Side Effects Of Antipsychotic Medications Research Articles

Oral discomfort and health behavior of patients with typical vs. atypical antipsychotic drugs.

Psychiatric patients suffer from oral diseases and side effects of antipsychotic medication. In particular, the typical antipsychotic drugs may cause severe hyposalivation with subsequent oral symptoms. We therefore aimed to compare oral health behavior and oral side effects of in-hospital patients taking typical vs. atypical antipsychotic drugs with the hypothesis that the former drugs cause more oral pain than the newer drugs. This cross-sectional questionnaire and interview study investigated subjective oral symptoms and their health behavior in 170 hospitalized psychiatric patients, comparing those taking typical vs. atypical antipsychotic drugs. Cross-tabulations and chi-square tests were used for analyses. Persistent oral pain lasting throughout the day was reported by 46% in the typical, and 5% in the atypical antipsychotic group patients, respectively. In both groups, the pain was mainly in the tongue and buccal mucosa and was described as a burning sensation. A significantly higher prevalence of xerostomia was reported in the typical antipsychotic medication group (66%) compared with the atypical antipsychotic medication group (53%, p<0.01). Self-assessed dental health was assessed as poor by two-thirds of the patients of whom 69% reported toothbrushing once daily. Approximately half of them reported having had a visit to a dentist within the previous year. Of the women 28%, and of the men 17%, respectively, had received professional consultations for oral symptoms. The current results on psychiatrically hospitalized patients emphasize the need for awareness of oral discomfort and its subsequent effects on the quality of life in this challenging patient group. Focus should also be placed on a wide range of support encouraging the patients to maintain good daily oral hygiene and seek professional dental help when needed.

Differential effects of cannabis constituents on schizophrenia-related psychosis: a rationale for incorporating cannabidiol into a schizophrenia therapeutic regimen.

Schizophrenia is a serious mental health disorder that confers one of the highest mortality rates of all psychiatric illnesses. Although the disorder's psychotic symptoms are treatable with conventional antipsychotics, they remain incurable. Moreover, medication adherence is poor, and individuals with schizophrenia choose to self-medicate with illicit substances, including cannabis. It is well-established that the delta-9-tetrahydrocannabinol (delta-9-THC) component of cannabis elicits psychotomimetic effects at high doses; worsens schizophrenia-related psychosis; commonly develops into cannabis use disorder in individuals with schizophrenia; and increases the risk of earlier-onset schizophrenia symptoms in those harboring genetic susceptibility. However, individuals with schizophrenia commonly use cannabis and cannabis derivatives such as cannabidiol (CBD). These products seem to alleviate psychotic symptoms and relieve adverse side effects of antipsychotic medications. Therefore, one notion that has gained traction is the potential utility of cannabis-derived cannabidiol (CBD) as adjunct treatment to reduce schizophrenia-associated psychosis and other symptoms. Currently, preclinical and clinical data remain inconclusive. The present review distinguishes the mechanisms underlying schizophrenia-associated vs. cannabis-induced psychosis; reviews the evidence for delta-9-THC-mediated exacerbation vs. CBD-mediated amelioration of schizophrenia-associated psychosis; and describes potential approaches for incorporating CBD into schizophrenia therapeutic regimen in a safe and efficacious manner.

Synergistic action of vitamin D3 and A on motor activity regulation in mice model of extrapyramidal syndrome: Correlational insights into astrocyte regulation, cytokine modulation, and dopaminergic activity

BackgroundExtrapyramidal syndromes (EPS) represent neurological side effects of antipsychotic medications, characterized by motor disturbances. While previous studies have indicated the neuroprotective effects of vitamin D and A against EPS, the underlying mechanisms of this protection remain unclear. MethodsTwenty-four adult mice were categorized into four groups: positive and negative control groups, one receiving a dopamine antagonist, and the other receiving both a dopamine antagonist and vitamins D and A. Sections of the corticobasal loop, specifically the motor cortex (M1) and basal nuclei (CPu), were prepared for Immunohistochemistry (IHC) and stained with Glial Fibrillary Acidic Protein (GFAP) to visualize reactive astrocytes. ELISA assays for TNF-α, IL-6, IL-4, IL-13, and dopamine levels were performed on homogenized brain sections. ResultsThe EPS group exhibited a significant increase in TNF-α and IL-6 levels in M1 and CPu. Treatment with dopamine agonists and vitamin D&A resulted in significant reductions in IL-6 levels. Only the Vitamin D&A group showed a significant decline in TNF-α. The EPS group recorded significant decreases in IL-4 and IL-13, with IL-13 significantly elevated in the dopamine agonist and Vitamin D&A groups. IL-4 was notably increased in the Vitamin D&A groups. Dopamine concentration significantly declined in the EPS group, with improvements observed in the groups treated with dopamine agonists, and vitamin D&A. Reactive astrocytes were significantly expressed in the M1 and CPu of the EPS group but poorly expressed in other groups. ConclusionsEPS is linked to astrocyte activation, an upsurge in pro-inflammatory cytokines, a decline in anti-inflammatory cytokines, and dopamine in the corticobasal loop. Administration of vitamin D3 and A was found to suppres pro-inflammatory cytokines and repress anti-inflammatory cytokines associated with astrocyte activation.

Reviewing the Awareness of Mental Health Staff of the Possible Visual Side Effects of Antipsychotic Medications

Objective: A staff awareness project was undertaken in order to assess the awareness of clinical staff working in a UK community psychiatry practice of the visual side effects of antipsychotic medications. Study Design: A staff questionnaire was provided to assess baseline knowledge of the visual side effects of antipsychotic medication (the First Questionnaire). Subsequently, a short information sheet was provided regarding the visual side effects of antipsychotic medications. A Second Questionnaire for clinical staff was provided to assess reflections on knowledge gained. Results: 100% of respondents to the Second Questionnaire found the information sheet informative in refreshing or providing knowledge. 100% of the respondents to the Second Questionnaire also found the information sheet had improved their knowledge of the impact of antipsychotic on vision, and how it can be managed. 100% of respondents stated the information provided would influence their care of patients on antipsychotics and how they might approach care. Conclusion: Antipsychotic medications can cause ocular complications and visual side effects. Staff and patient education regarding these potential side effects can help promote patient safety.

Atypical antipsychotic use does not impact weight gain for individuals with extreme anorexia nervosa: a retrospective case–control study

BackgroundThere are no U.S. Food and Drug Administration (FDA)-approved medications for the treatment of anorexia nervosa (AN). Various medication classes have been evaluated for benefits in this population, including antipsychotics. Studies focused on use of antipsychotics for assistance with weight restoration in AN produced conflicting results. While current evidence does not suggest that antipsychotic medications can be generally recommended for persons with AN, some individuals might benefit from an antipsychotic medication for anxiety, mood, and the cognitive distortions that accompany the illness. It is well-established that atypical antipsychotics can cause weight gain when taken by other psychiatric populations. This published data can understandably limit the willingness of persons with AN to trial these medications. Given the conflicting results of studies examining antipsychotic-related weight gain in AN, it is currently hypothesized that individuals with extreme anorexia nervosa, restricting type, do not experience the weight gain seen in other psychiatric populations utilizing atypical antipsychotics.MethodsTwo hundred seventy-six individuals with extreme AN were enrolled in this retrospective, case–control study between April 1, 2016 and June 30, 2022 utilizing study-specific inclusion and exclusion criteria. Clinical and demographic data, including use of atypical antipsychotics and weights, were retrospectively obtained from chart review. Variables were assessed for normality using univariate statistics. Continuous variables were described using means (M) and standard deviations (SD) or medians and interquartile ranges (IQR) based on normality. Differences in weight gain between cohorts was ascertained via independent samples t-test. P values of < 0.05 were considered statistically significant, and all analyses were completed using SAS Enterprise Guide software version 7.1 (SAS Institute, Cary, NC) and R version 4.3.1 (R Core Team, 2023).ResultsUse of antipsychotics in this population of individuals with extreme AN did not impact the rate of weight gain (M: 1.7 kg/week, SD: 0.9 and 0.8, for cases and controls respectively).ConclusionsWeight gain is often cited by individuals with AN as a feared side effect of antipsychotic medications. In this study, there was no difference in weight trends for individuals taking atypical antipsychotic medications during the refeeding process compared with individuals who were not.

Negative Impacts of Psychiatric Medications on Oral Health: A Literature Review.

Evidence reveals that people with mental illnesses have a greater risk of experiencing oral diseases such as dry mouth and dental caries and have greater oral treatment needs. This is related to multifactorial causes such as factors related to the condition itself, symptoms, side effects of polypharmacy, anda lack of accessibility to dental services. This article aims to provide a summary of the reported prevalence of the most common mental illnesses in Saudi Arabia (SA), such as schizophrenia, obsessive-compulsive disorder (OCD), bipolar disorders, and dementia. The article further aims to review the negative impacts of anti-psychotic medications on oral health and the role of dentists toward people with mental illnesses. PubMed, Scopus, and Google Scholar were searched using the following keywords: special care dentistry, schizophrenia, OCD, bipolar disorder, and dementia. The main inclusion criteria were any studies describing "dental management of patients with mental illnesses" and "dental management of patients treated with anti-psychotic medications."Thematic analysis was used to summarize the findings of the included studies into main headings. Forty-eight articles/studies discussed dentistry, people with mental illnesses, and/or the negative impacts of psychotic medication on oral health. All studies were published between 1991 and 2021. In SA, the number of people with mental illnesses is increasing. Therefore, it is crucial for the dental team to understand the negative impacts of anti-psychotic medications on oral health, such as dry mouthand the increased risk of dental caries. This necessitates the need for regular dental visits and patient education on how they can mitigate the side effects of anti-psychotic medications on oral and general health.

Knowledge of antipsychotic medication and their side effects among psychiatric nurses at a tertiary hospital in Lesotho

Factors that impede the physical health monitoring of patients with severe mental illness are multidimensional, and healthcare providers’ knowledge and expertise regarding antipsychotic medication and side effects remain key determinants of the frequency and quality of screening a patient shall be subjected to. This challenge transcends the monitoring of patients treated with antipsychotics, where scholars have determined a lack of knowledge about screening for adverse effects, resulting in poor clinical assessments among patients prescribed antipsychotics. This study aimed to describe nurses’ knowledge regarding antipsychotic medications and their side effects at the psychiatric hospital in Lesotho. To guide the research process, a quantitative, non-experimental, descriptive approach was employed with 40 nurses out of 44 nurses as respondents, who were selected using convenience sampling, and respondents rated their knowledge regarding the side effects of antipsychotic medication using a Likert scale on a structured research questionnaire. The data were collected using a self-administered questionnaire, analysed using SPSS (version 28), and displayed using tables, frequencies, standard deviations, and means. This study's female respondents comprised 30 (75.0%) and 10 (25.0%) males. The mean age was 39.05 (SD 8.9), with eight years of psychiatry experience. A total of 29 (72.0%) had sufficient antipsychotic knowledge (t = 36.38, df = 39, p &lt; .000), 31 (78.3%) and had adequate knowledge of the side effects of antipsychotic drugs (t = 34.00375, df = 39, p &lt; .000). In conclusion, this study reveals a positive trend in nursing knowledge about antipsychotic medications and associated side effects, highlighting the importance of ongoing professional development to maintain and enhance this expertise.

Hypertension and psychosis.

Hypertension, a prevalent component of metabolic syndrome (MetS), is a well-known risk factor for cardiovascular diseases (CVD). Psychosis is a feature in the schizophrenia spectrum. Meta-analysis suggests that the prevalence of hypertension in schizophrenia and related disorders is 39%. This may be explained by a unidirectional association between hypertension and psychosis, in that psychosis can be a causative factor of hypertension via antipsychotic medication, inflammation and irregular autonomic nervous system activity through multiple mechanisms. Obesity is a side effect of antipsychotic medication and is a risk factor for hypertension. Obesity leads to raised blood pressure, atherosclerosis, increased triglyceride concentration and decreased high-density lipoprotein concentration. Inflammation accompanies hypertension and obesity. In recent years, the role of inflammation in the onset of psychosis has been increasingly recognised. It underlies the immune dysregulation observed in both schizophrenia and bipolar disorder. Interleukin-6, a marker and driver of inflammation, is related to obesity and plays a role in the pathogenesis of MetS and hypertension. The lack of preventive care of hypertension and other MetS risk factors for patients on antipsychotic medication is reflected in the high incidence of CVD in this population. It is important to detect and treat MetS and hypertension in patients with psychosis in order to reduce cardiovascular morbidity and mortality in this population.

Metabolic and Molecular Aspects of Schizophrenia: A Review

Despite decades of research, the causes and biology of schizophrenia remain unknown. The condition is associated with metabolic symptoms such as hyperinsulinemia, dyslipidaemia, type 2 diabetes (T2DM), and obesity. These sensations are a prevalent side effect of the new antipsychotic medications. Nevertheless, metabolic dysfunction in schizophrenia has been studied before the antipsychotic phase, and it has also been documented in patients with first- onset schizophrenia prior to antipsychotic treatment. We investigate the evidence for metabolic abnormalities in schizophrenia patients, both in the central and peripheral nervous systems. Post-mortem brain tissue molecular analysis indicated alterations in glucose metabolism and insulin signalling pathways, whereas blood-based molecular profiling revealed hyperinsulinemia and abnormalities in insulin and co-released factor synthesis after the development of symptoms. Yet, such features are not seen in all patients with the disorder, and not all people with such defects have schizophrenia symptoms. One explanation of these facts is the presence of an underlying metabolic sensitivity in a subset of persons that interacts with environmental or hereditary factors to create the disorder's overt symptoms.

Beyond antipsychotics: the role of medication and nonmedication factors in female sexual dysfunctions in schizophrenia.

To date, few studies have investigated male sexual dysfunctions (FSDs) in schizophrenia in non-Western countries, with most studies focusing on the sexual side effects of antipsychotic medications. Therefore, we aimed to screen for FSD in a sample of Egyptian females with schizophrenia, compare them to controls and to investigate demographic and clinical parameters associated with FSD. We conducted a cross-sectional study of 72 medicated and unmedicated females with schizophrenia (27 unmedicated and 45 medicated) and 24 controls. They were assessed using the Female Sexual Function Index (FSFI) and data were collected for demographic and clinical parameters. We found that females with schizophrenia had significantly lower scores on the FSFI compared to controls and that 93.1% of females with schizophrenia reached the threshold for FSD (FSFI score ≤26), compared to 87.5% of controls. Medicated and unmedicated subjects did not differ significantly in most domains of the FSFI. Age, duration of illness, positive and negative syndrome Scale total, positive and negative symptom scores correlated significantly with the majority of domains of the FSFI. Rates of FSD are very high in both schizophrenia and controls and correlate in schizophrenia with a number of demographic and clinical parameters, suggesting that FSDs are not restricted to the side effects of medications. There is a need to screen for sexual function in routine practice, and for developing active strategies to tackle sexual dysfunctions.

C-L Psychiatrists Bring Expertise to End-of-Life Care

C-L Psychiatrists Bring Expertise to End-of-Life Care

Improving physical health monitoring and interventions in a learning disabilities forensic psychiatric secure service.

Patients in psychiatric inpatient settings are at increased risk of developing physical health complications due to the structure of inpatient wards, the metabolic side-effects of antipsychotic medications and socioeconomic factors. Robust physical health monitoring and interventions are paramount in reducing this health inequality. To improve the quality of physical health interventions in the ward environment and empower patients to follow healthy lifestyle guidance to reduce their risk of metabolic syndrome. Patient weight and waist circumference data were collected at baseline and weekly throughout the 8-week intervention period. A questionnaire was recorded from baseline to week-5 to assess patient understanding. Two Plan-Do-Study-Act (PDSA) cycles were completed: (1) Series of weekly psychoeducation sessions and group exercise and (2) Implementation of healthy living diaries. Our data did not demonstrate any definitive impact upon the waist circumference and weight of participants. However, analysis of the questionnaires showed a consistent trend in knowledge improvement. Whilst our aim of reducing patient weight and waist circumference was not realised, there was a significant impact on participant's knowledge, demonstrating a subjective benefit of our interventions. Our project also highlighted inconsistencies in physical health measurements and data collection, providing vital information for further quality improvement measures.

The Needs and Experiences of Parents with Psychosis: A Qualitative Interview Study

Over a third of individuals diagnosed with a psychotic disorder are also a parent. The symptoms of psychosis and side effects of antipsychotic medication can impact on parents’ awareness of the needs of their children and, at times, the parent may be emotionally and practically unavailable to their child. This study assessed the expressed emotion of parents with psychosis and used qualitative methods to investigate their needs and experience in order to identify how best to support this parent group. Twelve parents with a diagnosed psychotic disorder and with a child aged between 3 and 11 years took part in semi-structured interviews. The majority of parents displayed high levels of warmth and low levels of negativity towards their child. Four themes were generated using reflexive thematic analysis: (1) the impact of psychosis on parenting, (2) the need to protect their child, (3) the need to feel normal, and (4) the impact of parenting stress on psychosis. These results showed how parents want to protect their children and feel normal despite experiencing psychosis. They also highlighted the cyclical relationship between parenting stress and psychotic symptoms, whereby psychotic symptoms can impact on a parent’s capacity to care for their child and parenting stress can exacerbate psychotic symptoms.

Evaluation of Physical Health in an In-Patient Psychiatric Rehabilitation Setting

AimsThe mortality gap between patients with serious mental illness (SMI) and without is around 15–20 years. This has multiple contributing factors including poor physical health, side effects of antipsychotic medications and sub-optimal medical management. Presented here is a detailed cross-sectional study of physical health measures in an in-patient rehabilitation population in Scotland. Results are compared to national averages and clinical guidelines with the aims to a) benchmark physical health in this population and b) where possible improve physical health.MethodsPhysical health data including observations, blood tests, and investigations was collected ahead of detailed structured interviews and physical exams performed by a post-foundation doctor. These results were compared to recommendations for physical health monitoring from numerous national and government guidelines (SIGN, NICE, Scottish Government, Maudsley). Data were collected in 4 domains, 1) Indicators of physical health, 2) Engagement with physical health, 3) Concordance with guidelines and 4) Outcomes of reviews.ResultsData were collected from 57 of all 62 in-patients. 34 reported being generally happy with their health vs 15 unhappy. 42% were obese (compared to 28% of the general population), 84% were smokers (vs 16% in the local population) 16% were hypertensive, 22% had raised HbA1c, 50% had raised cholesterol, 47% had QRISK &gt;10%. 68% agreed to a full physical health review, 65% agreed to flu vaccination. Completed cancer screening uptake compared to the Scottish population was low; Cervical (30% vs 71%), Bowel (8% vs 59%), Breast (23% vs 72%), AAA (0% vs 84%). Patients were generally up to date in terms of recorded weight (100%), BP (98.2%), HR (98.2%) and lipids (89.4%), but not ECG's (61.4%) and Diabetes screening (59.6%). 17 referrals were made to medics/surgeons, 29 to MDT's, 24 medications started, 9 stopped and 27 changed, most commonly statins (12 patients), vitamin D (8 patients) and hypoglycemics (5 patients).ConclusionCardiovascular disease indicators were notably raised, uptake of screening was very poor and there were areas where the service didn't meet national guidelines. The number of referrals and medication changes suggest an unmet need within such services. The findings, if generalisable across similar populations, suggest that more can be done to address ongoing poor physical health in populations with SMI and indeed patient readiness to comply with physical health screening. Screening for key physical health parameters needs to be augmented by working to engage patients and following up with management plans for abnormalities found.

Tardive dyskinesia in Chinese patients with schizophrenia: Prevalence, clinical correlates and relationship with cognitive impairment

ObjectiveTardive dyskinesia (TD) has a high prevalence and is one of the distressing side effects of antipsychotic medications. Few studies have explored the relationship between TD, clinical correlates, and cognition. The aim of this study was to assess the prevalence, clinical correlates and cognitive impairment of co-occurring TD in Chinese patients with schizophrenia. MethodsWe recruited 655 patients with chronic schizophrenia who met the DSM-IV diagnostic criteria for schizophrenia and collected clinical and demographic data. All patients were assessed using the Abnormal Involuntary Movement Scale (AIMS) for the severity of TD, Positive and Negative Syndrome Scale (PANSS) for psychopathological symptoms, and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for cognition. ResultsThe overall TD prevalence was 41.1%, 42.9% (246/574) in men and 28.4% (23/81) in women (χ2 = 6.1 df = 1, p < 0.05). There were significant differences in age, sex, duration of illness, number of hospitalizations, drug type, smoking and PANSS negative symptom subscore between TD and non-TD groups (all p < 0.05). Moreover, patients with TD scored lower for immediate memory, attention, delayed memory, and RBANS total scores (all p < 0.05). Logistic regression showed a significant correlation between TD and age, sex, drug type and attention subscore. ConclusionOur results suggest that multiple demographic and clinical variables may be associated with the development of TD. Moreover, TD patients may exhibit more cognitive impairment than non-TD patients.

METABOLIC SYNDROME IN PATIENTS WITH PSYCHOSIS USING SECOND-GENERATION ANTIPSYCHOTICS

Background: Persons with Schizophrenia are more likely to die from cardiovascular illness and are at a greater risk of developing obesity, diabetes mellitus (DM), hypertension (HTN), and dyslipidemias. Though the SGA were quite effective, their safety advantages have been questioned because of their propensity to induce weight gain and alter glucose,lipid metabolism. Objectives: 1.To study the incidence of metabolic syndrome (MS) due to selected SGA 2.To compare any differences in the metabolic profile of patients on various antipsychotics. Methodology: A Study was done for about a year among 120 Drug Naive patients with the diagnosis of schizophrenia or acute psychosis as per ICD 10 criteria,attending psychiatry OPD and were selected by systematic sampling method into four groups.With the Group (A) receiving Olanzapine, group (B) Risperidone, group (C) Quetiapine, group (D) Aripiprazole.Each group consisting of 30 patients.After 12 weeks of medication,Patients were screened for the MS using NCEP- ATP III criteria.Data was collected and analyzed using SPSS software,ANOVA was used to assess the significance of the difference of mean values of different parameters in between groups. Results: In the study concerning age group, majority of patients belong to 20-30(41.67%) yrs.There were no significant gender differences with 54.17% males and 45.80% females. Among 120 patients, 13(10.83%) patients developed MS after three months of continuous antipsychotic drug therapy. Among those who received Olanzapine and Risperidone, five patients from each group developed MS, and three patients who received Quetiapine fulfilled the criteria of MS.No patient on Aripiprazole developed MS. Conclusion: The psychiatrist needs to be aware of the potential metabolic side effects of antipsychotic medication and to include them in the risk/benefit assessment when choosing a specific antipsychotic. Multidisciplinary assessment of psychiatric and medical conditions is needed.

Chronic Effects of Loxapine, Iloperidone, Paliperidone on Mice Isolated Vas Deferens Contractility

Objective: Erectile dysfunction is a usual side effect of antipsychotic medications; this causes patients to avoid using drugs. The aim of this study to investigate the effects of iloperidone, paliperidone and loxapine on serotonin (5-HT), noradrenaline (NA), adenosine triphosphate (ATP) and potassium chloride (KCl)-induced contractions of the vas deferens in mice.Materials and Methods: The mice were randomly divided into experimental groups and treated by ip injection of drugs for 21 days. After the treatment, the effects of drugs were investigated on 5-HT, ATP, NA and KCl-induced contractile responses in the epididymal and prostatic portions of mice vas deferens strips. Results: 5-HT-induced contractile responses were significantly increased while ATP-induced contractile responses were significantly decreased in the both portions of the vas deferens obtained from the iloperidone, paliperidone and loxapine-treated groups. However, these drugs had no significant effect on NA- and KCl-induced contractions of mice vas deferens. Conclusion: These results showed that serotonin and ATP-induced contractions of vas deferens were affected by the chronic treatments of iloperidone, paliperidone, and loxapine. In mice chronically treated with these drugs, serotonergic and purinergic receptors may contribute to changes in vas deferens contractions that cause erectile dysfunction.

Abstract- Poster

Background –There are no studies conducted till now for assessing reliability of physical examination done virtually in the context of telepsychiatry, with only 2 studies examining the reliability of visual observations in telepsychiatry and showing contrasting results. Hence need to validate physical examination done virtually.Aims -To compare the reliability of tele-psychiatric assessments in picking up and assessing the severity of Extra Pyramidal Side Effects(EPSE) of antipsychotic medications in comparison with that of In-person physical examination (gold standard).Methods -An observational cross-sectional study where a total of 121 patients with primary psychiatric disorders on antipsychotic medications were recruited from clinical services of NIMHANS in a convenient fashion. A sequential procedure was carried out where an in-person physical examination looking for EPSE along with application of relevant scales was done by an independent examiner. This was immediately followed by a Virtual Physical Examination(ViPE) carried out by another blinded researcher using a 17 question scale created specifically for the ViPE. The scales used to assess severity of antipsychotic side effects were Abnormal Involuntary Movements Scale(AIMS) and Barnes Akathisia Rating Scale(BARS).Results –A total of 54 patients were found to have EPSE in in-person physical examination as opposed to 52 patients in VIPE. The measure of agreement in picking up EPSE between in-person physical examination and VipE was statistically significant (kappa coefficient – 0.832,significance<0.001).The agreement in severity of EPSE as compared on the Global outcome of severity AIMS scale 8(kappa coefficient – 0.777,significance<0.001) and Global assessment of severity of akathisia in BARS (kappa coefficient – 0.920,significance<0.001) were also statistically significant.Conclusion –ViPE is a reliable method to pick up and assess the severity of EPSEs.

Free Papers Compiled

Background – There are no studies conducted till now for assessing reliability of physical examination done virtually in the context of telepsychiatry, with only 2 studies examining the reliability of visual observations in telepsychiatry and showing contrasting results. Hence need to validate physical examination done virtually.Aims - To compare the reliability of tele-psychiatric assessments in picking up and assessing the severity of Extra Pyramidal Side Effects(EPSE) of antipsychotic medications in comparison with that of In-person physical examination (gold standard).Methods - An observational cross-sectional study where a total of 121 patients with primary psychiatric disorders on antipsychotic medications were recruited from clinical services of NIMHANS in a convenient fashion. A sequential procedure was carried out where an in-person physical examination looking for EPSE along with application of relevant scales was done by an independent examiner. This was immediately followed by a Virtual Physical Examination(ViPE) carried out by another blinded researcher using a 17 question scale created specifically for the ViPE. The scales used to assess severity of antipsychotic side effects were Abnormal Involuntary Movements Scale(AIMS) and Barnes Akathisia Rating Scale(BARS).Results – A total of 54 patients were found to have EPSE in in-person physical examination as opposed to 52 patients in VIPE. The measure of agreement in picking up EPSE between in-person physical examination and VipE was statistically significant (kappa coefficient – 0.832 ,significance<0.001).The agreement in severity of EPSE as compared on the Global outcome of severity AIMS scale 8(kappa coefficient – 0.777 ,significance<0.001) and Global assessment of severity of akathisia in BARS (kappa coefficient – 0.920 ,significance<0.001) were also statistically significant.Conclusion – ViPE is a reliable method to pick up and assess the severity of EPSEs.

Twenty-Four Week, Randomized, Double-Blind, Placebo-Controlled Trial of Metformin for Antipsychotic-Induced Weight Gain in Patients with First-Episode Psychosis: A Pilot Study.

Excessive weight gain and cardiometabolic dysfunction are common and clinically relevant side effects of antipsychotic medications. In this pilot study, we aimed to establish the feasibility of using metformin and its effectiveness in managing antipsychotic-induced weight gain in patients with first-episode psychosis (FEP) on follow-up with the Singapore Early Psychosis Intervention Programme in a 24-week, randomized, double-blind, placebo-controlled trial, to ascertain the effects of metformin discontinuation on body weight and evaluate the safety and tolerability of metformin. Participants between the ages of 16 and 40 with FEP assessed as clinically stable and who had gained ≥5% of their pre-drug weight after initiation of the antipsychotic treatment were recruited from outpatient clinics between April 2015 and April 2018. Seventeen participants met all the inclusion criteria and were randomized to receive metformin (n = 8) or the placebo (n = 9) at Week 0, with follow up assessments at Weeks 3, 6, 12, 24, and 36. Metformin was generally well-tolerated. Participants in the metformin arm were able to control their weight better than participants receiving the placebo, an effect that did not persist after discontinuation. Our results support the use of metformin as a safe and tolerable weight control measure in a typical outpatient sample of young people with FEP.