Typical Antipsychotics Research Articles

Malignant Catatonia in the Setting of Acute Methamphetamine and Cocaine Intoxication.

Malignant catatonia is a potentially lethal neuropsychiatric syndrome characterized by psychomotor abnormalities and autonomic instability. Patients with this syndrome require immediate treatment. Various psychiatric conditions and nonpsychiatric medical problems can trigger malignant catatonia. Use of psychostimulant drugs, including methamphetamine and cocaine, has not been previously reported to precipitate malignant catatonia. This case concerns a 35-year-old man hospitalized for psychosis due to methamphetamine and cocaine intoxication. He developed malignant catatonia the day after admission. He was treated with lorazepam for malignant catatonia, and his blood pressure was controlled with clonidine. Over 7 days, his condition resolved, and his mental status and vital signs returned to baseline. He was discharged to the community in stable condition and has returned to his baseline functional status. He remains free of catatonia and has maintained abstinence from methamphetamine and cocaine. Acute intoxication with psychostimulant drugs is a possible trigger for malignant catatonia, and administration of high potency first-generation antipsychotics in this setting may increase the risk. Patients hospitalized for stimulant intoxication should be monitored for signs and symptoms of catatonia, and D2 receptor antagonist medications should be used with caution in this population. Our case supports the potential role of altered dopamine and norepinephrine signaling in the pathogenesis of malignant catatonia. The patient provided written and verbal consent to publish the information in this case report.

Increased antipsychotic drug concentration in hospitalized patients with mental disorders following COVID-19 infection: a call for attention.

Examine the alterations in antipsychotic concentrations following coronavirus disease-2019 (COVID-19) infection among hospitalized patients with mental disorders and conduct an analysis of the factors influencing these changes. Data were collected from inpatients at Beijing Huilongguan Hospital between December 12, 2022, and January 11, 2023, pre- and post-COVID-19. Based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 329 inpatients with mental disorders were included (3 with incomplete data excluded). Primary outcomes assessed changes in antipsychotic concentrations pre- and post-COVID-19, while secondary outcomes examined factors linked to concentration increases and antipsychotic dose adjustments. Clozapine (P < 0.001), aripiprazole (P < 0.001), quetiapine (P = 0.005), olanzapine (P < 0.001), risperidone (P < 0.001), and paliperidone (P < 0.001) concentrations increased post-COVID-19 in patients with mental disorders. Notably, clozapine concentration surpassing pre-infection levels was highest. Clozapine users were more likely to adjust their dose (50.4%) compared to olanzapine (17.5%) and otherantipsychotics. Moreover, traditional Chinese patent medicines and antibiotics during COVID-19 infection were associated with antipsychotic reduction or withdrawal (OR = 2.06, P = 0.0247; OR = 7.53, P = 0.0024, respectively). Antipsychotic concentrations in hospitalized patients with mental disorders increased after COVID-19 infection, that may be related not only to COVID-19, but also to the use of Chinese patent medicines during infection. The pre-infection concentration and types of antipsychotics, patient's gender, and combination of traditional Chinese medicine or antibiotics, were factors found to correlate with increased drug concentrations and necessitate dose adjustments.

Obesity-associated factors in psychiatric outpatients: A multicenter questionnaire survey.

The prevalence of obesity is increasing worldwide, resulting in various health issues such as hypertension, dyslipidemia, diabetes mellitus, heart disease, and a lower life expectancy. Importantly, several psychiatric disorders and the use of psychotropic medications have been linked to obesity, and the possible risk factors need further investigation. This study examined the prevalence of obesity and its associated factors using a self-administered questionnaire. Participants were recruited from three outpatient clinics and individuals who met one or more of the ICD-10 F0-F9, G4 diagnoses were included. In total, 1384 participants completed the questionnaire about their lifestyle. Statistical analysis compared the demographic and clinical characteristics of the individuals who were obese (Body Mass Index: BMI ≥25) and those who were non-obese (BMI <25). The results revealed that the factors associated with obesity in psychiatric outpatients were being male, prolonged treatment duration, eating out frequently, and use of both second- and first-generation antipsychotics. The study emphasized the importance of closely monitoring BMI in individuals with multiple obesity-related factors.

Antidepressant and antipsychotic prescribing in patients with type 2 diabetes in Scotland: A time-trend analysis from 2004 to 2021.

Prescribing of antidepressant and antipsychotic drugs in general populations has increased in the United Kingdom, but prescribing trends in people with type 2 diabetes (T2D) have not previously been investigated. The aim of this study was to describe time trends in annual prevalence of antidepressant and antipsychotic drug prescribing in adult patients with T2D. We conducted repeated annual cross-sectional analysesof a population-based diabetes registry with 99% coverage, derived from primary and secondary care data in Scotland, from 2004 to 2021. For each cross-sectional calendar year time period, we calculated the prevalence of antidepressant and antipsychotic drug prescribing, overall and by sociodemographic characteristics and drug subtype. The number of patients with a T2D diagnosis in Scotland increased from 161 915 in 2004 to 309 288 in 2021. Prevalence of antidepressant and antipsychotic prescribing in patients with T2D increased markedly between 2004 and 2021 (from 20.0 per 100 person-years to 33.3 per 100 person-years and from 2.8 per 100 person-years to 4.7 per 100 person-years, respectively). We observed this pattern for all drug subtypes except for first-generation antipsychotics, prescribing of which remained largely stable. The degree of increase, as well as the overall prevalence of prescribing, differed by age, sex, socioeconomic status and subtype of drug class. There has been a marked increase in the prevalence of antidepressant and antipsychotic prescribing in patients with T2D in Scotland. Further research should identify the reasons for this increase, including indication for use and the extent to which this reflects increases in incident prescribing rather than increased duration.

Rash caused by lurasidone in old chinese patient with bipolar disorder: case-based review

BackgroundRash is one of common adverse drug reaction and which have been reported in typical and atypical antipsychotics. Reports of lurasidone induced skin reactions are sparse. In this study, we report a case of rash caused by lurasidone.Case presentationA 63-year-old man with bipolar disorder (BD) who is treated by lurasidone. However, the patient presents a rash all over after lurasidone dose increasing from 40 mg/day to 60 mg/day. With the diagnosis of drug induced rash, lurasidone was discontinued, and the rash complete disappears within 2 weeks. In addition, all case reports about antipsychotics associated rash were reviewed by searching English and Chinese database including Pubmed, Embase, Cochrane Library, CNKI and Wanfang database. A total of 139 articles contained 172 patients were included in our study. The literature review and our case suggest that the cutaneous adverse events caused by antipsychotic drugs should not be ignored, particularly for the patient who was first use or at dose increasing of antipsychotic.ConclusionsIn conclusion, we report a case of lurasidone related rash and review rash caused by antipsychotics. Psychiatrists should be alert to the possibility of the rash caused by antipsychotics, especially the patient was first use of antipsychotics or the antipsychotic dose was increasing.

Sex-specific differences in the clinical profile among psychiatric patients with pulmonary Embolism: a hospital-based retrospective study

BackgroundPulmonary embolism (PE) is a severe and life-threatening complication of venous thromboembolism. However, there is a lack of systematic studies on differences between female and male PE patients. This paper aimed to compare the sex-specific differences in clinical characteristics and laboratory indicators in psychotic patients with PE.MethodsThis retrospective study enrolled psychiatric patients with PE from June 2018 to June 2022 at Shenzhen Kangning Hospital (Shenzhen Mental Health Center). Demographic characteristics, factors associated with PE, and laboratory indices were collected to assess sex-specific differences.ResultsOf the 168 patients, 87 (51.8%) were female and 81 (48.2%) were male, with a mean age of 58 years for females and 46 years for male patients. The male group had higher ratio of hyperprolactinemia, more patients using antipsychotic medications, higher D-dimer levels at PE onset, greater D-dimer difference, and a higher rate of D-dimer elevation than the female group (p < 0.05). Female patients were significantly older, exhibited a higher prevalence of diabetes, and had a greater number of patients taking antidepressants and hypnotics/sedatives than male patients (p < 0.05). Schizophrenia spectrum disorders were more prevalent in male patients, while female patients had a higher incidence of mood disorders (p < 0.05). Among patients aged < 45 years, the male group had higher D-dimer levels at PE onset and greater D-dimer difference (p < 0.05). Among all 112 patients aged ≥ 45 years, male patients were more likely than female patients to have respiratory tract infections, higher D-dimer levels at PE onset, greater D-dimer difference, and a higher rate of D-dimer elevation (p < 0.05). The multiple linear regression analysis indicated that hyperprolactinemia and the use of first-generation antipsychotics (FGAs) were associated with D-dimer levels at PE onset in male patients, while the time of PE onset and protective restraints were associated with D-dimer levels at PE onset in female patients (p < 0.05).ConclusionPE-associated clinical features differ between male and female patients. These differences may imply that the processes and mechanisms of PE onset are sex specific. Male patients are more likely to have respiratory tract infections and higher D-dimer levels at PE onset than female patients. The use of FGAs may be associated with increased D-dimer in male psychiatric patients, while protective restraints may be associated with increased D-dimer in female psychiatric patients.

Generating Complex Explanations for Artificial Intelligence Models: An Application to Clinical Data on Severe Mental Illness.

We present an explainable artificial intelligence methodology for predicting mortality in patients. We combine clinical data from an electronic patient healthcare record system with factors relevant for severe mental illness and then apply machine learning. The machine learning model is used to predict mortality in patients with severe mental illness. Our methodology uses class-contrastive reasoning. We show how machine learning scientists can use class-contrastive reasoning to generate complex explanations that explain machine model predictions and data. An example of a complex class-contrastive explanation is the following: "The patient is predicted to have a low probability of death because the patient has self-harmed before, and was at some point on medications such as first-generation and second-generation antipsychotics. There are 11 other patients with these characteristics. If the patient did not have these characteristics, the prediction would be different". This can be used to generate new hypotheses, which can be tested in follow-up studies. Diuretics seemed to be associated with a lower probability of mortality (as predicted by the machine learning model) in a group of patients with cardiovascular disease. The combination of delirium and dementia in Alzheimer's disease may also predispose some patients towards a higher probability of predicted mortality. Our technique can be employed to create intricate explanations from healthcare data and possibly other areas where explainability is important. We hope this will be a step towards explainable AI in personalized medicine.

Trends and off-label utilization of antipsychotics in children and adolescents from 2016 to 2021 in China: a real-world study

BackgroundGlobal antipsychotic usage, including off-label prescriptions, has increased in recent decades. However, trends in China, particularly for children and adolescents, remain unclear. This study explored these trends from 2016 to 2021 and identified factors associated with off-label prescriptions.MethodsIn this retrospective study, we analyzed on-label and off-label prescriptions based on drug information approved by the China National Medical Products Administration. To identify factors associated with off-label prescriptions, we conducted multivariate logistic regression analysis.ResultsOur study included 48,258 antipsychotic prescriptions, 52.4% (25,295) of which were prescriptions for males. Of these, 61.7% (29,813) were off-label. Over time, the number of antipsychotics and the percentage of off-label prescriptions for children and adolescents overall increased from 2016 to 2021. The use of atypical antipsychotics increased, whereas that of typical antipsychotics decreased. For off-label usage, all of the factors in our study were associated with off-label usage, including age, sex, year, region, department, reimbursement, antipsychotic type, drug expense, number of polypharmacy and diagnoses. Additionally, tiapride (15.8%) and aripiprazole (18.6%) were the most common typical and atypical antipsychotics, respectively. For pediatric diseases, common diagnoses included mood or affective disorders (31.7%) and behavioral and emotional disorders, with onset usually occurring in childhood and adolescence (29.1%). Furthermore, a depressive state was the most common diagnosis for which antipsychotic polypharmacy was used for treatment.ConclusionIn this retrospective study, off-label antipsychotic prescriptions were common, with trends generally increasing among children and adolescents from 2016 to 2021. However, there is a lack of evidence supporting off-label usage, thus emphasizing the need for studies on the efficacy and safety of these treatments.

Haloperidol, Olanzapine, and Risperidone Induce Morphological Changes in an In Vitro Model of Human Hippocampal Neurogenesis.

Induced pluripotent stem cell (iPSC) based neuronal differentiation is valuable for studying neuropsychiatric disorders and pharmacological mechanisms at the cellular level. We aimed to examine the effects of typical and atypical antipsychotics on human iPSC-derived neural progenitor cells (NPCs). Proliferation and neurite outgrowth were measured by live cell imaging, and gene expression levels related to neuronal identity were analyzed by RT-QPCR and immunocytochemistry during differentiation into hippocampal dentate gyrus granule cells following treatment of low- and high-dose antipsychotics (haloperidol, olanzapine, and risperidone). Antipsychotics did not modify the growth properties of NPCs after 3 days of treatment. However, the characteristics of neurite outgrowth changed significantly in response to haloperidol and olanzapine. After three weeks of differentiation, mRNA expression levels of the selected neuronal markers increased (except for MAP2), while antipsychotics caused only subtle changes. Additionally, we found no changes in MAP2 or GFAP protein expression levels as a result of antipsychotic treatment. Altogether, antipsychotic medications promoted neurogenesis in vitro by influencing neurite outgrowth rather than changing cell survival or gene expression. This study provides insights into the effects of antipsychotics on neuronal differentiation and highlights the importance of considering neurite outgrowth as a potential target of action.

Tardive Dyskinesia with Antipsychotic Medication in Children and Adolescents: A Systematic Literature Review.

Tardive dyskinesia (TD) is a persisting, and potentially irreversible, movement disorder associated with treatment with dopamine receptor antagonists. Few data are available on the risk of TD in children and adolescents treated with antipsychotic medication. To review the literature on incidence, risk factors, and treatment options for antipsychotic-associated TD in children and adolescents (aged < 18 years). Relevant articles were identified through a systematic search of Embase and Medline performed in January 2024. Methodological quality was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute Critical Appraisal tools. Thirteen studies were identified. The reported TD point prevalence was 5-20%, with higher rates in studies involving typical antipsychotics. Lower estimates (around 1%) emerged from analyses of clinical database data suggesting underdiagnosis in clinical practice. Risk factors included treatment with typical antipsychotics, higher doses, longer duration of exposure, older age, female gender, higher baseline Abnormal Involuntary Movements Scale (AIMS) scores, intellectual impairment, and perinatal complications. Although relatively few cases have been reported in children and adolescents, TD remains a risk in this population. Individuals receiving antipsychotics should be monitored carefully for the emergence of abnormal movements. Other than dose reduction, discontinuation, or switch to a lower-risk antipsychotic, few interventions have demonstrated efficacy. The strongest evidence for pharmacological treatment is for VMAT-2 inhibitors (valbenazine and deutetrabenazine), but these drugs are not licensed for use in children. To reduce risk, antipsychotics should be prescribed only if necessary, at the minimum effective dose and for the minimum necessary duration.

Exploring Antipsychotic Use for Delirium Management in Adults in Hospital, Sub-Acute Rehabilitation and Aged Care Settings: A Systematic Literature Review.

International guidelines discourage antipsychotic use for delirium; however, concerns persist about their continued use in clinical practice. We aimed to describe the prevalence and patterns of antipsychotic use in delirium management with regard to best-practice recommendations. Primary outcomes investigated were prevalence of use, antipsychotic type, dosage and clinical indication. Eligibility criteria: studies of any design that examined antipsychotic use to manage delirium in adults in critical care, acute care, palliative care, rehabilitation, and aged care were included. Studies of patients in acute psychiatric care, with psychiatric illness or pre-existing antipsychotic use were excluded. we searched five health databases on 16 August, 2023 (PubMed, CINAHL, Embase, APA PsycInfo, ProQuest Health and Medical Collection) using MeSH terms and relevant keywords, including 'delirium' and 'antipsychotic'. Risk of bias: as no included studies were randomised controlled trials, all studies were assessed for methodological quality using the Mixed Methods Appraisal Tool. descriptive data were extracted in Covidence and synthesised in Microsoft Excel. Included studies: 39 studies published between March 2004 and August 2023 from 13 countries (n = 1,359,519 patients). Most study designs were retrospective medical record audits (n = 16). in 18 studies, participants' mean age was ≥65 years (77.79, ±5.20). Palliative care had the highest average proportion of patients with delirium managed with antipsychotics (70.87%, ±33.81%); it was lower and varied little between intensive care unit (53.53%, ±19.73%) and non-intensive care unit settings [medical, surgical and any acute care wards] (56.93%, ±26.44%) and was lowest in in-patient rehabilitation (17.8%). Seventeen different antipsychotics were reported on. In patients aged ≥65 years, haloperidol was the most frequently used and at higher than recommended mean daily doses (2.75 mg, ±2.21 mg). Other antipsychotics commonly administered were olanzapine (mean 11 mg, ±8.54 mg), quetiapine (mean 64.23 mg, ±43.20 mg) and risperidone (mean 0.97 mg, ±0.64 mg). The use of antipsychotics to manage delirium is strongly discouraged in international guidelines. Antipsychotic use in delirium care is a risk for adverse health outcomes and a longer duration of delirium, especially in older people. However, this study has provided evidence that clinicians continue to use antipsychotics for delirium management, the dose, frequency and duration of which are often outside evidence-based guideline recommendations. Clinicians continue to choose antipsychotics to manage delirium symptoms to settle agitation and maintain patient and staff safety, particularly in situations where workload pressures are high. Sustained efforts are needed at the individual, team and organisational levels to educate, train and support clinicians to prioritise non-pharmacological interventions early before deciding to use antipsychotics. This could prevent delirium and avert escalation in behavioural symptoms that often lead to antipsychotic use.

Determinants/Predictors of QT Abnormalities in Patients on Psychotropic Medications in a Nigerian Tertiary Hospital.

Cardiovascular disease is a major global burden and a leading cause of premature death among patients with severe mental illness. Over time, research and clinical practice have paid increased attention to the impact of psychiatric medications on cardiac repolarization. In a resource-limited setting, it is common for psychotropic medications to be initiated and maintained in an outpatient setting without baseline or follow up ECG. This study evaluated the determinants and predictors of QT abnormalities among patient taking psychotropic drugs. We conducted a cross-sectional study in a population of 150 psychiatric patients on psychotropics and 75 controls. We studied the effects of various psychotropic drugs on QT dispersion (QTd) and corrected QT interval (QTc) as well as correlation with the types and dosages of psychotropic drugs used. All the subjects had detailed clinical examination and resting electrocardiogram (ECG) at 25mm/sec done. QTc was determined using Bazett formula and QTd was determined by subtracting shortest from longest QT in 12-lead ECG. The prevalence of prolonged QTc and QTd as well as the mean QTc and QTd were significantly higher in patients than the control group. The mean QTc was significantly higher in patient on typical antipsychotics compared to those on atypical antipsychotics. Age, heart rate and antipsychotic dose in chlorpromazine equivalent were predictors of QTc with the heart rate being the most powerful predictor among them. Psychotropic drugs use is associated with QTc and QTd prolongation with age, heart rate and antipsychotic dose as predictors of QTc.

Trend in the Utilization of Antipsychotics in the National Health Coverage Era in Indonesia: A Cross-Sectional Study

The utilization pattern of antipsychotics has undergone significant changes since the introduction of atypical antipsychotics. Currently, medication for patients with schizophrenia predominantly uses atypical antipsychotics rather than typical antipsychotics. This study aimed to present the updated utilization pattern of antipsychotics among Indonesians. A cross-sectional study was conducted in 2019-2020 at the National Mental Hospital in Indonesia. Data were collected from medication-used reports from either inpatients or outpatients. A descriptive analysis was conducted to present the pattern and the annual total cost for each antipsychotic used. The pattern of typical antipsychotics used from 2019 to 2020 was likely to decline. The total cost estimated for typical antipsychotics in 2019 was IDR 475 million, and IDR 420 million in 2020. Trifluoperazine 5 mg was the most commonly typical antipsychotic used, followed by chlorpromazine 100 mg and haloperidol 5 mg. Eventually, the pattern of atypical antipsychotics used was likely to increase. The total cost was estimated at IDR 3.2 billion in 2019 and IDR 3.8 billion in 2020. Risperidone 2 mg was the most commonly atypical antipsychotic used, followed by clozapine 25 mg and risperidone 3 mg. This study proves the trend toward increased atypical antipsychotics used. Accordingly, the cost of schizophrenia treatment was elevated.

High circulating MIF levels indicate the association with atypical antipsychotic-induced adverse metabolic effects.

Atypical antipsychotics (AAPs) are primary medications for schizophrenia (SZ). However, their use is frequently associated with the development of adverse metabolic effects, and the mechanisms behind these negative effects remain inadequately elucidated. To investigate the role of macrophage migration inhibitory factor (MIF) in regulating antipsychotic-induced metabolic abnormalities, between 2017 and 2020, a cross-sectional study was conducted, involving 142 healthy individuals and 388 SZ patients undergoing treatment with either typical antipsychotic (TAP) or AAP medications. Symptoms of SZ patients were evaluated using the Positive and Negative Syndrome Scale (PANSS), and measurements of metabolic indices and plasma MIF levels were performed on all individuals. A significant increase in plasma MIF levels was observed in groups receiving five major AAP monotherapies in comparison to healthy controls (all p < 0.0001). There was no such increase shown in the group receiving TAP treatment (p > 0.05). Elevated plasma MIF levels displayed a notable correlation with insulin resistance (β = 0.024, p = 0.020), as well as with the levels of triglycerides (β = 0.019, p = 0.001) and total cholesterol (β = 0.012, p = 0.038) in the groups receiving AAPs. However, while the TAP group also displayed certain metabolic dysfunction compared to healthy controls, no significant association was evident with plasma MIF levels (all p > 0.05). In conclusion, plasma MIF levels exhibit a distinctive correlation with metabolic abnormalities triggered by AAPs. Hence, there is potential for further development of MIF as a distinctive marker for monitoring adverse metabolic effects induced by AAPs in clinical settings.

¿Hay alguna diferencia entre fumadores y no fumadores ingresados en un hospital psiquiátrico?

Objective: comparing the clinical profile, hospital indicators and psychiatric complications between smokers and non-smokers admitted to a psychiatric hospital. Methodology: this was a cross-sectional epidemiological study of the medical records of 573 patients admitted to a psychiatric hospital that complied with the smokefree law. Descriptive statistics, Fisher’s exact test and Mann-Whitney test was used. Results: of the 573 participants, 48% were smokers. The average age was 42.7 years. Smoking was more prevalent among those diagnosed with psychotic disorders (48.4%), those who used only first-generation antipsychotics (49.4%) and higher dosages of psychotropic drugs. The highest proportions of involuntary or court-ordered admissions occurred among smokers. The average number of attempted escapes, episodes of aggression and procedures to manage them was not high (ranging from 0.2 to 1.3 among smokers and from 0.1 to 0.9 among non-smokers). Conclusion: the data showed that smokers were more resistant to being hospitalized in a smoke-free environment. Although smoking cessation in this population is a challenge, neglecting it means devaluing the lives of people with mental disorders. Nurses and other professionals should be encouraged to discuss the scientific evidence about smoking in the psychiatric population.

Prescribing patterns in patients with obsessive-compulsive disorder: Retrospective, single-center study.

Obsessive-compulsive disorder (OCD) is marked by a high rate of treatment resistance. Patients are often left trialing medications within multiple drug classes with little response, causing heterogeneity to emerge in prescribing patterns. This analysis seeks to investigate the selection and dosing of the pharmacotherapy utilized, to portray an overview of prescribing trends in the United States. This retrospective, single center, review of electronic medical records investigated the pharmacotherapy utilization of patients with a primary diagnosis of OCD. Two hundred and ninety-five patients who received OCD treatment at an urban, academic medical center were included in the study. Patients were included in the review if they were at least eighteen years of age and were assigned a diagnosis of OCD according to DSM-5 criteria. Psychotropic pharmacotherapy was integrated into the care of 93% of patients. Selective serotonin reuptake inhibitors were the most utilized medication class at 85% followed by benzodiazepines (47%) and second-generation antipsychotics (37%). Tricyclic antidepressants and first-generation antipsychotics were the two medication classes utilized the least at 13% and 2% respectively. Additionally, mood stabilizers and serotonin-norepinephrine reuptake inhibitors were utilized at rates of 8% and 16%, respectively. Evidence-based treatment guidelines are being followed with varying augmentation strategies widely prevalent, thus displaying the heterogeneity in treating OCD. A high rate of benzodiazepine utilization highlights a practice trend with potential ties to clinical factors, such as the latency to treatment effect of other first-line pharmacotherapies. Future prospective studies are required to determine the cultural, pharmacoeconomic and pharmacogenomic factors that contribute to the variation in prescribing practices and whether these variations influence treatment outcomes.

Adherence to Antipsychotics among Patients with Schizophrenia at Selected Tertiary Level Hospitals

Background: Schizophrenia is a severe mental disorder where nonadherence is present in patients so that relapse, rehospitalization and treatment resistant can occur. Objectives: To identify the level of adherence to antipsychotics among patients with schizophrenia and to find its association with socio-demographic variables. Materials and method: A descriptive, cross-sectional study design was used for the study. 422 samples were collected using the purposive sampling technique Data was collected by the face-to-face interview technique during March, April, and May 2023. Questionnaire related to Socio-demographic information, standard valid tool Drug Attitude Inventory (DAI-10) was used as instrument. Data were analyzed using descriptive and inferential statistics with SPSS version 20. Results: The mean age of the respondents was 41.02, ±12.77. More than half52 (12.3%) of respondents were taking antipsychotics for more than 15 years. Majority of respondents 342 (81.0%) were taking atypical types of antipsychotics. Only 220 (52.1%) of respondents has moderate level of adherence towards antipsychotic medicine. Significant association was found between duration of illness and adherence level where p=0.006. There is mean difference found p=&lt;0.001 from nonadherent group to moderate adherent and adherent group and from moderate adherent-to-adherent group. Conclusion: Nonadherence was found important factor low Quality of life among schizophrenia patient. Implementation of community mental health program is necessary to reduce treatment gap and decrease nonadherence. It is essential to improve adherence on antipsychotic for better quality of life among schizophrenia patient.

EFFECTS OF NEUROLEPTICS WITH OR WITHOUT ANTI-CHOLINERGICS AMONG SCHIZOPHRENIC PATIENTS OF SOUTH GUJARAT

Objective: Neuroleptics (or anti-psychotics) indicated for the treatment of schizophrenia have significant dose-limiting extra-pyramidal side effects (EPS). Literature suggests limited evidence for the efficacy of anticholinergics in the treatment of neuroleptic-induced EPS. Thus, the present study was conducted to understand the effects of anti-cholinergics on EPS among schizophrenics already on neuroleptics (typical and atypical). Methods: This prospective, cross-sectional, observational study was conducted at a tertiary care teaching hospital in South Gujarat for 15 months. A total of 200 participants were included based on selection criteria and distributed equally among four groups (A, B, C, and D) of 50 participants each. The collected data were analyzed for sociodemographic profile, current treatment regimen, type of neuroleptic drug, present complaints of EPS, and addition of any anti-cholinergic agent. An abnormal involuntarily movement scale score was used for examining movement disorders in all study participants. Descriptive statistical analysis was done using Microsoft Excel 2019 and IBM SPSS software version 28, and p&lt;0.05 was considered statistically significant. Results: Hundred patients who were prescribed typical neuroleptics were divided into groups A (with anti-cholinergic) and B (without anti-cholinergic), whereas the remaining 100 patients being prescribed atypical neuroleptics were divided into groups C (with anti-cholinergic) and D (without anti-cholinergic) by simple randomization. The majority of 56% were young adults (18–35 years) with an overall male pre-ponderance (2.14:1). Out of 50 participants in both groups A and B, a higher number of group B participants experienced tremors, rigidity, difficulty in movements, and tardive dyskinesia (TD) (48/50 vs. 30/50, 36/50 vs. 6/50, 24/50 vs. 1/50, 36/50 vs. 19/50) as compared to group A, respectively. Similar results were noted with groups C and D, where a higher number of group D participants experienced tremors, rigidity, difficulty in movements, and tardive dyskinesia (TD) (15/50 vs. 5/50, 11/50 vs. 3/50, 18/50 vs. 2/50, and 16/50 vs. 4/50, respectively). All the results were statistically significant (p&lt;0.05). Conclusion: There was a significant reduction in EPS among schizophrenia patients who were prescribed atypical over typical neuroleptics. The addition of one anticholinergic to the drug regimen also significantly reduced the frequency of EPS in schizophrenia patients.

INFLUENCE OF DURATION OF UNTREATED PSYCHOSIS ON THE SHORT-TERM OUTCOME IN FIRST-EPISODE SCHIZOPHRENIA

Objectives: Schizophrenia is a devastating disease and many patients present late for treatment due to difficulty in identifying symptoms by family members. The objective of this study is to find if there is an association between a longer duration of untreated psychosis (DUP) and poor treatment outcome in first-episode Schizophrenics and to find if there is an association between premorbid social adjustment on DUP. Methods: Anti-psychotic-naïve patients with an international classification of diseases-10 schizophrenia were evaluated 12 weeks after their first in-patient hospitalization. Association between untreated initial psychosis duration (measured from the beginning of first symptom as well as from first hospital admission) was examined by conducting the clinical interview, symptom severity by positive and negative syndrome scale, and clinical global impression scale, pre-morbid social adjustment by premorbid social adjustment (PSA) scale; and symptoms improvement after treatment by CGI-I scale. Results: Of the 57 patients studied, 57.9% showed improvement after treatment, paranoid type was more common, patients responded better when treated with combined typical and atypical antipsychotics and improvement was better when DUP was &lt;2 years. There was a major negative correlation between positive syndrome scores and DUP. There was no association of DUP with negative syndrome score, psychopathology score and PSA score. Conclusion: DUP was an independent predictor of treatment outcome and early intervention is necessary for better prognosis.

A cross sectional study on prescription patterns of antipsychotic drugs among adults with psychiatric illness in a tertiary care hospital

Importance: Antipsychotic drugs are typically used to treat schizophrenia but they are also helpful for other psychotic symptoms, including manic states with psychotic symptoms including hallucinations, delusions. Objective: To study the prescribing patterns of antipsychotic drugs among people with psychiatric illness &amp; to study the prescribing factors comparison between elderly and Adolescent’s patients. Design and Settings: This is a prospective, comparative, cross sectional and observational study conducted on 100 patients in IP and OP psychiatry Department at Prathima Institute of Medical Sciences. In this study, we compared 1st generation antipsychotics with 2nd in prospective of their safety and effectiveness. Study Period: 6 months (Sep 2022- Feb 2023). Participants: Study population: 100.Study Criteria; Inclusion criteria includes: Adults of age 18-55 years, Geriatrics above 60years. Exclusion criteria includes: Paediatrics, Pregnant women. Main outcome and measure: 2nd generations antipsychotics are more commonly prescribed as it has more effectiveness and less side effects. Results: In our study population out of 100 patients, majority of the patients were from the age group of 30-35 years (20%), 25-30 years (17%). Among 100 patients, the most common symptoms were anger (30%), fearfulness (31%), decreased sleep (57%). Majority of the patients have been diagnosed with schizophrenia (26%), mixed anxiety and depressive disorder (26%). Atypical drugs were more commonly prescribed (risperidone 64%, olanzapine 14% and quetiapine 14%) than typical drugs (haloperidol 25%, chlorpromazine 2%). Conclusion and Relevance: we have observed that there is a greater need for patient education regarding psychiatric illness in order to have better patient outcomes, and providing knowledge regarding medication adherence. In this study, among typical and atypical antipsychotics the later are more commonly prescribed compared to former as it has more effectiveness and less side effects.