Impact Of Atypical Antipsychotics Research Articles

Impact of Atypical Antipsychotics as Adjunctive Therapy on Psychiatric Cost and Utilization in Patients with Major Depressive Disorder.

IntroductionPatients with major depressive disorder (MDD) incur high costs, despite established treatment options. Adding an atypical antipsychotic (AAP) to antidepressant therapy has shown to reduce depressive symptoms in MDD, but it remains unclear with which adjunctive AAP to initiate. As economic burden is one factor that can influence treatment selection, this study’s objective was to evaluate the impact of adjunctive AAP choice on psychiatric costs and healthcare utilization in MDD.Materials and MethodsThis retrospective cohort study analyzed de-identified data from: (1) IBM® MarketScan® Commercial (C), Medicare Supplemental (MS), and MarketScan Multi-State Medicaid (M) Databases, and (2) Optum® Clinformatics® Datamart. Adult MDD patients were included if they had: initiated adjunctive AAPs during study identification period (7/1/15-9/30/16 MarketScan C/MS, and Optum; 7/1/15-6/30/16 MarketScan M), and ≥12 months of continuous enrollment before (baseline) and after (follow-up) first treatment date. Models included generalized linear models (GLMs) for psychiatric costs (total inpatient and outpatient services, excluding outpatient pharmacy costs), and a two-part model (logistic regression for psychiatric hospitalizations, GLM for psychiatric hospitalization costs among hospitalized patients); models were adjusted for baseline characteristics.ResultsThe final study sample consisted of 10,325 patients (7657 aripiprazole, 1219 brexpiprazole, 827 lurasidone, 622 quetiapine). Using brexpiprazole as reference, lurasidone and quetiapine users had $1662 and $3894 higher psychiatric costs, respectively. Psychiatric costs were not statistically significantly different between aripiprazole and brexpiprazole (p>0.05). Quetiapine users had $15,159 (p<0.001) higher psychiatric hospitalization costs among those hospitalized, and higher odds of psychiatric hospitalization [2.11 (1.46–3.04); p<0.001] compared to brexpiprazole users. No statistically significant differences observed in psychiatric hospitalization risk comparing aripiprazole and lurasidone with brexpiprazole (p>0.05).ConclusionIn MDD, brexpiprazole users had significantly lower psychiatric costs than lurasidone and quetiapine users, and significantly lower psychiatric hospitalization risk than quetiapine users. Adjunctive AAP choice may impact subsequent healthcare costs and utilization in MDD.

Affective Symptoms as Prognosis Factor in Schizophrenia

Background Schizophrenia has a multidimensional symptomatology that includes affective, aggressive, disorganized, positive and negative clinical manifestations. We selected the affective symptoms as a target for our study because they could have significant impact over the prognosis and quality of patient’s life. Objective To assess the presence of mood symptoms, depressive type and the impact of atypical antipsychotics over these clinical manifestations. Methods This prospective, open label, randomized trial included 36 inpatients, 22 male and 14 female, medium age 25.4 years, diagnosed with schizophrenia according to DSM IV TR criteria that were admitted for acute psychotic de-compensations. During this 12 months trial patients were evaluated using PANSS, CGI-S and CDSS (Calgary Depression Scale for Schizophrenia) every 4 weeks. There were formed 4 equally groups of patients and each group received a different antipsychotic: olanzapine mean daily dose (mdd) 12.7 mg/day, risperidone mdd 5.8 mg/day, aripiprazole mdd 15 mg/day or quetiapine mdd 650mg/day. Results Patients with depressive symptoms at admission had a poorer prognosis over 12 months (PANSS improvements -22.5+/-4.3 in significant CDSS group defined as score over 6 vs. -29.3+/-2.2 in low CDSS score group, p Conclusions Depressive symptoms are negative prognosis factor and need to be actively addressed and monitored. The four antipsychotics evaluated in this trial were equipotent in decreasing the depressive symptoms severity.

PMH59 - Impact of atypical antipsychotics use on long acting stimulants persistence among children and adolescents with attention deficit hyperactivity disorder

PMH59 - Impact of atypical antipsychotics use on long acting stimulants persistence among children and adolescents with attention deficit hyperactivity disorder

Suicide attempts in veterans with bipolar disorder during treatment with lithium, divalproex, and atypical antipsychotics

Suicide attempt rates were assessed in 1306 subjects in this 6 year retrospective study of Bipolar disorder. Participants were Veterans from 5 different Veterans Administration Hospitals who met criteria for bipolar type 1 or 2 and who had at least one prescription for lithium or divalproex or both during the study period. This study focused on the impact of atypical antipsychotics on the suicide attempt rate when used in addition to or in place of lithium or divalproex. Medication exposure was calculated using computerized pharmacy records. Suicide attempts were established through chart review including emergency room records, inpatient records, and outpatient records. There were a total of 117 suicide attempts and 2 suicide completions during the study period. Most attempts (59%) occurred when patients were on no medications. Nearly 90% of subjects spent an average of 45 months during the 6 year period on none of the aforementioned medications. The lowest percentage of suicide attempts (15%) occurred while on lithium, 21% while on divalproex and 24% while on atypical antipsychotics. When total months of exposure were taken into account, the lowest attempt rate occurred on lithium plus divalproex (6.3 attempts per 10,000 months of exposure), followed by divalproex alone (7.0 attempts/10,000 months of exposure), and lithium alone (7.7 attempts per 10,000 months of exposure). Patients on atypical antipsychotics alone had an attempt rate of 26.1 attempts per 10,000 months of exposure. In this study, lithium and divalproex provided protection against suicide attempts. Results need to be replicated in future prospective studies and clearly strategies for improving medication compliance among veterans are warranted.

Pharmacologic Treatments for Co-Occurring Substance Use Disorders in Patients with Schizophrenia

Substance use disorders are a common comorbidity in patients with schizophrenia, and are associated with a variety of negative outcomes. Research assessing pharmacotherapy of substance use disorders in patients with schizophrenia is in its infancy, but preliminary data indicate that, in particular, atypical antipsychotic medications may help patients with co-occurring disorders reduce substance use. Clozapine, despite its potential side effects, shows the most promise. Data related to other medications, which may also be helpful in patients with schizophrenia, are reviewed. Further controlled trials are needed to assess the impact of atypical antipsychotics, mood stabilizers, and other agents on substance abuse in patients with schizophrenia. Until such data are avail-Mary F. Brunette, Douglas L. Noordsy, and Alan I. Green are affiliated with the Department of Psychiatry, Dartmouth Medical School. able, clinicians should follow established principles of pharmacotherapy for patients with dual disorders, which include using medications to treat both disorders simultaneously over time in the context of psychosocial treatment for dual disorders.

Impact of atypical antipsychotics on quality of life, self-report of symptom severity, and demand of services in chronically psychotic patients

Objective: The study investigated whether the introduction of atypical neuroleptics in the formulary of a large community mental health clinic had any impact on demand for services, quality of life, symptom presentation and cost of care of patients with chronic psychotic illnesses over a 3-year period. Methods: BJC Behavioral Health Services provides and coordinates mental health services for citizens residing in St. Louis City, St. Louis County and the counties of St. Francois, Iron and Washington, MO. We searched the BJC Behavioral Health Services and the Missouri Pharmacy Database to identify patients who had been switched from a typical to an atypical neuroleptic for a minimum of 3 months between 5/1/1997 and 4/30/2000. We excluded patients treated with more than one neuroleptic simultaneously and those with incomplete records. The primary outcome measures were: level of care assignment. Secondary outcomes were a quality of life scale, and a symptom severity inventory. Twenty-five patients met final entry criteria (out of a census of 6280 patients on 3/6/2000). Results: In this naturalistic sample of patients with chronic severe psychotic symptoms, atypical neuroleptic treatment resulted in a marked reduction in demand of services, marked improvement on perception of quality of life, and a trend towards reduction in symptom severity, particularly in the cluster of affective symptoms of the SLSS, over a 3-year period. We also found that the cost of care after switching to atypical neuroleptics was increased, which coincided with increased number of services provided to the patients. These changes appeared to be the result of improved compliance with outpatient services such as follow-up visits and rehabilitative activities.

Impact of Atypical Antipsychotics on Quality of Life in Patients with Schizophrenia

Schizophrenia is a long-term disabling illness that affects approximately 1% of the population. Its course is generally chronic with acute psychotic exacerbations that may require frequent hospitalisations. The clinical picture includes a range of symptoms such as delusions, hallucinations, agitation, suspiciousness, hostility, conceptual disorganisation, blunted affect, emotional and social withdrawal, lack of spontaneity, poverty of speech and a wide range of neurocognitive deficits. Over the past 50 years, antipsychotic medications have emerged as the cornerstone of management in concert with other important interventions, such as psychosocial and economic support and rehabilitation efforts. However, the unrivalled role of conventional antipsychotic medications has been continuously challenged by the wide range of adverse effects of these medications and their lack of usefulness in the treatment of neurocognitive deficits as well as deficit and negative symptoms. In addition, the lack of subjective tolerability of these agents and their negative impact on quality of life have complicated management for a large number of patients. Over the last 15 years, several new atypical antipsychotic medications have been introduced, including amisulpride, remoxipride, risperidone, sertindole, olanzapine, zotepine, quetiapine, ziprasidone and aripiprazole. In general, the new antipsychotics have shown themselves to be at least comparable in efficacy to conventional antipsychotics but with superior subjective tolerability and a more favourable adverse effect profile. The majority of quality of life studies involving new antipsychotic agents have evaluated the benefits of risperidone, olanzapine and clozapine; only a few studies have examined the effects of other new antipsychotics. While most of these studies have methodological and design limitations, the weight of evidence from them nevertheless points to a trend towards a more positive impact on quality of life with atypical agents. A number of recommendations can be made. First, more independent well designed and controlled studies are urgently needed to evaluate the effects of antipsychotic therapy on quality of life in patients with schizophrenia. New comparative studies should explore not only the differences between new and old antipsychotics but also identify any potential differences between individual new agents. The role of cost-effectiveness studies such as cost utility approaches in schizophrenia needs to be revisited, notwithstanding the fact that these types of studies have been reported to be feasible in schizophrenia. Finally, quality-of-life-based pharmacoeconomic studies of antipsychotic agents should not concentrate solely on cost reduction or containment, as it is likely that in order to maximise the benefits of new antipsychotic medications, greater expenditure on rehabilitation programmes and other support services will be necessary in the short-term at least.