Showing papers in "Clinical Schizophrenia & Related Psychoses in 2015"
TL;DR: Physicians should be aware of the possibility of new-onset psychotic symptoms and rhabdomyolysis in patients that use SC.
Abstract: Background: Synthetic cannabinoid (SC) or “spice” refers to a variety of herbal/chemical mixtures, which mimic the effects of marijuana. They are generally marked as “herbal incense” and best known by the brand names of “K2,” “spice,” “aroma,” “Mr. Nice Guy” and “dream.” Little data are available on the psychopathological and physical effects of SC. Case Description: We reported on a 23-year-old man without prior psychiatric history who developed acute psychosis and severe rhabdomyolysis (creatine phosphokinase [CPK]: 44,300 UI/L) associated with “Mr. Nice Guy” consumption. To our knowledge, this is the first case report of severe rhabdomyolysis associated with SC use in the U.S. Conclusions: Physicians should be aware of the possibility of new-onset psychotic symptoms and rhabdomyolysis in patients that use SC.
48 citations
TL;DR: Testing the applicability of the transtheoretical model of behavior change to predicting exercise behavior in those with schizophrenia demonstrated that the TTM and its associated measures may be valid for integration into interventions for promoting exercise in individuals with schizophrenia.
Abstract: Introduction: Mortality in individuals with schizophrenia, including deaths not attributable to accidents and suicide, is at least twice that of the general population. While increasing physical exercise could promote positive mental and physical health outcomes in individuals with schizophrenia, only one other study of the determinants of exercise within this population has been reported. Our study attempts to resolve this void in knowledge by testing the applicability of the transtheoretical model (TTM) of behavior change to predicting exercise behavior in those with schizophrenia. Methods: Forty-nine participants (42 with schizophrenia and 7 with schizoaffective disorder) from three community mental health centers in Melbourne, Australia, completed a series of questionnaires, an interview, physical health measures, and had their medical records examined. These measures were used: TTM exercise stage, TTM mediators of change, health status, health-risk behaviors, use of antipsychotic medications, psychopathology, psychiatric history, and demographic information. Variables found to be significantly correlated with exercise stage were then included in a series of regression analyses to determine their relative predictive power for exercise stage. Results: The results demon strated that the TTM and its associated measures may be valid for integration into interventions for promoting exercise in individuals with schizophrenia, despite high levels of psychopathology symptoms. Conclusions: Routine clinical practice should promote exercise in people with schizophrenia and the TTM may be of benefit to this end. Strategies that promote exercise when self-perceived poor health is seen as a significant barrier are particularly important, as is the reduction of caffeine consumption and other health-adverse behaviors.
22 citations
TL;DR: Alpha-lipoic acid (ALA), a potent antioxidant, counteracts this effect of antipsychotic-induced weight gain and may be helpful in reducing weight for patients taking antipsychotics.
Abstract: A possible mechanism of antipsychotic-induced weight gain is activation of hypothalamic monophosphate-dependent kinase (AMPK) mediated by histamine 1 receptors. Alpha-lipoic acid (ALA), a potent antioxidant, counteracts this effect and may be helpful in reducing weight for patients taking antipsychotics. The objective of this open-label study was to assess the efficacy of ALA (1,200 mg) on twelve non-diabetic schizophrenia patients over ten weeks. Participants lost significant weight during the intervention (-2.2 kg±2.5 kg). ALA was well tolerated and was particularly effective for individuals taking strongly antihistaminic antipsychotics (-2.9 kg±2.6 kg vs. -0.5 kg±1.0 kg). Clinical Trial Registration: NCT01355952.
21 citations
TL;DR: Data from 2 randomized, double-blind studies indicated that patient perceptions about treatment satisfaction, side effects, and medication adherence were maintained in patients with schizophrenia receiving maintenance treatment with AOM 400.
Abstract: Objectives: To further characterize the clinical profile of long-term treatment with aripiprazole once-monthly 400 mg (AOM 400) by examining patient-centered outcomes in adults with schizophrenia. Methods: Data are from 2 separate studies: a 52-week, multicenter, randomized, double-blind, placebo-controlled study and a 38-week, multicenter, randomized, double-blind, active-controlled study that evaluated the clinical profile of AOM 400 as maintenance treatment in patients with schizophrenia. The studies were conducted from July 2008 through February 2011 and from September 2008 through August 2012, respectively. Both studies included the Drug Attitude Inventory (DAI), the Medication Adherence Questionnaire (MAQ), the Patient Satisfaction with Medication Questionnaire, and a resource utilization and hospitalization form as prespecified patient-centered endpoints. Results: A total of 710 patients entered the oral stabilization phase in the 52-week study, and 403 patients were randomized to double-blind trea...
13 citations
TL;DR: It is concluded that epidemiologic evidence highlights potential causal links between cannabis use and schizophrenia; however, neurobiological evidence for causality remains weak.
Abstract: Cannabis has been implicated as a risk factor for the development of schizophrenia, but the exact biological mechanisms remain unclear. In this review, we attempt to understand the neurobiological pathways that link cannabis use to schizophrenia. This has been an area of great debate; despite similarities between cannabis users and schizophrenia patients, the evidence is not sufficient to establish cause-and-effect. There have been advances in the understanding of the mechanisms of cannabis dependence as well as the role of the cannabinoid system in the development of psychosis and schizophrenia. The neurobiological mechanisms associated with the development of psychosis and effects from cannabis use may be similar but remain elusive. In order to better understand these associations, this paper will show common neurobiological and neuroanatomical changes as well as common cognitive dysfunction in cannabis users and patients of schizophrenia. We conclude that epidemiologic evidence highlights potential causal links; however, neurobiological evidence for causality remains weak.
12 citations
TL;DR: The case of a patient with treatment-resistant schizophrenia who responded to MCT, whose persecutory and referential delusions improved with a course of twelve sessions of therapy, and had a positive impact on her psychosocial functioning is reported.
Abstract: Metacognitive training for patients with schizophrenia (MCT) is a novel form of psychotherapy that aims to promote insight into the relationship between metacognitive deficits and psychotic symptoms, especially delusions MCT has been found to be effective in reducing the delusional conviction and other positive symptoms in patients with schizophrenia However, we are not aware of any research in which MCT has been used specifically to manage treatment-resistant schizophrenia patients We report the case of a patient with treatment-resistant schizophrenia who responded to MCT Her persecutory and referential delusions improved with a course of twelve sessions of therapy Further, the improvement in delusions had a positive impact on her psychosocial functioning A follow-up after two months of therapy revealed sustained improvement
10 citations
TL;DR: There is clinical utility in cataloguing the needs of younger and older women with schizophrenia and conceptualizing interventions according to gender and age rather than viewing needed services along purely diagnostic lines.
Abstract: Objective: Recognizing that needs differ between men and women with schizophrenia and that they vary over time, this review attempts to categorize the needs that are relevant to younger and to older women Method: This is a selective literature review focusing on topic areas the two authors determined to be most germane to women with schizophrenia Articles were selected on the basis of currency, comprehensiveness, and study design Particular attention was paid to the voices of the women themselves Results: There is considerable overlap between the needs of younger and older women with schizophrenia, but as a general rule, younger women require preventive strategies to stop the escalation of illness while older women require recovery interventions to regain lost hopes and abilities Conclusions: There is clinical utility in cataloguing the needs of younger and older women with schizophrenia and conceptualizing interventions according to gender and age rather than viewing needed services along purely dia
8 citations
TL;DR: Primary analyses from a 12-week, randomized, open-label trial where adult schizophrenia outpatients receiving risperidone, olanzapine, or aripiprazole were switched to iloperidone suggest the immediate-switch method is associated with greater proportion of initial dizziness.
Abstract: Objective: To describe secondary analyses from a 12-week, randomized, open-label trial where adult schizophrenia outpatients receiving risperidone, olanzapine, or aripiprazole were switched to iloperidone. Methods: Patients were randomized into two groups: one where the antecedent antipsychotic dose was titrated downwards to zero over 2 weeks (n=240), and the other group where the antecedent antipsychotic was abruptly stopped (n=260). Adaptations of the Clinical Global Impression scale were used to evaluate clinical changes. Other assessments included the reporting of adverse events (AEs), study discontinuation, body weight, and metabolic variables. Results: Improvement was steady throughout the study for both gradual- and immediate-switch groups starting at Week 1 and continuing through Week 12. Discontinuations due to AEs in the first 2 weeks of treatment were higher for the immediate-switch group compared with the gradual-switch group (10.8% vs. 5.4%, NNT 19, 95% CI 10–151). Fewer patients in the gradualswitch group experienced dizziness as an AE, whereas a higher percentage of patients in the immediate-switch group exhibited earlier onset of a therapeutic response within the first 2 weeks; both groups were comparable thereafter with low rates of dizziness and similar efficacy outcomes. Conclusions: Switching to iloperidone can be accomplished either with a gradual crossover or immediate discontinuation of the prior antipsychotic; however, the immediate-switch method is associated with greater proportion of initial dizziness. The observed outcomes are consistent with what has been previously reported regarding iloperidone’s favorable akathisia/EPS profile and modest impact on somnolence/ sedation, body weight, and metabolic variables.
8 citations
TL;DR: Right-sided hemiatrophy may be an addition to the list of neuro-developmental and structural cerebral anomalies associated with psychotic disorders including schizophrenia.
Abstract: Objectives: To report the finding of psychosis in a patient with Davidoff-Dyke-Masson Syndrome. Method: Case report. Conclusions: Right-sided hemiatrophy may be an addition to the list of neuro-developmental and structural cerebral anomalies associated with psychotic disorders including schizophrenia.
6 citations
TL;DR: A case of aripiprazole-induced hypoprolactinemia in an adult male with first-episode psychosis is reported, and the possible effects of abnormally low prolactin are discussed.
Abstract: Aripiprazole is an atypical antipsychotic that acts as a partial agonist at dopamine D2 receptors. Compared to other atypical antipsychotics, aripiprazole has less metabolic side effects and is less likely to increase prolactin. Moreover, it has been shown to have a unique prolactin lowering effect. While aripiprazole has been associated with subnormal prolactin levels in children, no documented cases of hypoprolactinemia in adults exist thus far. Here we report a case of aripiprazole-induced hypoprolactinemia in an adult male with first-episode psychosis, and the possible effects of abnormally low prolactin are discussed.
6 citations
TL;DR: In this paper, the benefit of short-term treatment with the atypical antipsychotic asenapine versus placebo on depressive symptoms in patients with acute schizophrenia in an exacerbated state was evaluated.
Abstract: Background: Although depressive symptoms are a frequently occurring phenomenon in schizophrenia, effective treatments remain an area of clinical need. Objective: To assess the benefit of short-term treatment with the atypical antipsychotic asenapine versus placebo on depressive symptoms in patients with acute schizophrenia in an exacerbated state. Methods: Data were pooled from intent-to-treat (ITT) populations of three 6-week, randomized controlled studies with fixed doses of asenapine (ASE; n=427), olanzapine (OLA; n=82), risperidone (RIS; n=54), haloperidol (HAL; n=97), or placebo (PLA; n=254). Change from baseline Calgary Depression Scale for Schizophrenia (CDSS) total score and individual item scores were assessed at Day 21 and Day 42 in the total patient population (n=914), and in patients presenting with a CDSS total score of .6 at baseline (n=248). Mixed model repeated measures (MMRM) analyses were performed on patient data. Results: The observed change from baseline in CDSS total score was signif...
TL;DR: The case of M, age 59, who was treated with risedronate for osteoporosis, and was subsequently diagnosed with atypical psychosis after other organic causes were excluded, suggests that the risedonate might have triggered a psychotic reaction that resolved following cessation of treatment.
Abstract: As women age and enter menopause, they are sometimes more susceptible than men to certain physical and mental disorders such as osteoporosis and late-onset schizophrenia. Risedronate (Actonel©) is a bisphosphonate used for the treatment of osteopenia. Early initiation of pharmacotherapy for osteopenia is recommended to prevent greater bone loss. The most common side effects of risedronate include fever and flu-like symptoms, hypocalcemia, bone and joint pain, peripheral edema, fatigue, change in bowel movements, osteonecrosis of the jaw, and atrial fibrillation. Though reports in the professional literature of psychotic reactions to risedronate are scant, there have been FDA reports as well as patient discussions of psychiatric side effects from this medication on popular websites. We report the case of M, age 59, who was treated with risedronate for osteoporosis, and was subsequently diagnosed with atypical psychosis after other organic causes were excluded. Though it is conceivable that age-related psychosocial and physical factors triggered late-onset schizophrenia, the temporal relationship between the termination of treatment with risedronate and the improvement in her mental state suggests that the risedronate might have triggered a psychotic reaction that resolved following cessation of treatment.
TL;DR: Reports on various Congress sessions concerning approaches to prevention in schizophrenia and social cognition are brought you.
Abstract: Approaches to Prevention in Schizophrenia A number of presentations at the 2015 ICOSR addressed potential strategies for prevention in schizophrenia. These ranged from prenatal supplements to what constitutes an optimal maintenance therapy in schizophrenia. One of the most hotly debated sessions at the conference centered on whether patients with schizophrenia need maintenance antipsychotic treatment. Wolfgang Fleischhacker from Medical School Innsbruck in Austria argued that, although it is unclear which antipsychotics are most effec tive for maintenance treatment after the first episode of psy chosis, it has been consistently shown that in the short term antipsychotic use is associated with significantly reduced relapse rates. Robin Emsley from Stellenbosch University in South Africa showed that discontinuation of antipsychotic maintenance results in treatment failure of the next relapse in one out of six patients. However, the overwhelming majority of studies exploring the effectiveness of antipsychotic maintenance treatment are relatively short, with limited data available beyond three years after the first episode of psychosis. Lex Wunderink from Friesland Mental Health Services in the Netherlands presented the results of a first randomized clinical trial with a seven-year follow-up. Patients were randomly assigned to early antipsychotic dose reduction/discontinuation or to standard maintenance treatment groups. Wunderink’s findings suggest that relapse rates were initially higher in the dose reduction/discontinuation group but leveled at three years. At seven years of follow-up, patients in the dose reduction/discontinuation arm of the study showed a significantly better recovery rate and functional remission compared to patients in the maintenance treatment group (Wunderink et al., 2013). This study underscores the im portance of using longer follow-up periods in clinical trials of maintenance treatment and of including functional status, in addition to relapse rate, as an outcome evaluation. Although the findings of this study strongly indicate that guided dose reduction and, if possible, discontinuation may be a feasible strategy leading to better long-term functional outcome, Wunderink pointed out that additional studies are needed before such a strategy can become a general guideline in treating patients with first-episode psychosis.
TL;DR: The case of a patient suffering from disorganized schizophrenia who had life-threatening hematological side effects to treatment with antipsychotic agents was reported, and long-term mECT was administered and the patient achieved remission with no notable side effects.
Abstract: Owing to unresolved questions concerning the efficacy and safety of electroconvulsive therapy (ECT) in the treatment of schizophrenia, and widespread negative attitudes toward ECT, maintenance ECT (mECT) is generally considered only as a last resort. Nevertheless, in some clinical situations, the advantages of mECT may outweigh the risks and associated concerns. We report the case of a patient suffering from disorganized schizophrenia who had life-threatening hematological side effects to treatment with antipsychotic agents. Long-term mECT was administered and the patient achieved remission with no notable side effects. He was able to maintain a peaceful daily routine and improved functioning. Considering the lack of controlled trials in this area, this case and other similar cases reported in the literature add support to a possible benefit of mECT in disorganized schizophrenia, particularly when pharmacotherapy is insufficient or contraindicated
TL;DR: A female patient with chronic paranoid schizophrenia who had an unexpected weight gain and developed MetS during a cross-switch from a polypharmacy of olanzapine, valproate and sulpiride to ziprasidone monotherapy is described.
Abstract: Second-generation antipsychotics (SGAs), valproate, and sulpiride are related to significant weight gain and risk of metabolic syndrome (MetS). Among SGAs, olanzapine and clozapine are associated with the highest metabolic risk while ziprasidone is among one of the SGAs with the lowest risk. Several reports suggest that weight loss is observed in switching other antipsychotics to ziprasidone. Here we describe a female patient with chronic paranoid schizophrenia who had an unexpected weight gain and developed MetS during a cross-switch from a polypharmacy of olanzapine, valproate and sulpiride to ziprasidone monotherapy.
TL;DR: This preprinted manuscript has been reviewed and accepted for publication but has yet to be edited, typeset and finalized, and will be replaced with the final, published version after it has been published in the print edition of the journal.
Abstract: 1 CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES Rapid Electronic Article in Press This preprinted manuscript has been reviewed and accepted for publication but has yet to be edited, typeset and finalized. This version of the manuscript will be replaced with the final, published version after it has been published in the print edition of the journal. The final, published version may differ from this proof. DOI: 10.3371/CSRP.MAGA.022015 © 2015 Walsh Medical Media LLC