Article

Real-World Antipsychotic Treatment Practices

University of Texas at San Antonio, San Antonio, Texas, United States
The Psychiatric clinics of North America (Impact Factor: 1.87). 10/2007; 30(3):401-16. DOI: 10.1016/j.psc.2007.04.008
Source: PubMed

ABSTRACT

This article examines real-world antipsychotic use in the treatment of schizophrenia by comparing real-world prescribing with medication algorithms and guidelines, by evaluating the evidence underlying recommendations and guidelines, and by examining the roles of side effects and medication adherence in real-world prescribing decisions.

    • "Clozapine is the only approved medication for treatment of resistant schizophrenia (TRS) due to its superior efficacy (Leucht et al., 2013). Clozapine underuse (only prescribed for 5% of eligible patients (Moore et al., 2007)) is mainly due to its side effects which reduce initial prescription (Nielsen et al., 2013) and cause discontinuation. There are clear protocols for managing some side effects (i.e. "
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    ABSTRACT: Clozapine induced sedation is common but its management is unclear. We analyzed the factors associated with clozapine-induced sedation and the efficacy of common pharmacological strategies. We conducted a naturalistic observational study using two years electronic records of a cohort patients and three analyses: a cross sectional analysis of factors associated with total number of hours slept (as an objective proxy of sedation), and two prospective analyses of which factors were associated with changes in hours slept and the efficacy of two pharmacological strategies. 133 patients were included, of which 64.7% slept at least 9h daily. Among monotherapy patients (n=30), only norclozapine levels (r=.367, p=.03) correlated with hours slept. Using the prospective cohort (n=107), 42 patients decreased the number of hours slept, due to decreasing clozapine (40%) or augmenting with aripiprazole (36%). These two strategies were recommended to 22 (20.6%) and 23 (21.5%) subjects respectively but the majority (81.8% and 73.9%) did not reduce number of hours slept. Thus, pharmacological and non-pharmacological factors are involved in sedation. Norclozapine plasma levels correlated with total sleeping hours. Reducing clozapine and aripiprazole augmentation were associated to amelioration of sedation, although both strategies were effective only in a limited numbers of subjects.
    No preview · Article · Nov 2015 · European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology
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    • "Atypical antipsychotics (also known as second generation antipsychotics, SGAs) have proven effective in the treatment of schizophrenia and schizoaffective disorder yielding improvements in both positive and negative symptoms [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11]. Many SGAs are also indicated for the treatment of the different phases of bipolar disorder (BD) (i.e. "
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    ABSTRACT: Aim. To confirm the efficacy and tolerability of ziprasidone as adjunctive therapy in bipolar patients partially responding to clozapine or with persisting negative symptoms, overweight, or with metabolic syndrome. Methods. Eight patients with psychotic bipolar disorder were tested with the BPRS, the HAM-D, and the CGI at T0 and retested after 2 weeks (T1). Plasma clozapine and norclozapine levels and BMI were tested at T0 and T1. Results. Ziprasidone was well tolerated by all the patients. BPRS and HAM-D scores were reduced in all patients. BMI was reduced in patients with a BMI at T0 higher than 25. Plasma levels of clozapine and norclozapine showed an irregular course.
    Full-text · Article · Apr 2014
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    ABSTRACT: Monotherapy is quite frequently discussed way of treatment of severe disabling mental disorders (schizophrenia - F20, bipolar affective disroder- type I-F31, depressive disorders- F32,F33). Despite the fact that monotherapy is usually recommended as the first line treatment the data from clinical practice show that clinical practice sometimes differs from what is suggested. We decided to analyze data from our group of in-patients treated at the 1st Department of Psychiatry of LF UPJŠ and FNLP during 2007 with all three diagnosis already mentioned. Files of 275 in-patients were included for analysis and we found that 47% of in-patiens were discharged from the hospital with monotherapy. Despite the finding that combination/ augmentation of tretament were found to be a slightly more frequent in these groups of in- patiens if we consider that most of our in-patiens represent a group with moderate to severe disorders ( more re-hospitalisation, treatment- resistent, chronic patients,...) it is quite positive outcome. The fact that monotherapy was a reality in 47% of our in-patiens shows that monotherapy can be used in the treatment of severe mental disorders (like schizophrenia, bipolar affective disorders, depressive disorders).
    No preview · Article · Jan 2007 · Psychiatrie
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