Role Of Antipsychotic Drugs Research Articles

Improving the physical health of overweight/obese people suffering from severe mental disorder: what is the role of antipsychotic drugs and of lifestyle psychosocial interventions?

People with severe mental disorders experience premature mortality compared with the general population. Several factors contribute to the mortality gap, including the adoption of unhealthy lifestyle behaviours, poor screening for physical illnesses, difficulties in accessing healthcare facilities, specific clinical features of mental disorders and some pharmacological treatment such as antipsychotic medications with serious metabolic side effects.In the present study, carried out in the framework of the LIFESTYLE trial, a funded nationwide multicentric study, we aimed to assess the impact of different antipsychotics in mediating the effectiveness of psychosocial intervention on healthy lifestyle behaviours. The antipsychotics have been grouped in metabolically more problematic (MMP) vs. metabolically less problematic (MLP). The final sample consists of 401 participants with a mean age of 45.6±11.8 years, mainly female (57.1%), suffering from bipolar disorder (43.4% of cases), schizophrenia spectrum disorders (29.7%) and depressive disorders (26.9% of cases). 36.2% of patients (N=145) received MMP antipsychotics, 32.2% were treated with MLP antipsychotics and 31.6% did not take any antipsychotic medication, but were treated with antidepressants, mood stabilizers and/or benzodiazepines. At 6-month follow-up, patients receiving the experimental lifestyle intervention and treated with MLP medication reported a significant reduction in BMI (p<0.05).Our findings clearly indicate that a multilevel, personalized and individualized therapeutic approach for the treatment of patients with severe mental disorders is needed, with the involvement of different physicians and health providers for an appropriate long-term management of patients with severe mental disorders.

The Role of Antipsychotic Drugs in the Treatment of Neuropsychiatric Symptoms of Dementia

Patients with dementia frequently experience comorbid behavioral and psychiatric symptoms that are harmful to both patients and their caregivers and contribute to the high healthcare costs associated with Alzheimer’s dementia. Despite their frequent use in the past, there is limited evidence to support the efficacy of first-generation antipsychotics. Second-generation antipsychotics may be modestly helpful for reducing global neuropsychiatric symptoms, psychosis, and agitation/aggression but are associated with potentially serious adverse reactions. The decision to utilize an antipsychotic requires thoughtful consideration of the potential risks and benefits for the individual patient.

From the Guest Editors

Back to table of contents Next article From the Guest EditorsFull AccessFrom the Guest EditorsHelen Lavretsky, M.D., M.S., and Dilip Jeste, M.D.Helen LavretskySearch for more papers by this author, M.D., M.S., and Dilip JesteSearch for more papers by this author, M.D.Published Online:1 Jan 2013https://doi.org/10.1176/appi.focus.11.1.1AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The current issue of FOCUS is dedicated to the field of Geriatric Psychiatry. Geriatric mental health research topics covered in this issue encompass the latest clinically relevant studies on successful aging (1) and the use of natural products and supplements for prevention of geriatric mood and cognitive disorders (2), as well as articles on novel preventive strategies for late-life depression (3) and suicide (4), and the topics of end-of-life care including dementia (5) and palliative care (6). The breadth of the topics is reflective of the breadth and depth of the field of geriatric mental health, which is charged with developing strategies for maintaining optimal mental and physical health and functioning in older adults.Healthcare efforts have been long focused on increasing longevity that resulted in the increase in the average life expectancy in the United States by 20 years over the last seven decades. To respond to this challenge, geriatric psychiatry research is no longer restricted to the studies of late-life diseases but is developing an understanding of successful aging and preventive strategies to ensure lasting independence, resilience, and optimal quality of life for the rapidly growing U.S. and global population of older adults.At the same time, the needs of older adults with late-life depression and suicidal behavior, and those with cognitive disorders with neuropsychiatric symptoms and their families, remain the main focus of attention for geriatric psychiatrists and allied mental health practitioners. Depression is a leading cause of disease burden, disability, and distress for millions of older adults. In 2010, almost 6,000 adults over age 65 died by suicide in the United States, and perhaps 200,000 worldwide. Because older adults are the most rapidly growing segment of the population, the rates of depression and suicide in this age group are expected to rise dramatically in coming decades. Development of effective preventive approaches to late-life depression and suicide is a major public health priority.In addition, the burden of chronic medical illnesses has increased dramatically, with over 90% of the U.S. older adults living with one or more chronic and life-threatening diseases. Families often have to cope with the daunting task and stress of caregiving for many years, which has a detrimental effect on caregiver health. Dementia is a common terminal illness plagued with neuropsychiatric symptoms that contributes to the high healthcare costs associated with Alzheimer’s disease and related dementing illnesses. Patients, families, and the society at-large often struggle to cope with the burden of increasing dependence while trying to maintain meaningful personal experiences. Geriatric psychiatrists are often involved with caring for patients with terminal dementia or medical illnesses and their families. End-of-life care ethical and practical issues are becoming increasingly important for clinicians and researchers. A patient- and family-centered approach helps optimize health by addressing the whole person’s balance of body, mind, and spirit.We are grateful to all contributors to this issue, all of whom are prominent scholars and researchers in the field of geriatric mental health, for their thoughtful and forward looking contributions. We hope the readers will enjoy the state-of-art summary of the field provided in the current issue.References1 Depp CA, Martin AS, Jeste DV: Successful aging: implications for psychiatry. Focus 2013; 11:3–14Link, Google Scholar2 Varteresian TC, Merrill DA, Lavretsky H: The use of natural products and supplements in late-life mood and cognitive disorders. Focus 2013; 11:15–21Link, Google Scholar3 Okereke OI, Lyness JM, Lotrich FE, Reynolds CF: Depression in late-life: a focus on prevention. Focus 2013; 11:22–31Link, Google Scholar4 Conwell Y: Suicide and suicide prevention in later life. Focus 2013; 11:39–47Link, Google Scholar5 Keenmon C, Sultzer D: The role of antipsychotic drugs in the treatment of neuropsychiatric symptoms of dementia. Focus 2013; 11:32–38Link, Google Scholar6 Irwin SA: Palliative care. Focus 2013; 11:48–51Link, Google Scholar FiguresReferencesCited byDetailsCited ByClinical Characteristics of Comorbid Narcissistic Personality Disorder in Patients With Borderline Personality DisorderJournal of Personality Disorders, Vol. 32, No. 4Forensische Psychiatrie, Psychologie, Kriminologie, Vol. 12, No. 3 Volume 11Issue 1 Winter 2013Pages 1-2Geriatric Psychiatry PDF download

Use of antipsychotic drugs and lithium in mania

Studies highlighting the difficulties associated with lithium suggest that the role of antipsychotic drugs and mood stabilizers in bipolar disorder should be reconsidered. To review the efficacy and mode of action of antipsychotic drugs in mania, and to consider the differences between official guidelines and routine clinical practice in the use of these agents for mania. Review of research, guideline- and practice-based literature. Guidelines recommend lithium or valproate as first-line treatments for mania, and antipsychotic agents only as 'adjuncts' for agitation, dangerous behaviour or psychosis. However, in routine practice, antipsychotic drugs are often prescribed. The effectiveness of these agents in mania has been established by several studies; newer atypical compounds demonstrate antimanic efficacy with a reduced incidence of neurological side-effects. Antipsychotic drugs are important in the treatment of bipolar disorder and mania. Future studies should evaluate the long-term efficacy and safety of newer atypical antipsychotic agents, and the place of anticonvulsants in combination with antipsychotics in bipolar disorder.