Treatment Of Chronic Schizophrenia Research Articles

Clinical study of lurasidone combined with nutritional intervention strategy in the treatment of chronic schizophrenia

BackgroundSchizophrenia is a complex mental disorder with a chronic course. The atypical antipsychotics represented by lurasidone are commonly used in chronic schizophrenia, and its mechanism of action determines the superiority of efficacy and safety. However so far, there are still some adverse reactions, of which the more significant are lethargy, nausea, and sedentary inability. In view of these situations, we will combine nutrition intervention with the use of lurasidone to eliminate adverse reactions and provide help for the formulation of treatment plans.Subjects and MethodsThe study will be based on whether to add nutrition intervention as a difference set up control experiment, the experimental group using lurasidone combined nutrition intervention, the control group using lurasidone single factor intervention. The patients who received treatment in the psychiatric department of our hospital from March 2021 to March 2022 were selected as the research objects, and the efficacy and adverse reactions of the patients were monitored during the treatment. The efficacy will be judged by the medical scale of symptom severity of patients with schizophrenia (Positive and Negative Syndrome Scale, PANSS) and the monitoring data will be statistically analyzed by SPSS.ResultsWith the treatment, the results of the Experimental group and the control group are shown in Table 1. The PANSS scores of the two groups finally reached a range of 30-40, with a difference of 4. The incidence of nausea, lethargy and sedentary disorder in adverse symptoms was higher in the control group, and the difference was statistically significant (P < 0.05). It shows that nutritional intervention cannot affect the efficacy of psychosis itself, yet can alleviate the adverse symptoms after medication.Table 1.Efficacy and adverse reactions of the two groupsGroupPANSSNauseaSomnolenceSedentary disorderExperimental group (n=46)32.3±4.13(6.5%)4(8.7%)2(4.3%)Control group (n=41)36.3±5.28(19.5%)6(14.6%)5(12.2%)P>0.05<0.05<0.05<0.05ConclusionsThe group of schizophrenics is not limited to a certain age. Therefore, adverse symptoms caused by psychotropic drugs need to be considered in the practice. Symptoms in the course of the patient’s disease can be used as a treatment optimization path. Although the nutrition intervention strategy has no direct impact on the indicators of mental illness, the prevention of adverse symptoms during treatment can improve the actual experience of patients. In the future, the nutrition strategy will be adaptively optimized to improve the rehabilitation effect of chronic schizophrenia.AcknowledgementsThe research is supported by: Key Discipline of Nutrition and Food Hygiene of Changsha Medical university Quality Engineering Construction Project+2016; Study on Intervention Effect of Mindfulness Acceptance Stress Project on Nurses Aid to COVID-19+Outstanding Youth Project of Scientific Research of Hunan Education Department +2020(264)20B070.

Traditional Chinese Medicine Decoction Combined With Antipsychotic for Chronic Schizophrenia Treatment: A Systematic Review and Meta-analysis.

Despite several studies suggesting the effectiveness of traditional Chinese medicine (TCM) in schizophrenia, there is still a lack of systematic summary and analysis on the role of TCM as adjuvant therapy in chronic schizophrenia. For this purpose, we conducted a meta-analysis to study the efficacy of TCM as an adjuvant combined with antipsychotics in the treatment of chronic schizophrenia. Until April 2020, based on the review of six electronic databases, eight articles were selected. The articles compared TCM decoction assisted antipsychotic therapies with an antipsychotic alone in the treatment of chronic schizophrenia by analyzing a total of 810 cases. The results showed that TCM combined with antipsychotics have beneficial effects on the Positive and Negative Syndrome Scale (PANSS), including the changes in total score, negative score, and the clinical effects evaluated by the PANSS scale. Subgroup analysis showed that the effects of auxiliary TCM with different efficacy on the positive and psychopathological scores were significantly different. It was found that adjuvant treatment with TCM can reduce some side effects and improve the patient's living conditions in the evaluation of the Schizophrenia Quality Of Life Scale (SQLS). Many studies have proved that TCM is safe and well-tolerated. Although the difficulties of using limited TCM remains to be generalized, it still has great potential in the adjuvant treatment of chronic schizophrenia.

Targeting the Prolactin Receptor Signaling Using an Antipsychotic Drug to Suppress Pancreatic Cancer

Pancreatic cancer (PCa) is deadly cancer with an abysmal five‐year survival rate of < 6%. PCa has a bad prognosis and is associated with resistance to standard of care chemotherapeutic gemcitabine and high recurrence rate after surgery. Unfortunately, gemcitabine remains the drug of choice for metastatic pancreatic adenocarcinoma, with minor improvements in survival rate. Hence, there is a need for novel therapeutic interventions for the treatment of PCa. Here we report that prolactin receptor (PRLR) is overexpressed in both PCa tissues and in cell lines. When it is bound by the ligand prolactin (PRL), various downstream events such as JAK‐STAT and ERK‐MAPK signaling pathways are activated. In PCa cell lines, PRL treatment induced dose‐ and time‐dependent STAT3, and ERK1/2 phosphorylation. Moreover, while PRL did not affect PCa cell proliferation, it significantly enhanced pancosphere formation suggesting that PRL affects stem cells. We manipulated PRLR levels using the CRISPR/Cas9 system. This resulted in the lower colony and spheroid formation capacity, decreased migration in vitro as well as reduced tumor‐forming capacity in an orthotopic model of PCa in C57BL/6 mice. Based on these results, we propose that PRL signaling is a novel target for therapeutic intervention. Currently, there are no known small molecules targeting PRL‐PRLR signaling, and X‐ray crystal structure of the intracellular domain of PRLR is not available. Hence, we obtained a homology model for the C‐terminal intracellular region of the receptor and performed a virtual screening for small molecules in silico. In this, we demonstrated that penfluridol (a first‐generation antipsychotic drug) interacts with the JAK2 binding site of the receptor. Penfluridol is known for its long half‐life and is used in the treatment of chronic schizophrenia. We experimentally confirmed binding of penfluridol to PRLR in the cells by using the cellular thermal shift assay (CETSA). Penfluridol treatment decreased PRL‐induced STAT3 and ERK phosphorylation, spheroid formation as well as the migration of PCa cells. We observed a significant increase in autophagy based on increased levels of LC3B, p62 and enhanced expression of autophagy‐related genes ATG‐5, −7 and −12 after penfluridol treatment. Penfluridol treatment also significantly decreased tumor burden in orthotopic PCa model and induced the expression of autophagic related proteins. Taken together, these results suggest that PRL‐PRLR signaling is important for PCa growth and repurposing penfluridol to target PRL‐signaling an effective therapeutic targeting strategy for treating the disease.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Cost-effectiveness of 3-month paliperidone treatment for chronic schizophrenia in Spain

Background: A 3-month long treatment of paliperidone palmitate (PP3M) has been introduced as an option for treating schizophrenia. Its cost-effectiveness in Spain has not been established.Aims: To compare the costs and effects of PP3M compared with once-monthly paliperidone (PP1M) from the payer perspective in Spain.Methods: This study used the recently published trial by Savitz et al. as a core model over 1 year. Additional data were derived from the literature. Costs in 2016 Euros were obtained from official lists and utilities from Osborne et al. The authors conducted both cost-utility and cost-effectiveness analyses. For the former, the incremental cost per quality-adjusted life-year (QALY) gained was calculated. For the latter, the outcomes were relapses and hospitalizations avoided. To assure the robustness of the analyses, a series of 1-way and probability sensitivity analyses were conducted.Results: The expected cost was lower with PP3M (4,780€) compared with PP1M (5,244€). PP3M had the fewest relapses (0.080 vs 0.161), hospitalizations (0.034 v.s 0.065), and emergency room visits (0.045 v.s 0.096) and the most QALYs (0.677 v.s 0.625). In both cost-effectiveness and cost-utility analyses, PP3M dominated PP1M. Sensitivity analyses confirmed base case findings. For the primary analysis (cost-utility), PP3M dominated PP1M in 46.9% of 10,000 simulations and was cost-effective at a threshold of 30,000€/QALY gained.Conclusions: PP3M dominated PP1M in all analyses and was, therefore, cost-effective for treating chronic relapsing schizophrenia in Spain. For patients who require long-acting therapy, PP3M appears to be a good alternative anti-psychotic treatment.

Longer Duration of Untreated Psychosis Hinders Improvement in Treatment of Chronic Schizophrenia: Community Based Early Intervention is an Evidence Based Option.

To determine the effects of community-based mental health services on the quality of life and disease symptoms of chronic schizophrenia patients and to determine the effects of duration of untreated psychosis on outcome. The first year records of schizophrenia patients who had been followed up at Zeytinburnu CMHC for at least 12months, have been used to asses outcome using initial and 12th month quality of life (QoL), positive and negative symptom scale (PANSS) scores. Highly significant improvements were shown in the QoL and PANSS scores. There were significant differences between the two study groups (duration of untreated psychosis >2years, versus duration of untreated psychosis <2years) in terms of improvements in QoL and PANSS scores. Formation of early intervention teams that seek to provide preventive activities (i.e. for schizophrenia) in countries that have changed to community based mental health systems is a sound mental health implementation.

Abstract 1310: Targetingprolactin signaling to suppress pancreatic cancer stem cells

Abstract Background: Pancreatic cancer (PCa) is a major cause of cancer related mortality in United States with &amp;lt; 6% survival rate. It is an aggressive and devastating disease, which is characterized by poor prognosis, invasiveness, rapid progression, profound resistance to drug treatment and recurrance after surgery. Presently, single agent based chemotherapy (e.g. Gemcitabine) is the major treatment for metastatic adenocarcinoma of pancreas but it has a tumor response rate of below 10%. Moreover combination therapy of gemcitabine and erlotinib only marginally improved survival rate. Hence, there is a dire need to identify novel ways to inhibit pancreatic cancer growth. Methods: PCa cells (MiaPaCa-2 and PanC-1) were grown to 70-80% of confluency and treated with and without prolactin (PRL) and JAK2, STAT3 and ERK phosphorylation in presence and absence of antipsychotic compound were evaluated by western blot. Growth of PCa lines (MiaPaCa-2, PanC-1, BxPC-3, AsPC-1) and normal ductal epithelial cells (HPNE) was measured by hexosaminidase and clonogenicity, respectively. Pancosphere formation was used to identify effects on stem cells. Results: We have recently identified that the receptor for the pituitary hormone prolactin is overexpressed in pancreatic cancers, and in pancreatic cancer cell lines. When prolactin (PRL) binds its cognate receptor (PRLR), it induces various downstream events including the JAK-STAT and ERK MAPK pathways. In pancreatic cancer cell lines, we observe that PRL treatment induced dose- and time-dependent JAK2, STAT3, and ERK1/2 phosphorylation. Furthermore, there was an increase in the expression of cancer stem cell (CSC) markers DCLK1 (doublecortin calmodulin like kinase 1) and CD44. In addition, PRL-induced pancosphere formation further suggesting that PRL affects stem cells. Based on these data, we conclude that PRL signaling enhances stemness in pancreatic cancers, and therefore we decided to target it for therapeutic intervention. For this, we developed a homology model for the C-terminal intracellular region of the receptor and performed a virtual screening in silico with FDA approved drugs. One compound, a first generation antipsychotic drug diphenylbutylpiperidine, also called Penfluridol was found to interact with the region of the receptor that also binds site for JAK2. The compound has a long half-life, and is used in the treatment of chronic schizophrenia and similar psychotic disorders. We have further determined that Penfluridol inhibits PRL-induced STAT3 and ERK phosphorylation. In addition, the compound reduced proliferation, colony formation, and spheroid formation. Moreover, it induced cells to undergo autophagy by activating LC3B and increasing expression of autophagy-related genes ATG5, 7 and 12. Conclusions: PRL signaling through its cognate PRLR receptor is critical for aggressive pancreatic cancer behavior, and therefore may be an effective therapeutic strategy. Citation Format: Prasad Dandawate, Gaurav Kaushik, Dharmalingam Subramaniam, Prabhu Ramamoorthy, Scott J. Weir, Roy A. Jensen, Shrikant Anant. Targetingprolactin signaling to suppress pancreatic cancer stem cells. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1310.

Economic and clinical comparison of atypical depot antipsychotic drugs for treatment of chronic schizophrenia in the Czech Republic

Purpose:The Czech Republic is faced with making choices between pharmaceutical products, including depot injectable antipsychotics. A pharmacoeconomic analysis was conducted to determine the cost-effectiveness of atypical depots.Methods:An existing 1-year decision-analytic framework was adapted to model drug use in this healthcare system. The average direct costs to the General Insurance Company of the Czech Republic of using paliperidone palmitate (Xeplion®), risperidone (Risperdal Consta®), and olanzapine pamoate (Zypadhera®) were determined. Literature-derived clinical rates populated the model, with costs adjusted to 2012 Euros using the consumer price index. Outcomes included quality-adjusted life-years (QALYs), days in remission, and proportions hospitalized or visiting emergency rooms. One-way sensitivity analyses were calculated for all important inputs. A multivariate probability analysis was used to examine the stability of results using 10,000 iterations of simulated input over reasonable ranges of all included variables.Results:Expected average costs/per patient treated were €5377 for PP-LAI, €6118 for RIS-LAI, and €6537 for OLZ-LAI. Respective QALYs were 0.817, 0.809, and 0.811; ER visits were 0.127, 0.134, and 0.141; hospitalizations were 0.252, 0.298, and 0.289. Results were generally robust in sensitivity analyses. PP-LAI dominated RIS-LAI and OLZ-LAI in 90.2% and 92.1% of simulations, respectively. Results were insensitive to drug prices but sensitive to adherence and hospitalization rates.Conclusions:PP-LAI dominated the other two drugs, as it had a lower overall cost and superior clinical outcomes, making it the preferred choice. Using PP-LAI in place of RIS-LAI for chronic relapsing schizophrenia would reduce the overall costs of care for the healthcare system.

Targeted Intermittent Treatment in Chronic Schizophrenia

OPINION article Front. Psychiatry, 14 March 2013Sec.Molecular Psychiatry https://doi.org/10.3389/fpsyt.2013.00013

PMH4 Extent of Attaining and Maintaining Symptom Remission by Antipsychotic Medication in the Treatment of Chronic Schizophrenia: Evidence from the Catie Study

PMH4 Extent of Attaining and Maintaining Symptom Remission by Antipsychotic Medication in the Treatment of Chronic Schizophrenia: Evidence from the Catie Study

Extent of attaining and maintaining symptom remission by antipsychotic medication in the treatment of chronic schizophrenia: Evidence from the CATIE study

BackgroundData on attaining and maintaining symptom remission associated with specific antipsychotic medications are rare and variant. AimsTo examine remission rates and their variation by antipsychotic medication in chronic schizophrenia in the National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) given it has an 18-month duration and representative antipsychotic medications. MethodsSymptom remission was examined using the Remission in Schizophrenia Working Group remission criteria of attaining and maintaining for 6months with mild ratings on 8 specific Positive and Negative Syndrome Scale (PANSS) items. Remission rates were assessed (a) up to 18months across CATIE's switching phases (n=1332); and (b) in phase 1 (that involved double-blind randomization to one of five antipsychotic medications) to compare antipsychotic medication differences in attaining and maintaining remission among patients not in remission at baseline (n=941). ResultsAt baseline 16.2% of patients were in symptomatic remission. Across the medication phases of CATIE only 11.7% attained and then maintained at least 6months of symptomatic remission, and 55.5% (n=623) experienced no symptom remission at any visit. During the first medication randomization phase, attaining and maintaining remission for 6months was highest for the olanzapine (12.4%) medication group followed by the quetiapine (8.2%), perphenazine (6.8%), ziprasidone (6.5%), and risperidone (6.3%) groups. ConclusionsAs currently defined, remission appears to be a very difficult therapeutic target to attain and maintain in chronic schizophrenia and may differ by antipsychotic medication. Pragmatically, remission gradients may be effectively studied by applying modified duration and symptom criteria.

Therapeutic processes and clinical outcomes of body psychotherapy in chronic schizophrenia – An open clinical trial

Persistent negative symptoms are an ongoing challenge in the treatment of chronic schizophrenia. Evidence from randomised controlled trials suggests that arts/non-verbal therapies may be effective in treating negative symptoms of schizophrenia. These treatments have not yet been evaluated in open clinical settings. The present uncontrolled clinical trial examines the therapeutic processes and clinical outcomes of group body psychotherapy (BPT) on marked negative symptoms in patients with chronic schizophrenia. Changes in symptom scores, subjective quality of life, social functioning and emotional processing between baseline and post-treatment were assessed. The ratings from clinical assessments of independent researchers were compared with the post-therapy summary assessment of the therapists. A total of 39 eligible patients were referred, out of which 18 patients agreed to participate and received BPT in addition to treatment as usual within three therapy groups run by different therapists. Patients had high symptom levels and low psychosocial functioning at baseline. Negative symptoms and general psychopathology significantly reduced during treatment. Positive symptoms and other outcomes did not change. Researcher ratings of psychopathology were in line with the assessment of clinical outcome by therapists and qualitative observations on changes in movement behaviour during therapy. The results of this study are consistent with findings from a RCT ( Röhricht & Priebe, 2006), indicating that BPT is associated with reduced negative symptoms even when administered in routine clinical settings. Therapists’ qualitative judgements may be considered as a valid source for assessing treatment outcomes. Future studies should explore effects of longer term treatments on other outcomes.

Added ondansetron for stable schizophrenia: A double blind, placebo controlled trial

It is well documented that 5-hydroxytryptamine3 (5-HT3) receptors are involved in the pathogenesis of schizophrenia and cognitive impairment. The purpose of this study was to assess the efficacy of ondansetron, a 5-HT3 receptor antagonist as an adjuvant agent in the treatment of chronic schizophrenia in particular for cognitive impairments. This investigation was a 12-week, double blind study of parallel groups of patients with stable chronic schizophrenia. Thirty patients were recruited from inpatient and outpatient departments. All participants met Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision (DSM-IV-TR) criteria for schizophrenia. To be eligible, patients were required to have been treated with a stable dose of risperidone as their primary antipsychotic treatment for a minimum period of 8 weeks. The subjects were randomized to receive ondansetron (8 mg/day) or the placebo in addition to risperidone. Clinical psychopathology was assessed with Positive and Negative Syndrome Scale (PANSS). Cognition was measured by a cognitive battery. Patients were assessed at baseline and after 8, and 12 weeks after the medication started. The PANSS scores and cognitive performance were used as the outcome measures. The ondansetron group had significantly greater improvement in the negative symptoms, general psychopathological symptoms and PANSS total scores over the trial. Administration of ondansetron significantly improved visual memory based on improvement on visual reproduction, visual paired associate and figural memory sub tests of Wechsler Memory Scale — Revised. The present study indicates ondansetron as potential adjunctive treatment strategy for chronic schizophrenia particularly for negative symptoms and cognitive impairments.

A 12-week, double-blind, placebo-controlled trial of donepezil adjunctive treatment to risperidone in chronic and stable schizophrenia

There is considerable incentive to develop new treatment strategies that effectively target cognitive deficits in schizophrenia. One of the theoretically promising novel treatment candidates is acetylcholinesterase inhibitors that increase the synaptic levels of cholinergic, nicotinic, and muscarinic receptor activity. The purpose of this study was to assess the efficacy of donepezil as an adjuvant agent in the treatment of chronic schizophrenia in particular for cognitive impairments. This investigation was a 12-week, double-blind study of parallel groups of patients with stable chronic schizophrenia. Thirty patients were recruited from inpatient and outpatient departments, age ranging from 22 to 44 years. All participants met DSM-IV-TR. diagnostic criteria for schizophrenia. To be eligible, patients were required to have been treated with a stable dose of risperidone as their primary antipsychotic treatment for a minimum period of 8 weeks. The subjects were randomized to receive donepezil (10 mg/day) or placebo, in addition to risperidone (4–6 mg/day). Clinical psychopathology was assessed with Positive and Negative Syndrome Scale (PANSS). Cognition was measured by a cognitive battery. Patients were assessed by a psychiatrist at baseline and after 8, and 12 weeks after the medication started. The PANSS scores and cognitive performance were used as the outcome measures. The donepezil group had significantly greater improvement in the negative symptoms over the 12-week trial. There were no differences between the donepezil and placebo groups on any neurocognitive assessments at endpoint (week 12). The present study indicates donepezil as a potential adjunctive treatment strategy for negative symptoms of chronic schizophrenia.

Policy Implications of CATIE

Back to table of contents Previous article Next article LetterFull AccessLetterRobert A. Rosenheck M.D.Douglas L. Leslie Ph.D.Jalpa A. Doshi Ph.D.Robert A. Rosenheck M.D.Search for more papers by this authorDouglas L. Leslie Ph.D.Search for more papers by this authorJalpa A. Doshi Ph.D.Search for more papers by this authorPublished Online:1 Jun 2008https://doi.org/10.1176/ps.2008.59.6.695AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Policy Implications of CATIETo the Editor: We contributed an article to the May issue's special section on interpreting the implications of CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) ( 1 ). As the section was being prepared for publication, the editor asked Richard Frank for a commentary on our article ( 2 ), which was also included in the CATIE special section. We are taking this opportunity to respond to Frank's commentary. We agree that caution should be exercised in the implementation of formulary policies and that full consideration must be given to the concerns of advocates and consumers. We also think that mental health services researchers and economists are responsible to taxpayers and other purchasers of health care for offering a balanced consideration of the value of public expenditures. We think four issues may deserve further clarification. First, Frank suggested that our appraisal of what is known may have been based too exclusively on the CATIE trial and that it may be premature to come to any conclusion about the cost-effectiveness of second-generation antipsychotics. However, the many studies we reviewed extend considerably beyond CATIE, which was only the most recent of a series of independent studies that have called into question the superiority of second-generation antipsychotics over older drugs. This perspective is perhaps most clearly reflected in the conclusion of the Texas Medication Algorithm Project authors, a distinguished group of schizophrenia experts, that second-generation antipsychotics should no longer be considered uniformly preferable to older drugs in the treatment of chronic schizophrenia ( 3 ). There are not likely to be additional large studies of these issues, so a broad consideration of current knowledge seems warranted. Second, Frank expresses concern that the high drop-out rate from CATIE at 18-months seriously limits what can be concluded about these drugs. However, CATIE, like several other large trials that we cited, was substantially longer and had higher follow-up rates, at equivalent time points, than most previous trials and thus is more informative than previous studies, many of which lasted only six weeks ( 4 ) or stopped collecting data after the first medication change. Third, Frank implies that we proposed placing strict restrictions on the use of second-generation antipsychotics. In fact, we suggested that a range of policy options be considered, most of which were not especially strict, and we sought to identify those that would be likely to be too precipitous or disruptive and thus should be avoided. Moreover, current practice is quite restrictive in that it relies predominantly on the five or six most expensive antipsychotics rather than on the full range of about 20 antipsychotic drugs currently available. One recent study showed that older drugs can offer new hope to patients who have failed to benefit from a second-generation agent ( 5 ). We believe that choices can be widened and costs lowered at the same time. Fourth, we quoted a state Medicaid official who commented on the influence of coalitions between left-leaning advocacy groups and conservative businesses to highlight the political difficulties involved in considering cost-containment initiatives that would keep up with emerging research findings. Neither advocates nor businesses are focused on the cost concerns to the taxpaying public, and we think that mental health researchers should not ignore these concerns.We agree that caution is warranted whenever health care policy is considered, but the need for caution should not, in itself, be a reason for inaction. The substantial public investment in government-funded studies such as CATIE can be justified only if new findings are carefully considered in developing policies that might better serve the public interest.

Cost-Effectiveness of Second-Generation Antipsychotics and Perphenazine in a Randomized Trial of Treatment for Chronic Schizophrenia

Cost-Effectiveness of Second-Generation Antipsychotics and Perphenazine in a Randomized Trial of Treatment for Chronic Schizophrenia

A placebo controlled study of the propentofylline added to risperidone in chronic schizophrenia

Impaired activity of the purinergic system is a plausible common factor that could be responsible for many aspects of schizophrenia. Based on purinegic hypothesis of schizophrenia, pharmacological treatments enhancing adenosine activity could be effective treatment in schizophrenia. Propentofylline is a novel xantine derivative which is being developed for treatment of degenerative and vascular dementia. It enhances extracellular adenosine level via inhibition of adenosine uptake. The purpose of the present investigation was to assess the efficacy of propentofylline as an adjuvant agent in the treatment of chronic schizophrenia in an 8-week double blind and placebo controlled trial. Eligible participants in this study were 50 patients with chronic schizophrenia. All patients were inpatients and were in the active phase of the illness, and met DSM-IV-TR criteria for schizophrenia. Patients were allocated in a random fashion, 25 to risperidone 6 mg/day plus propentofylline 900 mg/day (300 mg TDS) and 25 to risperidone 6 mg/day plus placebo. The principal measure of the outcome was Positive and Negative Syndrome Scale (PANSS). Although both protocols significantly decreased the score of the positive, negative and general psychopathological symptoms over the trial period, the combination of risperidone and propentofylline showed a significant superiority over risperidone alone in the treatment of positive symptoms, general psychopathology symptoms as well as PANSS total scores. The means Extrapyramidal Symptoms Rating Scale for the placebo group were higher than in the propentofylline group over the trial. However, the differences were not significant. The present study indicates propentofylline as a potential adjunctive treatment strategy for chronic schizophrenia. Nevertheless, results of larger controlled trials are needed, before recommendation for a broad clinical application can be made.

Metabolic adverse events of antipsychotics treatment in chronic schizophrenia

Background:Although the mechanisms explaining metabolic impairments observed during antipsychotic treatment are not well known, there are important differences between drugs regarding the possibility of inducing lipidic and glucose impairments.Objective:To assess the effects of atypical and typical antipsychotics -olanzapine, aripiprazole, risperidone and haloperidol over the weight, glucose and HDL-cholesterol levels, during 24 weeks of treatment.Method:A 43 patients group, 30 male and 13 female, mean age 42.1, admitted during an acute phase of chronic schizophrenia (DSM-IV-TR), were distributed on flexible dose of olanzapine (N=12) 10-20 mg/day, aripiprazole (N=11) 15-30 mg/day, risperidone (N=10) 4-8 mg/day or haloperidol (N=10) 10-20 mg/day. Weight, fasting glucose and HDL-cholesterol were weekly monitored during the first month and monthly after that. Inclusion criteria: baseline glucose and HDL-cholesterol levels within normal range. Exclusion criteria: familial history of diabetus mellitus or obesity.Results:Regarding the weight gain, the safest antipsychotic is aripiprazole (+0.4+/-0.2 kg at endpoint), followed by haloperidol (+1.9+/-0.2 kg), while olanzapine (+5.6+/-1.1 kg) and risperidone (+3.4+/-0.5 kg) are less tolerated. The glucose level >125 mg/dl was observed at endpoint in 3 patients with risperidone, 6 with olanzapine, 2 with haloperidol. The HDL-cholesterol over 40 mg/dl (men) and over 50 mg/dl (female) appeared in 4 cases of olanzapine and 3 cases of risperidone treated patients.Conclusions:There are quantitative differences in the level of weight gain, HDL-cholesterol and glucose level induced by antipsychotics. The safest antipsychotic agent is aripiprazole because it doesn't induce significant weight gain or other metabolic complications.

Celecoxib as adjunctive therapy in schizophrenia: A double-blind, randomized and placebo-controlled trial

Some evidence suggests that the pathophysiology of schizophrenia is associated with the abnormal immune system, and cytokines may be important in schizophrenia. Cyclooxygenase-2 (COX-2) inhibitors such as celecoxib reduce the production of proinflammatory cytokines including Th1-like cytokines. Indeed, COX-2 inhibitors rebalance type-1 and type-2 immune response. The purpose of the present investigation was to assess the efficacy of celecoxib as an adjuvant agent in the treatment of chronic schizophrenia in an eight-week, double-blind and placebo-controlled trial. Eligible participants in this study were 60 patients with chronic schizophrenia. All patients were inpatients and were in the active phase of the illness, and met DSM-IV criteria for schizophrenia. Patients were allocated in a random fashion, 30 to risperidone 6 mg/day plus celecoxib 400 mg/day (200 mg bid) (morning and evening) and 30 to risperidone 6 mg/day plus placebo. Although both protocols significantly decreased the score of the positive, negative and general psychopathological symptoms over the trial period, the combination of risperidone and celecoxib showed a significant superiority over risperidone alone in the treatment of positive symptoms, general psychopathology symptoms as well as PANSS total scores. The means Extrapyramidal Symptoms Rating Scale for the placebo group were higher than in the celecoxib group over the trial. However, the differences were not significant. The results of this study suggest that celecoxib may be an effective adjuvant agent in the management of patients with chronic schizophrenia and anti-inflammatory therapies should be further investigated.

Cost-Effectiveness of Second-Generation Antipsychotics and Perphenazine in a Randomized Trial of Treatment for Chronic Schizophrenia

Cost-Effectiveness of Second-Generation Antipsychotics and Perphenazine in a Randomized Trial of Treatment for Chronic Schizophrenia

P.3.c.040 The comparison of efficacy between aripiprazole and haloperidol in treatment of chronic schizophrenia and schizoaffective disorder: results for 16-week clinical study

P.3.c.040 The comparison of efficacy between aripiprazole and haloperidol in treatment of chronic schizophrenia and schizoaffective disorder: results for 16-week clinical study