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1.
Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia-spectrum and bipolar I disorders: Four-year follow-up of the ACCESS II study.
Schöttle, D, Schimmelmann, BG, Ruppelt, F, Bussopulos, A, Frieling, M, Nika, E, Nawara, LA, Golks, D, Kerstan, A, Lange, M, et al
PloS one. 2018;(2):e0192929
Abstract
UNLABELLED The ACCESS-model offers integrated care including assertive community treatment to patients with psychotic disorders. ACCESS proved more effective compared to standard care (ACCESS-I study) and was successfully implemented into clinical routine (ACCESS-II study). In this article, we report the 4-year outcomes of the ACCESS-II study. Between May 2007 and December 2013, 115 patients received continuous ACCESS-care. We hypothesized that the low 2-year disengagement and hospitalization rates and significant improvements in psychopathology, functioning, and quality of life could be sustained over 4 years. Over 4 years, only 10 patients disengaged from ACCESS. Another 23 left for practical reasons and were successfully transferred to other services. Hospitalization rates remained low (13.0% in year 3; 9.1% in year 4). Involuntary admissions decreased from 35% in the 2 years prior to ACCESS to 8% over 4 years in ACCESS. Outpatient contacts remained stably high at 2.0-2.4 per week. We detected significant improvements in psychopathology (effect size d = 0.79), illness severity (d = 1.29), level of functioning (d = 0.77), quality of life (d = 0.47) and stably high client satisfaction (d = 0.02) over 4 years. Most positive effects were observed within the first 2 years with the exception of illness severity, which further improved from year 2 to 4. Within continuous intensive 4-year ACCESS-care, sustained improvements in psychopathology, functioning, quality of life, low service disengagement and re-hospitalization rates, as well as low rates of involuntary treatment, were observed in contrast to other studies, which reported a decline in these parameters once a specific treatment model was stopped. Yet, stronger evidence to prove these results is required. TRIAL REGISTRATION Clinical Trial Registration Number: NCT01888627.
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2.
Metabolic syndrome and atypical antipsychotics: Possibility of prediction and control.
Franch Pato, CM, Molina Rodríguez, V, Franch Valverde, JI
Revista de psiquiatria y salud mental. 2017;(1):38-44
Abstract
INTRODUCTION Schizophrenia and other psychotic disorders are associated with high morbidity and mortality, due to inherent health factors, genetic factors, and factors related to psychopharmacological treatment. Antipsychotics, like other drugs, have side-effects that can substantially affect the physical health of patients, with substantive differences in the side-effect profile and in the patients in which these side-effects occur. To understand and identify these risk groups could help to prevent the occurrence of the undesired effects. MATERIAL AND METHOD A prospective study, with 24 months follow-up, was conducted in order to analyse the physical health of severe mental patients under maintenance treatment with atypical antipsychotics, as well as to determine any predictive parameters at anthropometric and/or analytical level for good/bad outcome of metabolic syndrome in these patients. RESULTS There were no significant changes in the physical and biochemical parameters individually analysed throughout the different visits. The baseline abdominal circumference (lambda Wilks P=.013) and baseline HDL-cholesterol levels (lambda Wilks P=.000) were the parameters that seem to be more relevant above the rest of the metabolic syndrome constituents diagnosis criteria as predictors in the long-term. CONCLUSIONS In the search for predictive factors of metabolic syndrome, HDL-cholesterol and abdominal circumference at the time of inclusion were selected, as such that the worst the baseline results were, the higher probability of long-term improvement.
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3.
Switching from quetiapine to ziprasidone: a sixteen-week, open-label, multicenter study evaluating the effectiveness and safety of ziprasidone in outpatient subjects with schizophrenia or schizoaffective disorder.
Karayal, ON, Glue, P, Bachinsky, M, Stewart, M, Chappell, P, Kolluri, S, Cavus, I
Journal of psychiatric practice. 2011;(2):100-9
Abstract
OBJECTIVE The objectives of this study were to evaluate the effects of switching from quetiapine to ziprasidone on weight, safety, and effectiveness METHODS In this study, 241 subjects with schizophrenia or schizo affective disorder who had been treated with quetiapine (≥300 mg/day) for ≥3 months with either suboptimal efficacy or poor tolerability were enrolled in a 16-week, open-label, flexible-dose trial, with a 16-week follow-up (total 32 weeks). Quetiapine was tapered and discontinued over the course of 2 weeks, while ziprasidone was titrated up and dosed at 40-80 mg b.i.d. The primary endpoint was weight change (kg) from baseline at 16 weeks. Secondary endpoints were change in waist/hip circumference, lipid profile, fasting glucose, and glycosylated hemoglobin (HbA1c). Additional secondary endpoints included changes in scores on the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions Improvement and Severity Scales (CGI-I and CGI-S), the Calgary Depression Scale for Schizophrenia (CDSS), the Schizophrenia Cognition Rating Scale (ScoRS), and the Global Assessment of Functioning (GAF). Safety measures included adverse event (AE) reporting and administration of the Abnormal Involuntary Movement Scale (AIMS). RESULTS At week 16, there was a small but statistically significant decrease in weight, with a mean change from baseline of -0.73 kg (1-sided 95% upper confidence bound=-0.33) using the last observation carried forward [LOCF] approach. There were small mean decreases in levels of total cholesterol, low density lipoprotein (LDL), and triglycerides at week 16, but no change in fasting glucose or HbA1c. At week 16, there were also significant changes indicating improvement in the secondary clinical assessments, including the PANSS scores, CGI-S, CDSS, SCoRS and GAF. There was no change in the AIMS. AEs included insomnia (12.4%), somnolence (13.7%), and nausea (9.1%). CONCLUSION Subjects switching from quetiapine to ziprasidone showed a small but significant decrease in weight as well as improved lipid profiles, regardless of their metabolic status and disease severity at baseline. Subjects also showed improvement in clinical symptoms and in cognitive functioning. Ziprasidone, with a comparatively neutral metabolic profile relative to other antipsychotics, may be an effective treatment alternative for patients experiencing weight gain or lack of tolerability with quetiapine.
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4.
Treatment of a first episode of psychotic illness with quetiapine: an analysis of 2 year outcomes.
Kopala, LC, Good, KP, Milliken, H, Buiteman, C, Woodley, H, Rui, Q, Whitehorn, D, Love, L, Balshaw, R, Kiss, I, et al
Schizophrenia research. 2006;(1):29-39
Abstract
BACKGROUND The first episode of a psychotic disorder provides a unique opportunity to initiate optimal treatment but when a new medication becomes available, little data exist to guide the appropriate use in this population. OBJECTIVES The objectives were to determine the optimal doses and titration of quetiapine for this group and to measure outcomes (including symptom response, social functioning, mood alterations, motor symptoms, metabolic parameters and cognitive functioning) over 2 years of treatment with quetiapine. DESIGN Thirty nine subjects with a first episode of psychosis referred to the Nova Scotia Early Psychosis Program in Halifax, Canada, were invited to participate in this study. Standardized clinical, laboratory, and neuropsychological assessments were performed at baseline and following treatment with quetiapine at intervals out to 2 years. RESULTS Quetiapine was effective in treating the psychotic and mood symptoms while not causing extra-pyramidal signs or symptoms (EPSS). Pre-existing motor dysfunction improved. No anticholinergic medications were required. Several domains of cognitive function also improved (sustained attention, the number of perseverative errors, visuomotor speed and sequencing, verbal fluency and verbal memory). Weight gain was observed along with increases in cholesterol levels but there was no glucose dysregulation. CONCLUSIONS The results of this two year, naturalistic study of people with a first episode of psychosis indicated that quetiapine was well tolerated and effective for this population. Significant improvements in cognitive functioning also provided evidence for potential longer-term benefits of early and optimal treatment with this agent. However, monitoring metabolic parameters, as recommended for other atypicals, is likely prudent.
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5.
[QTc-interval prolongation in therapy with atypical antipsychotics--results of an open, non-randomized survey].
Finzel, M, Fric, M, Laux, G
Psychiatrische Praxis. 2004;:S178-80
Abstract
The introduction of Ziprasidone stimulated discussion about frequency and importance of QTc-interval prolongations with antipsychotic therapy. In an open non-randomized study we collected data about QTc-interval, electrolytes, vital parameters and associated clinical symptoms in patients treated with atypical antipsychotics. 33 patients were scanned and some moderate QTc-interval prolongations but no clinical events were seen. Due to scarcity of such events existing data should be completed by large scale clinical studies and by registration of severe QTc-interval prolongations and torsades de pointes in central drug monitoring systems.
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6.
[Vitamin B6 add-on therapy in treatment of schizophrenic patients with psychotic symptoms and movement disorders].
Miodownik, C, Cohen, H, Kotler, M, Lerner, V
Harefuah. 2003;(8-9):592-6, 647
Abstract
INTRODUCTION Although there is great progress in the treatment of positive symptoms in schizophrenic patients and movement disorders induced by neuroleptics, it is still a problem for clinicians. In this study vitamin B6 treatment was provided to 15 patients who suffered from schizophrenia and schizoaffective disorder with positive psychotic symptoms and tardive dyskinesia. METHODS This study was a double-blind crossover controlled during 9 weeks. Each patient was treated with up to 400 mg/day vitamin B6 versus placebo. Every week the patients' conditions were evaluated with Positive and Negative Symptoms Scale (PANSS), Extrapyramidal Symptoms Rating Scale (ESRS) and a blood sample of level pyridoxal was taken. RESULTS The results did not show any therapeutic effect of psychotic symptoms from vitamin B6 added to antipsychotic agents, which patients received on a constant base. On the other hand, there was significant improvement in tardive dyskinesia and parkinsonian symptoms. There was no direct correlation between pathological symptoms and the serum baseline level of vitamin B6 nor its level during the treatment. CONCLUSION The authors suggest that vitamin B6 may be efficient as the treatment for tardive dyskinesia and parkinsonism induced by neuroleptic agents. There is a need for further studies with larger samples and higher doses of vitamin B6 in order to examine the possibility of a positive therapeutic effect as an augmentation agent for the treatment of psychotic symptoms.
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7.
Smoking, gender, and dietary influences on erythrocyte essential fatty acid composition among patients with schizophrenia or schizoaffective disorder.
Hibbeln, JR, Makino, KK, Martin, CE, Dickerson, F, Boronow, J, Fenton, WS
Biological psychiatry. 2003;(5):431-41
Abstract
BACKGROUND Prior reports of decreased levels of essential fatty acids among schizophrenic patients have generated several hypotheses proposing inherent abnormalities in phospholipid and fatty acid metabolism and have provided the basis for treatment trials; however, these essential fatty acid aberrations may be attributable to uncontrolled factors, such as smoking, rather than abnormalities inherent to schizophrenia. METHODS Erythrocyte fatty acid compositions were quantified in 72 medicated schizophrenic or schizoaffective patients both at baseline and after 16 weeks of supplementation with 3 g/day of either ethyl-eicosapentaenoic acid or placebo. Current smoking status, gender, dietary survey, and Montgomery Asburg Depression Rating Scale, Repeatable Battery for the Assessment of Neuropsychological Status, Abnormal Involuntary Movement Scale, and Positive and Negative Syndrome Scale scores were assessed. RESULTS Schizophrenic patients who smoked had lower baseline erythrocyte docosahexaenoic acid percent (2.98 +/-.7 vs. 3.59 +/- 1.2, p <.005) and eicosapentaenoic acid (EPA) percent (.39 +/-.13 vs. 47 +/-.22, p <.05), compared with nonsmokers, with a significant gender interaction (p <.01) in multivariate analyses of variance. Baseline arachidonic acid did not differ. Smokers reported lower dietary intake (percent total fat) of linolenic acid (F = 10.1, p <.003) compared with nonsmokers. Nonsmoking women reported greater dietary intake of EPA compared with smoking men or nonsmokers of either gender. CONCLUSIONS Smoking status, gender, and dietary intake significantly predicted erythrocyte polyunsaturated fatty acid status among schizophrenic patients. No evidence was found for subgroups of schizophrenia or relationships to specific symptom severity on the basis of erythrocyte fatty acids. Prior reports of abnormalities of essential fatty acid metabolism among schizophrenic patients may have been an artifact of patients' smoking behavior and differences in dietary intake of omega-3 fatty acids.
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8.
Double-blind antiglucocorticoid treatment in schizophrenia and schizoaffective disorder: a pilot study.
Marco, EJ, Wolkowitz, OM, Vinogradov, S, Poole, JH, Lichtmacher, J, Reus, VI
The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry. 2002;(3):156-61
Abstract
BACKGROUND Antiglucocorticoids, such as ketoconazole, have been investigated as antidepressant agents in major depression and other conditions. Despite evidence that a significant number of patients with schizophrenia and schizoaffective disorder are both hypercortisolemic and depressed, the antidepressant effects of antiglucocorticoids have never been assessed in these populations. METHODS Fifteen symptomatic patients with diagnoses of schizophrenia or schizoaffective disorder, who were at least partially treatment-resistant, were treated with ketoconazole, up to 800 mg/day, (n = 8) or placebo (n = 7) for four weeks in a double-blind manner. The study medication was added to a pre-stabilized antipsychotic and/or antidepressant medication regimen. RESULTS Ketoconazole treatment, compared to placebo, was associated with significant improvements in observer-rated depression, but not in subjectively rated depression, positive or negative psychotic symptom ratings, or cognitive performance scores. CONCLUSIONS These pilot data partially support the hypothesis that antiglucocorticoids reduce depressive symptoms in patients with schizophrenia and schizoaffective disorder, although objective and subjective ratings may not be similarly affected during a four-week course of treatment. Further studies with larger sample sizes, more extensive endocrine assessments and longer duration of drug administration seem warranted.
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9.
A study of quetiapine: efficacy and tolerability in psychotic adolescents.
Shaw, JA, Lewis, JE, Pascal, S, Sharma, RK, Rodriguez, RA, Guillen, R, Pupo-Guillen, M
Journal of child and adolescent psychopharmacology. 2001;(4):415-24
Abstract
OBJECTIVE To study the effectiveness, safety, and tolerability of quetiapine in adolescents with psychotic disorders. METHODS This study was an 8-week, open trial using quetiapine with 15 adolescents, ages 13-17 years, mean age 15.1 years, with a diagnosis of a psychotic disorder. Our primary instruments focused on psychotic symptomatology as measured by the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Positive and Negative Syndrome Scale (PANSS), and the Young Mania Rating Scale (YMRS). Other measures included adverse events, clinical laboratory tests, vital signs, electrocardiogram (ECG), extrapyramidal (EPS) measures, and ophthalmologic examination. RESULTS Quetiapine significantly reduced psychotic symptoms as measured by the BPRS, PANSS, YMRS, CGI, and CGI Severity of Illness scale. The average weight gain was 4.1 kg. After correction for expected weight gain, the mean weight gain over the 8-week period was 3.4 kg. Prolactin and cholesterol remained unchanged. Trends were found for a decrease in T4 and an increase in thyroid-stimulating hormone. Common adverse effects were somnolence, agitation, drowsiness, and headache. No significant findings were noted on repeat ECGs, EPS measures, or ophthalmic examination. The final average treatment dose was 467 mg/day (range 300-800 mg/day). CONCLUSIONS Quetiapine is suggested to be effective treatment of youths with psychotic disorders and to have a favorable side-effect profile.
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10.
[Vitamin E is ineffective in treatment of late dyskinesias].
Bridler, R
Praxis. 2001;(18):809-10