Second-generation Medications Research Articles

Extrapyramidal Effects of First and Second Generation Antipsychotics: A Review

Antipsychotics are essential for treating major psychiatric disorders like schizophrenia. Second-generation antipsychotics were developed to reduce the risk of extrapyramidal symptoms (EPS) caused by antipsychotic medications. While second-generation drugs have a lower risk of EPS than first-generation treatments, studies show that they can still cause EPS, with clozapine being the least risky and risperidone the most. A literature search of PubMed and Scopus databases until April 2023 found that high doses, a history of past EPS, comorbidities, and specific second-generation medications can increase the risk of EPS. The choice of a first-generation comparator also influences study findings. Although the prevalence and severity of EPS vary with antipsychotics, these medications have not met expectations in terms of tolerability. EPS is still a clinical issue, even in the era of second-generation antipsychotics. This review offers a concise overview of EPS induced by antipsychotics.

OLANZAPINE FOR NAUSEA AND VOMITING IN VARIOUS ETIOLOGIES : A REVIEW

Nausea is an unpleasant response followed by the risk of vomiting that results rapid forced ejection of gastric substance from the stomach upwards and out of the mouth. The Gastrointestinal tract, vestibular system, and thalamus are the sites that cause this event. Serotonin type 3 (5-HT3), Mu, neurokinin-1 (NK-1), kappa opioids, dopamine type 2 (D2) are CTZ receptors that cause emesis. 5-HT3 antagonists, antihistamines, and phenothiazines are common antiemetic agents. Olanzapine is an atypical antipsychotic second-generation medication with antiemetic properties. This article review used a classical method to identify studies related to the mechanism and efficacy of olanzapine as an antiemetic. The journal article related to olanzapine in nausea and vomiting that published on 2002 until 2022 for critical appraisal. The purpose of this literature review is to provide a review of antiemetics, especially olanzapine as a therapy option, as well as to evaluate the mechanism and efficacy of olanzapine. The activity of olanzapine with several receptors associated with nausea and vomiting suggests that it may have antiemetic activity. Olanzapine inhibits the 5-HT2C receptor, which is located near small intestine enterochromaffin cells and is required for the emetic response. In CINV therapy, research suggests combining olanzapine 10 mg with a 5-HT3 antagonist, NK-1 antagonist, dexamethasone. There is a lack of data in literature on the use of olanzapine in hyperemesis gravidarum. From the review we concluded that olanzapine can be considered for use as a therapy for the treatment of nausea and vomiting.

The Novel Antipsychotic Lumateperone (Iti-007) in the Treatment of Schizophrenia: A Systematic Review.

Lumateperone (also known as ITI-007 or ITI-722) represents a novel second-generation medication characterized by a favorable safety and tolerability profile. This is attributed to its notable selectivity for D2 receptors within specific regions of the brain. The U.S. Food and Drug Administration (FDA) granted approval for the treatment of schizophrenia in adults in December 2019. Additionally, it gained approval for addressing depressive episodes associated with bipolar I and II disorders in adults, either as a standalone therapy or in conjunction with lithium or valproate, in December 2021. The objective of this investigation is to systematically review the existing literature to assess the safety, tolerability, and efficacy of lumateperone in the treatment of schizophrenia. Lumateperone has demonstrated effectiveness in addressing positive, negative, and cognitive symptoms associated with schizophrenia. The evaluation of safety indicators in the reviewed studies indicates that lumateperone is deemed to be a well-tolerated and safe antipsychotic. Additional research is warranted to explore lumateperone's efficacy in managing major depressive disorders, behavioral issues in Alzheimer's disease and dementia, sleep maintenance insomnia, bipolar disorders, and personality disorders.

Clinical Effectiveness of Second-Generation Injectable Antipsychotics


 The evidence in this report is limited because statistical information was not adequately reported in included studies.
 When comparing second-generation paliperidone palmitate injections and first-generation haloperidol decanoate injections, there is little-to-no difference in treatment success or adverse events.
 When comparing second-generation risperidone injections and first-generation haloperidol decanoate and fluphenazine decanoate injections given together, there is little-to-no difference in whether patients discontinue treatment.
 Hospitalization appears higher for patients who receive haloperidol decanoate injections compared to those who receive second-generation risperidone or aripiprazole injections, but there is little-to-no difference when comparing injections of risperidone to those of haloperidol decanoate and fluphenazine decanoate given together.
 There is little-to-no difference between patients who stop treatment when comparing risperidone injections to any oral second-generation antipsychotics, second-generation olanzapine injections compared to oral olanzapine, or aripiprazole injections compared to oral aripiprazole. There is little-to-no difference in adverse events between patients given aripiprazole injections compared to those given oral aripiprazole.
 Some studies showed a difference in relapse between second-generation injections compared to oral second-generation medication, while other studies showed little-to-no differences.
 Patients may experience fewer hospital days when given olanzapine injections compared to those receiving oral olanzapine.

Time-series analysis of recent antihyperglycemic medication prescribing trends for a diverse sample of Medicare enrollees with type 2 diabetes mellitus in an integrated health system.

Despite high type 2 diabetes mellitus (T2DM) prevalence in Medicare enrollees, newer therapeutic options, and revised treatment guidelines, little is known about US antihyperglycemic prescribing trends after 2015. This research describes recent monthly antihyperglycemic prescribing trends in a large, diverse population of Medicare enrollees from the US Mid-Atlantic region. Encounter data (July 2018-July 2020) for Medicare enrollees 65 years of age or older with T2DM were extracted from electronic health records of a large integrated health system. Descriptive time-series regression models were estimated to describe monthly prescribing rates (ie, prescription orders per 100 eligible plan members with T2DM) overall and by medication subgroups for all-eligible and continuously-eligible samples. Trends in monthly prescription orders per 100 eligible plan members with T2DM were reported. The monthly all-eligible member sample (n > 22,000) exhibited an overall positive baseline monthly prescribing rate of 23.88 T2DM medication orders per 100 members with T2DM and a significant positive monthly prescribing rate trend (ie, change) of 0.12 T2DM medication orders per 100 members with T2DM (P < 0.05). Subgroup T2DM medication order rates per 100 members with T2DM at baseline were 16.28 for first-generation medications, 3.87 for human insulins, 3.04 for insulin analogs, 0.58 for second-generation medications, and 0.11 for combination medications. Human insulins, insulin analogs, and second-generation medications had positive monthly trends (P < 0.05). Among second-generation medications, sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) agonists had positive monthly trends (P < 0.05). Continuously eligible members with T2DM (n = 19,185) had no significant overall monthly prescribing trend; however, human insulins, insulin analogs, and second-generation medications and the SGLT-2 inhibitor class had positive monthly prescribing trends (P < 0.05). In a diverse Medicare sample, this study observed increasing monthly trends for second-generation medications, human insulins, and insulin analogs consistent with emerging evidence. Among second-generation medications, SGLT-2 inhibitors became the most commonly prescribed over time.

Dietary Habits and Obesity in Patients with Psychotic Disorders in Rural Areas in Northwestern Greece

People suffering from psychotic disorders display high rates of physical morbidity and mortality in comparison to the general population. The present study explores the relation between the dietary habits, the prevalence of obesity and the occurrence of physical morbidity in patients who suffer from psychotic disorders in rural regions of northwest Greece. Two scales were applied to evaluate the quality of life (Quality of Life Questionnaire II, Moorehead–Ardelt) and the dietary habits (Dietary Instrument for Nutrition Education (DINE) Questionnaire) of these patients. The study sample used in this study consisted of 55 patients who suffered from a psychotic disorder. Most (75%) were male, with a mean age of 51.5 years and an average duration of disease of 25.1 years. Of these, 38.2% (21 patients) were obese with a BMI &lt; 30 Kg/m2, 32.7% (16 patients) were overweight and 29.1% had a normal body weight. The majority of the sample, 80%, was treated with second-generation medications. With regards to their dietary habits, 94.5% (52/55) of the sample showed a low intake of fiber content, 67.3% (37/55) showed a high intake of saturated fats and 100% (55/55) a low intake of unsaturated fats. The rates of physical morbidity in the present sample were 21.8% with at least one disease and 14.5% with two diseases, whereas 5.5% met the criteria for metabolic syndrome (MS). The average BMI of the women was statistically significantly higher compared to the men. The majority of the sample (69.1%) exhibited acceptable levels of quality of life. No co-relations of quality of life with BMI were found. In addition, no co-relations of BMI with dietary habits were revealed.

New Horizons. A New Paradigm for Treating to Target with Second-Generation Obesity Medications.

In treating obesity as a chronic disease, the essential goal of weight loss therapy is not the quantity of weight loss as an end unto itself but rather the prevention and treatment of complications to enhance health and mitigate morbidity and mortality. This perspective on obesity care is consistent with the complications-centric American Association of Clinical Endocrinology (AACE) obesity guidelines and the diagnostic term of adiposity-based chronic disease (ABCD). Many complications require 10% to 20% weight loss to achieve therapeutic goals; however, existing obesity medications fail to produce ≥10% weight loss in the majority of patients. In June, 2021, semaglutide 2.4 mg/week was approved for chronic weight management. Phase 3 clinical trials demonstrated that this medication produced > 10% placebo-subtracted weight loss, more than half of patents lost ≥15%, and over one third lost ≥20% of baseline weight. This essentially doubles effectiveness over existing obesity medications, provides sufficient weight loss to ameliorate a broad range of complications, and qualifies as the first member of a second-generation class of obesity medications. The advent of second-generation medications fully enables a treat-to-target approach for management of ABCD as a chronic disease. Specifically, with this degree of efficacy, second-generation medications permit active management of body weight as a biomarker to targets associated with effective treatment and prevention of specific complications. ABCD can now be managed similar to other chronic diseases such as type 2 diabetes, hypertension, and atherosclerosis, which are treated to biomarker targets that can be modified based on the clinical status of individual patients [ie, hemoglobin A1c (HbA1c), blood pressure, and low-density lipoprotein cholesterol (LDL-c)] to prevent the respective complications of these diseases.

Public Health Center on Tuberculosis Management in Korea: From 1945 to the Late 1970s.

Tuberculosis (TB) was called "ruinous disease" in colonial Korea. However, it is no longer a threat to the lives of the Korean people. Public Health Centers (PHC) have played a role in the reduction of TB prevalence by providing free medical treatment and vaccination. PHCs are valued highly for suggesting the possibility of TB suppression. Despite these outcomes, the achievements of PHCs may be slightly overstated from a therapeutic perspective. PHCs could not prevent and treat TB well in their conditions at the time in Korea. The concept of PHC in Korea that emphasizes prevention rather than treatment came from the US. There is a need to reevaluate the achievements of PHCs in TB control. The South Korean government established an anti-TB network system named "Health-Net" in 1962. PHCs were the primary institutions against TB. The "100,000 Tuberculosis Patients Registration Program" was conducted by the government through PHCs, which was an effective anti-TB program. The success of the registration program was a result of the effort by PHCs and anti-TB private organizations. Free medications distributed by PHCs helped to decrease mortality due to TB. The implementation of the "Tuberculosis Prevention Act" in 1968 strengthened the management function of PHCs. A larger anti-TB budget by the law made new prescriptions possible, including second-generation medications. It also enabled the recruitmen of more manpower for TB control, finding TB patients, and BCG vaccination. However, there were some limits of PHCs' therapeutic role in these achievements. At first, the lower cure rate in patients receiving medical care at PHCs was a main problem. The fact that PHCs accounted for nationwide TB patients was another problem. It is unclear that PHCs had an active role in TB management. There were no specific TB treatment programs except the follow-up treatment dependent on the only one medication. PHCs in the 1960s and 1970s achieved the results of patient registration and free treatment in TB control, but there was a limit to their therapeutic function.

Schizophrenia Pharmacology: Past, Present, and Future Targets for Intervention.

The first medication for schizophrenia was discovered serendipitously. Years later, it was shown that the medication worked by blocking dopamine, and to this date, all available antipsychotic medications also work by blocking dopamine. They differ, however, in many other respects. The so-called first-generation medications have a wide range of receptor affinities, but in all cases, they have a higher affinity for dopamine receptors than for serotonin receptors. In contrast, so-called second-generation medications have a higher affinity for serotonin receptors than for dopamine receptors. A third category of medication acts as a partial agonist at the dopamine receptor. It is likely that a fourth category will also become available and these medications will act as agonists at the N-methyl-d-aspartate receptor, although clinical trials thus far have struggled to demonstrate efficacy. In addition to medications that treat symptoms of psychosis, medications are under development to directly target some of the more fundamental aspects of cognition that are impaired in schizophrenia, including memory, sensory processing, attention, and executive function. Several promising strategies are discussed.

Subjective Experiences of Antipsychotic Treatment: A Comparison of First- and Second-generation Medications among Patients with Schizophrenia

Subjective Experiences of Antipsychotic Treatment: A Comparison of First- and Second-generation Medications among Patients with Schizophrenia

Reduction in inpatient resource utilization and costs associated with long-acting injectable antipsychotics across different age groups of Medicaid-insured schizophrenia patients.

Objective:Evaluate utilization of inpatient healthcare resources and associated costs after 12 months of treatment using long-acting injectable (LAI) antipsychotic medications among a large sample of Medicaid-insured patients categorized by different age groups.Method:Adult patients with schizophrenia were identified from the Thomson Reuters MarketScan Research database (1/1/2006–12/31/2010) before initiation of treatment using LAI antipsychotic agents. Utilization of inpatient healthcare resources and associated direct medical costs were compared for 12-month baseline and 12-month follow-up periods.Results:Among 3,094 Medicaid-insured patients with schizophrenia initiating treatment with LAIs, the mean number of all-cause hospitalizations and hospitalization days were reduced by 24% and 31% (p<0.0001) compared with baseline, respectively, with similar significant reductions among all age groups (18–30, 31–40, 41–50, and 51–60 years). During 12-month follow-up with LAIs, mean reductions in all-cause costs were $4,369 (18–30 years, p<0.0001), $3,681 (31–40 years, p<0.0001), $2,051 (41–50 years, p=0.1332), and $4,492 (51–60 years, p=0.0107). Subanalyses separating first-generation and second-generation medication groups resulted in mean reduction in all-cause costs of $3,561 and $3,645, respectively.Conclusions:Results from this large cohort study provide naturalistic real-world evidence of the utility of LAIs in patients with schizophrenia and suggest that these agents may help to reduce the risk of relapse across all age groups (especially among younger patients). Given that relapse prevention is the ultimate goal of antipsychotic treatment, results from this large Medicaid patient population establish the value of LAIs for the management of schizophrenia.

Attitudes towards antipsychotics among patients with schizophrenia on first- or second-generation medications.

Background:Given the paucity of research in this area, this study attempted to assess attitudes toward antipsychotic medications and its correlates among patients with schizophrenia, either on first-generation antipsychotics (FGAs) or second-generation antipsychotics (SGAs) medications.Materials and Methods:Structured assessments of attitudes to antipsychotics, psychopathology, insight and side-effects were carried out in 120 patients with DSM-IV schizophrenia; 89 of these were on SGAs and 31 on FGAs.Results:Patients had predominantly positive attitudes toward antipsychotics. Severity of side-effects was the principal correlate of attitudes, explaining 19.5% of the variance, followed by greater insight (4.2% of the variance). Other factors such as younger age, male gender, employment, higher family income, urban residence and lower symptom-severity explained only a negligible proportion of the variance (0.2%) in attitudes. Patients on SGAs had more positive views of their medications than those on FGAs. They felt more normal on their medications, believed that their thoughts were clearer on medications, felt that good things about their medications outweighed the bad and believed that their medications helped them from falling ill again. In addition, they did not feel as tired and sluggish on their medications and did not believe that medications were unnatural or controlled their bodies.Conclusions:Positive attitudes toward antipsychotics were common among patients with schizophrenia. Attitudes were principally determined by severity of side-effects and insight levels. Patients on SGAs had better attitudes, possibly because of less severe side-effects and greater insight among them. The importance of exploring patients’ attitudes toward their antipsychotics is highlighted by this study.

Antipsychotics in Adults With Schizophrenia: Does Sponsorship of Research Articles Affect the Findings?

Letters5 March 2013Antipsychotics in Adults With Schizophrenia: Does Sponsorship of Research Articles Affect the Findings?Thomas E. Finucane, MDThomas E. Finucane, MDFrom Johns Hopkins Bayview Medical Center, Baltimore, Maryland.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-5-201303050-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:As suggested in Hartling and colleagues' review comparing first-generation with second-generation antipsychotics (1) and shown in other contexts, the sponsorship of research articles may affect the findings. Can the authors say anything about the effects of pharmaceutical sponsorship on the outcomes of the trials that they reviewed? They note that chance of bias was substantial in many of the studies, and funding was not disclosed in 19% of articles (1). Corrupt research might be a particular problem with these vendors, as they have been paying billions of dollars in fines recently for a variety of behaviors related ...Reference1. Hartling L, Abou-Setta AM, Dursun S, Mousavi SS, Pasichnyk D, Newton AS. Antipsychotics in adults with schizophrenia: comparative effectiveness of first-generation versus second-generation medications: a systematic review and meta-analysis. Ann Intern Med. 2012;157:498-511. [PMID: 22893011] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Johns Hopkins Bayview Medical Center, Baltimore, Maryland.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAntipsychotics in Adults With Schizophrenia: Comparative Effectiveness of First-Generation Versus Second-Generation Medications Lisa Hartling , Ahmed M. Abou-Setta , Serdar Dursun , Shima S. Mousavi , Dion Pasichnyk , and Amanda S. Newton Antipsychotics in Adults With Schizophrenia: Does Sponsorship of Research Articles Affect the Findings? Lisa Hartling , Amanda S. Newton , and Serdar Dursun Metrics 5 March 2013Volume 158, Issue 5_Part_1Page: 362KeywordsAntipsychoticsBehaviorConflicts of interestSchizophrenia ePublished: 5 March 2013 Issue Published: 5 March 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Antipsychotics in Adults With Schizophrenia: Comparative Effectiveness of First-Generation Versus Second-Generation Medications

Debate continues about the comparative benefits and harms of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) in treating schizophrenia. To compare the effects of FGAs with those of SGAs in the treatment of adults aged 18 to 64 years with schizophrenia and related psychosis on illness symptoms, diabetes mellitus, mortality,tardive dyskinesia, and a major metabolic syndrome. English-language studies from 10 electronic databases to March 2012, reference lists of relevant articles, and gray literature. Randomized trials for efficacy and cohort studies at least 2 years in duration for adverse events. Two independent reviewers extracted data from 114 studies involving 22 comparisons and graded the strength of evidence for primary outcomes as insufficient, low, moderate, or high using the Grading of Recommendations Assessment, Development and Evaluation approach. Few differences of clinical importance were found for core illness symptoms; lack of precision in effect estimates precluded firm conclusions for many comparisons. Moderate-strength evidence showed a clinically important benefit of haloperidol over olanzapine for improving positive symptoms, but the benefit was scale-dependent: It was seen when the Scale for the Assessment of Positive Symptoms was used but not when the Positive and Negative Syndrome Scale (PANSS) was used. Moderate-strength evidence showed a clinically important benefit of olanzapine over haloperidol in improving negative symptoms when the PANSS and the Scale for the Assessment of Negative Symptoms were used. Low-strength evidence showed no difference in mortality for chlorpromazine verus clozapine or haloperidol versus aripiprazole,increased incidence of the metabolic syndrome for olanzapine versus haloperidol (risk differences, 2% and 22%), and higher incidence of tardive dyskinesia for chlorpromazine versus clozapine (risk differences, 5% and 9%). Evidence was insufficient to draw conclusions for diabetes mellitus. All studies had high or unclear risk of bias. Length of study follow-up was often too brief to adequately measure adverse events. Medication comparisons, dosage, and outcome measurement were heterogenous for head-to-head comparisons. Selective patient populations limit generalizability. Clear benefits of FGAs versus SGAs for treating schizophrenia remain inconclusive because of variation in assessing outcomes and lack of clinically important differences for most comparisons. The strength of evidence on safety for major medical events is low or insufficient. Agency for Healthcare Research and Quality.

Medication Adherence and Hospitalization Among Patients With Schizophrenia Treated With Antipsychotics

This analysis assessed rates of medication adherence and predictors of nonadherence and hospitalization among patients treated with long-acting injectable and oral antipsychotic therapies. Data were from a retrospective analysis of Florida Medicaid recipients with schizophrenic disorder (ICD-9-CM code 295.XX) who received a prescription for an antipsychotic between July 1, 2004, and June 30, 2005. Patients were required to have filled one additional antipsychotic prescription during follow-up. Adherence measures included medication possession ratio (MPR), medication persistence, medication consistency, and maximum gap in treatment. Multivariate logistic regression models identified predictors of nonadherence and hospitalization. Patients were considered adherent if they had an MPR ≥ .8. A total of 12,032 patients met selection criteria. The mean ± SD MPR was .79 ± .23, medication persistence was 94.1% ± 16.4%, medication consistency was 83.3% ± 16.4%, and the maximum gap in treatment was 29.7 ± 41.4 days. Thirty-seven percent of patients were hospitalized for any cause, and 32% had a psychiatric hospitalization. Predictors of nonadherence included newly starting treatment; younger age; a substance abuse diagnosis; use of a mood stabilizer, antidepressant, anxiolytic, or anticholinergic; and receipt of long-acting first-generation antipsychotics. Receipt of long-acting second-generation therapy or receipt of both first- and second-generation medications was associated with lower likelihood of nonadherence. Predictors of hospitalization risk included a diagnosis of other psychoses or substance abuse, anticholinergic use, and nonadherence to therapy. Results document rates of antipsychotic adherence and predictors of nonadherence and hospitalization. Findings may be useful to health plan administrators, formulary decision makers, and physicians.

A Call for Improved Prevention and Reduction of Obesity Among Persons With Serious Mental Illness

The primary purpose of this Open Forum is to alert the psychiatric community to a recently published policy paper by the National Association of State Mental Health Program Directors (NASMHPD), Obesity Reduction and Prevention Strategies for Individuals With Serious Mental Illness. The report was developed through a comprehensive review of materials and extensive discussions in an expert panel meeting held August 9-10, 2007. The report indicates that psychiatrists who disregard the physical health of their patients and focus only on treating the patient's psychiatric condition are not only neglectful but are also contributing to the epidemic of obesity among people with serious mental illness. The NASMHPD Medical Directors Council has concluded that psychiatrists in the public mental health system are doing far too little to prevent and reduce obesity among patients the system serves.

Position statement Euromed Network on Mental Health and Migration

Introduction/contextMigration is one of the most important challenges ofthe XXIst century. Europe in particular has seen a dra-matic rise in migration over the past decade, and allindications suggest that this increase will continue wellinto the future.It is becoming increasingly clear that the mentalhealth needs of migrants require specific attention.Recent reports indicate that migrants are underrepre-sented in mental health care centers, are subject tomore diagnostic error, more coercive measures andinvoluntary treatment, less psychotherapy and less sec-ond generation medication [1,2]. The specific relation-ship between migration and mental health remainsunclear, although a number of protective and risk fac-tors have been identified [3]. What would appear to beclear is that there is a robust relationship betweenmigration and schizophrenia, with odds rations varyingfrom 2 to 8 for individuals from the European commu-nity for the former and Afrocaribbean migrants for thelatter [4]. In addition, research indicates that the chil-dren of immigrants-second generation citizens-also havehigher odds ratios for the development of psychotic andaffective disorders.All of this has implications for psychology and psy-chiatry as a whole. The field of transcultural psychiatryovertly emphasizes the biopsychosocial model: thatmigration overwhelmingly impacts the incidence of schi-zophrenia emphasizes that experience itself, and notsimply biological structure or genetics is involved. Diffi-culties with diagnosis demand reconsideration of exist-ing nosological systems, as reflected, for example, inthe pathway towards the DSM-V and the ICD-11,and treatment issues, be they psychotherapeutic orpharmacological indicate that treatments may need tobe adapted given the cultural and/or ethnic backgroundand migratory experience of the patient [5,6].A clear conclusion is thatthe mental health needs ofimmigrants are not being met [7]. This can be seen atthe two levels identified above and are related to bothprevention and treatment. To that end the Euromednetwork calls for the development of both clinical andinstitutional cultural competence by attending toresearch, training, and advocacy. This human rightsissue which involves considerable suffering implicates alllevels of stakeholders, from individuals to their families,from clinicians to the institutions they work for, tohealth care systems, professional associations, and pro-fessional training programs.ResearchMost all of what we know about migration and mentalhealth comes from research. Although considerablestrides have been made in this area, it is clear that thereremains much to be done. We call for more research tobe facilitated and carried out in this area. It is note-worthy that the vast bulk of psychological and psychia-tric research uses a“gold standard” that is notrepresentative of more than 80% of the world’spopula-tion, which means that much of what we know may beof questionable applicability to the latter, which is parti-cularly true of clinical trials.Indeed, the field of ethnopsychopharmacology clearlydemonstrates that pharmacokinetics and pharmacody-namics are not“universal” but rather vary with thegenetic makeup [6]. Thus treatment, be it pharmacologi-cal or psychological, needs to be investigated at morepopulation specific levels in order to ensure that allpatients receive an optimal quality of care.

Antipsychotic Dose Equivalents and Dose-Years: A Standardized Method for Comparing Exposure to Different Drugs

A standardized quantitative method for comparing dosages of different drugs is a useful tool for designing clinical trials and for examining the effects of long-term medication side effects such as tardive dyskinesia. Such a method requires establishing dose equivalents. An expert consensus group has published charts of equivalent doses for various antipsychotic medications for first- and second-generation medications. These charts were used in this study. Regression was used to compare each drug in the experts' charts to chlorpromazine and haloperidol and to create formulas for each relationship. The formulas were solved for chlorpromazine 100 mg and haloperidol 2 mg to derive new chlorpromazine and haloperidol equivalents. The formulas were incorporated into our definition of dose-years such that 100 mg/day of chlorpromazine equivalent or 2 mg/day of haloperidol equivalent taken for 1 year is equal to one dose-year. All comparisons to chlorpromazine and haloperidol were highly linear with R(2) values greater than .9. A power transformation further improved linearity. By deriving a unique formula that converts doses to chlorpromazine or haloperidol equivalents, we can compare otherwise dissimilar drugs. These equivalents can be multiplied by the time an individual has been on a given dose to derive a cumulative value measured in dose-years in the form of (chlorpromazine equivalent in mg) x (time on dose measured in years). After each dose has been converted to dose-years, the results can be summed to provide a cumulative quantitative measure of lifetime exposure.

Impact of antipsychotic medication on family burden in schizophrenia: Longitudinal results of CATIE trial

Background This study evaluated the effectiveness of first- and second-generation antipsychotics in reducing family burden associated with schizophrenia. Methods The family caregivers of 623 SCID-diagnosed patients enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) randomly assigned to a first-generation antipsychotic (perphenazine) or one of four second-generation drugs (olanzapine, quetiapine, risperidone or ziprasidone) were interviewed about resources provided and stresses experienced at baseline and followed for 18 months. Patient symptoms, side effects and service use were assessed as well. Hierarchical regression analyses evaluated the effect of treatment assignment on four burden factors: problem behavior, resource demands and disruption, impairment in activities of daily living and patient helpfulness. Intention-to-treat analyses with all available observations classified based on initial treatment assignment, including observations after medications changed were followed by secondary analyses excluding observations after the first medication change, i.e. only considering initial medication. Results Despite significant reductions on the problem behavior and resource demands/disruption factors, there were no significant differences between perphenazine and any of the second-generation medications. When only initial treatment period observations were included, patients were perceived as more helpful when medicated with perphenazine as compared to risperidone. In comparisons between second-generation drugs, patients on quetiapine were perceived as more helpful than those on risperidone ( p = 0.004). Conclusion In this 18-month randomized trial, there was no evidence of superiority of second-generation antipsychotics in relieving family burden.

The Appropriateness of Routine Medication Treatment for Schizophrenia

Although national guidelines specify appropriate strategies for the treatment of schizophrenia, this disorder presents challenges to clinicians and health-care organizations. To improve care, it is useful to understand how often patients receive appropriate treatment. Most research evaluating treatment was performed when first-generation antipsychotic medications were the modal treatment. Given that most prescriptions are now for second-generation medications, this study describes current clinical problems and the appropriateness of treatment in routine practice. Between 2002 and 2004, a random sample of patients (n = 398) were interviewed at baseline and 1 year at 3 Department of Veterans Affairs mental health clinics. Symptoms and side effects were assessed. Analyses examined whether prescribing were consistent with guidelines in patients with significant psychosis, depression, parkinsonism, akathisia, tardive dyskinesia, or elevated weight. Few patients met criteria for depression, parkinsonism, or akathisia. A total of 44% of patients had significant psychosis, 11% had tardive dyskinesia, and 46% were overweight. Medication was appropriate in 27% of patients with psychosis, 25% of patients with tardive dyskinesia, and 2% of patients with elevated weight. Management of elevated weight improved modestly over time. Treatment was more likely to improve for patients whose psychiatrists had more than 12 patients with schizophrenia in their caseload. Compared with the 1990s, outpatients are more likely to have significant psychosis. The rate of appropriate treatment of psychosis is unchanged. Weight gain has become a prevalent side effect, yet treatment is rarely changed in response to weight. There is a need for interventions that improve management of psychosis and weight.