Addressing Side Effects From Antipsychotic Treatment in Schizophrenia
Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA. The Journal of Clinical Psychiatry
(Impact Factor: 5.5).
02/2011; 72(2):e07. DOI: 10.4088/JCP.9101tx3c
Antipsychotic treatment of schizophrenia is associated with an array of adverse events, many of which are difficult for patients to tolerate and promote nonadherence to treatment. Serious adverse events include extrapyramidal symptoms (EPS), hyperprolactinemia, weight gain leading to metabolic syndrome, sedation, cognitive deficits, and hypotension. Clinicians need to be aware of each antipsychotic's propensity to cause these adverse events as well as strategies for avoiding or minimizing the occurrence of adverse events.
Available from: Connie Sánchez
- "The exact mechanism for development of EPS is not fully understood, although it is generally accepted that dysfunction in dopaminergic transmission of the nigrostriatal pathway plays a key role (Glazer, 2000; Tuppurainen et al., 2010). Reduced DA transmission in the form of DA receptor blockade by antipsychotic treatment in schizophrenia is frequently manifested by the side effects of EPS and hyperprolactinemia, since dopamine exerts a potent and tonic inhibition of prolactin secretion under normal conditions (Kane, 2011). In a study of 159 patients on different medications, 27 cases (17%) of hyperprolactinemia were reported after SSRI treatment, and the occurrence was the highest for sertraline followed by paroxetine and other antidepressants (Petit et al., 2003). "
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ABSTRACT: It is known that newer antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs), provide advantages in tolerability over antidepressants such as the tricyclics. However, even within the SSRI class, differences in efficacy or tolerability exist between the individual drugs. Among the three most widely prescribed SSRIs are paroxetine, sertraline, and escitalopram. Escitalopram is commonly referred to as an SSRI, but also has well-documented allosteric properties, and thus can be further classed as an allosteric serotonin reuptake inhibitor. All three antidepressants are efficacious compared with placebo, but there is evidence that escitalopram is more effective than a range of other antidepressants. There are no direct data to regard either paroxetine or sertraline as a superior antidepressant. Escitalopram is superior compared with paroxetine, which has a less favorable tolerability profile. Paroxetine is associated with cholinergic muscarinic antagonism and potent inhibition of CYP2D6, and sertraline has moderate drug interaction issues in comparison with escitalopram. Overall, as an allosteric serotonin reuptake inhibitor that is somewhat different from classical SSRIs, escitalopram is the first choice judged by combined efficacy and tolerability, and nonclinical data have offered possible mechanisms through which escitalopram could be more efficacious, based on its interaction with orthosteric and allosteric binding sites at the serotonin transporter.
Available from: Amal Abdel-Baki
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ABSTRACT: The first episode of a psychotic disorder typically occurs in late adolescence or young adulthood, a critical time of development with respect to personality, social role, education, and vocation. The first few years of psychosis appear to be a critical period during which intervention needs to be initiated before the consequences of psychosis become more severe. Early intervention is therefore crucial in maximizing outcomes. Although response rates to antipsychotic medication in first-episode psychosis (FEP) are good, there is a relatively high risk of relapse. The greatest challenges that physicians face in treating FEP and preventing relapse are engaging patients in treatment and preventing non-adherence to therapy. Overall rates of non-adherence to antipsychotic medications for FEP patients are estimated to be at or higher than 50% within the first year of treatment, suggesting that malleable factors linked to non-adherence need to be targeted in interventions provided. Factors influencing adherence can be categorized into four groups: (1) environment-related, (2) patient-related, (3) medication-related, and (4) illness-related. This paper will review the factors associated with adherence and discuss solutions to optimize engagement, adherence to medication, and treatment in order to prevent relapse. Factors like social and family support, therapeutic alliance, attitudes and beliefs toward illness and medication, insight, substance use disorders, medication efficacy, tolerability, and accessibility will be discussed. Solutions, such as early psychosis specialized services integrating psychosocial therapies and careful selection of appropriate antipsychotic medication, will be proposed.
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ABSTRACT: Background Epidemiological information on age-related cardiovascular disease in people with intellectual disability (ID) is scarce and inconclusive. We compared prevalence and incidence of cerebrovascular accident and myocardial infarction over age 50 in a residential population with ID to that in a general practice population.
Method A retrospective descriptive study was conducted, based on medical records of 510 persons with ID and 823 general practice patients, aged 50 years and over.
Results Lifetime prevalences after age 50 were similar in both populations: 5.7% (95% CI 4.0–8.1%) in persons with ID and 4.4% (95% CI 3.1–6.0%) in the general population (Pearson chi-square 1.17, P = 0.279). Incidence per gender was similar between cohorts (men P = 0.86, women P = 0.36). There was no difference in incidence rates between the ID and control groups [relative risk = 1.5 (95% CI 0.9–2.4)].
Conclusion Prevalence and incidence of myocardial infarction and cerebrovascular accident in ageing persons with ID do not appear different from those in the general population. It has to be taken into account that underdiagnosis and selection bias towards a more disabled group may have lead to underestimation of age-related cardiovascular morbidity, and the higher age and underrepresentation of Down syndrome to overestimation.
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