Side Effects Of Antipsychotic Medications Research Articles

Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong

This research examines the experience of stigma associated with psychiatric treatment among Chinese patients with schizophrenia in Hong Kong. In focus groups patients described stigma experiences related to clinic visits and the side effects of antipsychotic medications. Additionally, they revealed various adverse treatment experiences during hospitalization which point to the presence of structural discrimination. Based on the focus group findings, a questionnaire was developed and completed by 320 and 160 patients with schizophrenia and diabetes mellitus, respectively. Results showed that patients with schizophrenia were more likely to anticipate stigma, conceal illness, and default on clinic visits than patients with diabetes. Medication-induced stigma occurred in 48% of patients with schizophrenia. It brought about the unwelcome disclosure of illness, workplace difficulties, family rejection, and treatment non-adherence. Adverse experiences during hospitalization were reported by 44% of patients with schizophrenia. They included negative staff attitudes, excessive physical/chemical restraints, inadequate information/complaint systems, and limited rights. We conclude that stigma, at both individual and structural levels, represents a central experience of the treatment of schizophrenia in Hong Kong. Because inequitable health policy, resource allocation, and service organization privilege service providers’ control over users, treatment-related stigma may be a prime example of the social production of stigma and discrimination based on power difference between the stigmatizers and the stigmatized. To examine this critically we need to redirect stigma research to tractable clinical circumstances and structural mechanisms that produce and maintain stigmatizing and discriminatory psychiatric practice. Destigmatization programs must be evaluated not only by change in public attitudes but also by how much they reduce structural stigma and improve patients’ lives.

Assessment of the side effects of antipsychotic medication

Assessment of the side effects of antipsychotic medication

Assessment of the side effects of antipsychotic medication

Antipsychotic medication is the first-line treatment for people with psychosis in the State Hospital, Carstairs: Scotland's only high-security forensic hospital. The Clinical Standards for Schizophrenia (Clinical Standards Board for Scotland 2001) require clinicians to use standardised rating scales to monitor the side effects associated with medication. Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) (Day et al 1995) was implemented in the hospital in December 2003. A baseline audit was carried out following its implementation to establish the incidence of side effects. Of those patients audited (n=152), 87 (57 per cent) reported either low or medium (n=51, 34 per cent) LUNSERS scores, indicating an acceptable level of medication tolerance. It is expected that clinicians will continue to use LUNSERS as part of their routine clinical practice to help inform patients and meet national standards.

Neuroleptic Dysphoria, Comorbid Drug Abuse in Schizophrenia and the Emerging Science of Subjective Tolerability—Towards a New Synthesis

One of the frequent but under-recognized side effects of antipsychotic medications is the subtle subjective changes including feelings of anxiety, distress and lack of pleasure, which are collectively labeled as neuroleptic-induced dysphoria and, ultimately, often lead to dislike and aversions to medications, with serious clinical consequences. Yet, those very patients take to frequent abuse of illicit drugs. Several surveys estimated the association of drug abuse in schizophrenia as ranging somewhere between 10–70%. One popular and frequently accepted explanation for such high association has been the self-medication hypothesis. In other words, patients take to illicit drugs as a way of dalleviating symptoms of the illness as well as medication-induced side effects, particularly neuroleptic dysphoria. Recent clinical and neuro-imaging studies have, for the first time, directly linked the genesis of neuroleptic dysphoria to the dopamine-binding ratios in the nigrostriatal complex. This recent evidence comes from the study of dopamine receptor occupancy using PET scanning as well as from dopamine depletion SPECT studies. Meanwhile, emerging evidence from research in the addiction field has implicated dopamine in the same neural circuitry in motivational and reinforcement behaviour, which is central to initiation and continuation of dependency states. As the self-medication hypothesis proved incapable of explaining all the varied pictures of dysphoria and comorbid addictions, a unifying hypothesis is put forward to argue that both vulnerability to drug addictions and medication-induced dysphoria vary on independent facets of the illness itself. The mechanism that possibly links both lies in a dysregulated dopamine signaling in the nucleus accumbens resulting from frontal/cortical and hippocampal dysfunction. Besides the neurochemical argument, clinical and epidemiological data seem also to add support to this proposition. Such proposal not only represents a major rethinking of the concept of schizophrenia and its varied domains and manifestations but has also significant clinical implications in understanding and better management of comorbid drug abuse in the context of the illness itself. The recent intensified research efforts to understand the central mechanisms related to the role of dopamine in reward, punishment and pleasurable experiences as well as motivational and reinforcement behaviour, opens a new vista in understanding how and why patients like or dislike their medications based on their subjective responses to medication-taking. It is possible that the field is on the verge of a new science, which can collectively be called: “The Science of Subjective Tolerability Disorders.”

Ultraschallgestützte Analyse von Gang- und Handmotorik schizophrener Patienten

Neurological signs and disturbed psychomotor performance are consistently confirmed by clinical studies on schizophrenic patients. They could either be caused by the illness itself or could occur as side-effects of antipsychotic medication. Based on the clinical observation, differential diagnosis between catatonic symptoms of schizophrenia and extrapyramidal side-effects often remains unclear. Apart from their diagnostic value, motor disturbances can also be predictive parameters for prognosis of the disease and clinical response to antipsychotic treatment. Motor disturbances are mainly assessed by use of clinical ratings. In the last years, new approaches like infrared or ultrasonic movement analysis systems have been introduced to objectively determine motor disturbances in schizophrenic patients. Ultrasonic movement analysis systems calculate the three-dimensional positions of tiny markers, which are attached to moving body parts, with high spatial and temporal resolution. Thus, key parameters of gait and hand-movements can be determined exactly. Results of several studies using these new methods indicate that schizophrenia causes a primary disturbance of motor performance. Treatment with conventional antipsychotics intensifies many of the disabling motor deficiencies, whereas the influence of atypical antipsychotics on motor performance is either not detectable or much smaller. All in all, most results of studies using objective methods for the assessment of motor performance underline the advantages of treatment with atypical antipsychotics compared to conventional antipsychotics, particularly with regard to the patient's motor performance.

Loss of efferent vagal activity in acute schizophrenia

An increased heart rate has been reported in schizophrenia. It is unclear whether this is due to disease-related autonomic nervous system changes or a side effect of antipsychotic medication. Altered cardiac autonomic function might to some extent account for the elevated cardiovascular mortality rate of schizophrenic patients. We assessed heart rate variability (HRV) in 30 acute unmedicated schizophrenic patients and matched controls. Patients were re-investigated 2–4 days after initiation of treatment to assess effects of medication. Our study demonstrates that non-medicated schizophrenic patients were significantly different in heart rate (increase) and parasympathetic parameters (loss of efferent vagal activity) at rest and during deep respiration. No significant effect was found after initiation of neuroleptic therapy. We found a correlation between duration of disease and parasympathetic parameters as well as very low frequency power (VLF) and delusion (SAPS subscale). These data suggest that schizophrenia is accompanied by a loss of vagal efferent activity, probably due to disturbed cortical–subcortical circuits modulating the autonomic nervous system in acute psychosis. The definite mechanisms by which vagal activity might be suppressed in schizophrenia are unknown. Parasympathetic hypoactivity might increase the risk for sudden cardiac death and arrhythmias in this disease. Future studies are warranted to investigate the interaction between cardiac autonomic function and schizophrenia and to identify patients on risk.

Warum rauchen Schizophreniepatienten?

Patients suffering from schizophrenia are known to show an increased prevalence of nicotine addiction. The aim of this paper is to elucidate the relationship between schizophrenia and (chronic) use of nicotine. Nicotine seems to improve cognitive functions critically affected in schizophrenia, in particular sustained attention, focused attention, working memory, short-term memory, and recognition memory. Furthermore, several studies using evoked potentials (P50 paradigm) and prepulse inhibition of the acoustic startle reflex suggest that deficient preattentive information processing, a core feature of schizophrenia illness, is improved following treatment with nicotine. Smoking can also improve extrapyramidal secondary effects of antipsychotic medication and it induces cytochrome P4501A2, an enzyme system involved in the metabolism of several antipsychotics. There is substantial evidence that nicotine could be used by patients with schizophrenia as a "self-medication" to improve deficits in attention, cognition, and information processing and to reduce side effects of antipsychotic medication. Possible pharmacotherapeutic approaches for the regulation of abnormal neurotransmission at nicotinic acetylcholine receptors are discussed.

Resolution of Ziprasidone-Related Tardive Dyskinesia With a Switch to Aripiprazole

Sir: Tardive dyskinesia (TD) is a serious, potentially irreversible side effect of antipsychotic medications. Prevalence rates of 20% with the typical antipsychotics have been reported.1 Although the risk is smaller, treatment with atypical antipsychotic agents still poses a risk of TD. There is 1 report of ziprasidone-related TD in a patient who had other risk factors for TD, including advanced age, female gender, and affective illness.2 However, the report did not address the management of the patient's TD. We report a case of ziprasidone-related TD that resolved after a switch to aripiprazole therapy was made. Case report. Ms. A, a 52-year-old African American woman, was admitted for a psychotic exacerbation. She had a 20-year history of DSM-IV paranoid schizophrenia treatment characterized by frequent relapses, noncom-pliance with treatment, multiple antipsychotic trials, and hospitalizations. Her past history of TD was not known; however, over the past few years she had gained weight and had also been diagnosed with diabetes. There was no history of any illicit drug abuse. Ziprasidone 60 mg p.o. b.i.d. was initiated in December 2002 during Ms. A's hospitalization, with good control of her psychotic symptoms. Within 2 months of initiation of treatment with ziprasidone, she was noted to have buccal-oral tardive dyskinesia and had an Abnormal Involuntary Movement Scale (AIMS)3 score of 3. Vitamin E was added at a dose of 800 mg twice a day to manage the TD. She was discharged home on treatment with vitamin E 800 mg p.o. b.i.d. and ziprasidone 60 mg p.o. b.i.d. During Ms. A's follow-up outpatient visits, although her psychotic symptoms were stable, TD persisted. She had also discontinued vitamin E. After 12 months of ziprasidone therapy, a decision to switch to aripiprazole 15 mg/day was made. Over the next 2 months, her tardive dyskinesia gradually but completely remitted, and her symptoms of schizophrenia remained stable. Her AIMS score dropped to zero. Aripiprazole is an atypical antipsychotic drug with a unique mechanism of action; it inhibits central dopami-nergic neuron activity by a partial agonistic effect on the dopamine autoreceptor and also acts as an presynaptic D2 antagonist at postsynaptic D2 dopamine receptors. Through this mechanism, aripiprazole exerts activity as a dopamine agonist in hypodopaminergic states, while acting as a dopa-mine antagonist when dopaminergic activity is increased.4 Alteration of the sensitivity of dopaminergic receptors to dopamine in the corpus striatum has been studied in experimental models, and it has been proposed that the lingual-facial-buccal dyskinesia seen in humans could be the human equivalent of stereotyped behavior seen in experimental animals with chronic chlorpromazine pretreatment.5 There is also evidence from basic science studies that aripiprazole causes little D2 receptor up-regulation.6 Therefore, it is plausible that aripiprazole, by virtue of its dopamine agonistic activity, can potentially normalize D2 dopamine receptor up-regulation. These properties may play a role in both prevention of the emergence of TD and the treatment of TD. There is 1 other report of improvement of TD with aripiprazole in which improvement continued even after a conventional antipsychotic was added to the patient's regimen.7 We propose that for schizophrenic patients who have tardive dyskinesia and who do not desire clozapine treatment or cannot be prescribed clozapine due to medical contraindications, aripiprazole may provide alternate phar-macotherapy to treat psychoses and tardive dyskinesia. However, more research is needed in this direction.

Clinical effectiveness of new generation antipsychotics in adolescent patients

In addition to management of symptoms of disease, pharmacological interventions in adolescents with psychotic disorders must be clinically effective to provide the best possible outcome in terms of well-being, functioning, and disease burden. Six outcome domains should be considered: symptoms of disease, tolerability, everyday functioning, subjective well-being, family/carer burden, and treatment adherence. To date, few studies have compared the clinical effectiveness of the different new generation antipsychotics in adolescents. However, clear differences exist between available agents, particularly in terms of tolerability profile. This review will focus on the particular issues that clinicians need to consider in order to maximise the clinical effectiveness of the new generation antipsychotics in adolescent patients with psychosis. For example, adolescents are not only more susceptible to the side effects of antipsychotic medication than adults, but they are also more likely to be sensitive to the negative impact of side effects on appearance, body image, and self-esteem. Data available in children and adolescents will be reviewed, and the practical implications for patient management will be highlighted. The importance of dosing the new generation antipsychotics appropriately will also be discussed.

Metabolic Side Effects of Antipsychotic Medications: Clinical Laboratory Implications

Atypical antipsychotic medications are associated with increased risks of obesity, glucose intolerance, and diabetes, and dyslipidemia compared to the typical antipsychotic medications. Most antipsychotic medications, typical and atypical, block the D2 (dopamine) receptor; this can lead to increased prolactin levels since dopamine prevents excess prolactin secretion from the pituitary gland. The increasingly widespread use of atypical antipsychotic medications, coupled with improved awareness of medical problems in psychiatric patients, will increase the role of the clinical laboratory in managing patients with severe and persistent mental illness.

Metabolic Side Effects of Antipsychotic Medications: Clinical Laboratory Implications

Metabolic Side Effects of Antipsychotic Medications: Clinical Laboratory Implications

Loss of Efferent Vagal Activity in Acute Schizophrenia

Abstract An increased heart rate has been reported in schizophrenia. It is unclear whether this is due to disease-related autonomic nervous system changes or a side effect of antipsychotic medication. Altered cardiac autonomic function might to some extent account for the elevated cardiovascular mortality rate of schizophrenic patients. We assessed heart rate variability (HRV) in 30 acute unmedicated schizophrenic patients and matched controls. Patients were re-investigated 2–4 days after initiation of treatment to assess effects of medication. Our study demonstrates that non-medicated schizophrenic patients were significantly different in heart rate (increase) and parasympathetic parameters (loss of efferent vagal activity) at rest and during deep respiration. No significant effect was found after initiation of neuroleptic therapy. We found a correlation between duration of disease and parasympathetic parameters as well as very low frequency power (VLF) and delusion (SAPS subscale). These data suggest that schizophrenia is accompanied by a loss of vagal efferent activity, probably due to disturbed cortical–subcortical circuits modulating the autonomic nervous system in acute psychosis. The definite mechanisms by which vagal activity might be suppressed in schizophrenia are unknown. Parasympathetic hypoactivity might increase the risk for sudden cardiac death and arrhythmias in this disease. Future studies are warranted to investigate the interaction between cardiac autonomic function and schizophrenia and to identify patients on risk.

The quest for well-being: a qualitative study of the experience of taking antipsychotic medication.

Antipsychotic medication is integral to the treatment of severe and enduring mental health problems (e.g. schizophrenia). Such medication is associated with significant adverse side effects that can affect treatment adherence. To date there have been few attempts to analyse qualitatively service users' experience of taking antipsychotic medication. This study, conducted in Exeter, South West England, investigates the subjective experience of side effects of antipsychotic medication to gain a greater understanding of service users' experiences and to gain insights into adherence issues. Data were analysed using a variant of grounded theory (Glaser and Strauss, 1967) and a model of the experience of taking antipsychotic medication was constructed. The interview schedule was then refined and further interviews (including a focus group) were conducted among a diverse sample recruited from local day centres. Results indicated that people taking antipsychotic medication do not see side effects and symptoms as separate issues. Instead, they describe drugs as 'good' or 'terrible'-an indication of the total impact of their treatment. The model constructed reflects this, having the core concept of Well-being: that is, normality of function, feeling and appearance to the outside world. Major themes relating to this core category were managing treatment, evaluating treatment and understanding of the situation. Implications for medication adherence and clinical practice, including drug choice, are discussed, and the doctor-patient relationship is also considered.

Hyperglycemia with antipsychotic treatment.

Diabetes and mental disorders are common chronic illnesses in the United States. Recently, the introduction of a new class of atypical antipsychotic medications has been a major treatment advance for patients with mental disorders. Because of increased use of atypical antipsychotic medications, new and unanticipated side effects have often appeared. Treatment-emergent diabetes has been described for conventional and atypical antipsychotics. People with schizophrenia may be at increased risk for type 2 diabetes because of the side effects of antipsychotic medication, underlying predisposition, and less healthy lifestyles.

Association of Muscarinic M1 Receptor Genetic Polymorphisms with Psychiatric Symptoms and Cognitive Function in Schizophrenic Patients

Objective: The cholinergic system is important in the search for the pathophysiology of schizophrenia due to its role in cognitive function, interaction with the dopamine system in brain regions relevant to schizophrenia, side effects of antipsychotic medication and potential antipsychotic effect of muscarinic receptor antagonists. This study investigated the association of type I muscarinic receptor (CHRM1) genetic polymorphisms with the clinical characteristics of chronic schizophrenic inpatients. Methods: We determined the genotype of CHRM1 genetic polymorphisms in 243 schizophrenic patients hospitalized in chronic care wards. Psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS), and cognitive function was assessed using the Folstein Mini-Mental Status Examination (MMSE) test. Sixty of the 243 subjects also completed the Wisconsin Card Sorting Test (WCST). Results: There was a significant difference in the number of correct responses and the percentage of perseverative errors in the WCST in the CHRM1 C267A genotype group of schizophrenia patients. There was no significant association between age at onset, chlorpromazine equivalents, BPRS scores, MMSE or schizophrenia per se in patients with the CHRM1 C267A genotype. The full exon of the CHRM1 gene was screened out with single-strand conformation polymorphism, and 2 single nucleotide polymorphisms (C267A and C1353T) were identified in our patients and control subjects. These 2 single nucleotide polymorphisms were linked together without exception. Conclusion: This study demonstrated that in schizophrenic patients, the heterozygote group of CHRM1 C267A polymorphism (267C/A) had more correct responses and less perseverative errors on the WCST performance than the 267C/C homozygote group, implicating that this polymorphism may be related to prefrontal cortical function. Our results also suggested that the C267A polymorphism plays no major role in the susceptibility to and clinical manifestations of schizophrenia.

Obesity as a risk factor for antipsychotic noncompliance

Objective: Weight gain is a common side effect of antipsychotic medications and is of particular concern with most of the newer “atypical” antipsychotics. It is, therefore, increasingly important to understand the impact of obesity and perceived weight problems on compliance with these medications. Methods: A survey of treatment and health issues was mailed to local chapters of the National Alliance for the Mentally Ill (NAMI) and National Mental Health Association (NMHA), who distributed them to people with schizophrenia. Noncompliance was defined as a self-report of missing any antipsychotic medication in the previous month. The primary independent variables were (1) body mass index (BMI; weight [kg]/height [m 2])—categorized as normal (<25, n=73), overweight (25–30, n=104), or obese (>30, n=100)—and (2) subjective distress over weight gain. Other independent variables included demographics, medication attitudes, and treatment satisfaction. Result: BMI status and subjective distress from weight gain were predictors of noncompliance. Obese individuals were more than twice as likely as those with a normal BMI to report missing their medication (OR=2.5; CI 1.1–5.5). A comprehensive model suggested that the primary mediator of noncompliance was distress over weight gain. Conclusions: There appears to be a significant, positive association between obesity and subjective distress from weight gain and medication noncompliance, even when accounting for other possible confounding factors.

Antipsychotic-induced hyperprolactinaemia in women: pathophysiology, severity and consequences. Selective literature review.

Hyperprolactinaemia has for decades been an inevitable and neglected side-effect of antipsychotic medication. The recent introduction of prolactin-sparing antipsychotic agents makes a re-examination of this problem timely. To review the literature on antipsychotic-induced hyperprolactinaemia and its consequences. A search was made of the Medline database (1966-2002) for key articles, supplemented by cross-referencing. During antipsychotic treatment prolactin concentrations can rise to ten times normal levels or above, and existing data indicate that 17-78% of female patients have amenorrhoea with or without galactorrhoea. Survey data, however, suggest that clinicians underestimate the prevalence of these conditions. Long-term consequences of antipsychotic-related hypo-oestrogenism require further research but are likely to include premature bone loss. Antipsychotic-induced hyperprolactinaemia should become a focus of interest in the drug treatment of psychiatric patients.

Mental Health QUERI Initiative: expert ratings of criteria to assess performance for major depressive disorder and schizophrenia.

The purpose of this study was to examine mental health care experts' opinions about performance measures and associated data elements that could serve as the basis of an information system for monitoring the implementation of clinical practice guidelines for major depressive disorder (MDD) and schizophrenia in the Veterans Health Administration (VHA). Nineteen mental health care experts rated the meaningfulness and validity of performance measures and automated data elements. For MDD, experts rated the following measures as very meaningful and valid: (a) the results of depression screening, (b) the occurrence and results of diagnostic assessment for MDD, (c) the provision of antidepressant medication or psychotherapy, and (d) whether antidepressant medications were prescribed within the therapeutic dose range recommended by practice guidelines. For schizophrenia, expert reviewers rated therapeutic doses of antipsychotic medication and assessment for antipsychotic medication side effects as being very meaningful and valid. Performance measures that evaluate clinically significant aspects of care using specific, valid data elements are the most meaningful. Translation efforts by the VHA's Mental Health Quality Enhancement Research Initiative program include additional studies of the validity of some of the proposed data elements and the development of national clinical reminders for performance measures judged to be meaningful.

Ladislav Haskovec and akathisia: 100th anniversary.

Akathisia is a syndrome of objective and subjective motor restlessness manifested by an inability to sit or stand still. The patients are distressed and they pace constantly. Today, it is mostly known as a side-effect of antipsychotic medications. However, the phenomenon was observed before the

Antipsychotic use in Australia: the patients' perspective.

To describe patterns of self-reported medication use in a population-based sample of people with psychotic disorders; to establish correlates with clinical variables; to determine perceived side-effect burden; and investigate patient perception of efficacy for different classes of antipsychotic agent. Using the Australian Low Prevalence (Psychosis) Study database we analysed patterns of psychotropic medication and examined their clinical correlates. We also determined rates of reported side-effects and perceived benefit or otherwise associated with the different antipsychotic drugs. Of the 1126 persons interviewed, 88.6% were on psychotropic medication; 54.3% were using "typical" antipsychotics (24.8% in depot form), while 8.3% were on clozapine, 13.3% on risperidone, and 8.8% on olanzapine. Around 30% of women, and 20% of men, were on mood stabilizers or antidepressants. Over half of respondents were on more than one agent. Of those on only one agent, nearly 80% reported at least one side-effect; the mean number of side-effects was 3.9 for typical antipsychotics, and 3.3 for atypicals. Atypicals, notably clozapine, tended to be rated by patients as more efficacious than typicals; depot preparations, in particular, tended to be seen as unhelpful, and were associated with a higher side-effect burden. This study presents an insight into patients' perception of efficacy and side-effects of antipsychotic medications. The findings have implications for clinicians, and can inform treatment options in people with psychotic disorders.