Oral Antipsychotic Medication Research Articles

Effectiveness of community treatment orders for treatment of schizophrenia with oral or depot antipsychotic medication: changes in problem behaviours and social functioning

Effectiveness of community treatment orders for treatment of schizophrenia with oral or depot antipsychotic medication: changes in problem behaviours and social functioning

Community treatment orders and antipsychotic long-acting injections

The community treatment order (CTO) is the legal framework by which people in the community are compelled to accept treatment. Both antipsychotic long-acting injections (LAIs) and CTOs are used to address treatment non-adherence. To investigate the relationship between CTOs and LAI use in patients with schizophrenia. Prescribing, demographic and CTO data were collected for patients from four community mental health clinics in Melbourne, Australia, in 1998 and 2002. Against a background of increasing use of oral second-generation antipsychotic (SGA) medication and decreasing use of LAIs, the rates of CTO implementation doubled from 13% to 26% of patients with schizophrenia between 1998 and 2002. Proportionally more patients with a CTO are prescribed LAIs rather than oral SGAs. The relationship between receiving an LAI and being subject to a CTO is significant, and reflects the consideration given to enhancing adherence in a community mental health setting.

Quantifying Risk: The Role of Absolute and Relative Measures in Interpreting Risk of Adverse Reactions from Product Labels of Antipsychotic Medications

Pharmaceutical product labeling as approved by regulatory agencies include statements of adverse event risk. Product labels include descriptive statements such as whether events are uncommon or rare, as well as percentage occurrence for more common events. In addition tables are provided with the frequencies of the latter events for both product and placebo as observed in clinical trials. Competing products are not mentioned in a specific drug's product labeling but indirect comparisons can be made using the corresponding label information for the alternate product. Two types of tools are easily used for this purpose: absolute measures such as number needed to harm (NNH), and relative measures such as relative risk increase (RRI). The calculations for both of these types of quantitative measures are presented using as examples the oral first-line second-generation antipsychotic medications. Among three sample outcomes selected a priori, akathisia, weight gain, and discontinuation from a clinical trial because of an adverse reaction, there appears to be differences among the different antipsychotics versus placebo. Aripiprazole was associated with the highest risk for akathisia, particularly when used as adjunctive treatment of major depressive disorder (NNH 5, 95% CI 4-7; RRI 525%, 95% CI 267%-964%). Although insufficient information was available in product labeling to calculate the CI, olanzapine was associated with the highest risk for weight gain of at least 7% from baseline (NNH 6, RRI 640% for adults; NNH 4, RRI 314% for adolescents), and quetiapine for the indication of bipolar depression was associated with the highest risk of discontinuation from a clinical trial because of an adverse reaction (NNH 8, RRI 265% for 600 mg/d; NNH 15, RRI 137% for 300 mg/d). In conclusion, with certain limitations, it is possible for the clinician to extract information from medication product labeling regarding the frequency with which certain adverse reactions can be expected. This supplements, but does not replace, information reported directly in clinical trial reports.

Medication adherence and significant others' support of consumers with schizophrenia in Australia

Medication adherence is problematic in people with chronic illness. The purpose of this exploratory study was to examine the effects of the perceived support from significant others on the oral antipsychotic medication taking of consumers with schizophrenia. A convenience sample of 81 consumers took part in the study. The consumers were recruited by case managers from the community in the western region of Melbourne and in regional and rural Victoria, Australia. No difference was found in self-reported medication adherence between the consumers with significant others' support and those without significant others' support. The perceived effect of having a supportive relationship with significant others was not associated with increased medication adherence. The findings indicated that the significant others' support did not influence the self-reported medication adherence of the consumers with schizophrenia. The results highlighted the importance of considering medication adherence as a multidimensional concept.

Treatment patterns and clinical characteristics prior to initiating depot typical antipsychotics for nonadherent schizophrenia patients

BackgroundNonadherence with antipsychotic medication is an important clinical and economic problem in the treatment of schizophrenia. This study identified treatment patterns and clinical characteristics that immediately precede the initiation of depot typical antipsychotics in the usual treatment of schizophrenia patients with a recent history of nonadherence with oral antipsychotic regimens.MethodsData were drawn from a large, multisite, 3-year prospective noninterventional observational study of persons treated for schizophrenia in the United States, which was conducted between 7/1997 and 9/2003. The analytical sample included patients who, in the 6 months prior to enrollment, were considered nonadherent with oral antipsychotics and were not treated with depot antipsychotics (N = 314). Patients who were subsequently initiated on typical depots during the 3-year follow-up were compared with patients who continued therapy with only oral antipsychotic agents. Group comparisons were made on patient baseline characteristics and precedent variables that were assessed 1 to 6 months prior to depot initiation. Patient assessments were made at predetermined intervals throughout the 3-year study using standard psychiatric measures, a patient-reported questionnaire, and medical record information.ResultsA small proportion of patients (12.4%) who were recently nonadherent with oral antipsychotics were subsequently initiated on depot therapy during the 3-year study. Compared to patients treated with only oral antipsychotics, those subsequently initiated on a depot were significantly more likely to be hospitalized at depot initiation or the previous 30 days, to have recent involvement with the criminal justice system (arrests), recent illicit drug use, recent switching or augmentation of oral antipsychotics, and recent treatment with oral typical antipsychotics.ConclusionDespite prior nonadherence with oral antipsychotic medication, only a small proportion of nonadherent schizophrenia patients were initiated on depot antipsychotics in this 3-year prospective study. Patients subsequently initiated on depot had a more severe treatment pattern and clinical profile immediately preceding depot initiation. This profile may have triggered the decision to initiate a depot. Findings have important clinical and economic ramifications for practitioners, policy makers, and other decision makers, highlighting the need for early identification of and tailored therapeutics for schizophrenia patients with a history of nonadherence with their recent oral antipsychotic regimens.

Intramuscular olanzapine vs. intramuscular short-acting antipsychotics: safety, tolerability and the switch to oral antipsychotic medication in patients with schizophrenia or acute mania

This study compared the safety, tolerability and switch to oral medication in patients with bipolar disorder or schizophrenia who received intramuscular (IM) olanzapine or other IM antipsychotics for the treatment of acute agitation. Patients (N = 2011) from 15 countries participated in this prospective, observational, non-interventional study. Inpatients requiring treatment with at least one IM injection of a short-acting antipsychotic were assessed at baseline and within 7 days after the first IM injection. Treatment groups comprised: (i) patients prescribed IM olanzapine at baseline; and (ii) patients prescribed any other IM antipsychotic medication at baseline. Outcome measures included: treatment-emergent adverse events, concomitant psychotropic medication and the time taken to switch to oral medication. Fewer patients in the IM olanzapine group experienced an adverse event than patients in the other IM antipsychotic group (34.4% vs. 46.2%, p < 0.001). The most frequently reported adverse events in both groups were: sedation, Parkinsonism, disturbance in attention, akathisia, dystonia and orthostatic hypotension. Fewer patients in the IM olanzapine group used anticholinergics (13.9% vs. 42.5%, p < 0.001) or anxiolytics/hypnotics (47.6% vs. 51.6%, p = 0.023). Patients in the IM olanzapine group switched to oral medication earlier than patients in the other IM antipsychotic group (median time = 46.5 vs. 48.0 h, p = 0.009). These findings suggest that IM olanzapine may have a favourable impact on individual patients. However, the high rate of oral concomitant medication used throughout the study limits these findings from being associated with IM olanzapine alone.

When sleeve gastrectomy fails: adding a laparoscopic adjustable gastric band to increase restriction

The use of laparoscopic sleeve gastrectomy (LSG) as a procedure for morbid obesity has recently increased. The LSG procedure is used most often as a part of a biliopancreatic diversion with duodenal switch (BPDDS) or as a first stage that can be converted to a BPDDS or Roux-en-Y gastric bypass (RYGB). However, the surgical indications for LSG have rapidly expanded, and some centers use the sleeve as the primary operation for morbid obesity.The utility of LSG as a primary procedure is controversial, with consensus lacking in the literature. Whether the etiology of failed sufficient weight loss is the result of an inadequate sleeve or attributable to dilation or hypertrophy of the sleeve, the incidence of failed sleeve gastrectomies may be significant.In the treatment of a patient with a failed LSG, the options typically include creation of a tighter sleeve or conversion to biliopancreatic diversion or RYGB. These procedures, however, are complex and can carry significant morbidity.The authors report a case of a morbidly obese 42-year-old man who failed to lose sufficient weight after an LSG. Because the patient was dependent on several oral antipsychotic medications, he refused any malabsorptive procedure, and a decision was made to proceed with laparoscopic adjustable gastric banding (LAGB). The case proceeded successfully, and at this writing, 9 months after surgery, the patient has achieved a 57% excess weight loss from an original weight of 390 lb.The insertion of an LAGB into its normal anatomic position is feasible after a sleeve gastrectomy, and its use can induce sufficient restriction and weight loss results equivalent to those of a sleeve or band alone and possibly better.

Use of Depot Antipsychotic Medications for Medication Nonadherence in Schizophrenia

To describe factors associated with initiation of depot antipsychotic medications in psychiatric outpatients with schizophrenia and recent medication nonadherence. A national sample of psychiatrists reported on adult outpatients with schizophrenia who were nonadherent with oral antipsychotic medications in the last year. In total, 17.6% of psychiatrists initiated depot antipsychotic injections. Initiation was significantly and positively associated with public insurance, prior inpatient admission, proportion of time nonadherent, average or above average intellectual functioning, and living in a mental health residence. Use was inversely associated with using second-generation antipsychotics and other oral psychotropic medications prior to medication nonadherence. Psychiatrists who were male, nonwhite, and more optimistic about managing nonadherence were more likely to initiate depot injections. Initiation of depot injections is a joint function of patient, physician, treatment, and setting factors. Use of long-acting preparations in this population is uncommon despite clinical recommendations urging their use.

What CATIE Found: Results From the Schizophrenia Trial

What CATIE Found: Results From the Schizophrenia Trial

Personal Accounts: Reflections on Adherence to a Medications Regimen

Personal Accounts: Reflections on Adherence to a Medications Regimen

Personal Accounts: Reflections on Adherence to a Medications Regimen

Personal Accounts: Reflections on Adherence to a Medications Regimen

The Brief Adherence Rating Scale (BARS) validated against electronic monitoring in assessing the antipsychotic medication adherence of outpatients with schizophrenia and schizoaffective disorder

Among outpatients with schizophrenia, antipsychotic non-adherence is common, grossly under-detected by patients and their prescribers, and is associated with poor clinical outcomes. Using electronic monitoring (EM) as the reference standard we evaluated the reliability and validity as well as the sensitivity and specificity of a recently developed, brief, pencil-paper, clinician-administered adherence instrument [the Brief Adherence Rating Scale (BARS)] to assess the oral antipsychotic medication adherence of outpatients with schizophrenia and schizoaffective disorder. EM and BARS adherence and symptom severity ratings were gathered at baseline and prospectively at 6 monthly visits in 61 participants ( n = 35 with schizophrenia; n = 26 with schizoaffective disorder). A significant positive relationship was found between mean BARS and EM adherence ( β = 0.98; r s = 0.59, p < 0.0001). Cronbach's coefficient alpha revealed very high internal reliability for the BARS ( α = 0.92). A moderate-to-strong degree of test–retest reliability was also found for the BARS ( β ranged from 0.53 to 0.92 and r s ranged from 0.46 to 0.86). Regarding concurrent validity of the BARS, greater mean BARS adherence was significantly related to lower mean PANSS total scores ( β = − 0.40; r s = − 0.39, p = 0.002) and to lower mean Positive symptom sub-scale scores ( β = − 0.08, p = .007; r s = − 0.28, p = .02). An initial 3-month monitoring period with the BARS also demonstrated good sensitivity (73%) and specificity (74%) in identifying non-adherent outpatients (defined as < 70% mean EM adherence). Relative to EM, the BARS appears to provide valid, reliable, sensitive, and specific estimates of antipsychotic medication adherence of outpatients with schizophrenia and schizoaffective disorder. The BARS appears to be a promising candidate as a brief adherence assessment instrument for feasible use in community-based settings.

Electronic monitoring of antipsychotic medication adherence in outpatients with schizophrenia or schizoaffective disorder: An empirical evaluation of its reliability and predictive validity

This study examined the reliability and predictive validity of electronic monitoring (EM) in assessing the oral antipsychotic medication adherence of outpatients with schizophrenia or schizoaffective disorder. Sixty-one adult outpatients with schizophrenia or schizoaffective disorder who took a single oral antipsychotic medication were assessed monthly over a 6-month study period with EM of medication bottle opening. Symptom severity, as measured by the Positive and Negative Syndrome Scale (PANSS) total score, was assessed monthly over the 6-month study period. Cronbach's coefficient alpha revealed very high internal reliability ( α = 0.94). A high degree of test–retest reliability was found ( β ranged from 0.75 to 1.19 and r ranged from 0.63 to 0.90). As for predictive validity, greater mean EM adherence was significantly related to lower mean symptom severity.

Relationships Among Subjective and Objective Measures of Adherence to Oral Antipsychotic Medications

The most common ways of assessing adherence to oral antipsychotic medications in research and in clinical practice are self-report and physician report. This prospective study examined the agreement among measures of adherence to oral antipsychotic medications among 52 outpatients with schizophrenia. Participants were assessed at baseline during a visit to their outpatient clinic and followed for 12 weeks. Adherence was assessed by using subjective measures (self-report and physician report) and objective measures (pill counts conducted in the home, electronic monitoring, and blood plasma concentrations). Electronic monitoring was used as an imperfect standard against which other methods were judged. Data from pill counts and from electronic monitoring were strongly correlated (r(k)=.61). Self-report and physicians' ratings of compliance were weakly correlated with pill count and electronic monitoring when compliance scores were examined with rank-order correlations (r(k)=.18-.32). When the sample was dichotomized into adherent and nonadherent groups on the basis of electronic monitoring or pill count (at least 80% adherent), neither physicians nor patients identified adherent behavior (kappa<or=20). Blood plasma concentrations were not correlated with any other measures of adherence (kappa<or=20). Self-report and physician report were best correlated with clinical state (r(k)=-.27, r(k)=-.25), suggesting that patients and treating professionals may use clinical state to estimate adherence. Patients and physicians were not able to identify adherence. The inability of physicians to accurately identify adherent individuals is likely to have important consequences for prescribing behavior, health care costs, and patient outcomes.

Relationships Among Subjective and Objective Measures of Adherence to Oral Antipsychotic Medications

Relationships Among Subjective and Objective Measures of Adherence to Oral Antipsychotic Medications

Antipsychotic Polypharmacy Trends Among Medi-Cal Beneficiaries With Schizophrenia in San Diego County, 1999-2004

Antipsychotic Polypharmacy Trends Among Medi-Cal Beneficiaries With Schizophrenia in San Diego County, 1999-2004

Validity of Electronically Monitored Medication Adherence and Conventional Adherence Measures in Schizophrenia

Validity of Electronically Monitored Medication Adherence and Conventional Adherence Measures in Schizophrenia

Validity of Electronically Monitored Medication Adherence and Conventional Adherence Measures in Schizophrenia

This study evaluated the validity of prescriber, patient, and research assistant ratings of adherence to prescribed oral antipsychotic medication among outpatients with schizophrenia or schizoaffective disorder in comparison with electronic monitoring. Adult outpatients with schizophrenia (N=35) or schizoaffective disorder (N=26) received adherence assessments via electronically monitored medication vial caps as well as by monthly prescriber, patient, and research assistant report for up to six months. Electronic monitoring detected greater nonadherence rates (57%) than either prescribers (7%) or patients (5%), though the research assistant ratings were 54%. No directional bias was found between electronic monitoring and assignment of adherence by research assistants, although disagreement occurred in 36% of cases. Both patients and prescribers grossly overestimated medication adherence, which may interfere with or reduce the effectiveness of diligent medication management.

Impact of Splitting Risperidone Tablets on Medication Adherence and on Clinical Outcomes for Patients With Schizophrenia

Impact of Splitting Risperidone Tablets on Medication Adherence and on Clinical Outcomes for Patients With Schizophrenia

PREVALENCE OF OBESITY AND NIGHT-EATING SYNDROME IN PERSONS TAKING LONG-ACTING INJECTABLE ANTIPSYCHOTIC MEDICATIONS.

Purpose To determine the prevalence of obesity and night-eating syndrome (NES) in persons taking long-acting injectable antipsychotic medications. Background Many patients taking atypical antipsychotic medications become obese. Case reports have also described that some patients taking antipsychotic and mood-stabilizing medications develop new-onset NES, a potential contributor to the development of obesity. Methods Participants were 100 patients at the University of New Mexico Psychiatric Clinic receiving monthly or bimonthly injections of Haldol decanoate®, Prolixin decanoate®, or risperidol (Consta®). Patients9 weight and height measurements were obtained, converted into a body mass index (kg/m2) score, and classified as normal weight, overweight, or obese. Medical record review included participants9 mental health diagnoses, demographic information, and notation of other concurrent oral antipsychotic, antidepressant, or mood-stabilizing medications being prescribed for the patients. Patients were assessed for characteristics of NES with Stunkard9s standardized NES survey. Usable self-report data were collected on 96 (96%) of the patients enrolled. Results Participants did not exhibit a greater prevalence of obesity and overweight when compared with data reported for the general population. The prevalence of NES (n = 3; 3.13%) was less than figures that have been reported for the general population (9%). Forty-one percent of patients receiving Haldol decanoate, 24% of those receiving Prolixin decanoate, and 21% of those receiving Consta were obese; 60 patients (62.5%) were smokers. Conclusions In this sample, neither the prevalence of obesity nor of NES is greater among patients receiving long-acting injection antipsychotic medications compared with rates reported for the general US population. Limitations of this study include small sample size, confoundance with tobacco use, socioeconomic influences on access to food and shelter, the concurrent use of other psychiatric medications, including sleeping medications, the inability on the part of some patients to accurately complete the survey secondary to illiteracy and/or active psychosis, and the lack of an actual control group.