Clonazepam augmentation during treatment with antipsychotics in aggressive psychiatric inpatients - pilot study
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Clonazepam
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Objective: The Health Outcomes of a Canadian Community Cohort (HOCCC) study is a 1-year prospective observational study of outpatients with schizophrenia or related psychotic disorders. The purpose of the study was to compare effectiveness of antipsychotic treatment as measured by 1-year treatment completion rates.Design and methods: Patients (N = 929) were enrolled if in the course of usual clinical practice they switched to a second-generation antipsychotic (SGA). Observational data were collected for up to 1 year. The primary analysis compared 1-year treatment-completion rates for the olanzapine cohort with the other SGA cohort (quetiapine, risperidone, clozapine), using a chi-squared test.Results: Of 929 patients enrolled, 64.8% (516/796) of evaluable patients completed 1 year of treatment. There was no statistically significant difference in the proportion of treatment completers between the olanzapine cohort (67.4%, 256/380) and the other SGA cohort (62.5%, 260/416). Treatment-completion rates were risperidone 62.0% (127/205), quetiapine 63.7% (123/193) and clozapine 55.6% (10/18). Antipsychotic polypharmacy was common. Patients treated with olanzapine or risperidone had significantly higher increases in BMI than quetiapine-treated patients. There were no major differences between olanzapine monotherapy and pooled other SGA monotherapy groups in status of extrapyramidal symptoms from baseline to endpoint.Conclusions: Olanzapine and other SGAs exhibited similar rates of 1-year treatment completion. Further study of medication combinations is needed, given their perceived clinical value, and the high frequency of antipsychotic polypharmacy in clinical practice.Limitations: As most patients received several psychotropics and power was reduced in monotherapy analyses, comparisons between cohorts must be interpreted cautiously. Comparisons between individual antipsychotics were post hoc and not powered a priori. Accuracy and completeness of adverse event information for drugs other than olanzapine is limited.
Extrapyramidal symptoms
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Objective This analysis examined dosing patterns and safety of aripiprazole in elderly inpatients. Methods A total of 52 elderly inpatients treated with aripiprazole over 3 years were retrospectively identified to examine dosing patterns and side effects associated with use of aripiprazole. Results The most common psychiatric diagnoses in these patients were schizophrenia/schizoaf-fective disorder (29%), bipolar disorder (25%), and major depressive disorder (23%). The median starting and maximum daily doses were 5 mg and 10 mg, respectively. For patients whose dose was titrated upward during the hospitalization, the mean time to the first titration was 3.4 days and the mean time to achieve maximum dose was 5 days. Nine patients (17%) had documented side effects, with agitation/activation the most frequently reported effect (8%). Aripiprazole was continued after hospital discharge in 54% of patients, with most patients receiving 10 to 15 mg/day. Conclusion Aripiprazole was generally well tolerated, with agitation/activation the most common side effect reported in elderly inpatients. (Journal of Psychiatric Practice 2009;15:150–153).
Aripiprazole
Bipolar I disorder
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Tolerability
Extrapyramidal symptoms
Clinical Global Impression
Management of schizophrenia
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This study investigated the dosing patterns for aripiprazole augmentation for major depressive disorder (MDD) in a naturalistic treatment setting. Between 1 January 2009 and 31 March 2012, patients with a diagnosis of MDD who were receiving aripiprazole augmentation in conjunction with an ongoing antidepressant were recruited for this study. The electronic medical records and clinical data for a total of 276 patients were reviewed up to a year. The mean duration of aripiprazole augmentation was ∼5 months; the mean time to the first increase of aripiprazole was about 3 weeks; and the mean initial, first up-titrated, maximal, and maintenance doses were 3.4, 4.2, 4.7, and 4.4 mg/day, respectively. The most frequent adverse events were insomnia, followed by anxiety and sedation. The current results indicate that the actual doses of aripiprazole augmentation with ongoing antidepressant for MDD should be lower than the doses used in placebo-controlled clinical trials and those recommended by the US Food and Drug Administration. Adequately powered and well-controlled prospective studies are needed to better understand the exact role of low doses of aripiprazole augmentation in the treatment of MDD, particularly in routine practice.
Aripiprazole
Depression
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Treatment of patients with Treatment-resistant Schizophrenia (TRS), who fail to respond to multiple antipsychotic trials, including clozapine (CLZ), is challenging. Several alternative strategies are reported in studies, one of which includes augmenting antipsychotics (AP) with Electroconvulsive therapy (ECT). We discuss a case of an acutely psychotic patient with TRS who responded effectively and sustained remission to this strategy which was ECT combined with two AP, CLZ and aripiprazole. Notable improvement in clinical and cognitive outcomes was seen with just five right unilateral ECT sessions, CLZ titrated up to 62.5 mg/d and aripiprazole 20 mg/d with no adverse effects. Nine days into the psychiatric hospitalization, patient had decreased total scores on the Positive and Negative Syndrome Scale by 44% and an improved score on the St. Louis University Mental Status Exam by increasing from 3 to 22. This case report suggests that a subgroup of patients with TRS could benefit from a trial of adjunct ECT combined with AP to achieve a rapid alleviation of positive and negative symptoms which allows patients to have greater functional stability.
Aripiprazole
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Antidepressant medication
Pharmacotherapy
Depression
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To determine the frequency of administration, efficacy and safety of long acting antipsychotics in day-to-day psychiatric practice in outpatient clinics.The study included 90 patients with schizophrenia treated with haloperidol decanoate (n=18), rispolept consta (n=19), clopixol depot (n=25), paliperidone palmitate (n=25). Symptoms of schizophrenia were assessed with PANSS during 12 months.The use of long acting antipsychotics has proven to be effective and safe to control all symptom clusters in patients regardless of the disease duration.Определение частоты применения, эффективности и безопасности длительной терапии амбулаторных пациентов антипсихотиками пролонгированного действия в повседневной психиатрической практике психоневрологических диспансеров.Обследованы 90 больных шизофренией, из которых 18 получали галоперидол деканоат, 19 — рисполепт конста, 25 — клопиксол депо, 28 — палиперидона пальмитат. В течение 12 мес в процессе лечения проводили клиническую оценку психопатологической симптоматики по шкале PANSS.Применение антипсихотиков пролонгированного действия показало себя как достаточно эффективный и безопасный способ лечения больных шизофренией с разными кластерами психопатологических симптомов как с большой длительностью заболевания, так и недавно заболевших.
Paliperidone Palmitate
Outpatient clinic
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Ziprasidone
Discontinuation
Aripiprazole
Quetiapine Fumarate
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Stopping antipsychotic treatment can interrupt improvement and exacerbate the illness. The reasons for discontinuing treatment during controlled clinical trials were analyzed to explore this phenomenon.A post-hoc, pooled analysis was made of 4 randomized, double-blind clinical trials, 24-28 weeks in duration, involving 1627 patients with schizophrenia or a related disorder. Analyses combined all the atypical antipsychotic treatment groups in the studies.The majority of patients (53%) stopped their treatment at an early stage. Poor psychiatric response along with worsening symptoms was the most frequently given reason for discontinuing the course (36%), which was substantially more common than discontinuation due to poor tolerability of the medication (12%). This phenomenon was corroborated by less improvement in patients who discontinued treatment compared with those who completed, based on the PANSS total scores. Discontinuation due to poor response was, apparently, more predominantly linked to patient perception than to physicians' conclusions alone (80% vs. 20%). Discontinuation due to patient perception of poor response appeared to occur particularly early in the course of treatment. Patients who discontinued due to poor toleration of the medication responded in a more comparable manner with completers.Discontinuing treatment may lead to exacerbation of symptoms, undermining therapeutic progress. In these studies, poor response to treatment and worsening of underlying psychiatric symptoms, and to a lesser extent, intolerability to medication were the primary contributors to treatment being discontinued. Our findings suggest that adherence may be enhanced by effective symptom control, as objectively measured and as subjectively perceived. Such strategies may improve patients' willingness to undertake long-term therapy and increase the likelihood of a better prognosis.
Discontinuation
Tolerability
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