First Manic Episode in a Young Woman with Schizophrenia after Initiation of Oral Aripiprazole and Aripiprazole Long-Acting Injection / 우울ㆍ조울병

A woman in her twenties with schizophrenia developed immediate-onset mania after taking oral aripiprazole and receiving aripiprazole long-acting injection (ALAI). The dosage of aripiprazole was rapidly increased due to inadequate stimulating effect of low-dosage aripiprazole, but her manic symptomatology worsened. Clinicians should therefore carefully monitor for the induction of mania by oral aripiprazole and ALAI. Her manic symptomatology improved after adding 20 mg of blonanserin, 3 mg of risperidone, and 300 mg of quetiapine.

The Drug Adherence and Treatment Effect of the Paliperidone Long Acting Injection / 신경정신의학

OBJECTIVES: The aim of this study was to examine the drug adherence and treatment effect of the paliperidone long acting injection (LAI) in patients with schizophrenia or other psychotic disorders. METHODS: We reviewed the medical charts of patients who were prescribed paliperidone LAI from January 2010 to April 2014. Date of each injection, last observation, and first admission after use of the drug were obtained. Kaplan-Meier survival analysis was used for calculation of drug adherence. The dose of paliperidone LAI, concurrent oral antipsychotics, and anticholinergic agent was also obtained. Antipsychotics dose was calculated as olanzapine equivalent dose. RESULTS: The drug adherence of the paliperidone LAI on day 365 was 65%. The reasons for all cause discontinuation were follow-up loss, no effect, poor insight, rejection, extrapyramidal symptom, pain, etc. A total dose of 9.1 mg of oral antipsychotics was decreased, while the dose of anticholinergic agent was increased. CONCLUSION: The drug adherence of the paliperidone LAI was 65%, which was concordant with previous studies. The dose of concurrent oral antipsychotics was increased, while the dose of anticholinergic agent was decreased.

Questionnaire Survey on Collaboration between Hospital and Community Pharmacists to Ensure Safe Use of Long-acting Antipsychotic Injections / 社会薬学

In April 2014, a Letter of Rapid Safety Communication was issued, because 21 fatalities following administration of paliperidone palmitate (PP) were reported over a 5-month period since its launch in November, 2013. At the Department of Pharmacy of Hakodate Watanabe Hospital (our hospital), we established criteria for the use of long-acting antipsychotic injections (LAIs) when we began to prescribe LAIs at our hospital and shared information on the use of LAIs with pharmacists at community pharmacies by placing seals in medication notebooks. In March 2014, we conducted a questionnaire survey of pharmacists at 223 community pharmacies in Southern Hokkaido to compared the investigation items by the percentage of prescriptions filled in by the department of psychiatry among all the prescriptions dispensed by the pharmacies. The pharmacists who answered that injectable drug use information and seals for medication notebooks were necessary accounted for 75.8% and 74.2% of the responders, respectively. On the other hand, the percentages comprising the acquisition rates of information on injectable drug use and information on the injectable drugs used were low with 12.1% and 7.6% respectively. Also, a significant difference was seen in the recognition of LAI use in the comparison by the percentage of prescriptions filled in by the department of psychiatry among all of the prescriptions dispensed by the pharmacies (p＝0.001). Our results show that collaboration between hospital pharmacists and community pharmacists is necessary to ensure the safe use of LAI.

Successful Treatment of Anorexia Nervosa in a 10-year-old Boy with Risperidone Long-acting Injection

Although the effectiveness of medication in the treatment of anorexia nervosa is uncertain, atypical antipsychotics such as olanzapine and risperidone have been used empirically for decades. we describe the case of a 10-year-old boy with anorexia nervosa in whom remarkable improvement was seen following the administration of risperidone or risperidone long-acting injection and deterioration when these agents were ceased. Because this is, to the best of our knowledge, the first report describing the usefulness of risperidone long-acting injection for adolescent anorexia nervosa.

Efficacy and safety of paliperidone palmitate in the treatment of schizophrenia: a Meta-analysis / 中国药学杂志

OBJECTIVE: To evaluate the efficacy and safety of paliperidone palmitate long-acting injection (PP-LAI) in the treat-i lent of schizophrenia. METHODS: Published studies concerning PP-LAI for schizophrenia were searched systemically and assessed liy Jadad items. RevMan 5.2 software was used for data analysis and for calculating effectiveness and their 95% CIs. RESULTS: Twelve Clinical random control trials including 39 analytic sets were selected for Meta-analysis. The incidence of efficient cases in PP-LAI group was 1.7 (95% CI; 1.50-1.91) times higher than that in placebo group (Z=8.55, P<0.01) and equaled to the rate in risperidone group (RR=1, 95% CI: 0.88-1.13). Compared with the control group of placebo (RR=1.01, 95% CI: 0.97-1.05) t.nd risperidone (RR=1.07, 95% CI; 0.98-1.16), PP-LAI seemed to be well tolerated, with the same incidence of adverse e-vents. CONCLUSION: Paliperidone palmitate has certain efficacy and safety in the treatment of schizophrenia.

Registro Electrónico de Adherencia al Tratamiento de Esquizofrenia en Latinoamérica (e-STAR): Resultados clínicos del uso de risperidona inyectable de liberación prolongada a dos años de seguimiento / Electronic Schizophrenia Treatment Adherence Registry in Latin America (e-STAR): Clinical outcomes of long-acting injectable risperidone in a 2-year follow up

Schizophrenia is a chronic psychiatric disorder associated to high healthcare costs mainly driven by inpatient care. Lack of adherence to antipsychotic treatment is a common reason for relapse and rehospitalization leading to poor prognosis and global functional impairment of patients. Risperidone long-acting injection (RLAI) has demonstrated its efficacy in treating symptoms of schizophrenia and offers the potential to improve adherence to treatment. Objective To determine clinical and functional efficacy of RLAI and use of health resources (eg., hospitalizations) in a 2-year follow up study among patients with schizophrenia from Latin America. Method The electronic Schizophrenia Treatment Adherence Registry (e-STAR) is an observational study of patients who start treatment with RLAI. Data from patients recruited in Mexico, Colombia and Brazil were collected retrospectively for one year prior to baseline, at baseline and every three months for 24 months. Hospitalization rates and treatment regime were registered. Efficacy was assessed using the Clinical Global Impression of Illness-Severity Scale (CGI-S), while the Global Assessment of Functioning (GAF) and the Personal and Social Performance (PSP) were used for the evaluation of functioning. Results Seventy-three patients completed the two-year follow-up. The proportion of patients hospitalized declined from 16.4% before treatment to 4.1% after 2 years of treatment with RLAI. Only 2.7% discontinued the treatment due to lack of efficacy. Significant improvements were reported in illness severity as well as in global functioning assessed by the CGI-S, GAF and PSP scales, respectively. Discussion Our results give further support of the efficacy of RLAI for the treatment of schizophrenia. Additional to symptom severity reduction and functional recovery, improved treatment adherence and reduced hospitalization rates were observed with the use of RLAI. In a real world clinical setting, RLAI offer an effective long-term treatment for patients with schizophrenia, with a lower use of healthcare resources.

La esquizofrenia genera elevados costos al sistema de salud. La falta de adherencia al tratamiento es una de las principales causas de recaídas y hospitalizaciones en la esquizofrenia. Lo anterior conduce a un pobre pronóstico y deterioro funcional de los pacientes. La risperidona inyectable de liberación prolongada (RILP) ha demostrado su eficacia en el tratamiento de la esquizofrenia, ofreciendo la posibilidad de que los pacientes tengan una mayor adherencia terapéutica. Objetivo Determinar la eficacia y efecto sobre la funcionalidad y el uso de recursos hospitalarios de la RILP en una muestra de pacientes con esquizofrenia de América Latina a dos años de seguimiento. Método El Registro Electrónico de Adherencia al Tratamiento de Esquizofrenia en Latinoamérica (e-STAR) es un estudio observacional del uso de la RILP en la esquizofrenia. Se reclutaron pacientes de México, Colombia y Brasil. Se registró la información clínica del paciente un año previo al inicio del tratamiento con la RILP y de forma prospectiva cada tres meses hasta cumplir los 24 meses de seguimiento. Se registraron las hospitalizaciones y el esquema de tratamiento con la RILP. La escala de Impresión Clínica Global-Gravedad (CGI-S) se utilizó como indicador de eficacia mientras que la Escala Global de Funcionamiento (GAF) y la Escala de Desempeño Personal y Social (PSP) se utilizaron para evaluar el funcionamiento. Resultados Setenta y tres pacientes completaron los dos años de seguimiento. La proporción de pacientes hospitalizados disminuyó del 16.4 al 4.1% después de dos años de tratamiento con la RILP. El 2.7% descontinuó el tratamiento debido a falta de eficacia. Se observó una mejoría significativa en cuanto a la gravedad del padecimiento y el funcionamiento global. Discusión En la práctica clínica cotidiana, la RILP resulta ser un tratamiento a largo plazo efectivo para la esquizofrenia con el beneficio adicional de una menor utilización de recursos del sistema de salud.

Safety and Effectiveness of Long Acting Injectable Antipsychotic Paliperidone Palmitate Treatment in Schizophrenics : A 24-Week Open-Label Study

OBJECTIVES: We investigated the effectiveness and safety when treated in schizophrenics with paliperidone palmitate, a long acting injectable antipsychotic. METHODS: This was a 24-week open-label study, performed at one center in Korea. The eligible patients with schizophrenia diagnosed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria were enrolled. Patients received long-acting paliperidone palmitate injection (234 mg, baseline; 156 mg, week 1 ; then once 4 weeks flexible dosing). Effectiveness assessments were measured by the Positive and Negative Syndrome Scale (PANSS), The Clinical Global Impression Severity Scale (CGI-S), The Personal and Social Performance (PSP) at baseline, week 1, every 4 weeks untill 24 weeks or endpoint. Safety assessments were measured by The Extrapyramidal Symptom Rating Scale (ESRS), body weight (BW) and incidence of adverse events. Oral antipsychotics were stopped or tapered off within next 14 days. RESULTS: Of 20 patients recruited, 9 patients (45%) completed the study. Paliperidone palmitate produced a significant improvement in PANSS total score from baseline to endpoint. The response rate was 75% [mean change (+/- SD) -25.9 +/- 14.4, all p or = 10%) in paliperidone palmitate were anticholinergic adverse event, extrapyramidal symptoms, weight gain, akathisia, insomnia, headache, agitation, anxiety and GI trouble. ESRS score is not statistically significant, but tends to get better at the end of the study when compared to baseline. CONCLUSIONS: Our study results demonstrated maintained effectiveness and safety of paliperidone palmitate treatment in schizophrenics. And provides both clinicians and patients with a new choice of treatment that can improve the outcome of long term therapy. Their potential effectiveness and safety should be better addressed by future randomized-controlled trials.