Comparison of older patients with bipolar disorder and schizophrenia/schizoaffective disorder.

OBJECTIVE: The aim of this cross-sectional study was to explore differences in measures of symptoms and cognition, side effects, and functional impairment between older patients with schizophrenia and bipolar disorder. METHODS: Representative samples (N = 132) of older patients (age >54 years) with either bipolar disorder or schizophrenia and schizoaffective disorder were compared on several clinical and psychosocial variables. The measures used included the Brief Psychiatric Rating Scale, The Scale for the Assessment of Negative Symptoms, the Geriatric Depression Scale, the Abnormal Involuntary Movement Scale, the Clinical Global Impression, and the Mini-Mental Status Examination. RESULTS: Despite being similar in age (mean age: 68 years), patients with schizophrenia/schizoaffective disorder had significantly greater negative symptoms (Cohen's d = 1.2), a higher clinical global impression of impairment (Cohen's d = 1.16), were less likely to drive (Cohen's d = 0.79), were less likely to be married (Cohen's d = 0.55), and less likely to live independently (Cohen's d = 0.45). CONCLUSION: Although the absolute ratings suggested both diagnostic samples had significant disability, those with schizophrenia and schizoaffective disorder had a greater degree of impairment.

Weight decline in patients switching from olanzapine to quetiapine.

This open-label study investigated the strategy of switching patients who had gained excessive weight on olanzapine to quetiapine, with assessments of safety and continued efficacy as well as weight change. Patients who were psychiatrically stable on olanzapine but had gained >20% in weight and had body mass index >25 mg/kg(2) were switched to quetiapine over a 4-week period and followed for 6 weeks, the total study duration being 10 weeks. Assessments included weight change, antipsychotic efficacy using the Positive and Negative Symptom Syndrome Scale (PANSS), extrapyramidal adverse events using the Simpson-Angus Scale (SAS), and laboratory studies for metabolic measures. Of 16 enrolled patients, 12 completed the study. Mean weight loss was 2.25 kg (Cohen's d = 0.12; P = 0.03). There were no significant changes in PANSS total scores, SAS scores, or metabolic parameters. Switching patients to quetiapine, appears to be a viable strategy for managing olanzapine-induced weight gain as indicated by this 10-week open-label study. Prospective controlled trials of longer duration and larger number of subjects are needed.

Hyperglycemia and hypertriglyceridemia in real world patients on antipsychotic therapy.

There have been recent reports in the psychiatric literature of the possible association of glucose dysregulation and diabetes mellitus with the use of atypical antipsychotics. This article describes a retrospective chart review of patients from various clinical settings, including a continuing day treatment program, two inpatient programs, and a large private practice. Information was obtained with regard to weight, fasting blood glucose, lipid profiles, EKG changes, and medical comorbidities. The patients included those treated with conventional antipsychotic agents, clozapine, risperidone, olanzapine, and quetiapine. No one antipsychotic agent was associated with a statistically significantly higher prevalence of diabetes, lipid abnormalities, or EKG problems. It was noted, however, that there were higher rates of diabetes (17%), lipid abnormalities (43%), and hypertension (30%) across the sample. This finding suggests that the high prevalence of diabetes, lipid abnormalities, and hypertension in a young, chronically psychiatrically ill population makes the case for aggressive screening.

Older patients with schizophrenia: nature of dwelling status and symptom severity.

OBJECTIVE: This cross-sectional study enrolled elderly patients with diagnoses of schizophrenia or schizoaffective disorder. METHOD: The 85 subjects were dichotomized into two groups on the basis of dwelling status: those living independently (N=35) and those living in residential settings (N=50). The groups were compared with regard to scores on the Mini-Mental State Examination (MMSE), the Brief Psychiatric Rating Scale, the Scale for the Assessment of Negative Symptoms (SANS), the Geriatric Depression Scale and by age. RESULTS: Patients living independently had significantly higher MMSE scores, lower SANS scores, more years of education, and were younger than the patients living in residential settings. CONCLUSIONS: These data suggest that although cognition, negative symptoms, and age are important discriminators with regard to dwelling status, cognition and negative symptoms appear to have the strongest impact.

Does a preexisting anxiety disorder predict response to paroxetine in irritable bowel syndrome?

Irritable bowel syndrome (IBS) is the most common disorder in patients seen by gastroenterologists. Twenty subjects with IBS diagnosed with the Rome criteria were treated for 12 weeks with 20-40 mg/day of paroxetine (mean dose=31 mg/day). At baseline, 10 patients had a lifetime history of an anxiety disorder, and 10 patients did not have such a history. Both groups had similar improvement in abdominal pain, constipation, diarrhea, incomplete emptying, and bloating/ abdominal distension. Paroxetine was very well tolerated.

Paroxetine in Patients With Irritable Bowel Syndrome: A Pilot Open-Label Study.

BACKGROUND: Irritable bowel syndrome (IBS) is a common disorder and is the largest diagnostic cohort seen by gastroenterologists. There is a bidirectional comorbidity of IBS and psychiatric illness. Ours is the first study to examine the effect of any selective serotonin reuptake inhibitor in subjects with IBS. METHOD: Twenty subjects with Rome I criteria-diagnosed IBS were treated with 20 to 40 mg of paroxetine for 12 weeks. We utilized a computer-administered patient daily questionnaire taken by patients over the telephone using an interactive voice response system. RESULTS: Sixty-five percent of patients (13/20) reported a reduction in abdominal pain, and 55% (11/20) reported a reduction in pain frequency (total or mean number of days per week in which the patient had the symptom decreased by >/= 50%). Constipation and diarrhea were reduced in 69% and 57% of patients (9/13 and 8/14), respectively. Similarly, a clinically significant reduction in the symptoms of feeling of incomplete emptying (53% [9/17]) and bloating/abdominal distension (55% [11/20]) was apparent at study conclusion compared with baseline. On the Clinical Global Impressions scale at week 12, 47% (8/17) of the patients were much or very much improved. CONCLUSION: In our pilot open-label study, paroxetine was very effective in alleviating the abdominal pain and associated symptoms of IBS. These results warrant further examination in a placebo-controlled study.

Atypical Antipsychotics and Glucose Dysregulation: A Series of 4 Cases.

There have been reports in the psychiatric literature of the association of glucose dysregulation and diabetes mellitus with the use of atypical and typical (conventional) antipsychotics. We present a series of 4 additional cases in which psychotic disorders (DSM-IV) were treated with atypical antipsychotics, and patients subsequently developed glucose dysregulation or diabetes mellitus. The implications of these findings are discussed.

Topiramate in Bipolar and Schizoaffective Disorders: Weight Loss and Efficacy.

BACKGROUND: Although useful in bipolar disorder, mood stabilizers, such as lithium, divalproex sodium, and carbamazepine, can cause significant weight gain. METHOD: We conducted a retrospective chart review of 5 patients with DSM-IV bipolar disorder or schizoaffective disorder who were treated with topiramate as adjunctive therapy or monotherapy. RESULTS: All 5 patients had a good response to treatment at a mean topiramate dose of 195 mg/day (range, 100-375 mg/day). All patients lost a substantial amount of weight on topiramate treatment. The average weight loss was 22 lb (10 kg; range, 8-56 lb [4-25 kg]). None of the patients discontinued topiramate because of side effects. CONCLUSION: Topiramate may represent a valuable alternative to existing mood stabilizers, either as an adjunct or as monotherapy in patients with bipolar disorder or schizoaffective disorder.