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1.
Zh Nevrol Psikhiatr Im S S Korsakova ; 122(1. Vyp. 2): 13-19, 2022.
Article in Russian | MEDLINE | ID: covidwho-1727029

ABSTRACT

OBJECTIVE: To analyze clinical and therapeutic features of the transfer of patients with schizophrenia spectrum disorders from paliperidone palmitate of one-month action (PP-1M) to paliperidone of three-month action (PP-3M). MATERIAL AND METHODS: Data on the psychopharmacological therapy regimens of 677 patients with verified diagnoses of schizophrenia spectrum disorders (F20, F21, F25) treated with PP-3M drugs after PP-1M therapy were studied. RESULTS: The study showed the high efficacy of ultra-long-acting paliperidone therapy in 82.2% of patients with schizophrenia spectrum disorders. The unfavorable dynamics of the mental state in patients when transferring from the drug PP-1M to PP-3M was 14.0%, the return to therapy with PP-1M or tablet forms was 3.8%. Successful management of patients on PP-3M was not associated with sex and age, but was correlated with some clinical and therapeutic indicators. The most successful therapy with PP-3M was noted with the earlier appointment of PP-3M mainly as monotherapy, provided the previous stable condition on shorter-acting paliperidone preparations (including tablet forms). Predictors of a favorable prognosis of PP-3M therapy are also diagnostic categories such as paranoid schizophrenia, episodic type of course with increasing or stable personality changes and pronounced affective disorders in the structure of the clinical picture of the disease. CONCLUSION: The results demonstrate the high efficacy of PP-3M and its significant rehabilitation potential, which allows improving the quality of life and social functioning of patients, as well as optimizing the provision of psychiatric care to this contingent of patients, which is of particular importance in the conditions of the COVID-19 pandemic.


Subject(s)
Antipsychotic Agents , COVID-19 , Schizophrenia , Antipsychotic Agents/adverse effects , Delayed-Action Preparations/therapeutic use , Humans , Paliperidone Palmitate/therapeutic use , Pandemics , Quality of Life , SARS-CoV-2 , Schizophrenia/drug therapy , Treatment Outcome
3.
BMC Psychiatry ; 21(1): 633, 2021 12 20.
Article in English | MEDLINE | ID: covidwho-1635337

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had significant impacts on how mental health services are delivered to patients throughout Canada. The reduction of in-person healthcare services have created unique challenges for individuals with psychotic disorders that require regular clinic visits to administer and monitor long-acting injectable antipsychotic medications. METHODS: To better understand how LAI usage was impacted, national and provincial patient-level longitudinal prescribing data from Canadian retail pharmacies were used to examine LAI prescribing practices during the pandemic. Prescribing data on new starts of medication, discontinuations of medications, switches between medications, antipsychotic name, concomitant medications, payer plan, gender and age were collected from January 2019 to December 2020 for individuals ≥18-years of age, and examined by month, as well as by distinct pandemic related epochs characterized by varying degrees of public awareness, incidence of COVID-19 infections and public health restrictions. RESULTS: National, and provincial level data revealed that rates of LAI prescribing including new starts, discontinuations and switches between LAI products remained highly stable (i.e., no statistically significant differences) throughout the study period. CONCLUSIONS: Equal numbers of LAI new starts and discontinuations prior to and during the pandemic suggests prescribing of LAI antipsychotics, for those already in care, continued unchanged throughout the pandemic. The observed consistency of LAI prescribing contrasts with other areas of healthcare, such as cardiovascular and diabetes care, which experienced decreases in medication prescribing during the COVID-19 pandemic.


Subject(s)
Antipsychotic Agents , COVID-19 , Schizophrenia , Adolescent , Antipsychotic Agents/therapeutic use , Canada , Delayed-Action Preparations/therapeutic use , Humans , Pandemics , SARS-CoV-2 , Schizophrenia/drug therapy
4.
BMJ Open ; 11(12): e050501, 2021 12 20.
Article in English | MEDLINE | ID: covidwho-1583111

ABSTRACT

INTRODUCTION: Alterations in the cholinergic metabolism may cause various clinical symptoms of schizophrenia. In addition to the 'monoamine hypothesis,' neuroinflammation is also discussed as a cause of schizophrenia. To date, there has been no evidence of alterations in the central cholinergic transmitter balance in patients with schizophrenia under clinical conditions. By contrast, studies in critically ill patients have established the measurement of acetylcholinesterase activity as a suitable surrogate parameter of central cholinergic transmitter balance/possible pathophysiological changes. Butyrylcholinesterase activity has been established as a parameter indicating possible (neuro)inflammatory processes. Both parameters can now be measured using a point-of-care approach. Therefore, the primary objective of this study is to investigate whether acetylcholinesterase and butyrylcholinesterase activity differs in patients with various forms of schizophrenia. Secondary objectives address the possible association between acetylcholinesterase and butyrylcholinesterase activity and (1) schizophrenic symptoms using the Positive and Negative Syndrome Scale, (2) the quantity of antipsychotics taken and (3) the duration of illness. METHODS AND ANALYSIS: The study is designed as a prospective, observational cohort study with one independent control group. It is being carried out at the Department of Psychiatry and Psychotherapy III, Ulm University Hospital, Germany. Patient enrolment started in October 2020, and the anticipated end of the study is in January 2022. The enrolment period was set from October 2020 to December 2021 (extension required due to SARS-CoV-2 pandemic). The sample size is calculated at 50 patients in each group. Esterase activity is measured on hospital admission (acute symptomatology) and after referral to a postacute ward over a period of three consecutive days. The matched control group will be created after reaching 50 patients with schizophrenia. This will be followed by a comprehensive statistical analysis of the data set. ETHICS AND DISSEMINATION: The study was registered prospectively in the German Clinical Trials Register (DRKS-ID: DRKS00023143,URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023143) after approval by the ethics committee of the University of Ulm, Germany Trial Code No. 280/20. TRIAL REGISTRATION NUMBER: DRKS00023143; Pre-results.


Subject(s)
COVID-19 , Schizophrenia , Acetylcholinesterase , Butyrylcholinesterase , Cholinergic Agents , Cohort Studies , Control Groups , Humans , Observational Studies as Topic , Prospective Studies , SARS-CoV-2 , Schizophrenia/drug therapy , Treatment Outcome
7.
J Clin Psychiatry ; 82(5)2021 09 07.
Article in English | MEDLINE | ID: covidwho-1399456

ABSTRACT

Treatment-resistant schizophrenia (TRS) represents a major clinical challenge. The broad definition of TRS requires nonresponse to at least 2 sequential antipsychotic trials of sufficient dose, duration, and adherence. Several demographic, clinical, and neurologic predictors are associated with TRS. Primary (or early) TRS is present from the beginning of therapy, while patients with secondary (or later-onset) TRS initially respond to antipsychotics but become resistant over time, often after relapses. Guidelines worldwide recognize clozapine as the most effective treatment option for TRS, but clozapine is underused due to various barriers. Importantly, studies indicate that response rates are higher when clozapine is initiated earlier in the treatment course. Side effects are common with clozapine, particularly in the first few weeks, but can mostly be managed without discontinuation; they do require proactive assessment, intervention, and reassurance for patients. Furthermore, plasma leucocyte and granulocyte levels must be monitored weekly during the first 18-26 weeks of treatment, and regularly thereafter, according to country regulations. Therapeutic drug monitoring of clozapine trough plasma levels is helpful to guide dosing, with greatest efficacy at plasma clozapine levels ≥350 µg/L, although this level is not universal. Notably, plasma clozapine levels are generally greater at lower doses in nonsmokers, patients with heavy caffeine consumption, in women, in obese people, in those with inflammation (including COVID-19 infection), and in older individuals. Earlier and broader use of clozapine in patients with TRS is an important measure to improve outcomes of patients with this most severe form of the illness.


Subject(s)
Antipsychotic Agents/administration & dosage , Clozapine/administration & dosage , Schizophrenia/drug therapy , Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Drug Resistance/drug effects , Drug Tolerance , Female , Humans , Male
10.
BMC Psychiatry ; 21(1): 309, 2021 06 15.
Article in English | MEDLINE | ID: covidwho-1301849

ABSTRACT

BACKGROUND: Schizophrenia is a multifactorial disease involving interactions between genetic and environmental factors. Vitamin D has recently been linked to many metabolic diseases and schizophrenia. Vitamin D plays essential roles in the brain in the context of neuroplasticity, neurotransmitter biosynthesis, neuroprotection, and neurotransmission. Vitamin D receptors are demonstrated in most brain regions that are related to schizophrenia. However, very few studies in the literature examine the effects of 25-hydroxyvitamin D (25OHD) on schizophrenia symptoms. METHODS: This study aimed to examine the effects of vitamin D replacement on positive, negative, and cognitive symptoms of schizophrenia. Serum 25OHD levels of 52 schizophrenia patients were measured. SANS and SAPS were used to evaluate the severity of schizophrenia symptoms, and the Wisconsin Card Sorting Test: CV4 was used for cognitive assessment. The study was completed with 40 patients for various reasons. The patients whose serum 25OHD reached optimal levels after vitamin D replacement were reevaluated with the same scales in terms of symptom severity. The SPSS 25 package program was used for statistical analysis. The Independent-Samples t-test was used to examine the relationship between the variables that may affect vitamin D levels and the vitamin D level and to examine whether vitamin D levels had an initial effect on the scale scores. RESULTS: The mean plasma 25OHD levels of the patients was 17.87 ± 5.54. A statistically significant relationship was found only between the duration of sunlight exposure and 25 OHD level (p < 0.05). The mean SANS and SAPS scores of the participants after 25OHD replacement (23.60 ± 15.51 and 7.78 ± 8.84, respectively) were statistically significantly lower than mean SANS and SAPS scores before replacement (51.45 ± 17.96 and 18.58 ± 15.59, respectively) (p < 0.001 for all). Only the total attention score was significantly improved after replacement (p < 0.05). CONCLUSION: The data obtained from our study suggest that eliminating the 25OHD deficiency together with antipsychotic treatment can improve the total attention span and positive and negative symptoms in schizophrenia. The 25OHD levels should be regularly measured, replacement should be started when necessary, and the patients should be encouraged to get sunlight exposure to keep optimal 25OHD levels.


Subject(s)
Schizophrenia , Vitamin D Deficiency , Cross-Sectional Studies , Dietary Supplements , Humans , Schizophrenia/drug therapy , Vitamin D , Vitamin D Deficiency/complications , Vitamin D Deficiency/drug therapy
11.
Br J Psychiatry ; 219(1): 357-358, 2021 07.
Article in English | MEDLINE | ID: covidwho-1282281

ABSTRACT

Clozapine is under-used in the UK, and Casetta et al's recent paper in the BJPsych adds to a growing number of small studies that support the use of intramuscular clozapine to initiate and maintain treatment with oral clozapine. However, intramuscular clozapine remains unlicensed and, because of the risks associated with its administration, it should be used only cautiously before it can be adopted more widely into mainstream clinical practice.


Subject(s)
Antipsychotic Agents , Clozapine , Psychotic Disorders , Schizophrenia , Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Humans , Psychotic Disorders/drug therapy , Schizophrenia/drug therapy
15.
Perspect Psychiatr Care ; 57(4): 1991-1998, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1211562

ABSTRACT

PURPOSE: This study explored how patients with schizophrenia were provided with social support and treatment compliance during the pandemic. DESIGN AND METHODS: A total of 396 patients with schizophrenia and their relatives were interviewed by telephone calls. FINDINGS: Multiple antipsychotic use and depot antipsychotics were not superior in preventing relapse. A total of 70.2% of the patients wanted to meet with their psychiatrist online but only 7.1% of them were reached online. A total of 59% of patients were able to take their medication thanks to the extension of their drug prescriptions. PRACTICE IMPLICATIONS: Active inclusion of telepsychiatry applications in clinical practice is necessary for patients with schizophrenia. Government policies developed for treatment compliance seem important.


Subject(s)
Antipsychotic Agents , COVID-19 , Psychiatry , Schizophrenia , Telemedicine , Antipsychotic Agents/therapeutic use , Disease Progression , Humans , Pandemics , Patient Compliance , SARS-CoV-2 , Schizophrenia/drug therapy , Schizophrenia/epidemiology
16.
Acta Psychiatr Scand ; 144(1): 82-91, 2021 07.
Article in English | MEDLINE | ID: covidwho-1202211

ABSTRACT

OBJECTIVE: Psychiatric disorders have been associated with unfavourable outcome following respiratory infections. Whether this also applies to coronavirus disease 2019 (COVID-19) has been scarcely investigated. METHODS: Using the Danish administrative databases, we identified all patients with a positive real-time reverse transcription-polymerase chain reaction test for COVID-19 in Denmark up to and including 2 January 2021. Multivariable cox regression was used to calculate 30-day absolute risk and average risk ratio (ARR) for the composite end point of death from any cause and severe COVID-19 associated with psychiatric disorders, defined using both hospital diagnoses and redemption of psychotropic drugs. RESULTS: We included 144,321 patients with COVID-19. Compared with patients without psychiatric disorders, the standardized ARR of the composite outcome was significantly increased for patients with severe mental illness including schizophrenia spectrum disorders 2.43 (95% confidence interval [CI], 1.79-3.07), bipolar disorder 2.11 (95% CI, 1.25-2.97), unipolar depression 1.70 (95% CI, 1.38-2.02), and for patients who redeemed psychotropic drugs 1.70 (95% CI, 1.48-1.92). No association was found for patients with other psychiatric disorders 1.13 (95% CI, 0.86-1.38). Similar results were seen with the outcomes of death or severe COVID-19. Among the different psychiatric subgroups, patients with schizophrenia spectrum disorders had the highest 30-day absolute risk for the composite outcome 3.1% (95% CI, 2.3-3.9%), death 1.2% (95% CI, 0.4-2.0%) and severe COVID-19 2.7% (95% CI, 1.9-3.6%). CONCLUSION: Schizophrenia spectrum disorders, bipolar disorder, unipolar depression and psychotropic drug redemption are associated with unfavourable outcomes in patients with COVID-19.


Subject(s)
COVID-19/mortality , Mental Disorders/epidemiology , SARS-CoV-2/isolation & purification , Bipolar Disorder/drug therapy , Bipolar Disorder/epidemiology , COVID-19/psychology , Denmark/epidemiology , Humans , Male , Mental Disorders/diagnosis , Mood Disorders/diagnosis , Mood Disorders/epidemiology , Risk Factors , Schizophrenia/diagnosis , Schizophrenia/drug therapy , Schizophrenia/epidemiology
17.
Ann Palliat Med ; 10(5): 5010-5016, 2021 May.
Article in English | MEDLINE | ID: covidwho-1200421

ABSTRACT

BACKGROUND: Olanzapine and clozapine are atypical antipsychotics (AAPs) with the greatest risk of weight gain, and changes in feeding behavior are among the most important underlying mechanisms. However, few studies have investigated the role of diet-alone interventions in improving individuals' weight gain by taking AAPs. In closed management mental hospitals of China, family members are allowed to bring food to patients regularly, causing patients to have caloric intake added to their 3 daily meals. However, during the global pandemic of coronavirus disease 2019 (COVID-19), bringing food to the hospital was temporarily prohibited in mental health institutions in China to prevent the spread of the virus. This study sought to compare the body weight and body mass index (BMI) changes of patients taking olanzapine or clozapine undergoing diet-alone interventions caused by this prohibition. METHODS: A retrospective self-controlled study was conducted on 90 patients with schizophrenia from a single-center treated with olanzapine or clozapine monotherapy, or combined with aripiprazole or ziprasidone which has a small metabolic impact. A paired-samples t-test was used to compare the changes in body weight and BMI before and after the 3-month prohibition, and general linear regression was used to analyze the effects of gender, age, disease course, duration of drug exposure, and equivalent dose on the BMI improvement. Also, the percentage of people who lost weight and that of individuals who lost 5% of their pre-prohibition body weight were calculated. RESULTS: Paired-samples t-test showed that after 3-month prohibition, the patients' body weight (71.68±6.83 vs. 66.91±7.03, P<0.001) and BMI (26.43±2.11 vs. 24.63±1.81, P<0.001) decreased significantly. Weight loss rate accounted for 99.1%, and weight loss of 5% from the pre-prohibition body weight accounted for 71.8%. General linear regression showed that the duration of drug exposure (ß =-0.678, P<0.001) was significantly and negatively correlated with the BMI changes. No significant correlation of gender, age, disease course, or equivalent dose with BMI changes was found. CONCLUSIONS: Diet-alone interventions facilitate weight loss in chronically hospitalized schizophrenia patients taking AAPs. Conduction of dietary intervention in the early stages of medication may yield greater benefits.


Subject(s)
Antipsychotic Agents , COVID-19 , Clozapine , Schizophrenia , Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Body Weight , China , Clozapine/therapeutic use , Humans , Olanzapine/therapeutic use , Pandemics , Retrospective Studies , Risperidone/therapeutic use , SARS-CoV-2 , Schizophrenia/drug therapy
20.
Psychiatriki ; 32(2): 165-166, 2021 Jul 10.
Article in Greek, English | MEDLINE | ID: covidwho-1148407

ABSTRACT

The current coronavirus pandemic (COVID-19) has led mental health systems to uncertainty regarding safe continuation of clozapine monitoring protocols. Clozapine is without doubt the only antipsychotic available with repeatedly proven efficacy in treatment resistant schizophrenia.1 Replacing clozapine with an alternative antipsychotic in patients stabilized with clozapine can potentially lead to higher risk of relapse or exacerbation of severity of illness.1 Clozapine, as already known, has a number of side effects, some of which can be serious, thus patients receiving clozapine require ongoing scheduled monitoring. Side effects of clozapine include neutropenia or agranulocytosis, myocarditis, fever, hypersalivation, weight gain and constipation. These side effects can be detected and treated when recognized on time decreasing the possibility of serious consequences making the implementation of an ongoing treatment monitoring protocol for patients on clozapine mandatory.2 Since it was advised for all mental health providers in most countries worldwide to limit non-urgent hospital visits and procedures to reduce the risk of contamination a challenge arose for patients' ability to access health care facilities for their routine clozapine monitoring. Nevertheless, the majority of Mental Health Care Authorities decided to ensure access for all patients on clozapine to their routine monitoring protocol.3,4 To date, no data exist on any potential relationship between antipsychotic use and the risk of contamination with SARS-CoV-2 or the development of severe symptoms of the infection. The literature suggests that patients receiving antipsychotics, especially clozapine, have an increased risk of developing pneumonia, leading to the assumption that patients receiving clozapine are at higher risk to develop COVID-19. 1 Balancing the importance of monitoring continuation against the increased risk for COVID-19, an International Consensus Statement was recently published addressing a monitoring protocol with reduced visits. The Consensus suggested reduced hematologic monitoring frequency of every 3 months with a prescription of 90 days clozapine supply (if safe). The above applies to patients receiving clozapine for at least one year without neutropenia. Τhe risk of neutropenia after 12 months of clozapine treatment falls significantly.4 Based on the above it is suggested to all clozapine clinics to implement a guidance monitoring protocol for all patients on clozapine to ensure safety during the pandemic. Besides hematological monitoring that requires physical contact with healthcare workers it is significant to implement a telemedicine appointment in frequent intervals to monitor symptoms of infection, symptoms of cardiovascular diseases and constipation. Patient should also be advised to regularly monitor one's blood pressure and pulses and ideally be educated on how by a member of the staff. If a patient is detected with any symptoms related to the above an emergency appointment for evaluation should be planned. Overall, since both the consequences and the duration of the pandemic are unknown, mental health services must work jointly to implement a clozapine monitoring plan to ensure safe continuation in such a vulnerable population.


Subject(s)
COVID-19 , Clozapine , Drug Monitoring , Drug-Related Side Effects and Adverse Reactions/prevention & control , Mental Health Services , Risk Management/trends , Schizophrenia/drug therapy , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , COVID-19/epidemiology , COVID-19/prevention & control , Clozapine/administration & dosage , Clozapine/adverse effects , Drug Monitoring/methods , Drug Monitoring/standards , Health Services Accessibility/standards , Health Services Needs and Demand , Humans , Infection Control/methods , Mental Health Services/organization & administration , Mental Health Services/standards , Organizational Innovation , SARS-CoV-2 , Schizophrenia/epidemiology
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