Specific Antipsychotics Research Articles

Dr. Marder and Colleagues Reply

Back to table of contents Previous article Next article Letter to the EditorFull AccessDr. Marder and Colleagues ReplySTEPHEN R. MARDER, M.D., SUSAN M. ESSOCK, Ph.D., ALEXANDER L. MILLER, M.D., and ALAN FRIEDMAN, M.D., MT. SINAI CONFERENCE PARTICIPANTSSTEPHEN R. MARDERSearch for more papers by this author, M.D., SUSAN M. ESSOCKSearch for more papers by this author, Ph.D., ALEXANDER L. MILLERSearch for more papers by this author, M.D., and ALAN FRIEDMANSearch for more papers by this author, M.D., MT. SINAI CONFERENCE PARTICIPANTSSearch for more papers by this authorPublished Online:24 Jan 2015AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Drs. Foulds and Williams make a valid point regarding our article: smoking makes a substantial contribution to the morbidity and mortality of individuals with schizophrenia. Although we decided at the onset of our consensus meeting that we would not include discussion of all of the factors that should be monitored in patients with schizophrenia, we agree with the writers that psychiatrists should inquire about smoking routinely. If patients are smokers, clinicians should review the health hazards associated with smoking and the available approaches for promoting smoking cessation. Whenever feasible, clinicians should engage in attempts to motivate patients to give up smoking, and they should refer them to a specialized smoking cessation program.The letter from Dr. Steele provides an opportunity for us to underline the importance of mental health providers ensuring that their patients with schizophrenia receive adequate eye care. The recommendation for annual eye examinations for patients over 40 is a standard of care for all individuals rather than a special requirement for individuals with schizophrenia. The participants at the consensus meeting also recommended that psychiatrists inquire about the quality of vision on an annual basis and that they inquire specifically about changes in vision, the quality of distance vision, and the presence of blurry vision. Changes in vision should lead to a referral to an optometrist or an ophthalmologist. The additional requirement for slit-lamp examinations at 6-month intervals for patients receiving quetiapine is included in its package insert. As noted in the article, the meeting participants agreed that clinicians should follow the recommendations on the quetiapine package insert until there is more definitive evidence regarding the risk of cataracts. Because patients with schizophrenia often have risk factors for lens opacities, such as diabetes, hypertension, and poor nutrition, clinicians should inquire about visual changes and ensure that guidelines for visual monitoring are followed, independent of the antipsychotic prescribed. The article also noted that the level of evidence for an association of cataracts with specific antipsychotics could not be graded. As in several other areas, we hope that more definitive information will become available, resulting in updates to package inserts, whether those updates are more restrictive or more permissive. FiguresReferencesCited byDetailsCited byBorderline personality disorder and adolescent suicide attempt: the mediating role of emotional dysregulation9 August 2021 | BMC Psychiatry, Vol. 21, No. 1 Volume 162Issue 5 May 2005Pages 1029-1029 Metrics PDF download History Published online 24 January 2015 Published in print 1 May 2005

Cardiac Risk Must Be Weighed For Patients on Antipsychotics

Cardiac Risk Must Be Weighed For Patients on Antipsychotics

Pharmacogenetic and pharmacogenomic research for the prediction of response to antipsychotics in schizophrenia

AbstractTreatment of schizophrenia sufferers requires the use of antipsychotic drugs. First developed in the 1950s, two major types of antipsychotics are currently available: classical or conventional antipsychotics and atypical antipsychotics. Selection of treatment is based on trial and error strategies with a detrimental effect on patients' prognosis and chances of recovery. Clinical and genetic indicators have been investigated as predictors of response to antipsychotic treatment. Several studies have reported association between clinical observations and treatment outcome. However, clinical indicators require post‐treatment information that may delay selection of a beneficial drug. Alternatively, genetic polymorphisms have been suggested as useful pre‐treatment predictors. In the last decade, pharmacogenetic researchers have reported numerous associations between antipsychotic response and polymorphisms in genes coding for drug‐targeted receptors and metabolic enzymes. This research has provided information that can be used for the individual prediction of response to specific antipsychotics. Much more is expected from the surge of pharmacogenomic research in pharmaceutical companies. Novel targets for antipsychotic treatment, improved and safer drugs, and individualised treatment are some of the goals expected to achieve in the near future. Drug Dev. Res. 60:104–110, 2003. © 2003 Wiley‐Liss, Inc.

Global index of safety (GIS): A new instrument to assess drug safety

There is an asymmetry between the extraordinary development of measures and tools aimed at studying the beneficial effects of the drugs and the more limited methods to assess their safety profile. The goal of our study was to develop a global measuring tool to assess drugs' safety. We conducted a survey of Spanish psychiatrists in mental health centers and outpatient treatment units to assess the severity scores that they would assign to a list of the most common adverse events (AEs) that usually occur with antipsychotic treatment. The severity scores were then applied to the list of AEs that really occurred along a naturalistic pharmacoepidemiological study on the use of different antipsychotics in the treatment of schizophrenia. The Global Index of Safety (GIS) of the experimental group treated with olanzapine (OLZ) was compared with the GIS of the control group and with the GIS of specific antipsychotics for which the number of treated patients was greater than 100. A total of 194 psychiatrists rated the severity of each AE on a scale of 1 (insignificant) to 5 (extremely severe). The individual severity was applied to the 2949 schizophrenic patients included in a pharmacoepidemiological study. A GIS was calculated for every group of patients receiving the same treatments. The GIS of the control group was higher (4.3) than that calculated from the experimental group (2.5) (P < 0.001). The GIS of the risperidone (3.6) and haloperidol (6.0) subgroups were higher than that calculated from the OLZ group (P < 0.001). The development of a GIS may facilitate the comparison of the safety of several drugs and may constitute a very valuable aid for those involved in selecting drugs.