Antipsicóticos de primera y segunda generación en esquizofrenia: eficacia, efectividad y efecto de la dosis utilizada / First and second generation antipsychotics in schizophrenia: efficacy, effectiveness and effect of the dose used

Después de varias décadas de desarrollo de los fármacos antipsicóticos, la esquizofrenia sigue siendo en gran medida una enfermedad crónica con muchos pacientes que experimentan una mala calidad de vida. En este contexto, la aparición de los llamados antipsicóticos de segunda generación fue recibida con gran entusiasmo. Los clínicos esperaban que los nuevos antipsicóticos causaran no solamente menos efectos secundarios motores que los más antiguos, tal como la clorpromazina, sino también que mejoraran los síntomas y la funcionalidad general de los pacientes. Este artículo, de carácter narrativo, revisa cómo inicialmente la evidencia de un gran número de ensayos controlados aleatorios pareció favorecer muchas de estas suposiciones. Esta visión, sin embargo, no era universal, y algunos investigadores destacaron el potencial efecto del diseño de los estudios en los resultados. Un aspecto importante dice relación con la dosis utilizada de antipsicóticos de primera generación, siendo aquellos ensayos que usaron mayores dosis los que apoyaron el uso de antipsicóticos de segunda generación. Esta controversia se resolvió después de la publicación de tres estudios a gran escala, que incluían pacientes menos seleccionados y que enfocaban los resultados a largo plazo en un entorno clínico más "típico", los cuales no encontraron diferencias significativas entre los dos tipos de antipsicóticos. Desde entonces, las discusiones sobre la elección de los antipsicóticos han girado en torno a otros factores tales como los efectos secundarios, más que en su capacidad para controlar los síntomas.(AU)

After several decades of antipsychotic medication development, schizophrenia has largely remained a chronic disease with many patients experiencing poor quality of life. In this context, the appearance of so-called second generation antipsychotics was received with great enthusiasm. Clinicians hoped that the new antipsychotics would not only cause less motor side effects than older ones such as Chlorpromazine, but also improve patients' symptoms and overall functioning. In this narrative article we review how initially the vidence of a large number of randomized controlled trials appeared to favour many of these claims. This view was not universal though, and some researchers highlighted the potential effect of some design aspects of the trials in the results. A particular concern related to the dose of first generation antipsychotic used, with trials favouring second generation frequently using higher doses. This controversy was resolved after the publication of three large studies, including less selected patients and looking at longer-term outcomes in a more "typical" clinical setting, which failed to find significant differences between the two types of antipsychotics. Since then, discussions about the choice of antipsychotic revolve more around other factors such as side-effects than their capacity to control symptom.(AU)

Psychosis, Treatment Emergent Extrapyramidal Events, and Subsequent Onset of Huntington's Disease: A Case Report and Review of the Literature

Huntington's disease (HD) is an autosomal dominant neurodegenerative disease characterized by a triad of progressive motor dysfunction, cognitive decline and psychiatric disturbances. The hallmark of HD is the distinctive choreiform movement disorder that typically has a subtle, insidious onset in the fourth to fifth decade of life and gradually worsens over 10 to 20 years until death. Notably, two-thirds of HD patients present with chorea and one third with mental changes. The prevalence of psychiatric symptoms is significantly higher than in the general population, and is estimated to be around 66–73%. Here, we report a unique case of subsequent onset of HD in a patient previously treated for schizophrenia and complicated by the extrapyramidal side effects to antipsychotics.

Impact of Symptomology and Drug-induced Extrapyramidal Side Effects on Subjective Quality of Life for Schizophrenic Outpatients / 中国康复理论与实践

@#Objective To investigate the subjective quality of life(SQOL)in schizophrenia outpatients and explore the relationships among symptomology,drug-induced extrapyramidal side effects(EPS)and SQOL.Methods198 eligible subjects were recruited and interviewed using standard instruments.Multiple linear regression with stepwise method was used.ResultsEPS was found to significantly predict physical SQOL domain while anxiety and positive symptoms predicted psychological,social and environmental SQOL domains,respectively.ConclusionSQOL of schizophrenia outpatients could be improved if their anxiety and positive symptoms and EPS are effectively controlled.

Differences of Cognitive Function and Treatment Response between Smoking and Non-smoking Schizophrenic Patients / 신경정신의학

OBJECTIVES: The purpose of this study was to examine the differences of past histories, current symptoms, treatment responses and cognitive functions between smoking and nonsmoking schizophrenic patients. METHODS: The subjects were composed of 67 schizophrenic patients including 36 smokers and 31 non-smokers. They were examined by psychiatric history checklist, Simpson and Angus's rating scale for extrapyramidal side effects, positive and negative syndromes scale(PANSS), global assessment scale(GAS), and Vienna test including Standard Progressive Matrices(SFM), Cognitron, and Flicker Fusion Analyzer(FFA). RESULTS: The results were as follows: 1) Although the duration of illness of smokers was longer than that of non-smokers, the smokers had significantly higher score of GAS and significantly lower score of PANSS than non-smokers at admission 2) With effects of age and duration of illness controlled, there were no differences of mean dosage of neuroleptics, extrapyramldal side effects, PANSS improvement rate and GAS improvement rate between both groups. 3) With effects of age, duration of illness, and total PANSS score controlled, there were no differences of score of SFM, cognitron, and FFA. 4) In smokers, the PANSS improvement rate and the GAS improvement rate were positively correlated with mean number of daily smoked cigarettes, with effects of age and duration of illness controlled. CONCLUSIONS: In schizophrenic patients, smokers had less severe symptoms than non-smokers. In smokers, the PANSS improvement rate and the GAS improvement rate were positively correlated with mean number of daily smoked cigarettes. But smokers were not proven to have received higher dosage of neuroleptics, to have lower extrapyramidal side effects, or to have less severe impairment of cognitive function.