipsychotic affect length of admission and three-month outcome? Methods: Seventy-seven patients from the Early Psychosis Intervention Programme at the Institute of Mental Health were included in this study. Length of stay was obtained from hospital electronic records. Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores at three months were used to assess severity of psychopathology and level of functioning respectively. A secondary analysis was also done to measure time to discontinuation for any reason. Results: There was a significant reduction in PANSS total, positive, negative and general psychopathology scores in both groups at three months, with the patients on risperidone showing a greater reduction in PANSS negative scores compared to the patients on haloperidol. However, there were no statistically significant differences between length of hospitalization and total PANSS score at three months between the two groups. Time to discontinuation was longer in the risperidone group compared to the haloperidol group. Conclusion: The findings of this study suggest that risperidone has a better effect on negative symptoms and is better tolerated, resulting in a longer time to discontinuation. Thus, starting a patient with first-episode schizophrenia-spectrum disorder on risperidone would result in a better short-term outcome as compared to starting the same patient on haloperidol.

Concurrent Oral Antipsychotic Drug Use Among Schizophrenia Patients Initiated on Long-Acting Injectable Antipsychotics Post-Hospital Discharge.

Pharmacological treatment is central to effective management of schizophrenia. Prescribing clinicians have an increasing array of options from which to choose, and oral antipsychotic polypharmacy is common in routine clinical practice. Practice guidelines recommend long-acting injectable (LAI) formulations, typically viewed as monotherapeutic alternatives, for patients with established nonadherence. Yet there are limited data on the prevalence and nature of concurrent oral antipsychotic prescriptions in patients receiving LAIs. Our observational, claims-based study examined the frequency and duration of concurrent oral prescriptions in 340 Medicaid patients receiving LAI therapy. Specifically, we examined patients with a recent history of nonadherence and hospitalization for schizophrenia and included both first-generation antipsychotic depot medications (fluphenazine decanoate, haloperidol decanoate) and more recently available second-generation injectables (LAI risperidone, paliperidone palmitate). Of all patients initiated on LAIs, 75.9% had a concurrent oral antipsychotic prescription in the 6 months post-hospital discharge. Patients receiving concurrent prescriptions were frequently prescribed an oral formulation of their LAI agent, but many first-generation LAI users received a concurrent second-generation oral medication. The lowest rate of concurrent prescribing (58.8%) was found with paliperidone palmitate, whereas the highest rate was with LAI risperidone (88.9%). Overlap in oral and LAI prescriptions typically occurred for a substantial period of time (ie, >30 days) and for a notable percentage of the days covered by LAIs (often 50% or more). Our findings highlight the need to further examine such prescribing patterns, to probe the reasons for them, and to clarify the optimal roles of different antipsychotic treatments in clinical practice.

Evaluation of an Educational Program for Clinical Pharmacists to Conduct Standardized Assessments for Medication-Induced Movement-Related Disorders.

Movement disorders and tardive dyskinesia are common adverse effects of first-generation antipsychotic medications. Although the atypical agents are less likely to result in movement disorders, they are not entirely devoid of this risk. Movement disorders such as akathisia continue to be associated with newer antipsychotics like risperidone and aripiprazole,1,2 and all currently available antipsychotics carry a risk of tardive dyskinesia.3,4 In addition, the anticipated benefits of atypical antipsychotics have been tempered, and they come with their own unique set of adverse effects, factors that together have led to a re-evaluation of the use of conventional antipsychotics.5 Antipsychotic-induced movement disorders and tardive dyskinesia are often underrecognized in clinical practice, with potentially damaging implications for patient care.6 Despite the availability of validated rating scales, evidence of their use remains scarce. Studies have revealed a lack of documentation (both quantity and quality) of movement disorder assessment, as well as challenges associated with accurate detection and management of these adverse effects.7-9 Distinguishing one movement disorder from another continues to be challenging and requires careful evaluation by experienced raters.10 Pharmacists are well positioned to fill this role. Pharmacists build their practice according to a pharmaceut ical care model in which they are held accountable for providing rational drug therapy with the goal of optimizing patient outcomes.11 This goal is achieved by regularly monitoring patient-specific medical data, evaluating the management of medication, and providing pharmaceutical care for the purpose of identifying and resolving drug therapy problems.12,13 Numerous published reports have shown that the provision of clinical pharmacy services, including medication interventions, has resulted in better patient care, shorter hospital stays, and health care cost savings.14 The success of pharmacists in managing diabetes mellitus, lipid abnormalities, anticoagulation, and complex HIV drug regimens has been well documented.15,16 Despite these expanded roles in some settings, pharmacists have been found to represent an underutilized health care resource.17 In the field of mental health, research related to the provision of specific pharmaceutical care services is limited. As such, there is a unique opportunity to study the impact of training pharmacists to assess movement disorders. Pharmacists are in an excellent position to conduct such assessments, as they have regular contact with patients and are experts in medication management, which includes the evaluation and management of adverse effects. At the authors’ clinical site, formal training for such assessments is currently unavailable to pharmacists who routinely work with patients receiving antipsychotic therapy. The value of formal clinician training to better identify antipsychotic-induced movement disorders is emphasized in the literature, including the benefits of having trained pharmacists screen patients for the purpose of identifying and managing these adverse effects.18-20 In this study, investigators developed a new program to train clinical pharmacists to assess medication-related movement disorders. This research functioned as a pilot study, with only a small number of participants, with the intention to provide broader implementation of the program if successful.

Increase in Antipsychotic Polypharmacy Treatment in Patients with Schizophrenia Between 1994-2000 and 2010

Objective: The objective of this study is to determine the increase in the prevalence of antipsychotic polypharmacy in Dokuz Eylul University Psychotic Disorder Outpatient Unit over a period of 10 years. Methods: All accessible records of the patients, examined in the Dokuz Eylul University Psychotic Disorder Outpatient Unit between 1994 and 2000, and in 2010 were evaluated. Ninety one schizophrenia patients who had been examined between 1994 and 2000 and 102 schizophrenia patients who had been examined in 2010 were compared in terms of drug prescription patterns. Results: The point prevalence of antipsychotic polypharmacy showed a significant difference between two groups (p=0.022), polypharmacy increased from 32% to 49%. The number of first-generation antipsychotic (FGA) medications decreased from 46% to 26%, while the number of second-generation antipsychotic (SGA) medications increased from 71% to 99%. Conclusion: The prevalence of antipsychotic combinations both with other antipsychotics and other psychotropic medicines increased significantly over a period of 10 years. Keywords: Antipsychotics, combinations, monotherapy, polypharmacy, psychosis, schizophrenia.

The Interaction of Polymorphisms of IL10 and DBH Was Associated with General Symptoms of PANSS with TD in Chinese Han Schizophrenic Patients

ObjectiveTardive dyskinesia (TD) is a human hyperkinetic movement disorder as a result of potentially irreversible long-term chronic first-generation antipsychotic medications. Unfortunately, mechanisms involved in the development of TD have been poorly understood. Previous studies have indicated that some genetic polymorphisms of immune system and dopamine beta-hydroxylase (DBH) genes may be involved in the pathogenesis of TD. Rs1800872 and rs72393728 are located on the promoter of interleukin-10 (IL10) and DBH gene, respectively. The genetic association between the rs1800872 and TD is unclear. Previous studies have indicated that genetic variations of IL 10 and DBH are implicated in the positive and negative symptoms in schizophrenia. However, the interaction of two variations with severity of TD and symptoms of schizophrenic patients with TD has not been reported. The present study investigated whether these variations and their interaction were associated with clinical phenotypes of TD with schizophrenia in a genetically homogeneous northern Chinese Han population.MethodsRs1800872 and rs72393728 were genotyped in schizophrenic patients with TD (n = 372) and without TD (NTD; n = 412). The Abnormal Involuntary Movement Scale (AIMS) and Positive and Negative Syndrome Scale (PANSS) were applied to assess the severity of TD and psychopathology of schizophrenia, respectively.ResultsThe allele and genotype frequencies of rs1800872 and rs72393728 did not significantly differ between TD and NTD patients (p>0.05). No significant difference was found in the AIMS total score among the genotypes of two loci (p>0.05). Interestingly, the interaction of rs1800872 and rs72393728 showed a significant association with the PANSS general score (p = 0.011), and a trend toward to the PANSS total score (p = 0.055).ConclusionThese findings suggest that the interaction of rs1800872 and rs72393728 variants may play a role in psychopathology of the general symptoms on PANSS in schizophrenic patients with TD in a northern Chinese Han population.

Safety and Efficacy Review of Inhaled Loxapine for Treatment of Agitation

Agitation is common in patients with acute schizophrenia and bipolar disorder, and rapid and effective treatment of acute agitation is an important clinical goal. Loxapine is a first-generation antipsychotic medication available in the United States in oral form for more than three decades. In December 2012, an inhaled version of vaporized loxapine was approved by the U.S. FDA for the treatment of agitated adults in the context of schizophrenia or bipolar disorder. In this review, we examine available literature to describe efficacy and safety of inhaled loxapine in healthy patients and in those with pulmonary compromise. Limitations of the current evidence base to predict efficacy in "real world" patients are described, and safeguards necessary for appropriate use in psychiatric acute care settings are discussed.

Movement disorders in patients with schizophrenia and a history of substance abuse

The movement disorders acute dystonia, akathisia, Parkinsonian symptoms and tardive dyskinesia [extrapyramidal side effects (EPSs)] are recognized adverse effects of antipsychotic medication. Previous studies have indicated that substance abuse in patients with schizophrenia can worsen EPS. This study therefore investigated the relationship between drug and alcohol use and EPS in a group of patients with schizophrenia. Seventy patients with schizophrenia assessed for drug and alcohol use, global functioning, EPS and suicidality. Chlorpromazine equivalents were correlated to levels of EPS and substance abuse. Current EPS were found in 65% of the sample despite three-quarters of the patients receiving second-generation antipsychotics. An even higher level of patients, 87%, was found to have a history of EPS. A long history of schizophrenia independently predicted presence of any EPS, particularly akathisia, controlling for history of substance abuse which was a non-significant predictor. History or current use of alcohol or drug abuse did not predict EPS, except for alcohol abuse at the time of diagnosis which was associated with current akathisia. Length of illness was correlated with EPS, whereas suicidality was not linked to akathisia. Neither chlorpromazine equivalent antipsychotic dose nor whether the patient received first-generation or second-generation antipsychotic medication was significantly associated with EPS or substance abuse.

How We Got Barb Back: The Story of My Sister’s Reawakening After 30 Years of Schizophreniaby HawkinsMargaret; San Francisco, Red Wheel, 2010, 256 pages, $22.95

Back to table of contents Previous article Next article Book ReviewsFull AccessHow We Got Barb Back: The Story of My Sister’s Reawakening After 30 Years of SchizophreniaJeffrey L. Geller, M.D., M.P.H., , and Michael B. Friedman, M.S.W.Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H., Editor, and Michael B. FriedmanSearch for more papers by this author, M.S.W.Published Online:1 Oct 2012https://doi.org/10.1176/appi.ps.631003AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by HawkinsMargaret; San Francisco, Red Wheel, 2010, 256 pages, $22.95The book How We Got Barb Back: The Story of My Sister’s Reawakening After 30 Years of Schizophrenia is a well-written story by a woman who takes over care of her sister after their parents die. A bit too simplistic for those of us who have been there, the book could be helpful to people new to the hard experience of living with serious mental illness. And it certainly reinforces the considerable need to improve our nation’s mental health system.Barb had been brilliant and beautiful until her early twenties. She married but returned to her parents’ home after she could no longer cope. The family denied that Barb had a mental illness and therefore never sought help for her. When her sister becomes the caregiver, this changes because she is able (with considerable difficulty) to arrange for a visiting social worker, home aides, a visiting nurse, and even a psychiatrist who makes home visits. The psychiatrist prescribes a low dose of risperidone. The woman with schizophrenia gradually loses her fears, begins to read again, connects with people and a dog of which she had been terrified, and regains her humor. Barb is back.Well, she is sort of back. As happy as the sister is with the changes that Barb makes in the year after their father’s death, the story she tells gives no reason to believe that Barb will ever have the brilliant life she once seemed headed toward. Medication, caring people, and time can help a lot, but nothing can make up for the loss of 30 years of life experience. Barb has a better life, to be sure, and the story encourages us to hope she will get better still as time goes on. But how much better can she get? How much does that matter?One of the clear implications of this book is that Barb should have gotten treatment much sooner. Probably so, but it is also worth keeping in mind that the treatment she would have gotten 30 years ago would have likely been a first-generation antipsychotic medication at an excessively high dose, and it likely would have had dreadful side effects, including obesity and its concomitant health problems, tremors, and perhaps tardive dyskinesia, and a tremendous flattening of her personality. Some of these risks remain today. And many (perhaps most) people with schizophrenia do not respond as rapidly and clearly to medication as Barb has.Barb’s story has the great virtue of highlighting a number of major issues that the mental health system still needs to address: stigma, which presumably caused Barb to be hidden; the large number of people with serious and persistent mental illnesses who don’t get the care they need; difficulty in getting services at home; and lack of substantial support for family caregivers.Bottom line: I would recommend this book to family members and professionals new to the trials and tribulations of caregiving, but I will not put it on the reading list for my course on mental health policy.Mr. Friedman is a retired mental health advocate, administrator, and public official who teaches at Columbia University’s School of Social Work and Mailman School of Public Health as an adjunct associate professor.The reviewer reports no competing interests. FiguresReferencesCited byDetailsCited ByNone Volume 63Issue 10 October 2012Pages e3-e3 Metrics The reviewer reports no competing interests.PDF download History Published online 1 October 2012 Published in print 1 October 2012

Cognitive-Behavioral Therapy as an Adjunct to Second-Generation Antipsychotics in the Treatment of Schizophrenia

This study determined whether adding cognitive-behavioral therapy to treatment for outpatients with schizophrenia would be more effective than the use of second-generation antipsychotics alone. Thirty-three patients were randomly assigned to receive either second-generation antipsychotics alone (N=18) or second-generation antipsychotics plus cognitive-behavioral therapy (N=15). All patients received pharmacotherapy from a single provider and in a predetermined standard manner. Psychopathology ratings were done at baseline, at the end of treatment (12 weeks) and three months after completion of treatment (24 weeks). Twenty-five (76%) patients completed baseline and 12-week evaluations, and 17 (68%) patients who finished treatment also completed evaluations at 24 weeks. At the end of treatment persons in the second-generation antipsychotics plus cognitive-behavioral therapy group were rated as having less severe delusions than patients in the group receiving second-generation antipsychotics only, and this difference was maintained three months after treatment ended. Adding cognitive-behavioral therapy may help with reducing the severity of delusions among patients with schizophrenia.

Metabolic profile of first and second generation antipsychotics among Chinese patients

The metabolic profiles of Chinese patients treated with second-generation antipsychotic (SGA) medication and first-generation antipsychotic (FGA) medication were compared. The sample comprised 99 patients treated with SGA (risperidone, olanzapine and ziprasidone) and 99 with FGA (chlorpromazine, haloperidol and trifluoperazine) from the outpatient clinic of a teaching hospital in Hong Kong. The most frequent psychiatric diagnosis was schizophrenia, followed by affective disorder and other psychiatric diagnoses. Subjects were measured for body weight, body height, fasting lipid and glucose levels. SGA was associated with higher LDL-cholesterol level than FGA. Individual comparison of different antipsychotics showed that patients on olanzapine had the greatest increases in cholesterol and triglycerides among all antipsychotics. The finding suggested SGA, particularly olanzapine, were associated with more metabolic risk factors than first-generation antipsychotics.

Comparing effectiveness of risperidone with first-generation antipsychotic medications in patients with schizophrenia-spectrum disorders

This naturalistic retrospective study aims to compare effectiveness of a second-generation antipsychotic medication, risperidone, with first-generation antipsychotic medications (haloperidol and trifluoperazine) in an Asian population with first-episode schizophrenia-spectrum disorders. A total of 261 patients were assessed for time to discontinuation for any reason and specific reasons of discontinuation, controlling for baseline differences between groups. Some 90% of patients discontinued their antipsychotic medications before 18 months. Median time to discontinuation for any reason in risperidone was 69 days versus first-generation antipsychotic medications of 27 days. Specifically, the risperidone group had a longer time to discontinuation for any reason than haloperidol (HR = 0.61, p = 0.005) and trifluoperazine groups (HR = 0.63, p = 0.03), as well as a longer time to discontinuation due to intolerability of side effects than haloperidol (HR = 0.50, p = 0.008) and trifluoperazine groups (HR = 0.26, p = 0.001). There were no significant differences between medications for time to discontinuation due to lack of efficacy, patient's/family's decisions or other reasons. We conclude that there is a very high rate of discontinuation of the initial antipsychotic medications for various reasons, with risperidone having an overall longer time to discontinuation compared with first-generation antipsychotic medications.

Identifying Clinically Questionable Psychotropic Prescribing Practices for Medicaid Recipients in New York State

This study sought to identify and characterize rates of clinically questionable prescribing in New York State. As part of a quality improvement initiative, 34 national psychopharmacology experts identified a set of questionable prescribing practices recognizable from pharmacy claims data. Indicators of such practices were applied to Medicaid claims data for 217,216 beneficiaries in New York State who had an active psychotropic prescription on April 1, 2008. A total of 156,103 (72%) of these beneficiaries had one or more continuing (>90 days) prescriptions for a psychotropic. About 10% of adults were prescribed four or more psychotropics concurrently, and 13% of children and 2% of older adults were prescribed three or more concurrently. Prescribing an antipsychotic with a moderate-to-high risk of causing metabolic abnormalities approached 50% (46%) among individuals who had existing cardiometabolic conditions. Among beneficiaries prescribed second-generation antipsychotics with a moderate-to-high risk of causing metabolic abnormalities, over half (60%) had not received a metabolic screening test in the past year. Among women of reproductive age prescribed mood stabilizers, over one-quarter (30%) were prescribed a valproic acid-based formulation despite its potential for teratogenicity. Only 2% of youths under age 18 were prescribed benzodiazepines; however, about half (48%) had trials over 90 days' duration. Examination of pharmacy claims from Medicaid beneficiaries in New York State indicated that prescribing practices deemed clinically questionable by pharmacology experts are common. Aggregated pharmacy claims data can identify such practices, and reviews of these data can be a core component of efforts to improve prescribing practices.

Identifying Clinically Questionable Psychotropic Prescribing Practices for Medicaid Recipients in New York State

Identifying Clinically Questionable Psychotropic Prescribing Practices for Medicaid Recipients in New York State

Depression in Kraepelinian Schizophrenia

&lt;p&gt;&lt;strong&gt;Objective.&lt;/strong&gt; Depressive symptoms are prevalent, under- recognised and clinically important in patients suffering from schizophrenia. Depressive symptoms in schizophrenia patients are associated with distinct morbidity and mortality. The objective of this study was to investigate the prevalence of depressive symptoms in a subgroup of chronic schizophrenia, Kraepelinian schizophrenia, and the association with severity of illness. Kraepelinian schizophrenia is characterised by a chronic, unremitting, severe course of illness and severe deterioration of functioning in social, work and self-care domains. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method.&lt;/strong&gt; The Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impression Severity (CGI-S) scale were administered to 113 patients who fulfilled the criteria of Kraepelinian schizophrenia.&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results.&lt;/strong&gt; Sixty-eight males and 45 females participated in the study. Of this group, 17.7% scored 5 or more on the CDSS. The CGI-S scores indicated that almost half of the patients were moderately ill (i.e. a score of 4 on the CGI-S scale). Of the patients, 94 were receiving first-generation antipsychotic medication and 19 second- generation antipsychotic medication. Thirteen patients were also receiving antidepressant medication.&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion.&lt;/strong&gt; The findings of this study are consistent with current reports in the literature that depressive symptoms are not common in Kraepelinian schizophrenia, even though patients are moderately to severely ill in both symptom and functional domains.&lt;/p&gt;