Subjective and psychopathological response in patients under different antipsychotic treatments: are there differences in real clinical practice?

The aim of this study is to investigate whether subjective well-being in patients under treatment with typical (ATPs) and atypical antipsychotic (ATPsA) compounds can be compared with the improvement of psychopathological state and to verify if both variables correlate to adherence to treatment. We assessed 106 consecutive patients receiving ATPs or ATPsA in the University Psychiatric Ward of L?Aquila, according to DSM-IV diagnosis of Schizophrenia and Bipolar Disorder. Psychopathological state was assessed by Brief Psychiatric Rating Scale-4.0 version (BPRS), adherence to treatment and subjective well-being was assessed by Drug Attitude Inventory (DAI-10) and Subjective Well-being under Neuroleptics (SWN), respectively. BPRS and DAI-10 were administered on admission (T0) and at the end of recovery (T1). The subjects enrolled in this study were divided into 2 groups according to ATP prescribed. We observed an improvement of BPRS and SWN total scores in each group, and increasing scores in DAI-10, from admission to discharge, both in total samples and in each group. There were statistical differences between the patients receiving ATPs and those receving ATPsA regardindg the SWN total score and its different dimensions. This study emphasizes that patients receiving ATPsA show better subjective response compared with patients undergoing ATP treatment, although the adherence to pharmacotherapy and clinical improvement do not differ between the groups.

[Risperidone-induced symptomatic hyperprolactinemia in youth with schizophrenia: efficacy and tolerability of cabergoline treatment]. / Iperprolattinemia sintomatica da risperidone in pazienti giovani affetti da schizofrenia e trattamento con cabergolina: studio di efficacia e tollerabilità.

OBJECTIVES: The aim of our study is to evaluate, in youth schizophrenic responders outpatients coming to the SMILE (Service for Monitoring and for early Intervention Looking at the fight against the onset of mental Even psychological suffering of youths of the Psychiatric Department of the University of L'Aquila), the efficacy and tolerability of a low dose of cabergoline, in the treatment of risperidone-induced symptomatic hyperprolactinemia. MATERIALS AND METHODS: Ten schizophrenic young patients (6 male and 4 female; mean age: 23.3 +/- 0.5 years) who were clinical responders to risperidone treatment and showed symptomatic hyperprolactinemia, were treated with low dosage of cabergoline, 0.125 to 0.250 mg/week for 16 weeks. Plasma prolactin level, clinical symptomatology of hyperprolactinemia (UKU) and psychopathology (PANSS) was assessed at baseline and for three times (4, 8 and 16 week) along the follow-up of the study. RESULTS: After cabergoline treatment, the mean decrease in plasma prolactin levels was statistically significant (p < 0.05) for the global sample of youths with schizophrenia. Nine of these patients showed remission of clinical signs of hyperprolactinemia with normalization of prolactin values. No side effect was observed neither patients' psychopathological worsening. CONCLUSIONS: Our data confirm previous studies results, suggesting that low-dose cabergoline treatment of risperidone-induced symptomatic hyperprolactinemia may be safe and clinically effective in a relevant number of schizophrenic patients. Our sample didn't show any side-effects associated to cabergoline use, neither any cardiopulmonary complications as recently reported in literature data. These therapeutic strategies seem to be not influencing psychopathological outcome and for such reason could be a good strategy in clinical practice for the treatment of youths with schizophrenia especially when the efficacy of risperidone is so good to not indicate its withdrawal.

[Antipsychotic-induced symptomatic hyperprolactinemia: clinical consequences and therapeutic strategies]. / Iperprolattinemia sintomatica da antipsicotici: conseguenze cliniche ed indicazioni terapeutiche.

Hyperprolactinemia is a clinical condition characterized by a stable and persistent increase in the ematic prolactin levels. That condition presents some serious health consequences for the affected subjects determining both sexual and endocrine not sexual dysfunctions. Drugs which act on the dopaminergic system and/or on the dopamine hypophysis receptors, could increase the prolactin levels. Traditional antipsychotics used in the treatment of the schizophrenia, are one of the pharmachological classes more involved in this condition and a wide data from international literature describes its clinical and phisiopathologic characteristics. Generally, the atypical antipsychotic induce a significant lower increase of prolactin levels as regards the traditional ones However, above all in young psychotic patients treated with these new drugs, it has been shown an increase of prolactin levels over the superior limit of the normal range, in 70% of them. One of the reasons which more frequently induce a psychotic patient to interrupt an antipsychotic treatment, is represented by the presence of side effects expecially in the sexual sphere. These consequences are greater and more significant in young patients. For such reasons, the therapeutic alternatives to be consider in symptomatic hyperprolactinemia depend on a complete evaluation of the risk/benefit relationship considering the possibility of shifting to another antipsychotic drug, or using drugs with dopaminergic activity which, however, could be associate to some side effects and could determine a worsening of psychotic symptoms.