Asunto(s)
Antidepresivos/uso terapéutico , Toma de Decisiones , Trastorno Depresivo/tratamiento farmacológico , Antidepresivos/farmacología , Trastorno Depresivo/psicología , Sobredosis de Droga , Humanos , Inhibidores Selectivos de la Recaptación de Serotonina/farmacología , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéuticoRESUMEN
BACKGROUND: We examined the effects of ziprasidone on body mass index (BMI) and serum levels of glucose, cholesterol, and triglycerides. METHOD: As part of a multicenter study examining different strategies for switching to ziprasidone from other antipsychotics, we evaluated weight and serum glucose, cholesterol, and triglyceride measurements at baseline and following 6 weeks on ziprasidone treatment in 37 patients at our site. RESULTS: Short-term treatment with ziprasidone appeared to lead to significant reduction in serum cholesterol (p < .001) and triglyceride levels (p = .018) independent of changes in BMI. Ziprasidone treatment appeared to have no significant effect on BMI or glucose level, perhaps due to the small number of subjects. CONCLUSION: Ziprasidone appears to independently lead to a lowering of serum lipid levels.
Asunto(s)
Antipsicóticos/farmacología , Glucemia/efectos de los fármacos , Lípidos/sangre , Piperazinas/farmacología , Esquizofrenia/sangre , Esquizofrenia/tratamiento farmacológico , Tiazoles/farmacología , Adulto , Análisis de Varianza , Antipsicóticos/uso terapéutico , Glucemia/análisis , Índice de Masa Corporal , Peso Corporal/efectos de los fármacos , Colesterol/sangre , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Piperazinas/uso terapéutico , Trastornos Psicóticos/sangre , Trastornos Psicóticos/tratamiento farmacológico , Tiazoles/uso terapéutico , Triglicéridos/sangreRESUMEN
BACKGROUND: Although agitation associated with psychosis is a common presentation in the psychiatric emergency service, there is no consensus concerning the best treatment. Standard treatment often consists of intramuscular (i.m.) injection of high-potency neuroleptics, sometimes combined with benzodiazepines. The objective of this study was to determine the relative efficacy, safety, and tolerability of oral risperidone versus intramuscular haloperidol, both in combination with lorazepam, for the emergency treatment of psychotic agitation in patients who are able to accept oral medications. METHOD: A convenience sample of psychotic patients admitted to a large psychiatric emergency service who required emergency medication for the control of agitation and/or violence was offered risperidone (2 mg liquid concentrate) and oral lorazepam (2 mg) as an alternative to standard care at the institution, haloperidol (5 mg i.m.) and lorazepam (2 mg i.m.). Subjects who refused the oral medications were given the intramuscular treatment as a component of routine care. RESULTS: Thirty patients were enrolled in each treatment group. Although men were significantly more likely to choose oral medication (chi2 = 5.165, p < .023), other demographic characteristics did not differ significantly between the 2 treatment groups. Both groups showed similar improvement in agitation as measured by 5 agitation subscales of the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI) scale, and time to sedation. No patients receiving risperidone demonstrated any side effects or adverse events, while 1 patient receiving intramuscular treatment with haloperidol developed acute dystonia. One subject receiving risperidone required subsequent treatment with haloperidol for ongoing agitation. CONCLUSION: Oral treatment with risperidone and lorazepam appears to be a tolerable and comparable alternative to intramuscular haloperidol and lorazepam for short-term treatment of agitated psychosis in patients who accept oral medications.
Asunto(s)
Antipsicóticos/administración & dosificación , Haloperidol/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Lorazepam/administración & dosificación , Agitación Psicomotora/tratamiento farmacológico , Trastornos Psicóticos/tratamiento farmacológico , Risperidona/administración & dosificación , Enfermedad Aguda , Administración Oral , Adulto , Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Quimioterapia Combinada , Servicios de Urgencia Psiquiátrica , Femenino , Haloperidol/uso terapéutico , Humanos , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/uso terapéutico , Inyecciones Intramusculares , Lorazepam/uso terapéutico , Masculino , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Risperidona/uso terapéutico , Resultado del Tratamiento , Violencia/psicologíaRESUMEN
The enthusiasm produced by the introduction of antipsychotic medication in the 1950s gave way to a certain frustration in the 1970s and 1980s. Despite the development of a large number of new drugs, little progress was made in treatment because these new agents were, in essence, therapeutically equivalent. This lack of progress was perhaps also related to an emphasis on tardive dyskinesia in the 1970s, i.e., the preoccupation with a negative effect of treatment. The reverse is taking place today. Clozapine and the other atypical antipsychotics are associated in people's minds with fewer or absent extrapyramidal symptoms and less tardive dyskinesia than the older typical agents. As a result, a certain amount of complacency exists. Tardive dyskinesia not only may be painful and disfiguring, but it also predicts poor outcome in patients with schizophrenia. Although many treatments have been tried, none have proven completely efficacious. The best treatment for tardive dyskinesia and dystonia is prevention, which is a function of medication choice. Pharmacologic interventions for tardive dyskinesia include clozapine and the other atypical antipsychotics. If typical antipsychotics must be used, they should be started at the lowest possible levels. Studies of risperidone suggest that it, too, should be used at very low doses to minimize the risk of tardive dyskinesia. It is also possible that schizophrenic patients taking atypical antipsychotics may experience fewer spontaneous dyskinesias, although further study is warranted.
Asunto(s)
Antipsicóticos/efectos adversos , Discinesia Inducida por Medicamentos/tratamiento farmacológico , Distonía/inducido químicamente , Distonía/tratamiento farmacológico , Adulto , Acatisia Inducida por Medicamentos/tratamiento farmacológico , Algoritmos , Antipsicóticos/uso terapéutico , Benzodiazepinas , Clozapina/uso terapéutico , Árboles de Decisión , Esquema de Medicación , Discinesia Inducida por Medicamentos/etiología , Femenino , Humanos , Masculino , Olanzapina , Pirenzepina/efectos adversos , Pirenzepina/análogos & derivados , Pirenzepina/uso terapéutico , Probabilidad , Reserpina/uso terapéutico , Risperidona/efectos adversos , Risperidona/uso terapéutico , Esquizofrenia/tratamiento farmacológico , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Síndrome de Abstinencia a Sustancias/etiología , Tetrabenazina/uso terapéutico , Resultado del Tratamiento , Vitamina E/uso terapéuticoAsunto(s)
Antipsicóticos/uso terapéutico , Trastornos Distónicos/tratamiento farmacológico , Pirenzepina/análogos & derivados , Adulto , Antipsicóticos/efectos adversos , Benzodiazepinas , Trastornos Distónicos/inducido químicamente , Humanos , Masculino , Olanzapina , Pirenzepina/uso terapéutico , Esquizofrenia/tratamiento farmacológico , Resultado del TratamientoRESUMEN
OBJECTIVE: This study explored the relative efficacy of three different doses of clozapine. METHOD: Fifty patients who met Kane et al.'s criteria for treatment-refractory schizophrenia or schizoaffective disorder were studied. All subjects were randomly assigned to 100, 300, or 600 mg/day of clozapine for 16 weeks of double-blind treatment. Forty-eight patients completed this first 16 weeks. Of the 50 patients, 36 went on to second and third 16-week trials of double-blind treatment at the remaining doses. RESULTS: Four subjects (8%) responded to the first 16-week condition, and one subject (2%) responded to the next 16-week crossover condition. A chi-square comparison of the response rates from the three dose groups failed to show a significant effect. An analysis of variance (ANOVA) comparison of Brief Psychiatric Rating Scale-Anchored (BPRS-A) total change scores from baseline to last observation carried forward showed a significant dose effect (600>300>100 mg/day) at 16 weeks of treatment. A crossover ANOVA of the BPRS-A total scores from the 48-week study also showed that the main effect for dose was highly significant; the 100-mg/day dose gave the higher (poorer) values, and the 300- and 600-mg/ day doses gave equal (better) values. Gender played a role in clinical response to treatment at 100 mg/day. CONCLUSIONS: Clozapine treatment at 100 mg/day was less effective than at 300 or 600 mg/day. At 100 mg/day, women responded better than did men. The 600 mg/day group had the best results, but an occasional patient required up to 900 mg/day. Overall response rates were lower than expected.
Asunto(s)
Antipsicóticos/uso terapéutico , Clozapina/uso terapéutico , Esquizofrenia/tratamiento farmacológico , Antipsicóticos/administración & dosificación , Escalas de Valoración Psiquiátrica Breve/estadística & datos numéricos , Clozapina/administración & dosificación , Estudios Transversales , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Esquema de Medicación , Femenino , Haloperidol/administración & dosificación , Haloperidol/uso terapéutico , Humanos , Masculino , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/psicología , Psicología del Esquizofrénico , Resultado del TratamientoRESUMEN
BACKGROUND: Akathisia has been reported to predict more severe symptoms and poorer treatment response to typical neuroleptics among patients with schizophrenia. Akathisia has also been associated with symptom exacerbation. This study addressed four questions: 1) Does akathisia predict greater severity in global psychopathology? 2) Is this effect global or specific? 3) Does clozapine treatment alter this relationship? 4) Does severity of psychopathology covary with the level of akathisia? METHODS: Akathisia and clinical symptoms were examined in 33 "treatment refractory" schizophrenic patients treated with clozapine across 16 weeks. Weekly ratings were Barnes Akathisia Rating Scale, Abbreviated Dyskinesia Rating Scale, and Brief Psychiatric Rating Scale (BPRS). Patients were classified as "with" (n = 15) or "without" (n = 18) akathisia. Data analyses involved independent t-test comparisons of selected variables, between-group multivariate analyses of variance across time for BPRS Total scores and Guy's five factors, and partial correlations to assess covariation between BPRS scores and level of akathisia. RESULTS: Akathisia predicted more severe global psychopathology, specific to the Activation (AC) and Thought Disturbance (TH) factors. These relationships did not change with clozapine treatment even when akathisia declined. Interestingly, level of akathisia did not covary with severity of psychopathology. CONCLUSIONS: In this sample, akathisia predicted more severe psychopathology, specific to AC and TH BPRS factor scores. Clozapine treatment did not alter this relationship. Although the presence of akathisia predicted more severe symptoms, the level of akathisia did not covary across time with severity of psychopathology, suggesting an "uncoupling" of these symptom domains.
Asunto(s)
Acatisia Inducida por Medicamentos/psicología , Clozapina/efectos adversos , Esquizofrenia/tratamiento farmacológico , Psicología del Esquizofrénico , Adulto , Acatisia Inducida por Medicamentos/diagnóstico , Acatisia Inducida por Medicamentos/etiología , Clozapina/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esquizofrenia/diagnóstico , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: To present a critical overview of the available evidence for the efficacy and safety of antipsychotic agents in children and adolescents and to identify knowledge gaps and needs for further research. Data from adults that are relevant to children are discussed. METHOD: Mainly reports of double-blind, placebo-controlled studies were reviewed. RESULTS: In children and adolescents, antipsychotics are used to treat psychotic and a variety of nonpsychotic conditions. The amount of data based on well-designed, double-blind, placebo-controlled studies with satisfactory sample sizes in diagnostically homogeneous subjects is modest. CONCLUSIONS: Currently available standard antipsychotics have a definite role in the treatment of children and adolescents. The use of these agents is limited mainly by tardive and withdrawal dyskinesias and, in some patients, by excessive sedation. The atypical antipsychotics should be critically assessed and compared with psychosocial interventions; if effective, the combination of both types of treatments should be evaluated.
Asunto(s)
Antipsicóticos/uso terapéutico , Trastornos Psicóticos/tratamiento farmacológico , Adolescente , Psiquiatría del Adolescente/tendencias , Antipsicóticos/efectos adversos , Antipsicóticos/farmacocinética , Niño , Psiquiatría Infantil/tendencias , Ensayos Clínicos como Asunto , Humanos , Proyectos de Investigación , Resultado del TratamientoRESUMEN
Reduced monoamine oxidase activity has been proposed as a marker for vulnerability to schizophrenia. Reduced monamine oxidase activity has also been shown to occur in cigarette smokers. This study compared monamine oxidase activity level in a matched group of patients with schizophrenia who smoked with a group who did not. Lower levels of monoamine oxidase activity were found in the smokers and this is the likely explanation for the low levels hypothesized as a marker for schizophrenia.
Asunto(s)
Monoaminooxidasa/metabolismo , Esquizofrenia/enzimología , Fumar/metabolismo , Adulto , Biomarcadores , Humanos , Isoenzimas/metabolismo , Masculino , Persona de Mediana Edad , Monoaminooxidasa/sangre , Esquizofrenia/sangre , Fumar/sangreRESUMEN
The Mini-Mental State Examination (MMSE) is frequently used in schizophrenia studies. Therefore, it is surprising that no factor analysis of MMSE has been carried out in schizophrenic patients. The MMSE ratings of 80 long-term in-patients with DSM-III-R schizophrenia or schizoaffective disorder were introduced into a principal-component analysis with varimax rotation which generated three MMSE factors or subscales (frontal, memory and spatial). The limitations of this pilot study are the small sample size and the inclusion of only hospitalized patients.
Asunto(s)
Escala del Estado Mental/normas , Esquizofrenia/diagnóstico , Adulto , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Esquizofrenia/clasificación , Sensibilidad y EspecificidadAsunto(s)
Trastornos Mentales/tratamiento farmacológico , Enfermos Mentales , Placebos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Adolescente , Antidepresivos/uso terapéutico , Antimaníacos/uso terapéutico , Niño , Trastorno de la Conducta/tratamiento farmacológico , Trastorno Depresivo/tratamiento farmacológico , Ética Médica , Femenino , Humanos , Cloruro de Litio/uso terapéutico , Masculino , Proyectos de InvestigaciónRESUMEN
BACKGROUND: Polydipsia-hyponatremia is a poorly understood disorder that causes considerable mortality and morbidity. Hyponatremia in polydipsia-hyponatremia has been attributed to disturbances in antidiuretic hormone (ADH) function. Improvements in polydipsia-hyponatremia during clozapine treatment offered the chance to see if levels of ADH and other hormones associated with osmoregulation changed with improvement in biochemical and clinical measures of polydipsia-hyponatremia. METHOD: In this preliminary, longitudinal study, we studied 2 male schizophrenic patients (DSM-III-R) who had polydipsia-hyponatremia. Measures were (1) biochemical and clinical: serum sodium and osmolality, urine osmolality and specific gravity, normalized diurnal weight gain, and estimated urine volume and (2) endocrine: ADH, angiotensin II, atrial natriuretic peptide, and prolactin. Measures were collected during 2 months of baseline (typical neuroleptic) and 6 months of clozapine treatment. RESULTS: Single-case statistical procedures showed significant changes in sodium levels (a.m. and p.m.), estimated urine volume, and a.m. urine specific gravity in both patients and significantly decreased diurnal weight gain in 1 patient. Both serum and urine osmolality showed improvement, but values did not reach statistical significance. Low baseline ADH levels persisted through 6 months of clozapine treatment and showed no changes in the context of improvements in serum sodium and osmolality. No significant changes were seen in levels of angiotensin II and atrial natriuretic peptide. CONCLUSION: Given the limitations of this study, there is some evidence to suggest that the improvements in serum sodium and osmolality during clozapine treatment of polydipsia-hyponatremia may not be related to serum levels of ADH, although altered ADH receptor function cannot be ruled out. These data need to be extended in larger samples.
Asunto(s)
Angiotensina II/sangre , Factor Natriurético Atrial/sangre , Clozapina/uso terapéutico , Hiponatremia/tratamiento farmacológico , Vasopresinas/sangre , Intoxicación por Agua/tratamiento farmacológico , Adulto , Ritmo Circadiano , Humanos , Hiponatremia/sangre , Hiponatremia/orina , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Concentración Osmolar , Prolactina/sangre , Esquizofrenia/sangre , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/orina , Sodio/sangre , Orina , Intoxicación por Agua/sangre , Intoxicación por Agua/orinaAsunto(s)
Antipsicóticos/efectos adversos , Antipsicóticos/farmacología , Fertilidad/efectos de los fármacos , Esquizofrenia/tratamiento farmacológico , Amenorrea/inducido químicamente , Femenino , Humanos , Prolactina/metabolismo , Receptores de Dopamina D2/efectos de los fármacos , Psicología del EsquizofrénicoAsunto(s)
Discinesia Inducida por Medicamentos/etiología , Distonía/inducido químicamente , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Adulto , Acatisia Inducida por Medicamentos/etiología , Enfermedades de los Ganglios Basales/inducido químicamente , Femenino , Humanos , MasculinoAsunto(s)
Antipsicóticos/historia , Clorpromazina/historia , Pirenzepina/análogos & derivados , Trastornos Psicóticos/historia , Antipsicóticos/uso terapéutico , Benzodiazepinas , Clorpromazina/uso terapéutico , Clozapina/historia , Clozapina/uso terapéutico , Historia del Siglo XX , Humanos , Olanzapina , Pirenzepina/historia , Pirenzepina/uso terapéutico , Trastornos Psicóticos/tratamiento farmacológicoRESUMEN
Data on extrapyramidal symptoms (EPS) from both arms of the North American multicenter comparative study of risperidone, placebo, and haloperidol were analyzed. The subjects were 523 patients with chronic schizophrenia who, after a 1-week washout period, received placebo, risperidone (2, 6, 10, or 16 mg/day), or haloperidol (20 mg/day) for 8 weeks; the trial was completed by 253 patients. Severity of EPS was assessed by means of the Extrapyramidal Symptom Rating Scale (ESRS). Mean changes (increases) in ESRS scores from baseline to worst score were significantly lower in each risperidone group than the haloperidol group on the total ESRS (parkinsonism + dystonia + dyskinesia), total parkinsonism, hypokinetic symptoms, and on the questionnaire (p < 0.001). On several of the subscales (dyskinesia, buccolinguomasticatory, and Clinical Global Impression severity of dyskinesia), mean change scores were significantly lower in some of the risperidone groups than in the placebo group (p < 0.05). At the clinically most effective risperidone dose (6 mg/day), the mean ESRS change score was not significantly different from that of the placebo group. A significant linear relationship was noted between mean change scores and increasing risperidone dose on 4 of the 12 ESRS subscales; nevertheless, even at 16 mg/day of risperidone, mean change scores were lower than in the haloperidol group. A linear relationship between increasing risperidone dose and use of antiparkinsonian medications was also apparent. Acute dystonic reactions occurred both in patients receiving risperidone and haloperidol. Patients with severe baseline EPS were at higher risk of EPS during the study than patients with low or moderate baseline EPS. It is concluded that low doses of risperidone cause few or no EPS and recommendations for initiation of risperidone treatment are made.