Evaluation of adverse drug reactions in patients of schizophrenia in tertiary care teaching hospitals in Central India

Background: For decades, it has been observed that mental health is shrouded in stigma and discrimination. The scope, severity, and expense of impairment and costs to people, families, and societies are staggering. Mental illnesses are among the most frequent illnesses, affecting over a quarter of the population in any given year. According to national institute of mental health and neurosciences, Bangalore, the prevalence of schizophrenia has been considered as 4/1000 for all ages and both sexes. Aim and Objectives: The objectives of this study were to as follows: (1) To evaluate adverse drug reactions (ADRs) in patients with schizophrenia who received antipsychotic treatment and (2) to compare ADRs in typical versus atypical antipsychotic agents in schizophrenic patients. Materials and Methods: A total of 50 schizophrenic patients were enrolled for evaluating adverse effects to antipsychotic drugs. During the research, all ethical precautions were taken. All patients were followed up by medical history, history of drugs, and any severity of adverse drug reaction. Causality assessment was graded by Naranjo scale. Result: Among all of the antipsychotic drugs, risperidone (05%), quetiapine (04%), and aripiprazole (04%) have shown lowest propensity to cause serious adverse event. These drugs are most commonly prescribed drugs and are least likely to affect quality of life of patient. However, the risk of extrapyramidal symptoms is lower with olanzapine (05%) than haloperidol (34%) and even in case with risperidone at higher dose (20%). Although atypical antipsychotics such as olanzapine (46%) have shown maximum potential to produce metabolic side effect such as dyslipidemia and hyperglycemia compared to that of other antipsychotics. Conclusion: The most common adverse effects were found with typical and atypical antipsychotics such as weight gain, drowsiness, constipation, sedation, dyslipidemia, and hypotension.

Antipsychotics as a probable cause of Leukocytoclastic Vasculitis: A Systematic Review

Abstract: Leukocytoclastic vasculitis (LCV) is a skin condition that is a result of unregulated immune activation. The exact causes have to date not been established. The studied causes tend to have a higher probability of causing LCV. This raises concerns about a deep-seated causal relationship and the tendency of an individual for the development of LCV. Antipsychotics are a class of drug mainly used for psychiatric disorders including schizophrenia, schizophreniform disorder, or even depressive disorder with psychotic features. These drugs target the dopamine receptors in the central nervous system to exert their effects. They are classified as typical or the older antipsychotics and atypical or the newer antipsychotics. Prevalent in the current literature are the reported cases of LCV with antipsychotic medications. We carried out a systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) protocol to find out previously reported cases on LCV due to antipsychotic medication administration from inception till current date. Our study aims to check and in turn, discuss the causal relationship of antipsychotics with LCV.

Effects of typical or atypical antipsychotics on cognitive symptoms of the patients with schizophrenia / 上海交通大学学报（医学版）

Objective: To compare the effects of long-term use of typical and atypical antipsychotics on cognitive symptoms of the patients with schizophrenia. Methods: One hundred and two long-term inpatients with schizophrenia in Shanghai Jinshan Mental Health Center were included. According to the types of antipsychotics, the inpatients were divided into typical antipsychotics treatment group (typical group) or atypical antipsychotics treatment group (atypical group) with 51 cases each. Mental symptoms were evaluated by Positive and Negative Symptom Scale (PANSS), and cognitive symptoms were evaluated by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Results: Ninety-nine patients completed the investigation (49 cases in typical group and 50 cases in atypical group). PANSS score: the negative symptom score in the atypical group was lower than that in the typical group, and the difference was statistically significant (P=0.049). RBANS score: The total score of RBANS and the scores of immediate memory, language, attention and delayed memory in the atypical group were significantly higher than those in the typical group (all P<0.05). Conclusion: Compared with the patients who take typical antipsychotics, the patients with schizophrenia who take atypical antipsychotics for a long time have better cognitive symptom scores.

Efficacy of risperidone and haloperidol in treatment of schizophrenia in tertiary care hospital

Background: Schizophrenia is a chronic debilitating disease with significant morbidity and mortality that often requires either typical or atypical antipsychotic pharmacotherapy. Atypical antipsychotic drugs are preferred over typical because of lower risk of extra pyramidal side effects. As there is paucity of data in Indian population, the present study was taken up to evaluate the efficacy of haloperidol and risperidone in the treatment of schizophrenia.Methods: It was a comparative study conducted on 60 patients of Schizophrenia for one year in a tertiary care hospital. The study subjects were randomly assigned into 2 groups of 30 patients each, where group 1 were treated with atypical antipsychotic drug risperidone and group 2 with typical antipsychotic drug Haloperidol and both groups received the treatment for one year. Efficacy was measured using positive and negative syndrome scale (PANSS), clinical global impression - severity of illness (CGI-S), clinical global impression - improvement (CGI-I) scales.Results: Both haloperidol and risperidone were associated with comparable baseline to endpoint reduction in symptom severity. However, risperidone treated subjects had significantly greater decrease in symptom severity as measured by PANSS score and total score, CGI-S scale. However, there is no significant difference between two groups in terms of CGI-S score.Conclusions: The reduction in positive, negative and general scores in risperidone treated patients were significant with that of haloperidol treated patients.

Neutropenia with Multiple Antipsychotics Including Dose Dependent Neutropenia with Lurasidone

Antipsychotic-induced agranulocytosis is a significant side effect that is known to occur with most of the antipsychotic medications. It usually resolves once the medications are stopped and patients are able to be switched over to another antipsychotic medication. Lurasidone has not been reported to cause leukopenia and neutropenia. This case report is of a patient with a past history of risperidone induced-aganulocytosis developing dose related leukopenia and neutropenia with lurasidone.

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)

Association between Antipsychotic Use and Extrapyramidal Symptoms: / 医薬品情報学

<b>Objective: </b>To examine the association between atypical and typical antipsychotics and extrapyramidal symptoms (EPS), we analyzed the US Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report database (JADER) from the Pharmaceuticals and Medical Devices Agency (PMDA).<br><b>Methods: </b>A reporting odds ratio was calculated and used to detect spontaneous report signals, with detection defined as a lower limit >1 in a 95% confidence interval.  In addition, time to onset and age at onset of EPS were investigated.<br><b>Results: </b>Drug-reaction pairs were identified in both FAERS (<i>n</i>=29,017,485) and JADER (<i>n</i>=2,079,653).  In analyses of both databases, significant associations were found between atypical and typical antipsychotics and EPS.  Atypical antipsychotics cause EPS with a longer duration of therapy compared to typical ones.  EPS in patients treated with atypical antipsychotics was observed at a broad range of ages compared to the patients treated with typical ones.<br><b>Conclusion: </b>Atypical antipsychotics, like typical ones, may increase the risk of EPS.  Because of the longer latency of onset, it may be difficult to find EPS associated with atypical antipsychotics.  Therefore, the severe symptom may be developed in patients treated with atypical antipsychotics.  The attention should be paid to the EPS in patients of all ages treated with atypical antipsychotics.

Neuroleptic malignant syndrome / Síndrome neuroléptica maligna

Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse event associated with the use of antipsychotics (AP). The objective of this study was to investigate the profile of cases of NMS and to compare our findings with those published in similar settings. A series of 18 consecutive patients with an established diagnosis of NMS was analyzed, gathering data on demography, symptoms and signs. Two thirds of all cases involved woman with a past medical history of psychiatric disorder receiving relatively high doses of AP. The signs and symptoms of NMS episodes were similar to those reported in other series and only one case had a fatal outcome, the remaining presenting complete recovery. As expected, more than two thirds of our cases were using classic AP (68 percent), however the clinical profile of these in comparison with those taking newer agent was similar. Newer AP also carry the potential for NMS.

A síndrome neuroléptica maligna (SNM) é um evento adverso potencialmente fatal associado ao uso de antipsicóticos (AP). O objetivo deste estudo foi investigar as características clínicas de cases da SNM e comparar nossos resultados com os publicados na literatura. Uma série de 18 pacientes com diagnóstico confirmado de SNM foram analisados, associando dados demográficos, apresentação clínica, diagnóstico e tratamento. Dois terços dos casos envolveram mulheres com antecedentes psiquiátricos que recebeceram doses relativamente altas de AP. Os sinais e sintomas foram semelhantes àqueles já relatados na literatura e a maioria dos pacientes teve uma recuperação completa, exceto por um caso com desfecho fatal. Houve predomínio de pacientes que usam medicamentos neurolépticos clássicos (68 por cento), porém não houve diferença nas manifestações destes casos em relação àqueles que usavam AP novos. AP mais novos também têm o potencial de causar SNM.

Atypical Antipsychotics: The Benefit and Disadvantage / 대한정신약물학회지

Atypical antipsychotics have more beneficial effects than conventional antipsychotics, particularly with regard to negative symptoms, cognitive functions, and also have a superior side effect profile. Although with such advantages, the use of the atypical antipsychotics cause numerous complications such as hypertension, increase of insuline, diabetes mellitus due to gain in weight, hyperprolactinemia, sexual dysfunctions, cardiovascular symptoms as well as noncompliance due to the previously mentioned side effects and high medical expenses which burden individual and governments. Now is the time to consider both advantages and disadvantages to balance out gains and losses in using the atypical antipsychotics. Blind trust or exclusive decision in using the atypical antipsychotics are unsuitableness. The decision on the use of the medicine must be the one that balances out its general advantages and disadvantages and its appropriateness must be decided upon a full consideration of its pharmacology, efficacies and side effects.

Use of Atypical Antipsychotics in Psychotic Disorder and Behavioral Disorder Caused by physical Disease / 대한정신약물학회지

Psychotic disorders due to physical diseases are recently increased and show more complex manifestation than functional psychotic disorders. The psychiatrist's role in dealing with the acutely psychotic patient due to physical diseases is to control the patient's behavior and psychotic symptoms, to delineate the etiology of the psychosis, and to provide appropriate initial treatment and disposition. The control of behavioral and psychotic symptoms can be accomplished through supportive, physical, or pharmacological interventions. But among these interventions, pharmacological intervention shows most rapid responses. Traditionally, pharmacological treatments of these patients have been made by typical antisychotics, which have many adverse effects including extrapyramidal symptoms and therefore, it is problematic to prescribe typical antipsychotics to these patients who are vulnerable to antipsychotics. Recently developed atypical antipsychotics are known to have less drug induced side effects than typical antipsychotics. Studies using atypical antipsychotics to patients who have psychotic and behavioral problems induced by physical disease are increased. We summarized studies which have investigated the efficacy and tolerability of atypical antipsychotics in patients with psychotic and behavioral disorder induced by physical disease.