Number Of Antipsychotics Research Articles

Trends and off-label utilization of antipsychotics in children and adolescents from 2016 to 2021 in China: a real-world study

BackgroundGlobal antipsychotic usage, including off-label prescriptions, has increased in recent decades. However, trends in China, particularly for children and adolescents, remain unclear. This study explored these trends from 2016 to 2021 and identified factors associated with off-label prescriptions.MethodsIn this retrospective study, we analyzed on-label and off-label prescriptions based on drug information approved by the China National Medical Products Administration. To identify factors associated with off-label prescriptions, we conducted multivariate logistic regression analysis.ResultsOur study included 48,258 antipsychotic prescriptions, 52.4% (25,295) of which were prescriptions for males. Of these, 61.7% (29,813) were off-label. Over time, the number of antipsychotics and the percentage of off-label prescriptions for children and adolescents overall increased from 2016 to 2021. The use of atypical antipsychotics increased, whereas that of typical antipsychotics decreased. For off-label usage, all of the factors in our study were associated with off-label usage, including age, sex, year, region, department, reimbursement, antipsychotic type, drug expense, number of polypharmacy and diagnoses. Additionally, tiapride (15.8%) and aripiprazole (18.6%) were the most common typical and atypical antipsychotics, respectively. For pediatric diseases, common diagnoses included mood or affective disorders (31.7%) and behavioral and emotional disorders, with onset usually occurring in childhood and adolescence (29.1%). Furthermore, a depressive state was the most common diagnosis for which antipsychotic polypharmacy was used for treatment.ConclusionIn this retrospective study, off-label antipsychotic prescriptions were common, with trends generally increasing among children and adolescents from 2016 to 2021. However, there is a lack of evidence supporting off-label usage, thus emphasizing the need for studies on the efficacy and safety of these treatments.

Comparative analysis of anticholinergic burden scales to explain iatrogenic cognitive impairment and self-reported side effects in the euthymic phase of bipolar disorders: Results from the FACE-BD cohort

Bipolar disorders (BD) are characterized by cognitive impairment during the euthymic phase, to which treatments can contribute. The anticholinergic properties of medications, i.e., the ability of a treatment to inhibit cholinergic receptors, are associated with cognitive impairment in elderly patients and people with schizophrenia but this association has not been well characterized in individuals with remitted BD. Moreover, the validity of only one anticholinergic burden scale designed to assess the anticholinergic load of medications has been tested in BD. In a literature review, we identified 31 existing scales. We first measured the associations between 27 out of the 31 scales and objective cognitive impairment in bivariable regressions. We then adjusted the bivariable models with covariates: the scales significantly associated with cognitive impairment in bivariable and multiple logistic regressions were defined as having good concurrent validity to assess cognitive impairment. In a sample of 2,031 individuals with euthymic BD evaluated with a neuropsychological battery, two scales had good concurrent validity to assess cognitive impairment, whereas chlorpromazine equivalents, lorazepam equivalents, the number of antipsychotics, or the number of treatments had not. Finally, similar analyses with subjective anticholinergic side-effects as outcome variables reported 14 scales with good concurrent validity to assess self-reported peripheral anticholinergic side-effects and 13 to assess self-reported central anticholinergic side-effects. Thus, we identified valid scales to monitor the anticholinergic burden in BD, which may be useful in estimating iatrogenic cognitive impairment in studies investigating cognition in BD.

DETERMINING THE RISK OF CARDIOVASCULAR DISEASE IN PATIENTS DIAGNOSED WITH SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDER.

In Schizophrenia (SCZ) and Bipolar Affective Disorder (BAD) patients using the Framingham Heart Risk Scoring (FHRS), we aimed to investigate the possible cardiac arrhythmia risk by calculating electrocardiogram (ECG) parameters (QT, QTc, Tpe, and TPE/QTc ratios), which are ventricular repolarization markers. A total of 140 BAD and 253 SCZ patients were included in the study. Age, blood test results (fasting blood glucose, LDL-HDL-TC levels, hemogram values), blood pressure and heart rate, smoking status, antihypertensive drug use, and FHRS were calculated from the patient files, and sociodemographic information was recorded. In addition, ECG calculations were performed, and QT, QTc, TPe, TPe/QTc ratios and heart rate were measured. When we evaluated the cardiac risk indexes of SCZ and BAD patients, we detected that FHRS was higher in smokers, female patients, and those with other medical diseases such as diabetes mellitus (DM) (p<0.05). In addition, we found that QTc rates, markers of ventricular repolarization, were associated with FHRS, the number of antipsychotics used, patient age, disease duration, and the number of hospitalizations. TPe and QT rates were found to increase in parallel with FHRS. In addition, a positive correlation was found between QTc rates in females, patients with DM, and those using additional medical drugs. (p<0.05) In BAD and SCZ patients, diabetes diagnosis, other medical drug use, a high Framingham heart score, the number of antipsychotics, the disease duration, the patient&apos;s age, and an increased number of hospitalizations may increase the risk of cardiac arrhythmia. Therefore, possible cardiac risk should be considered in patients with chronic drug use, such as BAD and SCZ. Regulating the treatment and follow-up of this group of patients against possible cardiac risks will reduce cardiac mortality and morbidity

What factors should we modify to promote high functioning and prevent functional decline in people with schizophrenia?

Since research in schizophrenia mainly focuses on deficits and risk factors, we need studies searching for high-functioning protective factors. Thus, our objective was to identify protective (PFs) and risk factors (RFs) separately associated with high (HF) and low functioning (LF) in patients with schizophrenia. We collected information (sociodemographic, clinical, psychopathological, cognitive, and functional) from 212 outpatients with schizophrenia. Patients were classified according to their functional level (PSP) as HF (PSP > 70, n = 30) and LF (PSP ≤ 50, n = 95). Statistical analysis consisted of Chi-square test, Student's t-test, and logistic regression. HF model: variance explained: 38.4-68.8%; PF: years of education (OR = 1.227). RFs: receiving a mental disability benefit (OR = 0.062) and scores on positive (OR = 0.719), negative-expression (OR = 0.711), and negative-experiential symptoms (OR = 0.822), and verbal learning (OR = 0.866). LF model: variance explained: 42.0-56.2%; PF: none; RFs: not working (OR = 6.900), number of antipsychotics (OR = 1.910), and scores on depressive (OR = 1.212) and negative-experiential symptoms (OR = 1.167). We identified specific protective and risk factors for high and low functioning in patients with schizophrenia and confirmed that high functioning factors are not necessarily the opposite of those associated with low functioning. Only negative experiential symptoms are a shared and inverse factor for high and low functioning. Mental health teams must be aware of protective and risk factors and try to enhance or reduce them, respectively, to help their patients improve or maintain their level of functioning.

Combination Psychotropic Use for Schizophrenia With Long-Acting Injectable Antipsychotics and Oral Antipsychotics: A Nationwide Real-World Study in Japan.

Although several guidelines recommend monotherapy with antipsychotics for the treatment of schizophrenia, patients who receive long-acting injectable antipsychotics (LAIs) are frequently treated with oral antipsychotics (OAPs). In the present study, we investigated the detailed use of psychotropic medications among patients throughout Japan with schizophrenia who received LAIs or OAPs. The present study used data from the project for the Effectiveness of Guidelines for Dissemination and Education in psychiatric treatment from 94 facilities in Japan. The LAI group included patients who received any LAI, and the non-LAI group included patients who took only OAP medications at discharge. The participants of this study were 2518 schizophrenia patients (263 in the LAI group and 2255 in the non-LAI group) who received inpatient treatment and had prescription information at discharge between 2016 and 2020. This study revealed significantly higher rates of polypharmacy antipsychotics, number of antipsychotics, and chlorpromazine equivalents in the LAI group than in the non-LAI group. In contrast, the LAI group showed lower rate of concomitant use of hypnotic and/or antianxiety medication than the non-LAI group. Presenting these real-world clinical results, we want to encourage clinicians to keep monotherapy in mind for the treatment of schizophrenia, especially by reducing concomitant use of antipsychotics in the LAI group and reducing hypnotic and/or antianxiety medication in the non-LAI group.

Prescribing and deprescribing trends in schizophrenia: An overview of inpatients in Belgium and in the Canadian province of Québec.

Although switching to antipsychotic monotherapy improves patient outcomes in schizophrenia, antipsychotic deprescribing is rarely performed, and its use varies between countries, as do psychotropic prescribing patterns. This study aimed to determine factors associated with antipsychotic deprescribing at discharge after a psychiatric hospitalization and to compare psychotropic prescribing patterns between Belgium and Québec, Canada. Data on adult inpatients with schizophrenia were collected retrospectively in seven hospitals. At discharge, the number of antipsychotics had decreased in 22.2% of the 63 Canadian patients and 9.9% of the 516 Belgian patients. A number of factors increased the likelihood of antipsychotic deprescribing: a hospitalization in the Canadian hospital (aOR = 4.13, 95% CI 1.48-11.5), living in a residential facility (aOR = 2.51, 95% CI 1.05-4.39), ≥2 previous antipsychotic trials (aOR = 15.38, 95% CI 3.62-65.36), having an antipsychotic side effect (aOR = 1.86, 95% CI 1.01-3.44) and being in a general hospital (aOR = 2.28, 95% CI 1.09-4.75). Patients on a long-acting injectable antipsychotic (aOR = 0.51, 95% CI 0.26-0.98), with prior clozapine use (aOR = 0.36, 95% CI 0.13-0.95), greater antipsychotic exposure (aOR = 0.35, 95% CI 0.2-0.61) and more hypno-sedatives (aOR = 0.65, 95% CI 0.43-0.98), were less likely to be deprescribed. Specific deprescribing interventions could target patients who are less likely to be deprescribed.

Antipsychotic polypharmacy reduction versus polypharmacy continuation for people with schizophrenia.

BackgroundIn clinical practice, different antipsychotics can be combined in the treatment of people with schizophrenia (polypharmacy). This strategy can aim at increasing efficacy, but might also increase the adverse effects due to drug–drug interactions. Reducing polypharmacy by withdrawing one or more antipsychotics may reduce this problem, but must be done carefully, in order to maintain efficacy.ObjectivesTo examine the effects and safety of reducing antipsychotic polypharmacy compared to maintaining people with schizophrenia on the same number of antipsychotics.Search methodsOn 10 February 2021, we searched the Cochrane Schizophrenia Group's Study‐Based Register of Trials, which is based on CENTRAL, CINAHL, ClinicalTrials.Gov, Embase, ISRCTN, MEDLINE, PsycINFO, PubMed and WHO ICTRP.Selection criteriaWe included randomised controlled trials (RCTs) that compared reduction in the number of antipsychotics to continuation of the current number of antipsychotics. We included adults with schizophrenia or related disorders who were receiving more than one antipsychotic and were stabilised on their current treatment.Data collection and analysisTwo review authors independently screened all the identified references for inclusion, and all the full papers. We contacted study authors if we needed any further information. Two review authors independently extracted the data, assessed the risk of bias using RoB 2 and the certainty of the evidence using the GRADE approach. The primary outcomes were: quality of life assessed as number of participants with clinically important change in quality of life; service use assessed as number of participants readmitted to hospital and adverse effects assessed with number of participants leaving the study early due to adverse effects.Main resultsWe included five RCTs with 319 participants. Study duration ranged from three months to one year. All studies compared polypharmacy continuation with two antipsychotics to polypharmacy reduction to one antipsychotic. We assessed the risk of bias of results as being of some concern or at high risk of bias.A lower number of participants left the study early due to any reason in the polypharmacy continuation group (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.29 to 0.68; I2 = 0%; 5 RCTs, n = 319; low‐certainty evidence), and a lower number of participants left the study early due to inefficacy (RR 0.21, 95% CI 0.07 to 0.65; I2 = 0%; 3 RCTs, n = 201). Polypharmacy continuation resulted in more severe negative symptoms (MD 3.30, 95% CI 1.51 to 5.09; 1 RCT, n = 35).There was no clear difference between polypharmacy reduction and polypharmacy continuation on readmission to hospital, leaving the study early due to adverse effects, functioning, global state, general mental state and positive symptoms, number of participants with at least one adverse effect, weight gain and other specific adverse effects, mortality and cognition.We assessed the certainty of the evidence as very low or low across measured outcomes.No studies reported quality of life, days in hospital, relapse, depressive symptoms, behaviour and satisfaction with care.Due to lack of data, it was not possible to perform some planned sensitivity analyses, including one controlling for increasing the dose of the remaining antipsychotic. As a result, we do not know if the observed results might be influenced by adjustment of dose of remaining antipsychotic compound.Authors' conclusionsThis review summarises the latest evidence on polypharmacy continuation compared with polypharmacy reduction. Our results show that polypharmacy continuation might be associated with a lower number of participants leaving the study early, especially due to inefficacy. However, the evidence is of low and very low certainty and the data analyses based on few study only, so that it is not possible to draw strong conclusions based on the results of the present review.Further high‐quality RCTs are needed to investigate this important topic.

An evaluation of the prescribing of clozapine for treatment-resistant schizophrenia in one NHS Trust in England

Abstract Introduction As a merger of two trusts had occurred, and recent research on the impact of the delay of initiating clozapine (1), this study was initiated to investigate if NICE guidelines for the management of treatment-resistant schizophrenia (TR-SCZ) were followed. NICE recommends that clozapine is offered after a trial of two antipsychotics drugs of appropriate dose and duration. The risk of potentially fatal side effects and the need for regular blood monitoring can deter patients and prescribers in initiating clozapine at an earlier stage (1). Aim To evaluate the prescribing of clozapine in patients with TR-SCZ in a large NHS trust against NICE guidelines. Methods Due to a fixed project time scale of 3 months, the medical records of 20 patients with TR-SCZ were accessed in November 2019 in order to determine compliance with NICE guidelines. Inclusion criteria for the study included a diagnosis of TR-SCZ in patients over 18 but under 60 years-old and a first attempt of prescribing clozapine after 2017. The records were analysed to establish how many antipsychotics were prescribed before clozapine was initiated, the number of patients remaining on clozapine after nine months, and the reason for stopping (where appropriate). A collection tool was created in Excel and data was analysed using descriptive statistics. Results All 20 patients had tried at least two antipsychotics, with 75% (n=15) having tried more than two before the initiation of clozapine. The mode number of antipsychotics prescribed was three. At the point of data collection, 75% (n=15) of the patients remained on clozapine. Of the five patients no longer taking clozapine, three patients remained on it for more than nine months before it was stopped. Documented reasons for stopping included side effects (neutropenia (n=1) and tachycardia (n= 1)) and patient choice (n=3). Conclusion Clozapine is an effective treatment for TR-SCZ (1), (2). This is backed up by the majority of patients in this study remaining on the treatment after nine months. This study also agrees with previous research (1) indicating guidelines for prescribing clozapine are not followed. 75% of patients were prescribed more than the recommended two antipsychotics before clozapine was initiated. However, the patient notes did not indicate the reasons for using more than two other antipsychotics before trialling clozapine or impact of the delay of its initiation. It would therefore be prudent for future research to determine the reasons for and impact of prescribing clozapine after more than two other antipsychotics had been trialled. References (1) Shah P, Iwata Y, Plitman E, Brown EE, Caravaggio F, Kim J, Nakajima S, Hahn M, Remington G, Gerretsen P, Graff-Guerrero A. The impact of delay in clozapine initiation on treatment outcomes in patients with treatment-resistant schizophrenia: a systematic review. Psychiatry research. 2018 Oct 1;268:114-22. (2) National Institute for Health and Care Excellence. Psychosis and schizophrenia: treatment and management. (Clinical guideline 178.) c2014. [Updated 2021; cited 2021 Oct 14]. Available from: http://guidance.nice.org.uk/CG178

Prevalence and Risk Factors for QTc Prolongation in Acute Psychiatric Hospitalization.

Objective: Prolongation of corrected QT (QTc) interval increases the risk of severe ventricular arrhythmias, in particular torsades de pointes. Patients with severe mental illness (SMI) represent a vulnerable population. This study aimed to measure the prevalence of QTc prolongation in inpatients with SMI and to identify risk factors for QTc prolongation.Methods: Demographic, clinical, anthropometric, laboratory, and electrocardiographic information was extracted from the electronic records of a cohort of patients hospitalized in a psychiatry inpatient unit between July 1, 2017, and July 22, 2019. The primary outcome was the estimation of prevalence of QTc prolongation. The secondary outcome was the identification of risk factors for QTc prolongation.Results: A total of 597 admissions were included. Only 1.4% had a QTc > 500 msec, while 11.6% had a QTc > 460 msec. The proportion of women with a QTc > 470 msec was 3.6% and men with a QTc > 450 msec was 7.3%. Several risk factors were individually associated with QTc prolongation. In the multivariate model explaining almost one-third of QTc variance, female sex (P = .04), older age (P = .011), heart rate (P < .001), systolic blood pressure (P = .042), potassium (P = .012), hemoglobin (P = .006), number of antipsychotics (P = .026), and treatment with clotiapine (P = .012) and clozapine (P = .003) were associated with QTc length. Several factors beyond pharmacologic treatment identify subjects at risk for QTc prolongation, and polypharmacotherapy does not seem to increase the risk of QTc prolongation.Conclusions: QTc prolongation was rare in this cohort of SMI inpatients. Most of the risk factors involved in QTc prolongation are unchangeable elements or linked to general medical conditions, and only a few are modifiable factors, including psychotropic treatment.

Adverse Drug Reaction and Its Predictors Among Psychiatric Patients Taking Psychotropic Medications at the Mizan-Tepi University Teaching Hospital.

IntroductionPsychotropic medications are crucial in the treatment of a variety of psychiatric disorders. Use of second-generation antipsychotics (SGA) has been associated with many adverse events. Assessment and monitoring of ADRs is required to develop appropriate interventional strategies to manage, prevent and minimize the risks of undesirable effects and thus improve quality of life and adherence, avoid relapse, and reduce treatment costs.ObjectiveThe objectives of this study were to assess adverse drug reactions and its predictors in psychiatric patients taking psychotropic medications from the outpatient pharmacy of MTUTH.MethodsA cross-sectional study design was conducted using a structured questionnaire interviewing a psychiatric patient. One way ANOVA and bivariate logistic regression was computed for all independent variables to identify variables that fit for multivariate logistic regression. A p-value less than 0.05 was considered significant.Results and DiscussionsA total of 101 patients (91.8%) experienced one or more types of ADR in the current study. There was a statistically significant relationship between ADRs management and age, marital status, educational status, occupation, and monthly income of the study participants. The odds of having experienced autonomic adverse drug reactions experience among respondents aged 30 years and older higher than those under 30 years. Participants taking multiple medications were more likely to face psychiatric adverse drug reactions compared to those taking a single medication. Patients taking multiple psychotropic medications were ten times more likely to develop autonomic adverse drug reactions compared to those taking a single drug.ConclusionThe study revealed a moderate incidence of ADR in patients attending the psychiatric OPD. Age and number of antipsychotics were predictors of ADR (autonomic and psychiatric). This study revealed that there is a gap in the role of clinicians in the monitoring and reporting of ADRs.

Use of olanzapine compared with clozapine for treatment-resistant schizophrenia in a real-world setting: nationwide register-based study.

Clozapine is generally considered as the treatment of choice for patients with treatment-resistant schizophrenia (TRS). However, its superiority has recently been questioned because olanzapine has been suggested as non-inferior to clozapine in its effectiveness. We aimed to investigate the current status of clozapine prescriptions to identify any disparity between clinical guidelines and real-world practices. In this study, we utilised the Health Insurance Review Agency database in the Republic of Korea to investigate the real-world effectiveness of clozapine for patients with TRS. We compared differences in patient variables before and after clozapine administration, and we also performed survival analyses for both psychiatric admissions and emergency room visits among patients who used clozapine or olanzapine. This study investigated an incident cohort of 64 442 patients, and 2338 patients have been prescribed clozapine. Of these, 998 patients had TRS. In survival analysis, clozapine showed a worse survival rate for psychiatric admissions than olanzapine (hazard ratio 0.615). We also identified that clinicians tended to try a number of antipsychotics, as recommended, before starting patients on clozapine. In conclusion, we found that olanzapine led to higher survival rates for psychiatric admissions than clozapine. Thus, considering the risk of serious adverse effects, clozapine may be used conservatively. Considering several studies advocating superior efficacy of clozapine, further studies with extensive data are recommended.

Recent trends in antipsychotic polypharmacy in the treatment of schizophrenia

Ichihashi et al reported that 43% of patients had antipsychotic polypharmacy. Number of antipsychotics used in patients with schizophrenia in Japan was the greatest among Asian countries. However, the antipsychotic polypharmacy rate in Japan decreased gradually. Recent systematic review, meta‐analysis and meta‐regression analysis demonstrated that antipsychotic augmentation was superior to monotherapy. However, several cohort studies have suggested a significant association between antipsychotic daily dose and mortality. In addition, most pharmacokinetic interactions with antipsychotics occur at the metabolic level and usually involve changes in the activity of the major drug‐metabolizing enzymes involved in their biotransformation. Thus, avoidance of unnecessary polypharmacy, knowledge of the interaction profiles of individual agents, and careful individualization of dosage based on close evaluation of clinical response and possibly plasma drug concentrations are essential to prevent and minimize potentially adverse drug interactions in patients receiving antipsychotics.

Comparison of clozapine monitoring and adverse event management in a psychiatrist-only and a clinical pharmacist-psychiatrist collaborative clinic.

IntroductionIn an effort to establish clinical support for providers prescribing clozapine and to help reverse the national decline in clozapine utilization, a clinical pharmacist began seeing half the clozapine clinic patients, preceding the psychiatrist, at this facility in July 2017. The other half of the clozapine clinic patients continued being seen by the psychiatrist only. The purpose was to determine the impact of the pharmacist on clozapine management and identify barriers to clozapine use to potentially increase its utilization.MethodsBaseline data (clozapine dose, number of antipsychotics and other psychotropics, A1c, lipids, pulse, body mass index, weight, blood pressure, and number of medications for adverse effects) were collected via chart review from the first clinic visit and each follow-up visit. A provider survey was used to identify barriers and solutions to prescribing clozapine.ResultsThere were no statistically significant differences from baseline in patient outcomes between the collaborative and psychiatrist-only group. In the prepharmacist to postpharmacist analysis, there was a decrease in number of antipsychotics (−0.27 ± 0.65), number of other psychotropics (−0.18 ± 0.41), A1c (−0.04% ± 0.25%), clozapine dose (−7.96 mg ± 19.58 mg), and total cholesterol (−15.73 mg/dL ± 42.31 mg/dL). There were more pharmacologic (71 vs 19) and nonpharmacologic (154 vs 3) interventions documented in the collaborative group compared to the psychiatrist-only group. Eleven providers (69%) completed the survey. Providers' perception of patient refusal of monitoring was the barrier that received the most responses (54%). A pharmacist seeing every clozapine clinic patient was the solution that received the most responses (90%).DiscussionTrends were seen for decreasing the number of antipsychotics, other psychotropics, A1c, and total cholesterol as well as an increased number of nonpharmacologic and pharmacologic interventions documented in the collaborative group. Providers identified that pharmacists seeing every clozapine clinic patient would be a solution to clozapine underutilization, which demonstrates the perceived value of pharmacist involvement.

Finding treatment-resistant depression in real-world data: How a data-driven approach compares with expert-based heuristics.

BackgroundDepression that does not respond to antidepressants is treatment‐resistant depression (TRD). TRD definitions include assessments of treatment response, dose and duration, and implementing these definitions in claims databases can be challenging. We built a data‐driven TRD definition and evaluated its performance.MethodsWe included adults with depression, ≥1 antidepressant, and no diagnosis of mania, dementia, or psychosis. Subjects were stratified into those with and without proxy for TRD. Proxies for TRD were electroconvulsive therapy, deep brain, or vagus nerve stimulation. The index date for subjects with proxy for TRD was the procedure date, and for subjects without, the date of a randomly selected visit. We used three databases. We fit decision tree predictive models. We included number of distinct antidepressants, with and without adequate doses and duration, number of antipsychotics and psychotherapies, and expert‐based definitions, 3, 6, and 12 months before index date. To assess performance, we calculated area under the curve (AUC) and transportability.ResultsWe analyzed 33,336 subjects with no proxy for TRD, and 3,566 with the proxy. Number of antidepressants and antipsychotics were selected in all periods. The best model was at 12 months with an AUC = 0.81. The rule transported well and states that a subject with ≥1 antipsychotic or ≥3 antidepressants in the last year has TRD. Applying this rule, 15.8% of subjects treated for depression had TRD.ConclusionThe definition that best discriminates between subjects with and without TRD considers number of distinct antidepressants (≥3) or antipsychotics (≥1) in the last year.

Cultural adaptation and validity of the Malay version of the brief psychiatric rating scale (BPRS-M) among patients with schizophrenia in a psychiatric clinic

BackgroundThis study evaluates the psychometric properties of the Malay version of the Brief Psychiatric Rating Scale (BPRS-M) among patients with schizophrenia in a psychiatric outpatient clinic.MethodsNinety-nine schizophrenia outpatients were administered the Malay version of the Brief Psychiatric Rating Scale (BPRS-M), Malay version of Positive and Negative Syndrome Scale (PANSS), Malay version of Calgary Depression Scale for Schizophrenia (CDSS) and Malay version of World Health Organization Quality of Life – Brief Version (WHOQOL-BREF).ResultsAn exploratory factor analysis (EFA) of BPRS-M produced a seven-factor solution which accounted for 71.4% of the total variance. It exhibited fair internal consistency (Cronbach’s alpha coefficient of 0.75). “Positive symptoms” and “Resistance” factors had association with unemployment and number of antipsychotics, positively correlated with PANSS but negatively correlated with WHOQOL-BREF. “Mood disturbance” factor correlated with lifetime history of suicide attempts, Malay version of CDSS and WHOQOL-BREF (psychological). Both “Negative symptoms” and “Activation” factors were associated with male, lower education, unemployment and positively correlated with Malay version of PANSS but negatively correlated with WHOQOL-BREF.ConclusionsThe BPRS-M demonstrated promising psychometric properties in terms of dimensionality, reliability, and validity that generally justifies its use in routine clinical practice in Malaysia.

The Effect of Pharmacist-led Psychiatric Pharmacotherapy Conferences on the Appropriate Use of Antipsychotics

The Hakodate Watanabe Hospital has held pharmacist-led multidisciplinary psychiatric pharmacotherapy conferences since September 2013 in order to optimize pharmacotherapy. The effects of holding regular conferences on the correction of high-dose antipsychotic polypharmacy, prevention and reduction of adverse reactions to antipsychotics, and reduction of the drug costs were investigated in psychiatric inpatients prescribed 4 or more antipsychotics. The results revealed that the number of antipsychotics and number of all drugs were significantly reduced by 1, the chlorpromazine (CP)-equivalent dose was significantly reduced by approximately 350 mg, and the drug costs were significantly reduced by 176.5 yen/d. In regard to the effects on the laboratory test data, the blood glucose and hemoglobin A1c (HbA1c) levels were significantly reduced. In addition, 84.8% of the patients were assessed as "unchanged" using the Clinical Global Impression of Change (CGI-C), indicating the absence of any significant changes in the severity of the clinical psychiatric symptoms. The results confirm that psychiatric pharmacotherapy conferences are effective for promoting appropriate use of antipsychotics, reducing the incidence of metabolic adverse reactions, such as elevation of the blood glucose, and also reducing the drug costs. The above results suggest that psychiatric pharmacotherapy conferences encourage psychiatric medical teams to adjust prescriptions while sharing information, and are effective for optimizing pharmacotherapy.

Long acting injectable aripiprazole: An observational study

IntroductionSeveral trials have shown the efficacy of long acting injectable (LAI) second-generation anti-psychotics compared with other anti-psychotics. LAI aripiprazole is a novel therapeutic tool in the management of patients with schizophrenia.AimsThe present study aimed to evaluate the clinical outcomes of patients who initiated treatment with LAI aripiprazole, by comparing their clinical outcomes prior and after initiating treatment with LAI aripiprazole.MethodsThis observational, retrospective, mirror study assessed a series of socio-demographic and clinical variables during the 12 months prior to commencing LAI aripiprazole, while on another anti-psychotic medication, and the first 12 months of LAI aripiprazole. The sample included a series of consecutive patients receiving LAI aripiprazole at the Doctor Peset university hospital health area, in Valencia (Spain). The variables analyzed in the study included: emergency room visits, number and average length of hospitalizations, relapse, rate of abandonment of treatment and number of anti-psychotics needed as maintenance treatment.ResultsThe preliminary analysis showed a reduction in the rate of emergency room visits and the number of relapse and total hospitalizations while on LAI aripiprazole; however, there is no a reduction of the average length of hospitalizations. A reduction in the number of anti-psychotics as maintenance treatment was not appreciated, however, there was an improvement in treatment adherence.ConclusionsThe preliminary results showed that LAI aripiprazole is an useful option that could suppose a benefit concerning treatment adherence, a decreased in number of relapses and hospitalizations and use of health resources.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Akathisia: Prevalence and risk factors in patients with psychosis and bipolar disorder

IntroductionAkathisia is probably the most common and one of the most distressing of the movement disorders associated with antipsychotic drugs. Little is known about its prevalence and its risk factors in real-world psychotic and bipolar patients to date.ObjectivesThe main objective of this study was to determine the prevalence of akathisia and to determine the risk factors and the treatments associated with it in a sample of Tunisian patients with schizophrenia, schizoaffective or bipolar disorder.MethodsSeventy-four patients with schizophrenia, schizoaffective or bipolar disorder were included and assessed with a validated scale: the Barnes Akathisia scale (BAS). Ongoing psychotropic treatments were recorded.ResultsThe global prevalence of akathisia (as defined by a score ≥ 2 on the global akathisia subscale of the BAS) was 20.5%. Akathisia was significantly more common in patients with schizophrenia or schizoaffective disorder than in patients with Bipolar disorder (27.5% vs 9.4%; P = 0.049). However, the prevalence of akathisia did not differ according to sex, age, the illness duration, the presence of a comorbid anxiety disorder, the number of antipsychotics used, the type of the used antipsychotic (first vs second-generation), the antipsychotic chlorpromazine-equivalent total dosage, the use of benzodiazepines or anticholinergics, or the reported drug compliance.ConclusionsAkathisia seems to be more common in some psychiatric disorders than in others such as schizophrenia or schizoaffective disorder. Longitudinal studies would be required to draw any firm conclusions concerning the factors involved in the emergence of akathisia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Relationship between xerostomia and psychotropic drugs in patients with schizophrenia: evaluation using an oral moisture meter

Patients with schizophrenia are most commonly treated with antipsychotic medications, often with the addition of anxiolytics. This study used an oral moisture meter to evaluate xerostomia in patients with schizophrenia taking typical and atypical antipsychotics, anxiolytics and non-psychotropic medications. Patients diagnosed with schizophrenia according to ICD-10 criteria in the Department of Psychiatry, Kitasato University East, and affiliated hospitals were studied. All patients were on psychotropic medications. Patients with diseases associated with xerostomia, such as Sjögren's syndrome I, were excluded. A total of 127 patients were enrolled. Mean oral moisture was 27·81 ± 2·27% (normal, ≥30·0%). A significant association was observed between objective oral moisture and the subjective sense of dry mouth. Multivariate analysis revealed a negative correlation between the number of antipsychotics and, especially, anxiolytics, and the degree of oral moisture. Drug dosages themselves were not significantly correlated with dry mouth. These findings suggest that objective oral moisture measurements show decreased moisture in patients on these medications and that the degree of moisture shows a greater negative correlation with the number, as opposed to the dosages, of psychotropic drugs administered. When patients with schizophrenia visit a dental clinic, it is important for the dentist to accurately assess the degree of oral moisture and to determine the medications being taken. Based on these findings of the association of polypharmacy with xerostomia, dentists are encouraged to inform the psychiatrist of the need to actively manage patients' xerostomia.

Analysis of the attitudes towards the medication in ambulatory patients with diagnosis of schizophrenia

Introduction The scale autoapplied Drug Attitude Inventory (DAI) [1] is an instrument to evaluate the subjective response to the neuroleptics in patients diagnosed of schizophrenia. We have used the brief version [2]. Objectives To study the possible relation between DAI and sociodemographic factors [3] as well as medical treatment [4] (references 3 and 4 are not available for this abstract). Methods A descriptive and comparative study. Sample of 30 patients with ambulatory follow-up from Oviedo. Sociodemographic data and drug prescription were collected. Results Comparative analysis: DAI and sociodemographic, drug prescription (Table 1). Correlation between DAI/age/I number of antipsychotics (Table 2). The comparative analysis only shows positive significant correlation between DAI and antidepressant treatment. Conclusions There is no correlation of DAI depending on the age and the number of antipsychotics. The antidepressant treatment in schizophrenic patients could be a predictor variable of better punctuation in DAI.