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1

Antipsychotic prescribing in older people.  

PubMed

Antipsychotic medications have made a significant contribution to the care of the mentally ill people over the past 50 years, with good evidence that both typical and atypical agents are effective in the treatment of schizophrenia and related conditions. In addition they are widely used to good effect in other disorders including psychotic depression, dementia and delirium. Both typical and atypical agents may cause severe side-effects and, in the elderly in particular, there is an increased propensity for drug interactions. If used with care, antipsychotics are usually well tolerated, especially the atypical drugs. Although antipsychotics are effective at reducing psychotic symptoms their limitations should be recognised. They do not 'cure' the underlying illness, and the management of psychotic and behavioural symptoms must take into consideration treatment of physical illness as well as psychosocial interventions. In addition, the antipsychotic effect may take one to two weeks to be evident so doses should not be increased too rapidly. Often small doses are effective in the elderly if they are given sufficient time to work. As our understanding of the mechanisms of psychosis improves it is hoped that new drugs will be developed with novel mechanisms of action with improved efficacy and reduced side-effects. There are several drugs in development, some sharing similarities to currently available agents whilst others have novel mechanisms of actions involving glutamate and nicotinic receptors. Pharmacogenetics is also likely to be increasingly important over the next few years. As the genetic basis of many psychiatric disorders becomes more clearly established it is likely that drugs specifically designed for particular sub-groups of receptors will be developed. Finally, although the pharmacological treatment of psychotic disorders in younger people has been given considerable attention, there is a paucity of good quality research on antipsychotic drug use in older people. There is a need to redress this balance to ensure that the prescribing of antipsychotics in older people is evidence based. PMID:12957993

Neil, Wendy; Curran, Stephen; Wattis, John

2003-09-01

2

Antipsychotic polypharmacy: a Japanese survey of prescribers' attitudes and rationales  

PubMed Central

While combining antipsychotics is common in schizophrenia treatment, the literature on the reasons for antipsychotic polypharmacy (APP) is limited. We aimed to identify prescriber attitudes and rationales for APP in Japan where high APP utilization is reported. Two-hundred-seventeen psychiatrists participated in the survey, which assessed APP attitudes and behaviors. Prescribing APP to 47.7±24.7% (mean±SD) of their patients, psychiatrists reported that they were “moderately” concerned about APP. The most APP-justifiable factors were (1=“not at all” to 5=“extreme”): cross titration (4.50±0.67), randomized controlled evidence (3.67±0.83), and treatment of comorbid conditions (3.31±0.83). Conversely, APP-discouraging factors were: chronic side effects (4.14±0.64), difficulty determining cause and effect (4.07±0.74), and acute side effects (3.99±0.81). Comparing high to low APP prescribers (>50% vs. ?50% of patients), no differences emerged regarding APP justification and concerns. In multivariate analyses, high APP use was associated with practice at a psychiatric hospital (OR: 2.70, 95%CI: 1.29-5.67, p=0.009), concern about potential drug-drug interactions (OR: 1.56, 95%CI: 1.04-2.35, p=0.031), and less reliance on case reports of APP showing efficacy (OR: 0.64, 95%CI: 0.44-0.92, p=0.017) (r2=0.111, p=0.001). High and low APP prescribers shared a comparable degree of justifications and concerns. Future research should examine the impact of cultural determinants on APP. PMID:23602697

Kishimoto, Taishiro; Watanabe, Koichiro; Uchida, Hiroyuki; Mimura, Masaru; Kane, John M.; Correll, Christoph U.

2013-01-01

3

A pharmacy led program to review anti-psychotic prescribing for people with dementia  

PubMed Central

Background Anti-psychotics, prescribed to people with dementia, are associated with approximately 1,800 excess annual deaths in the UK. A key public health objective is to limit such prescribing of anti-psychotics. Methods This project was conducted within primary care in Medway Primary Care Trust (PCT) in the UK. There were 2 stages for the intervention. First, primary care information systems including the dementia register were searched by a pharmacy technician to identify people with dementia prescribed anti-psychotics. Second, a trained specialist pharmacist conducted targeted clinical medication reviews in people with dementia initiated on anti-psychotics by primary care, identified by the data search. Results Data were collected from 59 practices. One hundred and sixty-one (15.3%) of 1051 people on the dementia register were receiving low-dose anti-psychotics. People with dementia living in residential homes were nearly 3.5 times more likely to receive an anti-psychotic [25.5% of care home residents (118/462) vs. 7.3% of people living at home (43/589)] than people living in their own homes (p?anti-psychotics. Of the 161 people with dementia prescribed low-dose anti-psychotics, 91 were receiving on-going treatment from local secondary care mental health services or Learning Disability Teams. Of the remaining 70 patients the anti-psychotic was either withdrawn, or the dosage was reduced, in 43 instances (61.4%) following the pharmacy-led medication review. Conclusions In total 15.3% of people on the dementia register were receiving a low-dose anti-psychotic. However, such data, including the recent national audit may under-estimate the usage of anti-psychotics in people with dementia. Anti-psychotics were used more commonly within care home settings. The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia. PMID:23006528

2012-01-01

4

Prescribing trends of antipsychotics in youth receiving income assistance: results from a retrospective population database study  

PubMed Central

Background Prescribing of antipsychotics (AP) to young people has increased in the last decade internationally. We aimed to characterize AP prescribing in a population of low-income youth in Nova Scotia, Canada. Methods We conducted a population database study of AP prescription claims and health services utilization by young people aged 25 years and younger receiving drug benefits through the publicly funded Pharmacare program between October 1, 2000 to September 30, 2007. Results Four percent (1715/43888) of youth receiving Pharmacare benefits filled AP prescriptions. The use of second generation antipsychotics (SGAs) significantly increased (p?antipsychotic use significantly decreased. Pharmacare beneficiaries aged 21-25 years represented 45.2% of AP users. The majority (66%) of youth filling AP prescriptions had 2 or more psychiatric diagnoses. Most youth (76%) filled prescriptions for only one type of AP during the study period. Psychotic disorders were the most common indication for AP use except with risperidone, in which ADHD was the most likely reason for use. Co-prescribing of psychotropics was prevalent with antidepressants and mood stabilizers prescribed in 42% and 27% of AP users, respectively. General practitioners (GPs) prescribed incident APs most often (72%) followed by psychiatrists (16%). The age- and gender-adjusted rate of death was higher in AP users as compared to the age-matched general population of Nova Scotia. Conclusions SGA use increased significantly over seven years in a cohort of 0 to 25 years olds receiving Pharmacare benefits. Off-label use of APs was prevalent with ADHD and other non-psychotic disorders being common reasons for AP use. GPs initiated most AP prescriptions. Co-prescribing of other psychotropics, especially antidepressants and mood stabilizers, was prevalent even in younger age strata. This study raises further questions about AP prescribing in those 25 years of age and under, especially given the range of diagnoses and psychotropic co-prescribing. PMID:23890157

2013-01-01

5

Antipsychotic Medication Prescribing Trends in Children and Adolescents  

PubMed Central

The Food and Drug Administration has approved the use of antipsychotic medications in some children and adolescents with severe emotional and behavioral disorders. However, recent national data show a dramatic rise in off-label and Food and Drug Administration–approved uses of these medications. Of particular note is a twofold to fivefold increase in the use of antipsychotic medications in preschool children, despite little information on their long-term effects. This article describes the trend in pediatric antipsychotic medication use, possible explanations for the increase, implications for children’s health, and recommendations for pediatric providers who work with parents of children and adolescents who seek or receive antipsychotic medication treatments. PMID:22360933

Harrison, Joyce Nolan; Cluxton-Keller, Fallon; Gross, Deborah

2013-01-01

6

Youth, Caregiver, and Prescriber Experiences of Antipsychotic-Related Weight Gain  

PubMed Central

Objectives. To explore the lived experience of youth, caregivers, and prescribers with antipsychotic medications. Design. We conducted a qualitative interpretive phenomenology study. Youth aged 11 to 25 with recent experience taking antipsychotics, the caregivers of youth taking antipsychotics, and the prescribers of antipsychotics were recruited. Subjects. Eighteen youth, 10 caregivers (parents), and 11 prescribers participated. Results. Eleven of 18 youth, six of ten parents, and all prescribers discussed antipsychotic-related weight gain. Participants were attuned to the numeric weight changes usually measured in pounds. Significant discussions occurred around weight changes in the context of body image, adherence and persistence, managing weight increases, and metabolic effects. These concepts were often inextricably linked but maintained the significance as separate issues. Participants discussed tradeoffs regarding the perceived benefits and risks of weight gain, often with uncertainty and inadequate information regarding the short- and long-term consequences. Conclusion. Antipsychotic-related weight gain in youth influences body image and weight management strategies and impacts treatment courses with respect to adherence and persistence. In our study, the experience of monitoring for weight and metabolic changes was primarily reactive in nature. Participants expressed ambiguity regarding the short- and long-term consequences of weight and metabolic changes. PMID:24533223

Murphy, Andrea Lynn; Gardner, David Martin; Cooke, Charmaine; Kutcher, Stanley Paul; Hughes, Jean

2013-01-01

7

Antipsychotic Medication Prescription Patterns in Adults with Developmental Disabilities Who Have Experienced Psychiatric Crisis  

ERIC Educational Resources Information Center

Antipsychotic medication rates are high in adults with developmental disability. This study considered rates of antipsychotic use in 743 adults with developmental disability who had experienced a psychiatric crisis. Nearly half (49%) of these adults were prescribed antipsychotics. Polypharmacy was common with 22% of those prescribed antipsychotics

Lunsky, Yona; Elserafi, Jonny

2012-01-01

8

An attempt to improve antipsychotic medication adherence by feedback of medication possession ratio scores to prescribers.  

PubMed

Poor medication adherence is well documented for patients with severe and persistent mental illness. The State of Missouri implemented an early alert system to notify caregivers when patients fail to refill essential prescriptions in a timely manner and as an educational resource for providers on best practices for improving treatment adherence. Missouri Medicaid patients who were prescribed at least 1 of 9 orally-administered antipsychotic medications and who had at least 1 medication possession ratio (MPR) score below 0.8 were included in the adherence intervention group. Their prescribing clinicians and case managers were messaged electronically 2 times per week at the point that failure to refill the targeted prescription was identified. Notification occurred when the prescription had lapsed at 7 days, 30 days, and 45 days, and occurred in real time. In addition, MPR scores were provided monthly for the most recent 6-month period. Change in MPR scores was measured for the intervention group and for a matched control group. Trends in MPR scores were analyzed for both groups pre, during, and post intervention. In both the intervention and postintervention periods, there was a significant difference in the MPR scores between the two groups. The intervention group had a significantly greater increase in MPR score between preintervention and intervention periods. After the conclusion of the intervention, the MPR score decreased somewhat but was still higher than during the preintervention period. Results suggest that clinicians and patients need specific data about adherence in order to address the issue. PMID:20879908

Patel, Urvashi B; Ni, Quanhong; Clayton, Carol; Lam, Peter; Parks, Joseph

2010-10-01

9

Consultant psychiatrists' experiences of and attitudes towards shared decision making in antipsychotic prescribing, a qualitative study  

PubMed Central

Background Shared decision making represents a clinical consultation model where both clinician and service user are conceptualised as experts; information is shared bilaterally and joint treatment decisions are reached. Little previous research has been conducted to assess experience of this model in psychiatric practice. The current project therefore sought to explore the attitudes and experiences of consultant psychiatrists relating to shared decision making in the prescribing of antipsychotic medications. Methods A qualitative research design allowed the experiences and beliefs of participants in relation to shared decision making to be elicited. Purposive sampling was used to recruit participants from a range of clinical backgrounds and with varying length of clinical experience. A semi-structured interview schedule was utilised and was adapted in subsequent interviews to reflect emergent themes. Data analysis was completed in parallel with interviews in order to guide interview topics and to inform recruitment. A directed analysis method was utilised for interview analysis with themes identified being fitted to a framework identified from the research literature as applicable to the practice of shared decision making. Examples of themes contradictory to, or not adequately explained by, the framework were sought. Results A total of 26 consultant psychiatrists were interviewed. Participants expressed support for the shared decision making model, but also acknowledged that it was necessary to be flexible as the clinical situation dictated. A number of potential barriers to the process were perceived however: The commonest barrier was the clinician’s beliefs regarding the service users’ insight into their mental disorder, presented in some cases as an absolute barrier to shared decision making. In addition factors external to the clinician - service user relationship were identified as impacting on the decision making process, including; environmental factors, financial constraints as well as societal perceptions of mental disorder in general and antipsychotic medication in particular. Conclusions This project has allowed identification of potential barriers to shared decision making in psychiatric practice. Further work is necessary to observe the decision making process in clinical practice and also to identify means in which the identified barriers, in particular ‘lack of insight’, may be more effectively managed. PMID:24886121

2014-01-01

10

Antipsychotic medications, glutamate, and cell death: a hidden, but common medication side effect?  

PubMed

We hypothesize the interaction between antipsychotic medications and regulation of extracellular glutamate which has gone largely unnoticed in the medical community has significant clinical importance. Typical antipsychotic medications such as haloperidol elevate extracellular glutamate because they exert antagonist effects on dopamine D(2) and serotonin 5HT(1A) receptors. In contrast, serotonin 5HT(2A) receptor antagonists inhibit glutamate release. Glutamate is potentially excitotoxic through effects on ionotropic receptor channels and may exert synergistic effects with other neurotoxic pathways. In contrast to typical antipsychotic drugs, pharmacological properties of atypical antipsychotic medications at dopamine D(2), serotonin 5HT(1A) and 5HT(2A) receptors limit extracellular glutamate and may theoretically be neuroprotective in certain clinical settings. In this review we discuss three common clinical settings in which typical antipsychotic medications may potentiate neurotoxicity by elevating extracellular glutamate. The most common clinical setting, hypoglycemia during combined use of antipsychotic medications and insulin, presents a theoretical risk for 35 million diabetic patients worldwide using antipsychotic medications. Antipsychotic medication treatment during hypoxic episodes in the intensive care unit and following traumatic brain injury are two other common clinical settings in which this interaction poses theoretical risk. Further study is needed to test hypothesized risk mechanisms, and determine clinical and epidemiological consequences of these exposures. PMID:23265349

Isom, Amanda M; Gudelsky, Gary A; Benoit, Stephen C; Richtand, Neil M

2013-03-01

11

Public-academic partnerships: a program to improve the quality of antipsychotic prescribing in a community mental health system.  

PubMed

State mental health authorities can use public-academic partnerships to create professional roles in which leaders can track trends, identify problems, and carry out quality improvement projects to address key issues. Leaders with positions in both academic institutions and state mental health authorities ensure access to resources, technical expertise, and key relationships to improve quality. The authors describe a public-academic partnership in New Hampshire and a quality improvement program it carried out. The program encourages providers at community mental health centers to adopt prescribing practices that limit the cardiometabolic side effects of antipsychotic medicines. PMID:21885576

Brunette, Mary F; de Nesnera, Alexander; Swain, Karin; Riera, Erik G; Lotz, Doris; Bartels, Stephen J

2011-09-01

12

Commonly Prescribed Blood Thinner Associated with Higher Risk of Post-Surgery Complications  

MedlinePLUS

... Prescribed Blood Thinner Associated with Higher Risk of Post-Surgery Complications A blood thinner commonly prescribed to ... replacement is associated with an increased risk of post-surgery bleeding or infection, according to a study ...

13

Patient and prescriber perspectives on long-acting injectable (LAI) antipsychotics and analysis of in-office discussion regarding LAI treatment for schizophrenia  

PubMed Central

Background The research goal is to better understand prescriber, patient, and caregiver perspectives about long-acting injectable (LAI) antipsychotic therapy and how these perspectives affect LAI use. Addressing these perspectives in the clinic may lead to greater success in achieving therapeutic goals for the patient with schizophrenia. Methods Ethnographic information was collected from a non-random sample of 69 prescriber-patient conversations (60 with community mental health center [CMHC] psychiatrists; 9 with nurse-practitioners) recorded during treatment visits from August 2011 to February 2012, transcribed and analyzed. Discussions were categorized according to 11 predetermined CMHC topics. In-person observations were also conducted at 4 CMHCs, including home visits by researchers (n?=?15 patients) prior to the CMHC visit and observations of patients receiving injections and interacting with staff. Telephone in-depth interviews with psychiatrists, patients, and caregivers to gather additional information on LAI discussion, prescription, or use were conducted. Results Antipsychotic treatment decisions were made without patient or caregiver input in 40 of 60 (67%) of psychiatrist-patient conversations. Involvement of patients or caregivers in treatment decisions was greater when discussing LAI (15 of 60 [25%]) vs oral antipsychotic treatment (5 of 60 [8%]). LAIs were not discussed by psychiatrists in 11 of 22 (50%) patients taking oral antipsychotics. When offered, more LAI-naïve patients expressed neutral (9 of 19 [47%]) rather than favorable (3 of 19 [16%]) or unfavorable (7 of 19 [37%]) responses. Prescribers were most concerned about potentially damaging the therapeutic relationship and side-effects when discussing LAIs while patient resistance was often related to negative feelings about injections. Psychiatrists had some success in overcoming patient objections to LAIs by addressing and decomposing initial resistance. More than half (11 of 19 [58%]) of LAI-naïve patients agreed to start LAI treatment following office visits. Patient-described benefits of LAIs vs orals included perceived rapid symptom improvement and greater overall efficacy. Conclusions In this study, many psychiatrists did not offer LAIs and most patients and caregivers were not involved in antipsychotic treatment decision making. Opportunities to increase active patient engagement, address resistances, guide patient drug-formulation selection, and provide better LAI-relevant information for more individualized approaches to treating the patient with schizophrenia were present. PMID:24131801

2013-01-01

14

New safety concerns over diabetes drugs Two drugs commonly prescribed to treat diabetes  

E-print Network

New safety concerns over diabetes drugs Two drugs commonly prescribed to treat diabetes double of Type II Diabetes. Prescriptions for the drugs, known as thiazolidinediones, have doubled over the last. The results are published in the August edition of the journal Diabetes Care. Congregation 2007 page 5­9 Race

Feigon, Brooke

15

Metabolic consequences of second-generation antipsychotics in youth: appropriate monitoring and clinical management  

PubMed Central

Objective To review the metabolic consequences of second-generation antipsychotics in youth and current monitoring and intervention guidelines for optimal treatment. Background Second-generation antipsychotics have largely replaced the use of first-generation antipsychotics in treating psychotic disorders in youth. In addition, there has been a dramatic increase in using these medications to treat a variety of nonpsychotic disorders. These medications have significant metabolic side effects, including weight gain. This raises concern, given the problem of pediatric obesity. Materials and methods A review of current literature looking at prescribing practices and possible reasons for the increased use of second-generation antipsychotics in children and adolescents was conducted. Review of the mechanisms for why youth may be particularly vulnerable to the metabolic consequences (particularly weight gain) was similarly completed. In addition, data supporting the efficacy, rationale, and unique side-effect profile of each individual second-generation drug were evaluated to help inform providers on when and what to prescribe, along with current monitoring practices. The current evidence base for possible interventions regarding the management of antipsychotic-induced weight gain was also evaluated. Results and conclusion On the basis of the literature review, there are several speculated reasons for the increase in prescriptions of second-generation antipsychotics. The choice of antipsychotic for youth should be based upon the disorder being treated along with the unique side-effect profile for the most commonly used second-generation antipsychotics. Monitoring strategies are also individualized to each antipsychotic. The current interventions recommended for antipsychotic-induced weight gain include lifestyle management, switching medication to a drug with a lower propensity for weight gain, and pharmacologic (particularly metformin) treatment. PMID:25298741

Krill, Rebecca A; Kumra, Sanjiv

2014-01-01

16

Anticholinergic use in children and adolescents after initiation of antipsychotic therapy  

PubMed Central

Background Second generation antipsychotics (SGAs) are thought to have a lower likelihood of inducing extrapyramidal symptoms (EPS) than first generation antipsychotics (FGAs). Clinical observations suggest that younger patients may be more sensitive to SGA-associated EPS than adults and require therapy with anticholinergic agents, which are known to impair cognitive performance. The scope of anticholinergic use in this patient population and differences in utilization across SGAs (as well as FGAs) has not been extensively studied. Objective The primary objective of this study was to determine the proportion of patients five to 18 years of age who received anticholinergic therapy during the initial stages of antipsychotic treatment. A secondary objective was to compare anticholinergic use across patients receiving aripiprazole, risperidone, and quetiapine, SGAs previously identified to be the most commonly prescribed at the academic institution studied. Methods Patients five to 18 years of age initiating a trial of an antipsychotic between January 1, 2005 and September 1, 2008 were identified in a retrospective review of prescription and medical records. Demographic characteristics, antipsychotic and anticholinergic utilization, indications, diagnoses, and concomitant medications and doses were collected from the electronic medical record. For patients who received more than one therapeutic course of an antipsychotic during the identified timeframe, only the first course identified in the medical record was used for analyses. Anticholinergic utilization at antipsychotic initiation and after 30 days was assessed. Variables associated with anticholinergic use and differences across agents were identified. Results A total of 235 antipsychotic treatment courses were identified. Of these, 152 patients met our inclusion criteria and represented the first documented use of an antipsychotic at the present institution. Anticholinergic use at any time during the first 30 days of treatment was identified in 32 patients (21%) while EPS was documented for 12 patients (7.8%). FGA or polypharmacy defined as simultaneous use of ?1 scheduled antipsychotic versus SGA (OR=18.98; 95% CI:4.74 – 75.95) was the primary characteristic significantly associated with anticholinergic use 30 days after initiation. Risperidone, quetiapine, and aripiprazole were the three most commonly prescribed antipsychotics. Of these SGAs, anticholinergic use was most frequently prescribed with risperidone treatment (p=0.03). Conclusion Anticholinergic use exceeded the incidence of EPS as documented in the electronic medical record (21% vs 8%) and differed across individual medications as well as antipsychotic class. Use of an FGA or polypharmacy was a key predictor of anticholinergic use. PMID:20587746

Hong, Irene S.; Bishop, Jeffrey R.

2013-01-01

17

Assessing the Comparative-Effectiveness of Antidepressants Commonly Prescribed for Depression in the US Medicare Population  

PubMed Central

Background Depression is among the most common chronic illnesses in the US elderly Medicare population, affecting approximately 11.5% of beneficiaries with estimated costs of about US$65 billion annually. Patients with depression are typically treated with antidepressants - most commonly the Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs vary substantially in their costs, side effect profiles and convenience of use. All these factors might affect medication adherence and subsequently down-stream medical costs. Aims of Study To assess the comparative-effectiveness of three antidepressants (escitalopram, citalopram, sertraline) commonly-prescribed for depression in Medicare. Methods We used pharmacy and medical claims data for a 5 percent national random sample of Medicare beneficiaries who were diagnosed with depression in 2008 and followed until 12/31/2009. Key measures included drug spending, medication adherence to antidepressants, down-stream non-drug medical costs at three levels: all, psychiatric and depression related costs. Three methods were conducted to test robustness: generalized linear regression (GLM), propensity score matching, and instrumental variables (IV) approach. For the instrumental variables approach, we used a two-stage residual inclusion model, using geographic variation in the use of the various drugs as instruments. Specifically, we calculated the ratio of the number of individuals who used each drug to the total number of individuals using any antidepressants at the 306 Dartmouth hospital-referral regions. Results The regression and the propensity score matching method each showed that patients using escitalopram had significantly worse adherence, higher drug costs, and higher medical costs than patients using either citalopram or sertraline. However, our IV analysis yielded different results. While drug costs remained significantly higher for escitalopram patients, we found that escitalopram users had lower non-drug medical spending than patients who used citalopram, which was enough to offset the higher drug costs. The instrumental variables results also suggested that sertraline users had lower non-drug medical costs than citalopram users. The differences between sertraline and escitalopram were not statistically significant for medical spending, but sertraline users had lower drug costs and better adherence than escitalopram users. Discussion The IV method yielded somewhat different results than the GLM regressions and the propensity score matching methods. Once we controlled for selection bias using the instrumental variables, we found that escitalopram is actually associated with lower medical spending. One interpretation is that the IV approach mitigates selection biases due to unobserved factors that are not controlled in regular regressions. However, one conclusion remains the same: in every model, we found that sertraline was at least as cost-effective as or more cost-effective than the other drugs. Limitations Potential unobserved factors affecting the choice of three antidepressants are possible. Implications for Health Policies All methods indicated that sertraline is the most cost-effective drug to treat depression. Substantial savings to Medicare could be realized by using more cost-effective antidepressants such as sertraline. Implications for Further Research Geographic variation in the use of prescription drugs has been underutilized as an instrumental variable in comparative-effectiveness research. Our study demonstrates that it can help to control for selection biases in observational data. PMID:23525835

Kaplan, Cameron; Zhang, Yuting

2012-01-01

18

Comparative Effectiveness of Second-Generation Antipsychotic Medications in Early-Onset Schizophrenia  

PubMed Central

Scant information exists to guide pharmacological treatment of early-onset schizophrenia. We examine variation across commonly prescribed second-generation antipsychotic medications in medication discontinuation and psychiatric hospital admission among children and adolescents clinically diagnosed with schizophrenia. A 45-state Medicaid claims file (2001–2005) was analyzed focusing on outpatients, aged 6–17 years, diagnosed with schizophrenia or a related disorder prior to starting a new episode of antipsychotic monotherapy with risperidone (n = 805), olanzapine (n = 382), quetiapine (n = 260), aripiprazole (n = 173), or ziprasidone (n = 125). Cox proportional hazard regressions estimated adjusted hazard ratios of 180-day antipsychotic medication discontinuation and 180-day psychiatric hospitalization for patients treated with each medication. During the first 180 days following antipsychotic initiation, most youth treated with quetiapine (70.7%), ziprasidone (73.3%), olanzapine (73.7%), risperidone (74.7%), and aripirazole (76.5%) discontinued their medication (?2 = 1.69, df = 4, P = .79). Compared with risperidone, the adjusted hazards of antipsychotic discontinuation did not significantly differ for any of the 4-comparator medications. The percentages of youth receiving inpatient psychiatric treatment while receiving their initial antipsychotic medication ranged from 7.19% (aripiprazole) to 9.89% (quetiapine) (?2 = 0.79, df = 4, P = .94). As compared with risperidone, the adjusted hazard ratio of psychiatric hospital admission was 0.96 (95% CI: 0.57–1.61) for olanzapine, 1.03 (95% CI: 0.59–1.81) for quetiapine, 0.85 (95% CI: 0.43–1.70) for aripiprazole, and 1.22 (95% CI: 0.60–2.51) for ziprasidone. The results suggest that rapid antipsychotic medication discontinuation and psychiatric hospital admission are common in the community treatment of early-onset schizophrenia. No significant differences were detected in risk of either adverse outcome across 5 commonly prescribed second-generation antipsychotic medications. PMID:21307041

Olfson, Mark; Gerhard, Tobias; Huang, Cecilia; Lieberman, Jeffrey A.; Bobo, William V.; Crystal, Stephen

2012-01-01

19

Prevalence of commonly prescribed medications potentially contributing to urinary symptoms in a cohort of older patients seeking care for incontinence  

PubMed Central

Background Several medication classes may contribute to urinary symptoms in older adults. The purpose of this study was to determine the prevalence of use of these medications in a clinical cohort of incontinent patients. Methods A cross-sectional study was conducted among 390 new patients aged 60 years and older seeking care for incontinence in specialized outpatient geriatric incontinence clinics in Quebec, Canada. The use of oral estrogens, alpha-blocking agents, benzodiazepines, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, NSAIDs, narcotics and calcium channel blockers was recorded from each patient’s medication profile. Lower urinary tract symptoms and the severity of incontinence were measured using standardized questionnaires including the International Consultation on Incontinence Questionnaire. The type of incontinence was determined clinically by a physician specialized in incontinence. Co-morbidities were ascertained by self-report. Logistic regression analyses were used to detect factors associated with medication use, as well as relationships between specific medication classes and the type and severity of urinary symptoms. Results The prevalence of medications potentially contributing to lower urinary tract symptoms was 60.5%. Calcium channel blockers (21.8%), benzodiazepines (17.4%), other centrally active agents (16.4%), ACE inhibitors (14.4%) and estrogens (12.8%) were most frequently consumed. Only polypharmacy (OR?=?4.9, 95% CI?=?3.1-7.9), was associated with medication use contributing to incontinence in analyses adjusted for age, sex, and multimorbidity. No associations were detected between specific medication classes and the type or severity of urinary symptoms in this cohort. Conclusion The prevalence of use of medications potentially causing urinary symptoms is high among incontinent older adults. More research is needed to determine whether de-prescribing these medications results in improved urinary symptoms. PMID:23758756

2013-01-01

20

Relationship between adherence, symptoms, treatment attitudes, satisfaction, and side effects in prisoners taking antipsychotic medication  

Microsoft Academic Search

Objective: To examine the nature and clinical correlates of adherence in prisoners prescribed antipsychotic medication, and how these differ from findings in people taking antipsychotic medication who are not in prison.Method: Treatment adherence, satisfaction with antipsychotic medication, drug attitudes, symptoms, medication side effects, and insight (and insight dimensions) were assessed in 44 prisoners taking antipsychotic medication.Results: In a regression model,

Richard Gray; Dan Bressington; Judith Lathlean; Alice Mills

2008-01-01

21

Hypnosedative prescribing in outpatient psychiatry.  

PubMed

The objective of this study was to describe hypnosedative (HS) prescribing patterns in a typical sample of psychiatric outpatients. Prescription information was extracted from the clinical records of all current outpatients at two New Zealand public mental health centres. This included the type and duration of HS use and documentation of a clinical review of longstanding (>3 months) use, patient sex, age and ICD10 diagnoses. One-third of the patients (35.2%) were prescribed at least one HS; this was longstanding in two-thirds (69%). One in 10 had a coprescription of more than one HS drug. HS use was related to female sex and diagnosis, being more common among patients with nonpsychotic than psychotic disorders and very infrequent in patients on clozapine. In most longstanding cases, a clinical review had been documented. The logistic regression confirmed female sex, diagnosis and clozapine all as independent predictors of HS prescription. HS prescribing in psychiatric illness is more common than in the general population, often longstanding, with polypharmacy being common. The frequent use of antipsychotic drugs as HSs is of concern, given their side-effect profile. As there are risks involved with longstanding HS use, a better rationale for the role of medication in the management of sleep problems in psychiatric disorders is needed. PMID:23680995

Huthwaite, Mark A; Andersson, Viktoria; Stanley, James; Romans, Sarah E

2013-07-01

22

Socio demographic profile and utilization pattern of antipsychotic drugs among schizophrenic inpatients: a cross sectional study from western region of Nepal  

PubMed Central

Background Currently a large number of atypical antipsychotics available in the market are endorsed as better option for treating schizophrenia than the typical antipsychotics. Information regarding the utilization pattern of antipsychotic drugs is lacking in Nepalese population particularly in Western Nepal. By means of this study one is expected to acquire an idea concerning clinician’s preference to the antipsychotic drugs in actual clinical setup. The main objective of the study was to find the commonest antipsychotics prescribed in a tertiary care center among hospitalized patients in Western Nepal. Methods This cross sectional study was carried out between 1st January 2009 and 31th December 2010 at Manipal Teaching Hospital, Nepal. The diagnosis of schizophrenia was based on ICD-10 (Tenth revision).The main outcome variables of the study was commonest antipsychotic drug prescribed. Z test, Chi square test and logistic regression were used for analytical purpose. P-value < 0.05 was considered to be statistically significant. This is the first study done on the utilization pattern of antipsychotics drugs among hospitalized patients in Nepal. Results Out of 210 cases of schizophrenia, most of the patients were less than 40 yrs. 78.6%, male 61.9%, unemployed 86.7% and having their monthly income less than NPR 10000 /month 80.5%. As far as religion, 78.1% patients were the Hindus and ethnically schizophrenia was common among the Dalit 26.2%. The study revealed that 46.2% of patients were students followed by 25.2% of housewives. Olanzapine was the commonest antipsychotic drug to be prescribed 34.3%. It was observed that the psychiatrists had a tendency of using antipsychotic drugs by trade names [OR 3.3 (1.407, 8.031)] in male patients as compared to female patients. Conclusion According to the utilization pattern of antipsychotics, it is concluded that atypical antipsychotics were used relatively more commonly than that of typical antipsychotics. Among the atypical antipsychotic drugs, there is a trend of using Olanzapine during Schizophrenia as compared to other atypical antipsychotic drugs in Western Nepal. PMID:23522357

2013-01-01

23

Prevalence and correlates of antipsychotic polypharmacy in children and adolescents receiving antipsychotic treatment.  

PubMed

Antipsychotic polypharmacy (APP), which is common in adults with psychotic disorders, is of unproven efficacy and raises safety concerns. Although youth are increasingly prescribed antipsychotics, little is known about APP in this population. We performed a systematic PubMed search (last update 26 January 2013) of studies reporting the prevalence of APP in antipsychotic-treated youth. Summary statistics and statistical tests were calculated at the study level and not weighted by sample size. Fifteen studies (n = 58 041, range 68-23 183) reported on APP in youth [mean age = 13.4 ± 1.7 yr, 67.1 ± 10.2% male, 77.9 ± 27.4% treated with second-generation antipsychotics (SGAs)]. Data collected in these studies covered 1993-2008. The most common diagnoses were attention-deficit hyperactivity disorder (ADHD; 39.9 ± 23.5%) and conduct disorder/oppositional defiant disorder (CD/ODD; 33.6 ± 24.8). In studies including predominantly children (mean age = <13 yr, N = 5), the most common diagnosis were ADHD (50.6 ± 25.4%) and CD/ODD (39.5 ± 27.5%); while in studies with predominantly adolescents (mean age = ?13 yr, N = 7) the most common diagnoses were schizophrenia-spectrum disorders (28.6 ± 23.8%), anxiety disorders (26.9 ± 14.9%) and bipolar-spectrum disorders (26.6 ± 7.0%), followed closely by CD/ODD (25.8 ± 17.7). The prevalence of APP among antipsychotic-treated youth was 9.6 ± 7.2% (5.9 ± 4.5% in child studies, 12.0 ± 7.9% in adolescent studies, p = 0.15). Higher prevalence of APP was correlated with a bipolar disorder or schizophrenia diagnosis (p = 0.019) and APP involving SGA+SGA combinations (p = 0.0027). No correlation was found with APP definition [?1 d (N = 10) vs. >30-?90 d (N = 5), p = 0.88]. Despite lacking safety and efficacy data, APP in youth is not uncommon, even in samples predominantly consisting of non-psychotic patients. The duration, clinical motivations and effectiveness of this practice require further study. PMID:23673334

Toteja, Nitin; Gallego, Juan A; Saito, Ema; Gerhard, Tobias; Winterstein, Almut; Olfson, Mark; Correll, Christoph U

2014-07-01

24

[Antipsychotics in bipolar disorders].  

PubMed

This article is a review of the various treatments that are currently available, in particular in France, for the treatment of bipolar disorders. This article specifically addresses the use of novel antipsychotic agents as alternative therapy to a lithium therapy and/or the use of conventional antipsychotics. The prevalence of bipolar disorder over a lifetime is around 1% of the general population. Bipolar disorder consists of alternating depressive and manic episodes. It mainly affects younger subjects, and is often associated with alcohol and drug addictions. There are two main subtypes of bipolar disorder. According to the DSM IV-R, type 1 of bipolar disorder is characterised when at least one manic episode (or a mixed episode) has been diagnosed. Type 2 of bipolar disorder is related to patients enduring recurrent depressive episodes but no manic episode. Type 2 affects women more frequently as opposed to type 1 affecting individuals of both sexes. Manic-depressive disorder (or cyclo-thymic disorder) appears in relation to patients who has never suffered manic episode, mixed episode or severe depressive episode but have undergone numerous periods with some symptoms of depression and hypomanic symptoms over a two-year period during which any asymptomatic periods last no longer than two months. The average age of the person going through a first episode (often a depressive one) is 20 years-old. Untreated bipolar patients may endure more than ten manic or depressive episodes. Finally, in relation to 10 to 20% of patients, the bipolar disorder will turn into a fast cycle form, either spontaneously or as a result of certain medical treatments. Psychiatrists are now able to initiate various treating strategies which are most likely to be effective as a result of the identification of clinical subtypes of the bipolar disorder. Lithium therapy has been effectively and acutely used for patients with pure or elated mania and its prophylaxis. However, lithium medication may worsen depressive symptoms when used for a long term maintenance therapy. Additionally, mixed mania, rapid cycling type patients and bipolar disorder associated with substance abuse do not respond well to lithium therapy. In addition to the lithium therapy or in place of a lithium therapy, one can report the frequent use of antipsychotic agents in respect of patients with bipolar disorder during both the acute and maintenance phases of treatment. Antipsychotic agents have been used for almost forty years and may be used in combination with a lithium therapy. Conventional antipsychotics are effective but they may induce late dyskinesia, weight gain, sedation, sexual dysfunction and depression. These adverse side effects often lead to non compliance in particular in circumstances where antipsychotic agents are combined with a lithium therapy. A number of alternative somatic treatment approaches have been reported for patients who do not respond well or who are intolerant to lithium therapy. As such, valproate has received regulatory approval for the acute treatment of mania and carbamazepine has been indicated for this condition in a number of countries. Divalproex (Depakote) has recently obtained the authorization to market in France and may be prescribed for manic states or hypomanic states that do not tolerate lithium therapy or for which lithium therapy is contraindicated. A number of other anticonvulsants (lamotrigine, gabapentin and topiramate) are currently being tested. Because of the side effects of the conventional antipsychotic agents, atypical antipsychotic agents are currently on trial and appear to be of interest in the treatment of bipolar disorders. Currently, a number of prospective studies are available with clozapine, risperidone and olanzapine in the treatment of bipolar disorder. Most are short-term studies. Recent randomised, double-blind, placebo-controlled studies have shown clozapine, risperidone and olanzapine to be effective with antimanic and antidepressive effects, both as monotherapy and as add-on maintenance therapy with lithium

Vacheron-Trystram, M-N; Braitman, A; Cheref, S; Auffray, L

2004-01-01

25

The effects of most commonly prescribed second generation antidepressants on driving ability: a systematic review : 70th Birthday Prof. Riederer.  

PubMed

Driving a car is vital for the functional autonomy of patients to take part in activities of daily living. Both psychopathologic symptoms and psychopharmacologic treatment may impair driving ability. This article provides a systematic review of published studies (1980-2011) on commonly prescribed newer antidepressants and driving performance. A total of 21 studies could be included in the review, indicating that there is a lack of controlled patient studies. Investigations on newer antidepressants were frequently undertaken in healthy subjects focusing on acute or subchronic effects of application, predominately in young male participants, with dosages usually given in an ambulatory setting. No data, according to selection criteria, were found with respect to agomelatine, duloxetine, bupropion and viloxazine. There is evidence that the SSRIs (citalopram, escitalopram, fluoxetine, fluvoxamine, sertraline, paroxetine) and the SNRI venlafaxine have no deleterious effects on driving ability. Acute use of mirtazapine does produce impairments that diminish to some degree when given as a nocturnal dose and cannot be seen after repeated dosing in healthy controls. Patients obviously benefit from treatment with newer antidepressants; however, at least a subgroup does not reach performance level of healthy subjects. More patient studies are needed that elaborate specific relationships between clinical subtypes of the illness and response to different antidepressants, considering course and duration of illness, co-morbidities and not least neuropsychological and neurobiological characteristics. PMID:22684419

Brunnauer, Alexander; Laux, Gerd

2013-01-01

26

Psychotropic drug prescribing in an Australian specialist child and adolescent eating disorder service: a retrospective study  

PubMed Central

Background To describe the rates, indications, and adverse effects of psychotropic drug prescription in a specialist tertiary hospital child and adolescent eating disorder service. Methods Retrospective case note study of all active eating disorder patients (N?=?115) over the period of treatment from referral to time of study (M?=?2 years), covering patient demographics, clinical characteristics, drug prescriptions, indications, and adverse effects. Results Psychotropic drugs were prescribed in 45% of cases, most commonly antidepressants (41%), followed by anxiolytics (29%) and antipsychotics (22%), with 8% initiated before referral to the specialist eating disorder program. Common indications were depressed mood, agitation, anxiety, and insomnia. Patient clinical severity and complexity was associated with prescribing. Adverse effects, mostly minor, were recorded in 23% of antidepressant prescriptions, 39% of antipsychotic prescriptions, and 13% of anxiolytic prescriptions. Second generation antipsychotic prescription was associated with subsequent new onset binge eating, in this preliminary observational study. Self-harm by overdose of psychotropics occurred in 11% of patients prescribed medication. Conclusions Psychotropic medications were frequently prescribed to adolescent eating disorder patients to treat distressing symptoms. Prospective randomised controlled trials to clarify efficacy and safety are needed. Given the difficulties of conducting clinical trials in this population, services are encouraged to monitor and audit medication safety and efficacy in everyday practice, and to report their findings. PMID:24999406

2013-01-01

27

Antipsychotic and Benzodiazepine Use Among Nursing Home Residents: Findings From the 2004 National Nursing Home Survey  

PubMed Central

Objectives To document the extent and appropriateness of use of antipsychotics and benzodiazepines among nursing home residents using a nationally representative survey. Methods Cross-sectional analysis of the 2004 National Nursing Home Survey. Bivariate and multivariate analyses examined relationships between resident and facility characteristics and antipsychotic and benzodiazepine use by appropriateness classification among residents aged 60 years and older (N = 12,090). Resident diagnoses and information about behavioral problems were used to categorize antipsychotic and benzodiazepine use as appropriate, potentially appropriate, or having no appropriate indication. Results More than one quarter (26%) of nursing home residents used an antipsychotic medication, 40% of whom had no appropriate indication for such use. Among the 13% of residents who took benzodiazepines, 42% had no appropriate indication. In adjusted analyses, the odds of residents taking an antipsychotic without an appropriate indication were highest for residents with diagnoses of depression (odds ratio [OR] = 1.31; 95% confidence interval [CI]: 1.12–1.53), dementia (OR = 1.82; 95% CI: 1.52–2.18), and with behavioral symptoms (OR = 1.97, 95% CI: 1.56–2.50). The odds of potentially inappropriate antipsychotic use increased as the percentage of Medicaid residents in a facility increased (OR = 1.08, 95% CI: 1.02–1.15) and decreased as the percentage of Medicare residents increased (OR = 0.46, 95% CI: 0.25–0.83). The odds of taking a benzodiazepine without an appropriate indication were highest among residents who were female (OR = 1.44; 95% CI: 1.18–1.75), white (OR = 1.95; 95% CI: 1.47–2.60), and had behavioral symptoms (OR = 1.69; 95% CI: 1.41–2.01). Conclusion Antipsychotics and benzodiazepines seem to be commonly prescribed to residents lacking an appropriate indication for their use. PMID:20808119

Stevenson, David G.; Decker, Sandra L.; Dwyer, Lisa L.; Huskamp, Haiden A.; Grabowski, David C.; Metzger, Eran D.; Mitchell, Susan L.

2010-01-01

28

Antipsychotic Medication and People with Intellectual Disabilities: Their Knowledge and Experiences  

ERIC Educational Resources Information Center

Background: Antipsychotics are the most frequently prescribed psychotropic medication for people with intellectual disabilities. Many people are prescribed this medication for "challenging behaviours" without having had a formal diagnosis of a psychiatric disorder. Antipsychotics have been reported to have severe side-effect profiles, which can…

Crossley, Rachel; Withers, Paul

2009-01-01

29

Trabecular bone loss after administration of the second-generation antipsychotic risperidone is independent of weight gain  

Microsoft Academic Search

Second generation antipsychotics (SGAs) have been linked to metabolic and bone disorders in clinical studies, but the mechanisms of these side effects remain unclear. Additionally, no studies have examined whether SGAs cause bone loss in mice. Using in vivo and in vitro modeling we examined the effects of risperidone, the most commonly prescribed SGA, on bone in C57BL6\\/J (B6) mice.

Katherine J. Motyl; Ingrid Dick-de-Paula; Ann E. Maloney; Sutada Lotinun; Sheila Bornstein; Francisco J. A. de Paula; Roland Baron; Karen L. Houseknecht; Clifford J. Rosen

30

Electronic Prescribing  

MedlinePLUS

... Do you prescribe electronically?” For more information about electronic prescribing, call 1-800-MEDICARE (1-800-633- ... E S eRx eRx Electronic prescribing can help you. Electronic prescribing can keep you safe • Doctors have secure ...

31

Critical review of antipsychotic polypharmacy in the treatment of schizophrenia.  

PubMed

Antipsychotic polypharmacy remains prevalent; it has probably increased for the treatment of schizophrenia in real-world clinical settings. The current evidence suggests some clinical benefits of antipsychotic polypharmacy, such as better symptom control with clozapine plus another antipsychotic, and a reversal of metabolic side-effects with a concomitant use of aripiprazole. On the other hand, the interpretation of findings in the literature should be made conservatively in light of the paucity of good studies and potentially serious side-effects. Also, although the available data are still limited, two smaller-scale clinical trials provide preliminary evidence that converting antipsychotic polypharmacy to monotherapy could be a valid and reasonable treatment option. Several studies have explored strategies to change physicians' antipsychotic polypharmacy prescribing behaviours. These have revealed that, while the impact of purely educational interventions may be limited, more aggressive procedures such as directly notifying physicians by letters or phone calls can be more effective in reducing antipsychotic polypharmacy. In conclusion, antipsychotic polypharmacy can work for some clinically difficult conditions; however, it should be the exception rather than the rule and may be avoidable in many patients. More importantly, the paucity of the data clearly emphasizes the need for further investigations on not only advantages and disadvantages of antipsychotic polypharmacy, but also regarding effective interventions in already prescribed polypharmacy regimens. PMID:22717078

Fleischhacker, W Wolfgang; Uchida, Hiroyuki

2014-07-01

32

Patterns and costs of antipsychotic drug use in Taiwan: 1997 to 2001.  

PubMed

The advent of atypical antipsychotics greatly changed the treatment pattern for mental illnesses worldwide. This study was designed to determine the trend in prevalence, prescribing pattern, and cost of antipsychotic agents in Taiwan from 1997 to 2001. Data were obtained from claims completed for a random sample of 200,000 people registered with the National Health Insurance program. The antipsychotics monitored included all group N05A drugs in the Anatomical Therapeutic Chemical classification system (version 2000). Conventional and atypical antipsychotics were handled separately. Of the 195,971 eligible registrants, 37,441 (19.1%) received any kind of antipsychotic during this 5-year period, but only 713 (0.4%) used atypical antipsychotics. The prevalence of conventional antipsychotic use during each successive year of this study was 5.2%, 5.7%, 6.6%, 6.2%, and 6.1% and 0.1%, 0.1%, 0.1%, 0.2%, and 0.3% for atypical agents. Although far fewer registrants used them, atypicals comprised 19.1% of all prescribed amounts measured in defined daily doses and 56.1% of the cost for all antipsychotics in 2001. During the 5-year study period, atypical antipsychotics were prescribed for 405 (57%) patients with schizophrenia, 132 (19%) with affective disorder, 128 (18%) with other psychiatric disorders, and 48 (7%) with a nonpsychiatric disorder. With the loosening of reimbursement restrictions in 2002, continued growth of atypical antipsychotic use in Taiwan might be expected. PMID:15058752

Chou, Li-Fang

2003-01-01

33

Atypical Antipsychotic Usage Among Asian Americans and Pacific Islanders  

PubMed Central

Previous studies have shown significant ethnic differences in prescribing patterns of two or more antipsychotics. This study examined changes in atypical and typical antipsychotic prescriptions among Asian Americans and Pacific Islanders. Five hundred consecutive charts were reviewed for antipsychotics at the time of admission and discharge from each of two inpatient psychiatric facilities in Hawai‘i. Multiple antipsychotic prescription rates were 9% at intake and 6% at discharge. For the ethnic groups studied, there were no statistically significant differences by patient ethnicity regarding antipsychotics at intake (?2 = 29.2, df = 21, P = .110) or discharge (?2 = 20.5, df = 24, P = .667). There were no significant differences in prescription and polypharmacy patterns among Asian Americans and Pacific Islanders ethnic groups in this study. PMID:25285256

Goebert, Deborah; Else, Iwalani; Carlton, Barry; Matsu, Courtenay; Guerrero, Anthony

2014-01-01

34

Assessment of the knowledge and attitudes of intern doctors to medication prescribing errors in a Nigeria tertiary hospital  

PubMed Central

Context: Junior doctors are reported to make most of the prescribing errors in the hospital setting. Aims: The aim of the following study is to determine the knowledge intern doctors have about prescribing errors and circumstances contributing to making them. Settings and Design: A structured questionnaire was distributed to intern doctors in National Hospital Abuja Nigeria. Subjects and Methods: Respondents gave information about their experience with prescribing medicines, the extent to which they agreed with the definition of a clinically meaningful prescribing error and events that constituted such. Their experience with prescribing certain categories of medicines was also sought. Statistical Analysis Used: Data was analyzed with Statistical Package for the Social Sciences (SPSS) software version 17 (SPSS Inc Chicago, Ill, USA). Chi-squared analysis contrasted differences in proportions; P < 0.05 was considered to be statistically significant. Results: The response rate was 90.9% and 27 (90%) had <1 year of prescribing experience. 17 (56.7%) respondents totally agreed with the definition of a clinically meaningful prescribing error. Most common reasons for prescribing mistakes were a failure to check prescriptions with a reference source (14, 25.5%) and failure to check for adverse drug interactions (14, 25.5%). Omitting some essential information such as duration of therapy (13, 20%), patient age (14, 21.5%) and dosage errors (14, 21.5%) were the most common types of prescribing errors made. Respondents considered workload (23, 76.7%), multitasking (19, 63.3%), rushing (18, 60.0%) and tiredness/stress (16, 53.3%) as important factors contributing to prescribing errors. Interns were least confident prescribing antibiotics (12, 25.5%), opioid analgesics (12, 25.5%) cytotoxics (10, 21.3%) and antipsychotics (9, 19.1%) unsupervised. Conclusions: Respondents seemed to have a low awareness of making prescribing errors. Principles of rational prescribing and events that constitute prescribing errors should be taught in the practice setting. PMID:24808682

Ajemigbitse, Adetutu A.; Omole, Moses Kayode; Ezike, Nnamdi Chika; Erhun, Wilson O.

2013-01-01

35

Atypical antipsychotics are not all alike: side effects and risk assessment.  

PubMed

Atypical antipsychotic drugs are not all alike with respect to their pharmacologies, therapeutic uses, and side eff ects, although many clinicians lump them together and do not distinguish among them. Risk assessment for the potential use of a drug, such as aripiprazole (Abilify), should not focus on any particular adverse effect, but rather should consider risk assessment in a broader context. Specifically, what are the alternatives, and what are their inherent risk profiles? What is the risk of no treatment? Side eff ects commonly associated with a particular drug or class of drugs can also occur with other drugs. For any drug prescribed for any reason, prescribers should document discussion about common and potentially serious adverse effects, as well as document clinical monitoring. Alternative treatments and their inherent risks, along with the risks of not taking medication for a particular condition, should also be discussed with patients and documented. PMID:25346958

Howland, Robert H

2014-09-01

36

Staff Knowledge of the Side Effects of Anti-Psychotic Medication  

ERIC Educational Resources Information Center

Background: Anti-psychotic medications are widely prescribed to people with intellectual disabilities and have a range of negative side effects. The aim was to identify the level of knowledge of anti-psychotic medications and their side effects among key carers or home managers of adults with intellectual disabilities living in residential group…

Fretwell, Christine; Felce, David

2007-01-01

37

Off-label use of atypical antipsychotics: cause for concern?  

PubMed

Licensed indications for medicines were designed to regulate the claims that can be made about a medicine by a pharmaceutical company. Off-label prescribing (i.e. prescribing a drug for an indication outside of that for which it is licensed) is legal and an integral part of medical practice. In psychiatry, off-label prescribing is common and gives clinicians scope to treat patients who are refractory to standard therapy or where there is no licensed medication for an indication. However, efficacy or safety of such off-label use may not be established. There is a growing list of licensed indications for atypical antipsychotics (AAP) beyond schizophrenia and bipolar affective disorder, and also more evidence for other indications where pharmaceutical companies have not obtained a license. Pharmaceutical companies have promoted AAPs for off-label indications to increase sales and consequently have been fined by the US FDA for this. Since the 1990s, AAP use has expanded considerably, for example, the off-label use of quetiapine alone accounted for an estimated 17% of the AAP spend in New Zealand in 2010. There are a number of potential problems with the expanded use of AAPs outside of schizophrenia and related psychoses. A larger population will be exposed to their adverse effects, which include weight gain, type 2 diabetes mellitus, sudden cardiac death and increased mortality rates in the elderly with dementia. There are also concerns with the abuse of these agents, in particular quetiapine. Given that an increasing percentage of the population is being treated with these agents, off-label prescribing of AAPs is a cause for concern; they have a propensity to cause significant side effects and their efficacy and long-term safety for most off-label indications remains largely unknown, and therefore the risks and benefits of their use should be carefully weighed up prior to prescribing these agents off-label. PMID:22448598

McKean, Andrew; Monasterio, Erik

2012-05-01

38

Better prescribing  

PubMed Central

I have defined prescribing as a series of steps designed to improve patient well-being. Not all the steps in the process towards better prescribing have been examined; some have been accepted as being satisfactory, and some have been challenged which might normally have been accepted without comment. I have emphasized the need to provide information to doctors about drugs and also suggested what physicians might do to improve patient compliance. I have concentrated on providing practical ideas that the practising family physician can carry out in his daily practice, or within his College of Family Practice, to improve patient care through better prescribing. PMID:7420315

Heffernan, Michael W.

1980-01-01

39

Antipsychotic combinations for schizophrenia  

PubMed Central

This is the protocol for a review and there is no abstract. The objectives are as follows: The primary objectives of this review are to examine whether: Treatment with antipsychotic combinations is effective for schizophrenia; andTreatment with antipsychotic combinations is safe for the same illness.

Maayan, Nicola; Soares-Weiser, Karla; Xia, Jun; Adams, Clive E

2014-01-01

40

Treatment recommendations for extrapyramidal side effects associated with second-generation antipsychotic use in children and youth  

PubMed Central

BACKGROUND/OBJECTIVE: Antipsychotic use in children is increasing. The purpose of the present article was to provide guidance to clinicians on the clinical management of extrapyramidal side effects of second-generation antipsychotics. METHODS: Published literature, key informant interviews, and discussions with panel members and stakeholder partners were used to identify key clinical areas of guidance and preferences on format for the present recommendations. Draft recommendations were presented to a guideline panel. Members of the guideline panel evaluated the information gathered from the systematic review of the literature and used a nominal group process to reach a consensus on treatment recommendations. A description of the neurological abnormalities commonly seen with antipsychotic medications is provided, as well as recommendations on how to examine and quantify these abnormalities. A stepwise approach to the management of neurological abnormalities is provided. RESULTS: Several different types of extrapyramidal symptoms can be seen secondary to antipsychotic use in children including neuroleptic-induced acute dystonia, neuroleptic-induced akathisia, neuroleptic-induced parkinsonism, neuroleptic-induced tardive dyskinesia, tardive dystonia and tardive akathisia, and withdrawal dyskinesias. The overwhelming majority of evidence on the treatment of antipsychotic-induced movement disorders comes from adult patients with schizophrenia. Given the scarcity of paediatric data, recommendations were made with reference to both the adult and paediatric literature. Given the limitations in the generalizability of data from adult subjects to children, these recommendations should be considered on the basis of expert opinion, rather than evidence based. CONCLUSION: Clinicians must be aware of the potential of second-generation antipsychotics to induce neurological side effects, and should exercise a high degree of vigilance when prescribing these medications. PMID:23115503

Pringsheim, Tamara; Doja, Asif; Belanger, Stacey; Patten, Scott

2011-01-01

41

Antipsychotics, mood stabilisers, and risk of violent crime  

PubMed Central

Summary Background Antipsychotics and mood stabilisers are prescribed widely to patients with psychiatric disorders worldwide. Despite clear evidence for their efficacy in relapse prevention and symptom relief, their effect on some adverse outcomes, including the perpetration of violent crime, is unclear. We aimed to establish the effect of antipsychotics and mood stabilisers on the rate of violent crime committed by patients with psychiatric disorders in Sweden. Methods We used linked Swedish national registers to study 82 647 patients who were prescribed antipsychotics or mood stabilisers, their psychiatric diagnoses, and subsequent criminal convictions in 2006–09. We did within-individual analyses to compare the rate of violent criminality during the time that patients were prescribed these medications versus the rate for the same patients while they were not receiving the drugs to adjust for all confounders that remained constant within each participant during follow-up. The primary outcome was the occurrence of violent crime, according to Sweden’s national crime register. Findings In 2006–09, 40 937 men in Sweden were prescribed antipsychotics or mood stabilisers, of whom 2657 (6·5%) were convicted of a violent crime during the study period. In the same period, 41 710 women were prescribed these drugs, of whom 604 (1·4 %) had convictions for violent crime. Compared with periods when participants were not on medication, violent crime fell by 45% in patients receiving antipsychotics (hazard ratio [HR] 0·55, 95% CI 0·47–0·64) and by 24% in patients prescribed mood stabilisers (0·76, 0·62–0·93). However, we identified potentially important differences by diagnosis—mood stabilisers were associated with a reduced rate of violent crime only in patients with bipolar disorder. The rate of violence reduction for antipsychotics remained between 22% and 29% in sensitivity analyses that used different outcomes (any crime, drug-related crime, less severe crime, and violent arrest), and was stronger in patients who were prescribed higher drug doses than in those prescribed low doses. Notable reductions in violent crime were also recorded for depot medication (HR adjusted for concomitant oral medications 0·60, 95% CI 0·39–0·92). Interpretation In addition to relapse prevention and psychiatric symptom relief, the benefits of antipsychotics and mood stabilisers might also include reductions in the rates of violent crime. The potential effects of these drugs on violence and crime should be taken into account when treatment options for patients with psychiatric disorders are being considered. Funding The Wellcome Trust, the Swedish Prison and Probation Service, the Swedish Research Council, and the Swedish Research Council for Health, Working Life and Welfare. PMID:24816046

Fazel, Seena; Zetterqvist, Johan; Larsson, Henrik; Langstrom, Niklas; Lichtenstein, Paul

2014-01-01

42

Conformance to schizophrenia treatment guidelines in North West-Bank, Palestine: focus on antipsychotic dosing and polytherapy  

PubMed Central

Background Analysis of the prescribing patterns of antipsychotic drugs can improve therapeutic outcomes. The purpose of this study was to evaluate the prescribing pattern of antipsychotics and its conformance to international treatment guidelines. Methods A cross sectional study at primary psychiatric centers was carried out. Patients’ medical files were used to obtain demographic, medication and clinical information. International guidelines for schizophrenia were used to create conformance indicators. All statistical analyses were conducted using Statistical Package for Social Sciences. Results 250 patients were included in this study. A total of 406 antipsychotic agents were used; 348 (85.7%) were first generation antipsychotics (FGA). The prevalence of antipsychotic combination was 50.4% (n=126). There was no significant difference in positive (p=0.3), negative (p=0.06) and psychopathology (p=0.5) scores of schizophrenia symptoms among patients on monotherapy versus those on antipsychotic combination. Furthermore, no significant difference was observed in the annual cost of antipsychotic monotherapy versus combination therapy. One hundred and five patients (42%) were using optimum dose of (300 – 600 mg CPZeq) while the remaining were using sub or supra therapeutic doses. Analysis showed that use of depot, use of anticholinergic agents and increasing amount of total CPZeq were significant factors associated with antipsychotic combination. Conclusions This study indicated that antipsychotic prescribing was not in conformance with international guidelines with respect to maintenance dose and combination therapy. Type of antipsychotic treatment regimen, combination versus monotherapy, was not associated with better clinical or economic outcome. PMID:23816223

2013-01-01

43

Outpatient prescribing errors and the impact of computerized prescribing  

Microsoft Academic Search

BACKGROUND: Medication errors are common among inpatients and many are preventable with computerized prescribing. Relatively little is\\u000a known about outpatient prescribing errors or the impact of computerized prescribing in this setting.\\u000a \\u000a \\u000a OBJECTIVE: To assess the rates, types, and severity of outpatient prescribing errors and understand the potential impact of computerized\\u000a prescribing.\\u000a \\u000a \\u000a \\u000a \\u000a DESIGN: Prospective cohort study in 4 adult primary care

Tejal K. Gandhi; Saul N. Weingart; Andrew C. Seger; Joshua Borus; Elisabeth Burdick; Eric G. Poon; Lucian L. Leape; David W. Bates

2005-01-01

44

Antipsychotic Drug Side Effects for Persons with Intellectual Disability  

ERIC Educational Resources Information Center

Antipsychotic drugs are the most frequently prescribed of the psychotropic drugs among the intellectually disabled (ID) population. Given their widespread use, efforts to systematically assess and report side effects are warranted. Specific scaling methods such as the "Matson Evaluation of Side Effects" ("MEDS"), the "Abnormal Inventory Movement…

Matson, Johnny L.; Mahan, Sara

2010-01-01

45

Osteoporosis Associated with Antipsychotic Treatment in Schizophrenia  

PubMed Central

Schizophrenia is one of the most common global mental diseases, with prevalence of 1%. Patients with schizophrenia are predisposed to diabetes, coronary heart disease, hypertension, and osteoporosis, than the normal. In comparison with the metabolic syndrome, for instance, there are little reports about osteoporosis which occurs secondary to antipsychotic-induced hyperprolactinaemia. There are extensive recent works of literature indicating that osteoporosis is associated with schizophrenia particularly in patients under psychotropic medication therapy. As osteoporotic fractures cause significantly increased morbidity and mortality, it is quite necessary to raise the awareness and understanding of the impact of antipsychotic-induced hyperprolactinaemia on physical health in schizophrenia. In this paper, we will review the relationship between schizophrenia, antipsychotic medication, hyperprolactinaemia, and osteoporosis. PMID:23690768

Wu, Haishan; Deng, Lu; Zhao, Lipin; Zhao, Jingping; Li, Lehua; Chen, Jindong

2013-01-01

46

Tardive dyskinesia in patients treated with atypical antipsychotics: case series and brief review of etiologic and treatment considerations  

PubMed Central

Tardive dyskinesia (TD) is a disfiguring side-effect of antipsychotic medications that is potentially irreversible in affected patients. Newer atypical antipsychotics are felt by many to have a lower risk of TD. As a result, many clinicians may have developed a false sense of security when prescribing these medications. We report five cases of patients taking atypical antipsychotics who developed TD, review the risk of TD, its potential etiologic mechanisms, and treatment options available. The goal of this paper is to alert the reader to continue to be diligent in obtaining informed consent and monitoring for the onset of TD in patients taking atypical antipsychotics. PMID:24744806

Kim, Jungjin; MacMaster, Eric; Schwartz, Thomas L

2014-01-01

47

Effect of Atypical Antipsychotics on Fetal Growth: Is the Placenta Involved?  

PubMed Central

There is currently considerable uncertainty regarding prescribing practices for pregnant women with severe and persistent psychiatric disorders. The physician and the mother have to balance the risks of untreated psychiatric illness against the potential fetal toxicity associated with pharmacological exposure. This is especially true for women taking atypical antipsychotics. Although these drugs have limited evidence for teratological risk, there are reports of altered fetal growth, both increased and decreased, with maternal atypical antipsychotic use. These effects may be mediated through changes in the maternal metabolism which in turn impacts placental function. However, the presence of receptors targeted by atypical antipsychotics in cell lineages present in the placenta suggests that these drugs can also have direct effects on placental function and development. The signaling pathways involved in linking the effects of atypical antipsychotics to placental dysfunction, ultimately resulting in altered fetal growth, remain elusive. This paper focuses on some possible pathways which may link atypical antipsychotics to placental dysfunction. PMID:22848828

Raha, Sandeep; Taylor, Valerie H.; Holloway, Alison C.

2012-01-01

48

ACNP White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia  

Microsoft Academic Search

In elderly persons, antipsychotic drugs are clinically prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications (schizophrenia and bipolar disorder). The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia. In April 2005, the FDA, based on a meta-analysis of 17 double-blind randomized placebo-controlled trials among elderly

Dilip V Jeste; Dan Blazer; Daniel Casey; Thomas Meeks; Carl Salzman; Lon Schneider; Pierre Tariot; Kristine Yaffe

2008-01-01

49

The Role of Serotonin in Antipsychotic Drug Action  

Microsoft Academic Search

Recent interest in the role of serotonin (5-HT) in antipsychotic drug action is based mainly upon the fact that antipsychotic drugs such as clozapine, olanzapine, quetiapine, risperidone, sertindole, and ziprasidone are potent 5-HT2a receptor antagonists and relatively weaker dopamine D2 antagonists. These agents share in common low extrapyramidal side effects at clinically effective doses and possibly greater efficacy to reduce

Herbert Y Meltzer

1999-01-01

50

Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia  

Microsoft Academic Search

background The relative effectiveness of second-generation (atypical) antipsychotic drugs as com- pared with that of older agents has been incompletely addressed, though newer agents are currently used far more commonly. We compared a first-generation antipsychotic, perphenazine, with several newer drugs in a double-blind study. methods A total of 1493 patients with schizophrenia were recruited at 57 U.S. sites and random-

Jeffrey A. Lieberman; T. Scott Stroup; Joseph P. McEvoy; Marvin S. Swartz; Robert A. Rosenheck; Diana O. Perkins; Richard S. E. Keefe; Sonia M. Davis; Clarence E. Davis; Barry D. Lebowitz; Joanne Severe; John K. Hsiao

2005-01-01

51

Research on antipsychotics in India  

PubMed Central

Antipsychotic as a class of medications became available for treatment of various psychiatric disorders in the early 1950’s. Over the last 60 years many antipsychotics have become available. In line with the west, Indian researchers have evaluated the efficacy of antipsychotics in various conditions. Additionally, researchers have also evaluated the important safety and tolerability issues. Here, we review data originating from India in the form of drug trials, effectiveness, usefulness, safety and tolerability of antipsychotics. Additionally, data with respect to other important treatment related issues is discussed. PMID:21836703

Avasthi, Ajit; Aggarwal, Munish; Grover, Sandeep; Khan, Mohd Khalid Rasheed

2010-01-01

52

Antipsychotic drugs and safety concerns for breast-feeding infants.  

PubMed

Antipsychotic drugs prescribed to treat psychiatric symptoms during the postpartum period are secreted into breast milk. Because breast-feeding is crucial to infant development, it is important to select a medication that poses the fewest adverse consequences. Aripiprazole, haloperidol, perphenazine, and trifluoperazine demonstrate no known developmental dangers. Olanzapine, quetiapine, and risperidone are cited as safe, although monitoring is recommended. Chlorpromazine and clozapine may induce developmental concerns. There are limited safety data for asenapine, fluphenazine, iloperidone, loxapine, lurasidone, paliperidone, pimozide, thioridazine, thiothixene, and ziprasidone. Clinicians should choose medications considered to be the safest and prescribe them at the lowest effective doses. PMID:25365434

Parikh, Tapan; Goyal, Dharmendra; Scarff, Jonathan R; Lippmann, Steven

2014-11-01

53

Safe prescribing: a titanic challenge  

PubMed Central

The challenge to achieve safe prescribing merits the adjective ‘titanic’. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the ‘Seven C's’. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. PMID:22738396

Routledge, Philip A

2012-01-01

54

Safe prescribing: a titanic challenge.  

PubMed

The challenge to achieve safe prescribing merits the adjective 'titanic'. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the 'Seven C's'. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. PMID:22738396

Routledge, Philip A

2012-10-01

55

Race and Long Acting Antipsychotic Prescription at a Community Mental Health Center: A Retrospective Chart Review  

PubMed Central

Objective There has been concern that racial minorities are disproportionately prescribed Long Acting Injectable (LAI) antipsychotic drugs. Method Comprehensive administrative data and clinician survey were used to identify all patients with a DSM-IV diagnosis of schizophrenia who received long acting antipsychotic prescriptions from July 2009 to June 2010 at a community mental health center. Charts were reviewed retrospectively to validate long acting antipsychotic prescription (i.e. medication, dosage, etc.) and merged with administrative data from all center patients documenting socio-demographic characteristics (i.e. age, race, gender), and co-morbid diagnoses. The subsample of LAI patients was compared to non-LAI patients diagnosed with schizophrenia for the same period using bivariate chi square, t-tests, and multivariate logistic regression. Results White patients were significantly less likely to receive long acting antipsychotic prescriptions than minority patients (OR=.52, p<.0001), i.e. non-whites were 1.89 times more likely to receive such drugs. Age, gender, and co-morbid diagnoses, including substance abuse, were unrelated to LAI prescription and race/ethnicity was not associated with use of specific agents (haloperidol decanoate, fluphenazine decanoate, or risperidone microspheres) (p=.73). Conclusion Minorities are more likely than other patients with schizophrenia to receive long acting injection antipsychotics, suggesting that their prescribers may consider them less adherent to antipsychotic prescriptions. Other reasons such as increased risk for violence are also discussed. PMID:22579151

Aggarwal, Neil Krishan; Rosenheck, Robert A.; Woods, Scott W.; Sernyak, Michael J.

2013-01-01

56

Use and safety of antipsychotics in behavioral disorders in elderly people with dementia.  

PubMed

In recent years, the use of antipsychotics has been widely debated for reasons concerning their safety in elderly patients affected with dementia. To update the use of antipsychotics in elderly demented people, a MEDLINE search was conducted using the following terms: elderly, conventional and atypical antipsychotics, adverse events, dementia, and behavioral and psychotic symptoms in dementia (BPSD). Owing to the large amounts of studies on antipsychotics, we mostly restricted the field of research to the last 10 years. Conventional antipsychotics have been widely used for BPSD; some studies showed they have an efficacy superior to placebo only at high doses, but they are associated with several and severe adverse effects. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, trials with risperidone and olanzapine in elderly patients affected with dementia-related psychoses suggested the possible increase in cerebrovascular adverse events. Drug regulatory agencies issued specific recommendations for underlining that treatment of BPSD with atypical antipsychotics is "off-label." Conventional antipsychotics showed the same likelihood to increase the risk of death in the elderly as atypical agents, and they should not replace the atypical agents discontinued by Food and Drug Administration warnings. Before prescribing an antipsychotic drug, the following are factors to be seriously considered: the presence of cardiovascular diseases, QTc interval on electrocardiogram, electrolytic imbalances, familiar history for torsades des pointes, concomitant treatments, and use of drugs able to lengthen QTc. Use of antipsychotics in dementia needs a careful case-by-case assessment, together with the possible drug-drug, drug-disease, and drug-food interactions. PMID:24158020

Gareri, Pietro; De Fazio, Pasquale; Manfredi, Valeria Graziella Laura; De Sarro, Giovambattista

2014-02-01

57

Representation of People with Intellectual Disabilities in Randomised Controlled Trials on Antipsychotic Treatment for Behavioural Problems  

ERIC Educational Resources Information Center

Background: Behavioural problems are common in people with intellectual disability (ID) and are often treated with antipsychotics. Aim: To establish the frequency and characteristics of people with ID included in randomised controlled trials (RCTs) on antipsychotic treatment for behavioural problems, and to investigate the quality of these RCTs.…

Scheifes, A.; Stolker, J. J.; Egberts, A. C. G.; Nijman, H. L. I.; Heerdink, E. R.

2011-01-01

58

A Case-Control Study of Endometrial Cancer after Antipsychotics Exposure in Premenopausal Women  

Microsoft Academic Search

Objective: Most endometrial cancers are related to hormonal imbalance, and antipsychotics are a common cause of hyperprolactinemia. We investigated the possible relation between the use of antipsychotics and the risk of endometrial cancer. Methods: A case-control study was conducted on premenopausal women at the Chiba University Hospital between 1989 and 2000. The cases were 41 patients with histologically confirmed endometrial

Koji Yamazawa; Hideo Matsui; Katsuyoshi Seki; Souei Sekiya

2003-01-01

59

Antipsychotic, antidepressant, and cognitive-impairment properties of antipsychotics: rat profile and implications for behavioral and psychological symptoms of dementia.  

PubMed

Many dementia patients exhibit behavioral and psychological symptoms (BPSD), including psychosis and depression. Although antipsychotics are frequently prescribed off-label, they can have marked side effects. In addition, comparative preclinical studies of their effects are surprisingly scarce, and strategies for discovery of novel pharmacotherapeutics are lacking. We therefore compared eight antipsychotics in rat behavioral tests of psychosis, antidepressant-like activity, and cognitive impairment as a basis for preclinical evaluation of new drug candidates. The methods used in this study include inhibition of MK-801-induced hyperactivity, forced swim test (FST), passive avoidance (PA), spontaneous locomotor activity, and catalepsy. The drugs exhibited antipsychotic-like activity in the MK-801 test but with diverse profiles in the other models. Risperidone impaired PA performance, but with some dose separation versus its actions in the MK-801 test. In contrast, clozapine, olanzapine, lurasidone, and asenapine showed little or no dose separation in these tests. Aripiprazole did not impair PA performance but was poorly active in the MK-801 test. Diverse effects were also observed in the FST: chlorpromazine was inactive and most other drugs reduced immobility over narrow dose ranges, whereas clozapine reduced immobility over a wider dose range, overlapping with antipsychotic activity. Although the propensity of second-generation antipsychotics to produce catalepsy was lower, they all elicited pronounced sedation. Consistent with clinical data, most currently available second-generation antipsychotics induced cognitive and motor side effects with little separation from therapeutic-like doses. This study provides a uniform in vivo comparative basis on which to evaluate future early-stage drug candidates intended for potential pharmacotherapy of BPSD. PMID:24599316

Ko?aczkowski, Marcin; Mierzejewski, Pawe?; Bienkowski, Przemyslaw; Weso?owska, Anna; Newman-Tancredi, Adrian

2014-06-01

60

Long-acting Injectable Antipsychotics in First-episode Schizophrenia.  

PubMed

Antipsychotic medications are important for the successful management of schizophrenia. Continuous treatment with medication is superior in relapse prevention and non-adherence to antipsychotic medication is associated with a poor clinical outcome. Long-acting injectable antipsychotics (LAIs) that can guarantee adherence to a treatment regimen could be a useful treatment option. With the introduction of second-generation atypical antipsychotics-long acting injection (SGA-LAI), the risks for extrapyramidal adverse events are decreased. The indications for SGA-LAI have been extended from chronic, stabilized patients to acute psychotic patients. Some studies investigated the use of LAI in first-episode schizophrenia patients and raised the possibility of prescribing LAI as a treatment option. However, there is still limited research using LAI in first-episode schizophrenia. More well-designed, randomized, controlled clinical trials using SGA-LAIs in first episode schizophrenia are needed. Additionally, studies on side effects of SGA-LAI in long-term use are required prior to recommending LAI for patients with first episode schizophrenia. PMID:23678347

Jeong, Hyun-Ghang; Lee, Moon-Soo

2013-04-01

61

Quality of prescribing in care homes and the community in England and Wales  

PubMed Central

Background Care home residents are vulnerable to the adverse effects of prescribing but there is limited monitoring in the UK. Aim To compare prescribing quality in care homes in England and Wales with the community and with US nursing homes. Design and setting Cross-sectional analysis of a UK primary care database and comparison with the US National Nursing Home Survey including 326 general practices in 2008–2009 in England and Wales, with 10 387 care home and 403 259 community residents aged 65 to 104 years. Method Comparison of age- and sex-standardised use of ‘concern’ and common drug groups in the last 90 days and potentially inappropriate prescribing based on a consensus list of medications best avoided in older people (Beers criteria). Results Compared to the community, care home residents were more likely to receive ‘concern’ drugs, including benzodiazepines (relative risk (RR) = 2.05, 95% confidence interval (CI) = 1.90 to 2.22), anticholinergic antihistamines (RR = 2.78, 95% CI = 2.38 to 3.23), loop diuretics (RR = 1.47, 95% CI = 1.41 to 1.53), and antipsychotics (RR = 22.7, 95% CI = 20.6 to 24.9). Use of several common drug groups, including laxatives, antidepressants, and antibiotics, was higher, but use of cardiovascular medication was lower. Thirty-three per cent (95% CI = 31.7% to 34.3%) of care home residents in England and Wales received potentially inappropriate medication, compared to 21.4% (95% CI = 20.9% to 21.8%) in the community. The potentially inappropriate prescribing rate in US nursing homes was similar to England and Wales. Conclusion Care home prescribing has the potential for improvement. High use of anticholinergic and psychotropic medication may contribute to functional and cognitive decline. The targeting and effectiveness of medication reviews in care homes needs to be improved. PMID:22546592

Shah, Sunil M; Carey, Iain M; Harris, Tess; DeWilde, Stephen; Cook, Derek G

2012-01-01

62

Prevalence of atypical antipsychotic use in psychiatric outpatients: comparison of women of childbearing age with men.  

PubMed

To characterize current treatment practices, we compared the use of atypical antipsychotic drugs among women of childbearing age to men based on electronic medical records of 1073 hospital-based psychiatric outpatients given at least one second-generation antipsychotic drug. One quarter of psychiatric outpatients sampled were prescribed at least one atypical antipsychotic, in more than half of cases for off-label indications. Women were significantly more likely than men to be diagnosed with mood or anxiety disorders than psychotic disorders and to be prescribed quetiapine (60.7 vs. 48.0 %) or aripiprazole (31.2 vs. 23.9 %), but less likely risperidone (15.8 vs. 26.1 %) or ziprasidone (10 vs. 14 %). PMID:25253022

Camsar?, Ulas; Viguera, Adele C; Ralston, Laurel; Baldessarini, Ross J; Cohen, Lee S

2014-12-01

63

Increased Use of Antipsychotic Long-Acting Injections with Community Treatment Orders  

PubMed Central

Background: Community treatment orders (CTOs) are increasingly being used, despite a weak evidence base, and problems continue regarding Second Opinion Appointed Doctor (SOAD) certification of medication. Aims: The aim of the current study was to describe current CTO usage regarding patient characteristics, prescribed medication and CTO conditions. Method: A 1-year prospective cohort study with consecutive sampling was conducted for all patients whose CTO was registered in a large mental health trust. Only the first CTO for each patient was included. Measures included sociodemographic variables, psychiatric diagnosis, CTO date of initiation and conditions, psychotropic medication and date of SOAD certification for medication. This study was conducted in the first year of CTO legislation in England and Wales. Results: A total of195 patients were sampled (mean age 40.6 years, 65% male, 52% black ethnic origin). There was significant geographical variability in rates of CTO use (?2 = 11.3, p = 0.012). A total of 53% had their place of residence specified as a condition and 29% were required to allow access into their homes. Of those with schizophrenia, 64% were prescribed an antipsychotic long-acting injection (LAI). Of the total group, 7% received high-dose antipsychotics, 10% were prescribed two antipsychotics and only 15% received SOAD certification in time. Conclusions: There was geographical and ethnic variation in CTO use but higher rates of hospital detention in minority ethnic groups may be contributory. Most patients were prescribed antipsychotic LAIs and CTO conditions may not follow the least restrictive principle. PMID:23983926

Patel, Maxine X.; Matonhodze, Jane; Baig, Mirza K.; Gilleen, James; Boydell, Jane; Holloway, Frank; Taylor, David; Szmukler, George; Lambert, Tim; David, Anthony S.

2011-01-01

64

Monitoring for metabolic syndrome in people with intellectual disability on antipsychotic medication  

Microsoft Academic Search

Purpose – People with intellectual disability are subject to increased health morbidity when compared to the general population. This paper assesses the monitoring of metabolic syndrome in people with an intellectual disability who have been prescribed antipsychotic medication. Design\\/methodology\\/approach – A pre-audit analysis was followed by an audit of 32 patients. The height, weight and body mass index was recorded

Raghu Baburaj; Mohamed El Tahir

2011-01-01

65

Antipsychotic medication for early episode schizophrenia  

PubMed Central

Background Long-term treatment with antipsychotic medications in early episode schizophrenia spectrum disorders is common, but both short and long-term effects on the illness are unclear. There have been numerous suggestions that people with early episodes of schizophrenia appear to respond differently than those with multiple prior episodes. The number of episodes may moderate response to drug treatment. Objectives To assess the effects of antipsychotic medication treatment on people with early episode schizophrenia spectrum disorders. Search methods We searched the Cochrane Schizophrenia Group register (July 2007) as well as references of included studies. We contacted authors of studies for further data. Selection criteria Studies with a majority of first and second episode schizophrenia spectrum disorders comparing initial antipsychotic medication treatment with placebo, milieu, or psychosocial treatment. Data collection and analysis Working independently, we critically appraised records from 681 studies, of which five studies met inclusion criteria. We calculated risk ratios (RR) and their 95% confidence intervals (CI) where possible. For continuous data, we calculated mean difference (MD). We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. Main results Five studies (combined total n=998) met inclusion criteria. Four studies (n=724) provided leaving the study early data and results suggested that individuals treated with a typical antipsychotic medication are less likely to leave the study early than those treated with placebo (Chlorpromazine: 3 RCTs n=353, RR 0.4 CI 0.3 to 0.5, NNT 3.2, Fluphenaxine: 1 RCT n=240, RR 0.5 CI 0.3 to 0.8, NNT 5; Thioridazine: 1 RCT n=236, RR 0.44 CI 0.3 to 0.7, NNT 4.3, Trifulperazine: 1 RCT n=94, RR 0.96 CI 0.3 to 3.6). Two studies contributed data to assessment of adverse effects and present a general pattern of more frequent side effects among individuals treated with typical antipsychotic medications compared to placebo. One trial suggested a higher rehospitalisation rate for those receiving chlorpromazine compared to placebo (n=80, RR 2.29 CI 1.3 to 4.0, NNH 2.9). However, a higher attrition in the placebo group is likely to have introduced a survivor bias into this comparison, as this difference becomes non-significant in a sensitivity analysis on intent-to-treat participants (n=127, RR 1.69 CI 0.9 to 3.0). One study contributes data to a comparison of trifluoperazine to psychotherapy on long-term health in favour of the trifluoperazine group (n=92, MD 5.8 CI 1.6 to 0.0); however, data from this study are also likely to contain biases due to selection and attrition. One other study contributes data to a comparison of typical antipsychotic medication to psychosocial treatment on six-week outcome measures of global psychopathology (n=89, MD 0.01 CI ?0.6 to 0.6) and global improvement (n=89, MD ?0.03 CI ?0.5 to 0.4), indicating no between-group differences. On the whole, there is very little useable data in the few studies meeting inclusion criteria. Authors’ conclusions With only a few studies meeting inclusion criteria, and with limited useable data in these studies, it is not possible to arrive at definitive conclusions. The preliminary pattern of evidence suggests that people with early episode schizophrenia treated with typical antipsychotic medications are less likely to leave the study early, but more likely to experience medication-related side effects. Data are too sparse to assess the effects of antipsychotic medication on outcomes in early episode schizophrenia. PMID:21678355

Bola, John; Kao, Dennis; Soydan, Haluk; Adams, Clive E

2014-01-01

66

Planning a Prescribed Burn  

E-print Network

This leaflet explains how to plan for adequate fuel for a prescribed burn, control the fire, notify the proper authority, manage the burn itself, and conduct follow-up management. A ranch checklist for prescribed burning is included....

Hanselka, C. Wayne

2009-04-01

67

[Clinical stakes when switching from one antipsychotic to another].  

PubMed

Switching antipsychotics is more and more common in our clinical practice. Several reasons can explain this observation. We have more and more antipsychotics available on the market with different receptor binding profiles and also different tolerability issues. Usually, the reasons of the switch are the following: insufficient efficacy or problems of tolerance (weight gain, metabolic disorders, extrapyramidal symptoms, hyperprolactinemia, sedation, sexual dysfunction). So that the switch takes place without complications, it is essential for the clinician to have full knowledge of both the receptor binding profiles of the antipsychotics in question and their half-life. The clinician has to expect a dopaminergic rebound when the introduced antipsychotic has a lesser affinity for the dopaminergic D2 receptor than that which is withdrawn or if it is a partial agonist with a particularly long half-life. On the other hand, a histaminergic or cholinergic rebound can be expected if the new antipsychotic has a lesser affinity for these two receptors. In all these scenarios, a "plateau" switch will often be recommended. Now, if a faster switch is imperative, various medication strategies exist to try to decrease the impact of the rebound effects. PMID:24238644

Constant, É

2013-12-01

68

Schizophrenia, obesity, and antipsychotic medications: what can we do?  

PubMed

Obesity is one of the most common physical health problems among patients with severe and persistent mental illnesses, such as schizophrenia. Multifactorial in origin, obesity can be attributed to an unhealthy lifestyle as well as the effects of psychotropic medications such as second-generation antipsychotics. Excess body weight increases the risk for many medical problems, including type 2 diabetes mellitus, coronary heart disease, osteoarthritis, hypertension, and gallbladder disease. A PubMed search revealed 403 English-language citations to the query "schizophrenia" AND "obesity" and 469 citations to the query "obesity" AND "antipsychotics." The evidence is that different antipsychotics have different propensities for weight gain, and that children, adolescents, and fi rst-episode patients are at higher risk for weight gain associated with antipsychotic treatment. Monitoring body weight early in treatment will help predict those at high risk for substantial weight gain. Switching antipsychotic medication may or may not be clinically feasible, but can lead to a reduction in body weight. Lifestyle therapies and other nonpharmacological interventions have been shown to be effective in controlled clinical trials, but the evidence base for adjunctive medication strategies such as with orlistat, sibutramine, amantadine, nizatidine, metformin, topiramate, and others, is conflicting. At the very least, a "small-steps approach" to managing weight should be offered to all patients who are overweight or obese. PMID:18654065

Citrome, Leslie; Vreeland, Betty

2008-07-01

69

Consumer Strategies for Coping With Antipsychotic Medication Side Effects  

Microsoft Academic Search

Objective: This study was designed to investigate the strategies employed by consumers to manage the common side effects associated with antipsychotic medication use.Method: Focus group discussions and individual interviews involving 238 consumers, 25 carers and 16 mental health staff were employed to identify key side effects and a range of consumer coping strategies for managing these adverse effects.Results: Nine side

Tom Meehan; Terry Stedman; Jane Wallace

2011-01-01

70

A qualitative study of the attitudes of patients in an early intervention service towards antipsychotic long-acting injections  

PubMed Central

Objectives: The objective of this study was to investigate attitudinal themes to antipsychotic long-acting injections (LAIs) in patients in an early intervention team (EIT). Methods: Interviews were carried out with outpatients purposively sampled from an EIT to represent patients currently prescribed antipsychotic LAIs, oral antipsychotics and those not prescribed antipsychotic medication. Interviews were conducted and analysed according to grounded theory. Recruitment stopped when saturation of themes was reached. Results: Interviews from 11 patients were analysed (median age 24 years). Attitudes to LAIs were condensed into three key categories: therapeutic alliance and the psychiatrists’ recommendation of antipsychotic medication; patients’ knowledge and beliefs about LAIs; and patients’ views regarding the appropriateness of LAIs. Participants valued their psychiatrist’s recommendation as to the most appropriate antipsychotic. Attitudes to LAIs varied but were most positive among those currently receiving a LAI. Among those not prescribed LAIs, some were open to considering a LAI if their clinician recommended it but others were opposed to such treatment and preferred tables. There was a lack of awareness of LAIs as a treatment option among those not prescribed a LAI. Delay in being offered a LAI was reported in the group currently prescribed a LAI. Several participants associated oral antipsychotics, LAIs and mental illness with stigma. Some not prescribed a LAI had misperceptions about the nature of this treatment. Participants regarded the advantages of LAIs as convenience and avoiding forgetting to take tablets, while disadvantages included injection pain, fear of needles and coercion. Conclusion: Lack of knowledge, misperceptions and stigma related to LAIs and other treatment options should be addressed by providing patients with accurate information. This will facilitate patients being involved in choices about treatment, and should they decide to accept medication, which drug and formulation is most appropriate for their needs. Clinicians should avoid making assumptions about patients’ attitudes to LAIs; attitudes vary but some early intervention patients not prescribed LAIs are open to considering this treatment. Antipsychotic prescribing should result from a shared decision-making process in which clinicians and patients openly discuss the pros and cons of different formulations and drugs. The themes identified in this qualitative study require further exploration using quantitative methodology.

Das, Amlan K.; Malik, Abid

2014-01-01

71

Educating nonmedical prescribers  

PubMed Central

The last decade has seen developments in nonmedical prescribing, with the introduction of prescribing rights for healthcare professionals. In this article, we focus on the education, training and practice of nonmedical prescribers in the UK. There are around 20 000 nurse independent prescribers, 2400 pharmacist supplementary/independent prescribers, several hundred allied health professional supplementary prescribers and almost 100 optometrist supplementary/independent prescribers. Many are active prescribers, managing chronic conditions or acute episodes of infections and minor ailments. Key aims of nonmedical prescribing are as follows: to improve patient care; to increase patient choice in accessing medicines; and to make better use of the skills of health professionals. Education and training are provided by higher education institutions accredited by UK professional bodies/regulators,namely, the Nursing and Midwifery Council, General Pharmaceutical Council, Health Professions Council and General Optical Council. The programme comprises two main components: a university component equivalent to 26 days full-time education and a period of learning in practice of 12 days minimum under the supervision of a designated medical practitioner. Course content focuses on the following factors: consultation, decision making, assessment and review; psychology of prescribing; prescribing in team context; applied therapeutics; evidence-based practice and clinical governance; legal, policy, professional and ethical aspects; and prescribing in the public health context. Nonmedical prescribers must practise within their competence, demonstrating continuing professional development to maintain the quality engendered during training. Despite the substantial progress, there are several issues of strategy, capacity, sustainability and a research evidence base which require attention to fully integrate nonmedical prescribing within healthcare. PMID:22300374

Stewart, Derek; MacLure, Katie; George, Johnson

2012-01-01

72

Educating nonmedical prescribers.  

PubMed

The last decade has seen developments in nonmedical prescribing, with the introduction of prescribing rights for healthcare professionals. In this article, we focus on the education, training and practice of nonmedical prescribers in the UK. There are around 20,000 nurse independent prescribers, 2400 pharmacist supplementary/independent prescribers, several hundred allied health professional supplementary prescribers and almost 100 optometrist supplementary/independent prescribers. Many are active prescribers, managing chronic conditions or acute episodes of infections and minor ailments. Key aims of nonmedical prescribing are as follows: to improve patient care; to increase patient choice in accessing medicines; and to make better use of the skills of health professionals. Education and training are provided by higher education institutions accredited by UK professional bodies/regulators,namely, the Nursing and Midwifery Council, General Pharmaceutical Council, Health Professions Council and General Optical Council. The programme comprises two main components: a university component equivalent to 26 days full-time education and a period of learning in practice of 12 days minimum under the supervision of a designated medical practitioner. Course content focuses on the following factors: consultation, decision making, assessment and review; psychology of prescribing; prescribing in team context; applied therapeutics; evidence-based practice and clinical governance; legal, policy, professional and ethical aspects; and prescribing in the public health context. Nonmedical prescribers must practise within their competence, demonstrating continuing professional development to maintain the quality engendered during training. Despite the substantial progress, there are several issues of strategy, capacity, sustainability and a research evidence base which require attention to fully integrate nonmedical prescribing within healthcare. PMID:22300374

Stewart, Derek; MacLure, Katie; George, Johnson

2012-10-01

73

Use of antipsychotic and antidepressant within the Psychiatric Disease Centre, Regional Health Service of Ferrara  

PubMed Central

Background This study aimed at describing the type and dosage of psychopharmaceuticals dispensed to patients with psychiatric disorders and to assess the percentage of patients treated with antipsychotics and antidepressants, the associated therapies, treatment adherence, and dosages used in individuals registered at the Psychiatric Disease Center (PDC), Regional Health Service of Ferrara. Methods The analysis focused on therapeutic programmes presented to the Department of Pharmacy of the University Hospital of Ferrara of 892 patients treated by the PDC (catchment area of 134605 inhabitants). All diagnoses were made according to International Classification of Diseases (ICD-9). The analysis focused on prescriptions from September 2007 to June 2009. Data on adherence to prescribed therapy have were processed by analysis of variance. Results Among the patients 63% were treated with antipsychotics and 40% with antidepressants. Among patients receiving antipsychotics 92% used second-generation antipsychotics (SGAs) whereas the remaining 8% used first generation antipsychotics (FGAs). Antipsychotic doses were lower than Daily Defined Dose (DDDs), and SGAs were often given with anticholinergics to decrease side effects. Mean adherence to antipsychotic therapy was 64%. Among antidepressants, selective serotonin reuptake inhibitors (SSRIs) were the most often prescribed, 55%. Dosages of these were within the limits indicated by the technical datasheet but higher than DDDs. Only 26% of patients underwent monotherapy. In antidepressants polytherapy, medication was associated with another antidepressant, 6% or with an antipsychotic, 51%. Mean adherence to the antidepressant therapy was 64%. Conclusions Patients treated with antipsychotics tend to use doses lower than DDDs. The opposite tendency was noted in patients treated with antidepressants. Only a small percentage of patients (14%) modified their neuroleptic therapy by increasing the dosage. On the contrary, patients treated with antidepressants mainly tended to reduce the doses of their drugs. This study highlights the tendency to follow combination therapies, prescribing SGAs together with anticholinergics in order to minimize extrapyramidal side effects or by combining two antidepressants. The study showed low adherence for both pharmaceutical therapies, which is typical in the setting of the analyzed diseases. PMID:22185397

2011-01-01

74

Atypical and Typical Antipsychotics in the Schools  

ERIC Educational Resources Information Center

The use of antipsychotic medications within the school-age population is rapidly increasing. Although typical antipsychotics may be used in rare cases, this influx is largely secondary to the availability of the atypical antipsychotics. Reduction of possible adverse effects and increased efficacy represent the primary basis for the atypical…

Noggle, Chad A.; Dean, Raymond S.

2009-01-01

75

Documentation of Antipsychotic Use and Indications for Newly Diagnosed, Nonaggressive Dementia Patients  

PubMed Central

Objective: The purpose of this study was to determine the prevalence of antipsychotic use among nonaggressive patients with newly diagnosed dementia and to examine indications for antipsychotic use. Method: Patients had to be veterans older than 60 years, newly diagnosed with dementia (ICD-9-CM criteria) from 2001 to 2004 at the Michael A. DeBakey Veterans Affairs Medical Center in Houston, Tex. Patients diagnosed more than 1 year before telephone screening, living in a nursing home or having a caregiver less than 8 hours a week, and/or having aggression, determined by caregiver response on the Ryden Aggression Scale, were excluded. Medical records of eligible participants were then evaluated on the basis of 5 questions: (1) Was the patient taking an antipsychotic? (2) Were neuropsychiatric symptoms documented, with or without antipsychotics? (3) Did the patient have comorbid psychiatric diagnoses? (4) Did the physician attempt to decrease or discontinue the antipsychotic? and (5) Did the physician attempt non-pharmacologic interventions? Results: A total of 173 patients were eligible for medical record evaluation. Of these, 29 (17%) had been prescribed antipsychotics. Depression, nighttime disturbance, and irritability were the most often documented neuropsychiatric symptoms; however, 31% of patients had no documented symptoms. Mood disorder was documented in 36% of patient records; however, 94 patients (54%) had no comorbid psychiatric disorder. Twelve nonpharmacologic interventions were documented for dementia symptoms. Only 2 attempts to discontinue or decrease antipsychotics for the 29 patients using them were documented. Conclusion: A sizable minority of newly diagnosed, nonaggressive dementia patients are taking antipsychotics. Physicians need greater education and awareness of the benefits of nonpharmacologic interventions. PMID:18458729

Dhawan, Nikhil; Steele, Avila B.; Morgan, Robert O.; Snow, A. Lynn; Davila, Jessica A.; Kunik, Mark E.

2008-01-01

76

Long-acting injectable antipsychotics in the elderly: guidelines for effective use.  

PubMed

The elderly are at increased risk for psychosis because of age-related deterioration of cortical areas and neurochemical changes, comorbid physical illnesses, social isolation, sensory deficits and polypharmacy. The prevalence of psychiatric and neuropsychiatric disorders requiring treatment with an antipsychotic agent is expected to increase dramatically among people aged >64 years. Antipsychotic agents are effective in the treatment of schizophrenia, schizoaffective disorder, behavioural symptoms in patients with dementia, and mood disorders with psychosis. However, failure to adhere to a prescribed medication regimen by patients with psychosis is one of the most frustrating problems faced by mental healthcare providers, because of the high risk of relapse associated with partial compliance. For patients with psychosis who will not or cannot take oral medications on a regular daily basis or have other characteristics, such as memory, vision or auditory impairment, which contribute to partial compliance, long-acting injectable antipsychotic medication offers a solution. Older patients are especially at risk of adverse effects associated with traditional antipsychotic agents, such as motor effects, postural hypotension, excessive sedation, and anticholinergic effects because of age-related pharmacokinetic and pharmacodynamic factors, coexisting medical illnesses and concomitant medications. Therefore, drug dosage recommendations in the elderly are much more conservative than in younger patients. The appropriate starting dose of an antipsychotic in older individuals is 25% of the usual adult dose; total daily maintenance doses ranges from 25-50% of the adult dose. There are few studies regarding the use of depot antipsychotics in elderly patients. Studies that are available indicate that traditional antipsychotic agents given as depot injections are associated with positive outcomes in the elderly. Because the risks for extrapyramidal symptoms and tardive dyskinesia are reduced dramatically with atypical antipsychotics compared with traditional agents, the development of long-acting atypical antipsychotic formulations has been pursued. Of the atypical antipsychotics, risperidone is the first agent to be approved in a long-acting injectable formulation. Unpublished clinical data have revealed that patients treated with long-acting injectable risperidone (25mg, 50mg or 75mg) are more likely to show significant clinical improvement than placebo. In addition, hospitalisation rates decreased continuously and significantly during 1 year of treatment for patients who received long-acting injectable risperidone.Long-acting injectable antipsychotic medication should be considered for older patients for whom long-term treatment is indicated. The choice of which drug to use should be based on patients' history of response and personal preference, clinician's previous experience and pharmacokinetic properties. PMID:14651433

Masand, Prakash S; Gupta, Sanjay

2003-01-01

77

Attitudes towards the administration of long-acting antipsychotics: a survey of physicians and nurses  

PubMed Central

Background Discontinuation of antipsychotic treatment for schizophrenia can interrupt improvement and exacerbate the illness. Reasons for discontinuing treatment are multifactorial and include adherence, efficacy and tolerability issues. Poor adherence may be addressed through non-pharmacological approaches as well as through pharmacological ones, ie ensured delivery of medication, such as that achieved with long-acting injectable (LAI) antipsychotics. However, attitudes of healthcare professionals (HCPs) towards LAI antipsychotics may influence their prescribing decisions and may influence medication choices offered to patients. We therefore conducted a survey to investigate factors driving LAI use as well as physician and nurse attitudes to LAI antipsychotics and to different injection sites. Methods An independent market research agency conducted the survey of HCPs across Europe. Participants were recruited by telephone and completed the survey online. Using conjoint analyses (a multivariate statistical technique analysing preferences on the basis of ranking a limited number of attributes which are presented repetitively), attitudes to oral versus LAI medication and gluteal versus deltoid injection routes were assessed. Results A total of 891 HCPs across Europe were surveyed. Of these, 40% would choose LAI antipsychotics for first episode patients whereas 90% would select LAI antipsychotics for chronic patients with two to five psychotic episodes. Dominant elements in antipsychotic choice were low sedation but no tardive dyskinesia, no or mild pain at injection and low risk of embarrassment or impact upon therapeutic alliance. Eighty-six per cent of respondents considered that having the choice of a deltoid as well as gluteal administration site was beneficial over not having that choice. Two thirds of respondents said they agreed that medication administration via the deltoid muscle may reduce social embarrassment associated with LAI antipsychotics and most respondents (61%) believed that administration of LAI antipsychotics into the deltoid muscle as opposed to the gluteal muscle may be more respectful to the patient. Conclusions In this survey of physicians and nurses, attitudes towards LAI antipsychotics compared with oral medication were generally positive. Respondents considered that the availability of a deltoid administration route would offer increased choice in LAI antipsychotic administration and may be perceived as more respectful and less socially embarrassing. PMID:23414331

2013-01-01

78

Are Second Generation Antipsychotics a Distinct Class?  

PubMed Central

Introduction Second generation antipsychotic medications have become synonymous with “atypicality.” To support the clinical lore of equivalent efficacy with reduced risk of extrapyramidal symptoms, clinical trials have overwhelmingly chosen a high-potency first-generation antipsychotic (e.g., haloperidol) as a comparator. Very few clinical trials have compared a second-generation antipsychotic with a low- or mid-potency first-generation antipsychotic medication. Methods We identified eight completed, published, double-blind, randomized clinical trials that compared a second-generation antipsychotic with a low- or mid-potency first-generation antipsychotic and reviewed outcome measures for efficacy and extrapyramidal symptoms; 1,241 patients were represented in these eight trials. Results Although data are very limited, mid- and low-potency first-generation antipsychotics show efficacy and extrapyramidal side effects that are comparable to those of second-generation antipsychotics. Conclusion Aside from clozapine, first-generation and second-generation antipsychotics represent a diverse group of medications that have heterogenous receptor profiles and side effects but comparable clinical efficacy and potential to cause extrapyramidal symptoms. Clinicians may provide better treatment for patients by considering the unique pharmacological and side-effect profile of each particular antipsychotic independent of its classification as a first- or second-generation agent. PMID:18664891

BONHAM, CAROLINE; ABBOTT, CHRISTOPHER

2013-01-01

79

Pharmacoepidemiology of Antipsychotic Use in Youth with ADHD: Trends and Clinical Implications  

PubMed Central

Although concern has been raised about antipsychotic prescribing to youth with attention-deficit/hyperactivity disorder (ADHD), the available database is limited to individual studies. Therefore, in order to provide a synthesis of prevalences and time trends, we conducted a systematic review and pooled analysis of pharmaco-epidemiologic data on antipsychotic use in ADHD youth. Of 1806 hits, 21 studies (N) were retained that reported analyzable data for three separate populations: 1) antipsychotic-treated youth (N=15, n=341,586); 2) ADHD youth (N=9, n=6,192,368), and 3) general population youth (N=5, n=14,284,916). Altogether, 30.5±18.5% of antipsychotic-treated youth had ADHD. In longitudinal studies, this percentage increased over time (1998-2007) from 21.7±7.1% to 27.7±7.7%, ratio=1.3±0.4. Furthermore, 11.5±17.5% of ADHD youth received antipsychotics. In longitudinal studies, this percentage also increased (1998-2006) from 5.5±2.6% to 11.4±6.7%, ratio=2.1±0.6. Finally, 0.12±0.07% of youth in the general population were diagnosed with ADHD and received antipsychotics. Again, in longitudinal studies, this percentage increased over time (1993-2007): 0.13±0.09% to 0.44±0.49%, ratio=3.1±2.2. Taken together, these data indicate that antipsychotics are used by a clinically relevant and increasing number of youth with ADHD. Reasons for and risk/benefit ratios of this practice with little evidence base require further investigation. PMID:23881713

Birnbaum, Michael L.; Saito, Ema; Gerhard, Tobias; Winterstein, Almut; Olfson, Mark; Kane, John M.; Correll, Christoph U.

2014-01-01

80

Pharmacoepidemiology of antipsychotic use in youth with ADHD: trends and clinical implications.  

PubMed

Although concern has been raised about antipsychotic prescribing to youth with attention-deficit/hyperactivity disorder (ADHD), the available database is limited to individual studies. Therefore, in order to provide a synthesis of prevalence and time trends, we conducted a systematic review and pooled analysis of pharmaco-epidemiologic data on antipsychotic use in ADHD youth. Of 1806 hits, 21 studies (N) were retained that reported analyzable data for three separate populations: 1) antipsychotic-treated youth (N = 15, n = 341,586); 2) ADHD youth (N = 9, n = 6,192,368), and 3) general population youth (N = 5, n = 14,284,916). Altogether, 30.5 ± 18.5% of antipsychotic-treated youth had ADHD. In longitudinal studies, this percentage increased over time (1998-2007) from 21.7 ± 7.1% to 27.7 ± 7.7%, ratio = 1.3 ± 0.4. Furthermore, 11.5 ± 17.5% of ADHD youth received antipsychotics. In longitudinal studies, this percentage also increased (1998-2006) from 5.5 ± 2.6% to 11.4 ± 6.7%, ratio = 2.1 ± 0.6. Finally, 0.12 ± 0.07% of youth in the general population were diagnosed with ADHD and received antipsychotics. Again, in longitudinal studies, this percentage increased over time (1993-2007): 0.13 ± 0.09% to 0.44 ± 0.49%, ratio = 3.1 ± 2.2. Taken together, these data indicate that antipsychotics are used by a clinically relevant and increasing number of youth with ADHD. Reasons for and risk/benefit ratios of this practice with little evidence base require further investigation. PMID:23881713

Birnbaum, Michael L; Saito, Ema; Gerhard, Tobias; Winterstein, Almut; Olfson, Mark; Kane, John M; Correll, Christoph U

2013-08-01

81

Antipsychotic drugs alter neuronal development including ALM neuroblast migration and PLM axonal outgrowth in C. elegans  

PubMed Central

Antipsychotic drugs are increasingly being prescribed for children and adolescents, and are used in pregnant women without a clear demonstration of safety in these populations. Global effects of these drugs on neurodevelopment (e.g., decreased brain size) have been reported in rats, but detailed knowledge about neuronal effects and mechanisms of action are lacking. Here we report on the evaluation of a comprehensive panel of antipsychotic drugs in a model organism (Caenorhabditis elegans) that is widely used to study neuronal development. Specifically, we examined the effects of the drugs on neuronal migration and axonal outgrowth in mechanosensory neurons visualized with green fluorescent protein expressed from the mec-3 promoter. Clozapine, fluphenazine, and haloperidol produced deficits in the development and migration of ALM neurons and axonal outgrowth in PLM neurons. The defects included failure of neuroblasts to migrate to the proper location, and excessive growth of axons past their normal termination point, together with abnormal morphological features of the processes. Although the antipsychotic drugs are potent antagonists of dopamine and serotonin receptors, the neurodevelopmental deficits were not rescued by co-incubation with serotonin or the dopaminergic agonist, quinpirole. Other antipsychotic drugs, risperidone, aripiprazole, quetiapine, trifluoperazine and olanzapine, also produced modest, but detectable, effects on neuronal development. This is the first report that antipsychotic drugs interfere with neuronal migration and axonal outgrowth in a developing nervous system. PMID:18282677

Donohoe, Dallas R.; Weeks, Kathrine; Aamodt, Eric J.; Dwyer, Donard S.

2008-01-01

82

Use Pattern and Off-Label Use of Atypical Antipsychotics in Bipolar Disorder, 1998-2002  

PubMed Central

Background Postmarketing surveillance that identifies patients at high risk for receiving off-label medications will help ensure that the benefits of such treatment outweigh the risks. Because many off-label uses have little scientific support, tracking the extent to which they occur as well as the particular circumstances under which they occur is important. Objective To describe the drug-use pattern for patients with bipolar disorder, and to identify demographic and clinical factors associated with off-label use of atypical antipsychotics before US Food and Drug Administration approval for this indication. Methods Using the PHARMetrics medical claims database, a total of 105,771 adult patients with a diagnosis of bipolar disorder were evaluated during the 5-year (1998–2002) study period. Study drugs included mood stabilizers, antipsychotics, and antidepressants. Off-label use of an atypical antipsychotic was defined as a patient taking olanzapine before March 2000 (when it received an indication for bipolar disorder) or any other atypical antipsychotic during the entire study period. Logistic regression analysis was used to determine the odds ratio of receiving a drug off-label. Results Utilization of and reimbursement for atypical antipsychotics increased during the 5-year period. Of the 10.5% of patients who took atypical antipsychotics, 7.1% took these drugs off-label. In addition, 11% of patients received lithium, 25% received other anticonvulsants, and 34% received antidepressants. Off-label use of atypical antipsychotics was associated with psychiatry specialist prescribers (odds ratio = 1.52; 95% CI, 1.44–1.59) and certain comorbidities, such as substance abuse (odds ratio = 1.51; 95% CI, 1.38–1.66), anxiety disorder (odds ratio = 1.20; 95% CI, 1.14–1.26), diabetes mellitus (odds ratio = 1.26; 95% CI, 1.16–1.37), cerebral vascular disease (odds ratio = 1.26; 95% CI, 1.10–1.45), and hypertension (odds ratio = 1.12; 95% CI, 1.05–1.20). Over time, there has been an increase in the number of drug therapies, including atypical antipsychotics, used to treat bipolar disorder. Conclusion Because of the significant association found between atypical antipsychotic use and several key comorbidities, it is important for physicians to recognize these associations and weigh the risks and benefits of atypical antipsychotics in their treatment strategies. PMID:25126291

Demland, Jeffery A.; Jing, Yonghua; Kelton, Christina M. L.; Guo, Jeff J.; Li, Hong; Wigle, Patricia R.

2009-01-01

83

When Medication Is Prescribed  

MedlinePLUS

... page please turn Javascript on. Feature: Depression When Medication Is Prescribed Past Issues / Fall 2009 Table of ... you have about the medicine. —NIMH Types of Medications There are several types of medications used to ...

84

Screening models for antipsychotic drugs  

Microsoft Academic Search

\\u000a Development of effective screening strategies for improved antipsychotic drugs (APDs) rely primarily on the actual hypotheses\\u000a for mechanism of action of these compounds. In the early times of the dopamine (DA) hypothesis of schizophrenia animal models\\u000a were designed to detect compounds which blocked the behavioural effects of high doses of dopaminergic drugs (e.g. amphetamine-,\\u000a apomorphine-and methylphenidate-induced stereotyped behaviour). Whenin vitroreceptor

Jorn Arnt

85

Genetics of Antipsychotic-induced Side Effects and Agranulocytosis  

Microsoft Academic Search

Antipsychotic medication has been enormously helpful in the treatment of psychotic symptoms during the past several decades.\\u000a Unfortunately, several important side effects that can cause significant morbidity and mortality. The two most common are\\u000a abnormal involuntary movements (tardive dyskinesia) and weight gain progressing through diabetes to metabolic syndrome. A\\u000a more rare and life-threatening adverse effect is clozapine-induced agranulocytosis (CIA), which

Nabilah I. Chowdhury; Gary Remington; James L. Kennedy

2011-01-01

86

[Predictors of adverse effects induced by antipsychotics].  

PubMed

Atypical antipsychotic drugs are superior to typical antipsychotic drugs in having a lower incidence of extrapyramidal side-effects, so atypical antipsychotic drugs have become the mainstream in the clinic. However, there is growing interest in the effects of antipsychotic treatment on other serious side-effects such as metabolic abnormalities, sexual function and QT prolongation. There is a need for biomarkers that can help in early identification of patients who are at risk for these serious side-effects. Hence, we have conducted psychopharmacological studies using OGTT, measurement of adipokines, holter ECG and genetic methods, aiming to identify key biomarkers to drive personalized medicine and new treatment development. PMID:23678593

Fukui, Naoki; Someya, Toshiyuki

2013-04-01

87

Prescribing of psychoactive drugs for chronically ill elderly patients.  

PubMed Central

The prescribing of psychoactive drugs for 1431 chronically ill elderly patients being assessed for long-term institutional or community care was surveyed. Psychoactive drugs had been prescribed for about one quarter of the patients; benzodiazepines were the most frequently prescribed group. Judging from the extensive prescribing of flurazepam and chloral hydrate, commonly used hypnotics, the main reason psychoactive drugs were prescribed was to provide night-time sedation. Antidepressants and drugs promoted as useful in improving cognitive function were infrequently prescribed. Commendable prescribing practices included the infrequent use of "cerebral vasodilators" and barbiturates. Questionable prescribing practices included the infrequent use of tricyclic antidepressants in severely depressed patients and the use of tranquilizers in patients described by their attending physician as markedly or extremely withdrawn. Images p1506-a PMID:26459

Achong, M. R.; Bayne, J. R.; Gerson, L. W.; Golshani, S.

1978-01-01

88

Antipsychotic drug effects on glutamatergic activity  

Microsoft Academic Search

Previous work from this laboratory indicated that some antipsychotic drugs possess unique action at N-methyl-d-aspartate (NMDA) receptors. A functional neurochemical assay showed that, at concentrations similar to those found in the cerebrospinal fluid (CSF) of schizophrenics, antipsychotic drugs augment NMDA activity while, at higher concentrations, NMDA activity is suppressed. Using similar analysis, the present paper reports that this pattern of

T. I Lidsky; E Yablonsky-Alter; L. G Zuck; S. P Banerjee

1997-01-01

89

Atypical Antipsychotic Drug Use and Diabetes  

Microsoft Academic Search

Recently, there has been increased concern about the occurrence of diabetes associated with the use of atypical antipsychotic (AAP) drugs. The relationship between diabetes, schizophrenia, and antipsychotic drugs is complex and intriguing, as untreated patients with schizophrenia are known to suffer from diabetes more often than the general population. Thirty individual case reports of clozapine-, 26 cases of olanzapine- and

Jambur Ananth; Ravi Venkatesh; Karl Burgoyne; Sarath Gunatilake

2002-01-01

90

Using Prescribed Fire in Oklahoma  

E-print Network

Prescribed Fire in Oklahoma Terrence G. Bidwell Professor and Extension Specialist Rangeland Ecology Tall Timbers Research Station Tallahassee, Florida Samuel D. Fuhlendorf Associate Professor RangelandE-927 Using Prescribed Fire in Oklahoma Using Prescribed Fire in Oklahoma Using Prescribed Fire

Balasundaram, Balabhaskar "Baski"

91

Atypical antipsychotics induce both proinflammatory and adipogenic gene expression in human adipocytes in vitro.  

PubMed

Schizophrenia requires lifelong treatment, potentially causing systemic changes in metabolic homeostasis. In the clinical setting, antipsychotic treatment may differentially lead to weight gain among individual patients, although the molecular determinants of such adverse effects are currently unknown. In this study, we investigated changes in the expression levels of critical regulatory genes of adipogenesis, lipid metabolism and proinflammatory genes during the differentiation of primary human adipose-derived stem cells (ADSCs). These cells were isolated from patients with body mass indices <25 and treated with the second-generation antipsychotics olanzapine, ziprasidone, clozapine, quetiapine, aripiprazole and risperidone and the first-generation antipsychotic haloperidol. We found that antipsychotics exhibited a marked effect on key genes involved in the regulation of cell cycle, signal transduction, transcription factors, nuclear receptors, differentiation markers and metabolic enzymes. In particular, we observed an induction of the transcription factor NF-KB1 and NF-KB1 target genes in adipocytes in response to these drugs, including the proinflammatory cytokines TNF-?, IL-1?, IL-8 and MCP-1. In addition, enhanced secretion of both IL8 and MCP-1 was observed in the supernatant of these cell cultures. In addition to their remarkable stimulatory effects on proinflammatory gene transcription, three of the most frequently prescribed antipsychotic drugs, clozapine, quetiapine and aripiprazole, also induced the expression of essential adipocyte differentiation genes and the adipocyte hormones leptin and adiponectin, suggesting that both glucose and fat metabolism may be affected by these drugs. These data further suggest that antipsychotic treatments in patients alter the gene expression patterns in adipocytes in a coordinated fashion and priming them for a low-level inflammatory state. PMID:25019983

Sárvári, Anitta K; Veréb, Zoltán; Uray, Iván P; Fésüs, László; Balajthy, Zoltán

2014-08-01

92

Assessing prescribing competence  

PubMed Central

Prescribing of medicines is the key clinical activity in the working life of most doctors. In recent years, a broad consensus regarding the necessary competencies has been achieved. Each of these is a complex mix of knowledge, judgement and skills. Surveys of those on the threshold of their medical careers have revealed widespread lack of confidence in writing prescriptions. A valid and reliable assessment of prescribing competence, separate from an overall assessment of medical knowledge and skill, would have many benefits for clinical governance and patient safety, and would provide a measure of the success of training programmes in therapeutics. Delivering such an assessment presents many challenges, not least of which are the difficulty in identifying a surrogate marker for competent prescribing in clinical practice and the challenge of ensuring that competence assessed in a controlled environment predicts performance in clinical practice. This review makes the case for an on-line OSCE as the most valid form of assessment and sets out the requirements for its development, scope, composition and delivery. It describes an on-going attempt to develop a national assessment of prescribing skills towards the end of undergraduate medical training in the UK. PMID:22114902

Mucklow, John; Bollington, Lynne; Maxwell, Simon

2012-01-01

93

Use of atypical antipsychotic drugs in patients with dementia.  

PubMed

Increasingly, atypical antipsychotic drugs are prescribed for elderly patients with symptoms of psychosis and behavioral disturbances. These symptoms often occur in patients with Alzheimer's disease, other dementias, or Parkinson's disease. As the average age of Americans increases, the prevalence of Alzheimer's disease and Parkinson's disease will rise accordingly. Although nonpharmacologic treatments for behavioral disturbances should be tried first, medications often are needed to enable the patient to be adequately cared for. Current guidelines recommend using risperidone and olanzapine to treat psychosis in patients with Alzheimer's dementia. Quetiapine and clozapine are recommended for treatment of psychosis in patients with Parkinson's disease. Additional research is needed for a recently approved agent, ziprasidone. To minimize side effects, these medications should be started at low dosages that are increased incrementally. Drug interactions, especially those involving the cytochrome P450 system, must be considered. Clozapine's potentially lethal side effects limit its use in the primary care setting. Informed use of atypical antipsychotic drugs allows family physicians to greatly improve quality of life in elderly patients with dementia and behavior disturbances. PMID:12800962

Motsinger, Charles D; Perron, Gregory A; Lacy, Timothy J

2003-06-01

94

Reversal of Startle Gating Deficits in Transgenic Mice Overexpressing Corticotropin-Releasing Factor by Antipsychotic Drugs  

Microsoft Academic Search

Chronically elevated levels of corticotropin-releasing factor (CRF) in transgenic mice overexpressing CRF in the brain (CRF-OE) appear to be associated with alterations commonly associated with major depressive disorder, as well as with sensorimotor gating deficits commonly associated with schizophrenia. In the present study, we tested the hypothesis that antipsychotics may be effective in normalizing prepulse inhibition (PPI) of acoustic startle

Anneloes Dirks; Lucianne Groenink; Koen G C Westphal; Jocelien D A Olivier; P Monika Verdouw; Jan van der Gugten; Mark A Geyer; Berend Olivier

2003-01-01

95

Antipsychotic drug effects on glutamatergic activity.  

PubMed

Previous work from this laboratory indicated that some antipsychotic drugs possess unique action at N-methyl-D-aspartate (NMDA) receptors. A functional neurochemical assay showed that, at concentrations similar to those found in the cerebrospinal fluid (CSF) of schizophrenics, antipsychotic drugs augment NMDA activity while, at higher concentrations, NMDA activity is suppressed. Using similar analysis, the present paper reports that this pattern of response is also shown by the antipsychotic drugs thioridazine and chlorpromazine. In contrast, promazine, which is structurally similar to chlorpromazine but lacking both D2-effects and antipsychotic potency, had no influence on NMDA receptors. In addition, sulpiride and metoclopramide, drugs with high affinity for D2-dopamine receptors but with weak or no antipsychotic efficacy, also lack effects at the NMDA receptor. Thus, the drugs with clinical efficacy that were tested in the present and previous studies all share unique influence on NMDA receptors. Further work with other antipsychotic agents will be necessary to determine if influence on NMDA receptors contributes to antipsychotic effectiveness. PMID:9295192

Lidsky, T I; Yablonsky-Alter, E; Zuck, L G; Banerjee, S P

1997-08-01

96

Digoxin prescribing in perspective  

PubMed Central

1 Prescribing aids based on creatinine clearance were evaluated in 86 out-patients taking digoxin at a district general hospital. Lanoxin tablets were dispensed in calendar packs to encourage patient compliance. 2 Despite a high degree of patient compliance and a more than three-fold variation in creatinine clearance the range of concentrations that would result from prescribing individual doses based on creatinine clearance was similar to that expected from prescribing one fixed dose for all male and another for all female patients. 3 Concentrations at which symptoms of toxicity occurred in 31 patients did not differ significantly from concentrations achieved in the remainder. 4 Only 17% of the variance in resting ventricular rate in patients with atrial fibrillation and no serious impairment of atrio-ventricular conduction was explained by the serum digoxin concentration. 5 Even when the serum digoxin concentration is known the patient's clinical condition must be the final determinant of dose. 6 Patients with symptoms of toxicity were distinguished by significantly lower serum creatinine concentrations and body weights, factors suggestive of a lower muscle mass. No other biochemical or clinical (other than serum digoxin concentration) factors influencing resting ventricular rate in atrial fibrillation were identified.

Dobbs, Sylvia M.; Rodgers, Elaine M.; Kenyon, W. I.; Livshin, D.; Slater, E.; Godsmark, Bernice

1977-01-01

97

Physicians' Decisions to Prescribe Benzodiazepines for Nervousness and Insomnia  

PubMed Central

OBJECTIVE To assess the effects of particular clinical cues on decisions about prescribing benzodiazepines. DESIGN A factorial survey based on social judgment theory. SETTING A midwestern U.S. medical school. PARTICIPANTS Physicians (n = 115) recruited from the staff by invitation and interview. MEASUREMENTS AND MAIN RESULTS Physicians indicated their level of agreement with prescribing a benzodiazepine for 24 hypothetical cases of nervousness and insomnia. The cases stemmed from the same scenario but varied systematically with regard to psychiatric diagnosis, recent ability to work, and long-term social stability. A fourth cue, called “health status,” covertly depicted the presence or absence of three common alcohol-related medical problems. One fourth of the physicians agreed with prescribing for 15 or more cases, and 15% disagreed for all of them. Agreement was cumulative and least common for major depression, more common for adjustment disorder, and most common for generalized anxiety. Agreement with prescribing for cases with alcohol-related medical problems was 14% less than that for cases without them. Over half the physicians agreed with prescribing for 4 or more of the 12 cases with alcohol-related medical problems. CONCLUSIONS Prescribing decisions varied widely. Some physicians avoided benzodiazepines unnecessarily for some cases, while others agreed with prescribing for patients with a high probability of alcohol abuse. Blanket calls for more or less prescribing are overly simplistic; physicians should be able to recognize substance use disorders among anxious patients and make prescribing decisions based on relevant literature and clinical cues. PMID:9034945

Brown, Richard L; Brown, Roger L; Saunders, Laura A; Castelaz, Carrie A; Papasouliotis, Orestis

1997-01-01

98

Struggles in prescribing : determinants of psychotropic drug use in multiple clinical settings  

Microsoft Academic Search

The main objectives of this thesis were to establish the prevalence of psychotropic drug use as well as possible determinants associated with its use in multiple clinical settings: psychiatric admission wards, an intensive care unit and two settings for the intellectually disabled. \\u000a\\u000aIn this thesis, we evaluated the question which class of antipsychotics is prescribed preferentially in newly admitted patients

J. J. Stolker

2002-01-01

99

Sensitivity to Antipsychotic Drugs in Older Adults  

Microsoft Academic Search

Antipsychotic medications are widely used to manage psychotic and behavioral disorders in older adults, including primary\\u000a psychotic disorders such as schizophrenia, and psychosis and behavioral disturbances associated with dementia. These two broad\\u000a diagnostic indications are associated with contrasting recommended treatment durations, with the former requiring indefinite\\u000a treatment across the life span. Antipsychotic drug dosing for schizophrenia is based primarily on

Chloe Leon; Philip Gerretsen; Hiroyuki Uchida; Takefumi Suzuki; Tarek Rajji; David C. Mamo

2010-01-01

100

Use of Antipsychotic Medications in Pediatric Populations: What Do the Data Say?  

PubMed Central

Recent reports of antipsychotic medication use in pediatric populations describe large increases in rates of use. Much interest in the increasing use has focused on potentially inappropriate prescribing for non FDA-approved uses and use amongst youth with no mental health diagnosis. Different studies of antipsychotic use have used different time periods, geographic and insurance populations of youth, and aggregations of diagnoses. We review recent estimates of use and comment on the similarities and dissimilarities in rates of use. We also report new data obtained on 11 Health Maintenance Organizations that are members of the Mental Health Research Network in order to update and extend the knowledge base on use by diagnostic indication. Results indicate that most use in pediatric populations is for disruptive behaviors and not psychotic disorders. Differences in estimates are likely a function of differences in methodology; however, there is remarkable consistency in estimates of use by diagnosis. PMID:24258527

Penfold, Robert B.; Stewart, Christine; Hunkeler, Enid M.; Madden, Jeanne M.; Cummings, Janet; Owen-Smith, Ashli A.; Rossom, Rebecca C.; Lu, Christine; Lynch, Frances L.; Waitzfelder, Beth E.; Coleman, Karen A.; Ahmedani, Brian K.; Beck, Arne L.; Zeber, John E.; Simon, Greg E.

2014-01-01

101

Quality of prescribing for schizophrenia: evidence from a national audit in England and Wales.  

PubMed

The National Audit of Schizophrenia (NAS) examined the quality of care received in England and Wales. Part of the audit set out to determine whether six prescribing standards, set by the national clinical guidelines for schizophrenia, were being implemented and to prompt improvements in care. Mental Health Trusts and Health Boards provided data obtained from case-notes for adult patients living in the community with schizophrenia or schizoaffective disorder. An audit of practice tool was developed for data collection. Most of the 5055 patients reviewed were receiving pharmacological treatment according to national guidelines. However, 15.9% of the total sample (95%CI: 14.9-16.9) were prescribed two or more antipsychotics concurrently and 10.1% of patients (95%CI: 9.3-10.9) were prescribed medication in excess of recommended limits. Overall 23.7% (95%CI: 22.5-24.8) of patients were receiving clozapine. However, there were many with treatment resistance who had no clear reason documented as to why they had not had a trial of clozapine (430/1073, 40.1%). In conclusion, whilst most people were prescribed medication in accordance with nationally agreed standards, there was considerable variation between service providers. Antipsychotic polypharmacy, high dose prescribing and clozapine underutilisation in treatment resistance were all key concerns which need to be further addressed. PMID:24491953

Patel, Maxine X; Bishara, Delia; Jayakumar, Simone; Zalewska, Krysia; Shiers, David; Crawford, Mike J; Cooper, Stephen J

2014-04-01

102

A Comparative Study of Sexual Dysfunction due to Typical and Atypical Antipsychotics in Remitted Bipolar-I Disorder  

PubMed Central

In the remitted phase of bipolar I disorder, sexual dysfunction is commonly due to drugs used in the treatment rather than the disease itself. There are very few studies, especially in the Indian population, addressing the frequency of sexual dysfunction due to antipsychotics in bipolar I disorder. Hence this study was done to determine the sexual dysfunction due to antipsychotics and to compare the same among typical and atypical antipsychotics. A cross sectional study with 108 male patients of remitted bipolar I disorder (DSM-IV), chosen by purposive sampling technique was done. Psychopathology was assessed using the Brief Psychiatric Rating Scale, Structured Interview Guide for the Hamilton Depression Rating Scale and Young Mania Rating Scale. Sexual side effects due to antipsychotics were assessed using the Udvalg for Kliniske ndersogelser (UKU) side effect rating scale. The total sample size was divided into two groups of those on typical antipsychotics (n = 53) and atypical antipsychotics (n = 55). The two groups were compared for sexual dysfunction using Chi-square test. Results showed dysfunction in at least one phase of the sexual response cycle, comprising of desire, arousal and orgasm, was present in 66% of the sample population. Erectile dysfunction was present in 42% of the sample population and it was the most common type of sexual dysfunction reported. It was also significantly different across the two groups (p = 0.025). There was no significant difference in other aspects of sexual dysfunction across the two groups. In conclusion patients of Bipolar I disorder experience sexual side effects of antipsychotics frequently. Erectile dysfunction is the most common sexual dysfunction among men and this is significantly higher with typical than atypical antipsychotics. PMID:21224908

Nagaraj, Anil Kumar M.; Nizamie, Haque S.; Akhtar, Sayeed; Sinha, Baxi Neeraj P.; Goyal, Nishant

2004-01-01

103

Cardiovascular effects of acute treatment with the antipsychotic drug olanzapine in rats.  

PubMed

Treatment with antipsychotics is associated with adverse cardiovascular effects such as orthostatic hypotension and arrhythmias. Despite the higher prevalence of cardiovascular complications in patients with schizophrenia, the effects of antipsychotic drugs on vascular tone and cardiac contractility have received little attention. In order to better understand the cardiovascular effects of antipsychotic drugs, we investigated if the atypical antipsychotic olanzapine alters in vivo cardiovascular function in rats. Male Sprague-Dawley rats were prepared with indwelling catheters. After 4 h of recovery from surgery, the mean arterial pressure (MAP), mean circulatory filling pressure (MCFP; index of body venous tone), heart rate, left ventricular peak systolic pressure (LVP) and cardiac contractility (±dP/dt) were measured in conscious, unrestrained rats for 60 min after a single injection of olanzapine (3 or 15 mg/kg, i.p.) or vehicle. Cardiovascular measurements were not altered at any time points in the vehicle-treated rats. Olanzapine did not affect heart rate, but dose-dependently decreased MAP, MCFP, LVP and +dP/dt. Acute olanzapine treatment in rats thus reduced blood pressure and venous tone, as well as cardiac contractile function. Decreased venous tone may be a contributing factor to orthostatic hypotension commonly observed in patients during initiation of antipsychotic therapy. PMID:24969105

Leung, Joanne Y T; Pang, Catherine C Y; Procyshyn, Ric M; Barr, Alasdair M

2014-09-01

104

Antibiotic prescribing in primary care, adherence to guidelines and unnecessary prescribing - an Irish perspective  

PubMed Central

Background Information about antibiotic prescribing practice in primary care is not available for Ireland, unlike other European countries. The study aimed to ascertain the types of antibiotics and the corresponding conditions seen in primary care and whether general practitioners (GPs) felt that an antibiotic was necessary at the time of consultation. This information will be vital to inform future initiatives in prudent antibiotic prescribing in primary care. Methods Participating GPs gathered data on all antibiotics prescribed by them in 100 consecutive patients’ consultations as well as data on the conditions being treated and whether they felt the antibiotic was necessary. Results 171 GPs collected data on 16,899 consultations. An antibiotic was prescribed at 20.16% of these consultations. The majority were prescribed for symptoms or diagnoses associated with the respiratory system; the highest rate of prescribing in these consultations were for patients aged 15–64?years (62.23%). There is a high rate of 2nd and 3rd line agents being used for common ailments such as otitis media and tonsillitis. Amoxicillin, which is recommended as 1st line in most common infections, was twice as likely to be prescribed if the prescription was for deferred used or deemed unnecessary by the GP. Conclusion The study demonstrates that potentially inappropriate prescribing is occurring in the adult population and the high rate of broad-spectrum antimicrobial agents is a major concern. This study also indicates that amoxicillin may be being used for its placebo effect rather than specifically for treatment of a definite bacterial infection. PMID:22640399

2012-01-01

105

Psychosis and Antipsychotic Medications in Alzheimer’s Disease: Clinical Management and Research Perspectives  

Microsoft Academic Search

Psychosis is common in patients with Alzheimer’s disease (AD) and contributes substantially to patient morbidity and caregiver distress. Antipsychotic medications are used to treat psychosis and other psychiatric or behavioral symptoms in AD, although optimal treatment guidelines have been elusive. Choosing the most advantageous medication for an individual patient is challenging. This article provides an overview of clinical management principles

David L. Sultzer

2004-01-01

106

Prescribing of psychotropic medications to the elderly population of a Canadian province: a retrospective study using administrative databases  

PubMed Central

Background. Psychotropic medications, in particular second-generation antipsychotics (SGAs) and benzodiazepines, have been associated with harm in elderly populations. Health agencies around the world have issued warnings about the risks of prescribing such medications to frail individuals affected by dementia and current guidelines recommend their use only in cases where the benefits clearly outweigh the risks. This study documents the use of psychotropic medications in the entire elderly population of a Canadian province in the context of current clinical guidelines for the treatment of behavioural disturbances. Methods. Prevalent and incident utilization of antipsychotics, benzodiazepines and related medications (zopiclone and zaleplon) were determined in the population of Manitobans over age 65 in the time period 1997/98 to 2008/09 fiscal years. Comparisons between patients living in the community and those living in personal care (nursing) homes (PCH) were conducted. Influence of sociodemographic characteristics on prescribing was assessed by generalized estimating equations. Non-optimal use was defined as the prescribing of high dose of antipsychotic medications and the use of combination therapy of a benzodiazepine (or zopiclone/zaleplon) with an antipsychotic. A decrease in intensity of use over time and lower proportions of patients treated with antipsychotics at high dose or in combination with benzodiazepines (or zopiclone/zaleplon) was considered a trend toward better prescribing. Multiple regression analysis determined predictors of non-optimal use in the elderly population. Results. A 20-fold greater prevalent utilization of SGAs was observed in PCH-dwelling elderly persons compared to those living in the community. In 2008/09, 27% of PCH-dwelling individuals received a prescription for an SGA. Patient characteristics, such as younger age, male gender, diagnoses of dementia (or use of an acetylcholinesterase inhibitor) or psychosis in the year prior the prescription, were predictors of non-optimal prescribing (e.g., high dose antipsychotics). During the period 2002/3 and 2007/8, amongst new users of SGAs, 10.2% received high doses. Those receiving high dose antipsychotics did not show high levels of polypharmacy. Conclusions. Despite encouraging trends, the use of psychotropic medications remains high in elderly individuals, especially in residents of nursing homes. Clinicians caring for such patients need to carefully assess risks and benefits. PMID:24109553

Dahl, Matthew; Schultz, Jennifer; Metge, Colleen; Raymond, Colette

2013-01-01

107

Atypical antipsychotics in mood disorders.  

PubMed

Bipolar disorder is ranked as the sixth most important worldwide cause of disability. Current treatment is based chiefly on lithium and/or anticonvulsants, of which sodium valproate is the most widely used. A significant minority of patients fail to respond fully to current treatments, particularly those with mixed mania and/or rapid cycling. Many patients are unable to tolerate the side-effects of current therapy in the long term, and adverse effects may contribute to the high rate of noncompliance observed in bipolar disorder. The shortcomings of current treatments are reflected in poor outcomes: two-thirds of patients with bipolar disorder require hospitalization on more than one occasion; employment and social functioning are significantly lower than in control groups; 93% of carers suffer at least moderate distress; and 25-50% of patients are believed to attempt suicide at least once. Bipolar disorder shares some features with schizophrenia, and several atypical antipsychotics have demonstrated efficacy in bipolar disorder. Quetiapine has a particularly favourable tolerability profile, with placebo-level extrapyramidal symptoms and prolactin levels across the entire dose range combined with a neutral effect on weight during long-term use, and may be a valuable treatment option in acute mania and bipolar disorder. PMID:12570066

Kasper, Siegfried; Stamenkovic, Mara; Letmaier, Martin; Schreinzer, Daniel

2002-08-01

108

Sensitivity to antipsychotic drugs in older adults.  

PubMed

Antipsychotic medications are widely used to manage psychotic and behavioral disorders in older adults, including primary psychotic disorders such as schizophrenia, and psychosis and behavioral disturbances associated with dementia. These two broad diagnostic indications are associated with contrasting recommended treatment durations, with the former requiring indefinite treatment across the life span. Antipsychotic drug dosing for schizophrenia is based primarily on studies of younger patients and thus may not apply to older adults. It is critically important to address the effects of aging on antipsychotic dosing given the recent emergence of data that suggest a critical role for age-related sensitivity to these drugs. Antipsychotic drugs are not only associated with somatic and neurological adverse effects but also increased all-cause mortality and sudden cardiac death in this vulnerable population. This review focuses on the sensitivity of older adults to adverse effects from antipsychotic medications and the current pharmacokinetic and pharmacodynamic explanatory models of susceptibility. Implications of recent research findings for individualized pharmacotherapy are discussed. PMID:20425307

Leon, Chloe; Gerretsen, Philip; Uchida, Hiroyuki; Suzuki, Takefumi; Rajji, Tarek; Mamo, David C

2010-02-01

109

Comparative effectiveness of antipsychotic drugs in schizophrenia  

PubMed Central

Chlorpromazine, which was discovered in 1952, has an exhaustively characterized efficacy/safety profile comprising serious limitations: effectiveness in the field failing to match efficacy in trials, residual symptoms in 50% of patients, a 20% relapse rate in compliant patients, and worrisome extrapyramidal side effects, including tardive dyskinesia in 5% per year. Second-generation “atypical” antipsychotics bypass these effects by having less affinity for the dopamine D2 receptor and affinities for other neuroreceptors. Clozapine, the lead atypical antipsychotic, was followed in the mid 1990s by risperidone, olanzapine, and quetiapine, which now account for over half of new antipsychotic prescriptions in North America, The debate over their relative efficacy involves the potential well-being of millions of schizophrenics and billions of dollars. Atypical antipsychotics are considerably more expensive; evidence for their superiority is highly variable and often inadequate, largely confined to short-term regulatory studies. Their effects on long-term outcome (particularly negative symptoms), relapse prevention, social and vocational functioning, suicide prevention and quality of life, and family and caregiver burden are largely unknown. The National institute of Mental Health's Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project is a combined efficacy-effectiveness trial that aims to answer these questions in a broad range of patients with schizophrenia and Alzheimer's disease. PMID:22033808

Stroup, T. Scott; A. Lieberman, Jeffrey; S. Swartz, Marvin; McEvoy, Joseph P.

2000-01-01

110

Antipsychotic drug doses and neuroleptic\\/dopamine receptors  

Microsoft Academic Search

ANTIPSYCHOTIC drugs, or neuroleptics, are thought to act by blocking dopamine receptors in the nervous system1-4. Recent direct evidence, based on stereospecific binding assays, supports this hypothesis of antipsychotic drug action5-9. As only a few antipsychotic drugs had been tested for their effects on the binding of haloperidol5-8, the question remained whether all antipsychotic drugs, regardless of chemical structure, would

P. Seeman; T. Lee; M. Chau-Wong; K. Wong

1976-01-01

111

Borderline Personality Disorder: Bipolarity, Mood Stabilizers and Atypical Antipsychotics in Treatment  

PubMed Central

In this article, it is aimed to review the efficacies of mood stabilizers and atypical antipsychotics, which are used commonly in psychopharmacological treatments of bipolar and borderline personality disorders. In this context, common phenomenology between borderline personality and bipolar disorders and differential features of clinical diagnosis will be reviewed in line with the literature. Both disorders can demonstrate common features in the diagnostic aspect, and can overlap phenomenologically. Concomitance rate of both disorders is quite high. In order to differentiate these two disorders from each other, quality of mood fluctuations, impulsivity types and linear progression of disorders should be carefully considered. There are various studies in mood stabilizer use, like lithium, carbamazepine, oxcarbazepine, sodium valproate and lamotrigine, in the treatment of borderline personality disorder. Moreover, there are also studies, which have revealed efficacies of risperidone, olanzapine and quetiapine as atypical antipsychotics. It is not easy to differentiate borderline personality disorder from the bipolar disorders. An intensively careful evaluation should be performed. This differentiation may be helpful also for the treatment. There are many studies about efficacy of valproate and lamotrigine in treatment of borderline personality disorder. However, findings related to other mood stabilizers are inadequate. Olanzapine and quetiapine are reported to be more effective among atypical antipsychotics. No drug is approved for the treatment of borderline personality disorder by the entitled authorities, yet. Psychotherapeutic approaches have preserved their significant places in treatment of borderline personality disorder. Moreover, symptom based approach is recommended in use of mood stabilizers and atypical antipsychotics. PMID:23024731

Belli, Hasan; Ural, Cenk; Akbudak, Mahir

2012-01-01

112

Socioeconomic inequalities in access to specialized psychotropic prescribing among older Swedes: a register-based study  

PubMed Central

Background: Mental disorders among older adults are mainly treated with psychotropic drugs. Few of these drugs are, however, prescribed by specialized geriatricians or psychiatrists, but rather from general practitioners (GPs). Socioeconomic inequalities in access to specialist prescribing have been found in younger age groups. Hence, we aimed to investigate whether there are socioeconomic differences in access to geriatrician and psychiatrist prescribing of psychotropic drugs among older adults. Methods: By record-linkage of The Swedish Prescribed Drug Register and The Swedish Education Register, we obtained information for persons aged 75–89 years who had filled a prescription for psychotropic drugs (antipsychotics, anxiolytics, hypnotic/sedatives or antidepressants) with information on prescriber specialty from July to October 2005 (n = 221 579). Multinomial regression analysis was used to investigate whether education was associated with geriatrician and psychiatrist prescribing of psychotropic drugs. Results: The vast majority of the psychotropic drugs were prescribed by ‘GPs and other specialists’ (?95% GPs). Older adults with higher educational level were more likely to be prescribed psychotropic drugs from psychiatrists and geriatricians. However, after adjustment for place of residence, the association between patient’s education and prescription by a geriatrician disappeared, whereas the association with seeing a psychiatrist was only attenuated. Conclusion: Access to specialized prescribing of psychotropics is unequally distributed between socioeconomic groups of older adults in Sweden. This finding was partially confounded by place of residence for geriatrician but not for psychiatrist prescribing. Further research should examine if inequalities in specialized psychotropic prescribing translate into worse outcomes for socioeconomically deprived and non-metropolitan-living older individuals. PMID:24860048

Fastbom, Johan; Ringbäck Weitoft, Gunilla; Fors, Stefan; Johnell, Kristina

2014-01-01

113

Drugs prescribed for self poisoners  

Microsoft Academic Search

Of 230 adults admitted for self poisoning over two months, 153 (67%) had previously been taking a total of 309 prescribed drugs. Of these patients, 119 (78%) had been given psychotropic drugs (usually benzodiazepines), 81 (53%) obtained them on repeat prescription, and 47 (31%) had been prescribed multiple psychotropic drugs, often in seemingly illogical combinations. The use of these drugs

L F Prescott; M S Highley

1985-01-01

114

Anatomy of a Prescribed Burn  

NSDL National Science Digital Library

This poster shows how prescribed burns operate, using careful planning and preparation to start a fire that will renew habitat without threatening ecosystems or homes. This image describes the steps required to prepare a prescribed burn, how fire crews set up for the burn, and how the wind is used to help control the fire.

Forestry, Florida D.; Smokeybear.com

115

Impact of atypical antipsychotic use among adolescents with attention-deficit/hyperactivity disorder.  

PubMed

Objectives To compare treatment patterns, resource utilization, and costs to US third-party payers of stimulant-treated adolescent attentiondeficit/ hyperactivity disorder (ADHD) patients who switched to or augmented with atypical antipsychotics (AAPs; not FDA-indicated for ADHD) with those who switched to or augmented with nonantipsychotic medications. Study Design Retrospective cohort study conducted using a US commercial medical/pharmacy claims database. Methods Adolescent patients with an ADHD diagnosis and ? 1 stimulant medication claim between January 2005 and December 2009 were identified. Patients were classified into the AAP or non-antipsychotic cohorts based on subsequent claims for AAPs or nonantipsychotic medications, respectively. Patients with psychiatric diagnoses for which AAPs are often prescribed were excluded. Patients were matched 1:1 from the AAP to the non-antipsychotic cohort using propensity score matching. Treatment patterns, resource utilization, and costs in the 12 months after AAP or non-antipsychotic initiation were compared using Cox models, Poisson regression, and Wilcoxon signed-rank tests, respectively. Results After propensity score matching, a total of 849 adolescents were included in each of the matched cohorts. Patients in the AAP cohort had a significantly higher rate of medication augmentation (27.7% vs 15.5%; hazard ratio = 2.56; 95% confidence interval [CI], 1.90-3.46; P < .001) than patients in the non-antipsychotic cohort. The AAP cohort also had significantly higher incidences of inpatient admissions (0.13 vs 0.05; incidence rate ratio [IRR] = 2.45; 95% CI, 1.73-3.48; P < .001), emergency department visits (0.39 vs 0.31; IRR = 1.27; 95% CI, 1.08-1.49; P = .004), and outpatient visits (14.82 vs 13.19; IRR = 1.12; 95% CI, 1.10-1.15; P < .001), and incurred significantly higher mean annual medical ($3622 vs $3311; P = .002), drug ($4314 vs $2884; P < .001), and total healthcare ($7936 vs $6195; P < .001) costs. Conclusions Stimulant-treated adolescents with ADHD who switched to or augmented with AAPs had significantly greater drug augmentation, healthcare resource utilization, and costs compared with the non-antipsychotic cohort. PMID:25365746

Wong, Vanja S; Pliszka, Steven R; Betts, Keith A; Hodgkins, Paul; Samuelson, Thomas M; Xie, Jipan; Erder, Haim; Dammerman, Ryan S; Robertson, Brigitte; Wu, Eric Q

2014-09-01

116

Cognition, schizophrenia, and the atypical antipsychotic drugs  

E-print Network

­7), although about 15% of patients with schizophrenia test within the normal range in all domains (8); (ivCommentary Cognition, schizophrenia, and the atypical antipsychotic drugs Herbert Y. Meltzer, Northwestern University, Chicago, IL 60208 The Cognitive Deficit in Schizophrenia Schizophrenia was originally

Park, Sohee

117

Role of Long-Acting Injectable Second-Generation Antipsychotics in the Treatment of First-Episode Schizophrenia: A Clinical Perspective  

PubMed Central

Approximately 80% of patients with the first-episode schizophrenia reach symptomatic remission after antipsychotic therapy. However, within two years most of them relapse, mainly due to low levels of insight into the illness and nonadherence to their oral medication. Therefore, although the formal data available is limited, many experts recommend prescribing long-acting injectable second-generation antipsychotics (mostly risperidone or alternatively paliperidone) in the early stages of schizophrenia, particularly in patients who have benefited from the original oral molecule in the past and agree to receive long-term injectable treatment. Early application of long-acting injectable second-generation antipsychotics can significantly reduce the risk of relapse in the future and thus improve not only the social and working potential of patients with schizophrenia but also their quality of life. PMID:22966444

Prikryl, Radovan; Prikrylova Kucerova, Hana; Vrzalova, Michaela; Ceskova, Eva

2012-01-01

118

Higher than Physician's Desk Reference (US) doses on atypical antipsychotics.  

PubMed

The Physician's Desk Reference (PDR) was established to provide for the practicing of a complete listing of all medications with the FDA-approved labelling, including dosage recommendations. Perhaps in order to maximise individual usage of medications, pharmaceutical companies have frequently targeted lowest possible doses for FDA approval. However, many patients with a variety of illnesses due to resistance and/or multiple illnesses, may need higher than these dose ranges to maximise therapeutic response. In terms of regularly prescribed atypical antipsychotics released over the past 10 years, only risperidone initially obtained approval for a dose for psychosis (16 mg) higher than that suggested currently (maximum of 8 mg). The dose that was approved for mania was lower: a maximum of 6 mg. The others: respectfully, olanzapine (schizophrenia: 15 mg, mania: 20 mg), quetiapine (schizophrenia: 750 mg; mania: 800 mg), ziprasidone (schizophrenia and mania: 160 mg) and aripiprazole (schizophrenia and mania: 30 mg) obtained approvals for psychosis that may limit adverse events but, at the same time, limit benefits. Other data from various sources (double-blind trials, open-label trials, reviews and case reports) have found safety and/or efficacy for the following maximum doses: olanzapine (40 mg), quetiapine (1600 mg), ziprasidone (320 mg) and aripiprazole (75 mg). Reports above those doses are included, but either are insufficient in numbers or bring up questions on safety. In many situations, feared increase in adverse events were not magnified by use of higher doses. PMID:16011445

Goodnick, Paul J

2005-07-01

119

Prescribed Range Burning in Texas  

E-print Network

Prescribed burning is an effective brush management technique for improving pasture accessibility and increasing the production of forage and browse. Fire also suppresses most brush and cactus species. This bulletin discusses how to plan...

White, Larry D.; Hanselka, C. Wayne

2000-04-25

120

Neuroleptic Malignant Syndrome in Children and Adolescents on Atypical Antipsychotic Medication: A Review  

PubMed Central

Abstract Objective Neuroleptic malignant syndrome (NMS) is a severe iatrogenic complication of treatment with antipsychotic medication. The purpose of this report is to examine the published cases of NMS in children and adolescents receiving atypical antipsychotic medication and review early warning symptoms, risk factors, and treatment in this population. Method An extensive review of the literature from 1990 to 2008 was conducted via computerized searches (PubMed and Ovid) to identify case reports. Descriptive statistics were employed to describe our findings. Results There were 23 episodes in 20 subjects, with ages ranging from 11 to 18 years. Increased creatine phosphokinase (CPK) was the most common finding (100%), followed by fever (78%), tachycardia (74%), rigidity (70%), and altered mental status (61%). The number of NMS symptoms ranged from 1 to 11 (mean 4.7?±?2.4) and positive laboratory findings ranged from 1 to 4 (2.2?±?1). The duration of NMS (mean 6.1?±?6.4 days) was one third of the duration associated with typical antipsychotics. Patients treated with bromocriptine had a shorter duration of illness, whereas the same was not true for those receiving dantrolene. In all cases, the NMS symptoms eventually resolved and there were no reported deaths or permanent sequelae. Conclusions NMS is a serious condition. Symptom presentation related to atypical agents differs from that seen with older antipsychotic medications. PMID:19702493

Lindenmayer, Jean-Pierre; Silva, Raul

2009-01-01

121

How antipsychotics become anti-"psychotic"--from dopamine to salience to psychosis.  

PubMed

The relationship between dopamine, psychosis and antipsychotics has been challenged by the suggestion that there is a delay, of weeks, between the onset of dopamine receptor blockade and improvement in psychosis. However, recent data show that there is no significant delay. In light of these new findings, it is proposed that dopamine, through its role in reward prediction and motivational salience, provides a link to psychosis. Psychosis results from aberrant reward prediction and aberrant attribution of salience that is caused by disordered dopamine transmission. Antipsychotics become anti-"psychotic" by blocking dopamine transmission and attenuating the motivational salience of the symptoms, leading to the common statement from patients that symptoms "don't bother me as much anymore". This attenuation of salience also impacts on normal motivational drives, providing an explanation for why antipsychotics might induce iatrogenic negative symptoms and dysphoria, often leading to non-compliance by patients. The implications of this framework for relapse and other clinical phenomena, animal models and future studies are discussed. PMID:15276708

Kapur, Shitij

2004-08-01

122

Lack of Effect of Stimulant Combination with Second-Generation Antipsychotics on Weight Gain, Metabolic Changes, Prolactin Levels, and Sedation in Youth with Clinically Relevant Aggression or Oppositionality  

PubMed Central

Abstract Background Second-generation antipsychotics (SGAs) are associated with weight gain, metabolic abnormalities, sedation/sleep disturbance, and prolactin abnormalities, especially in youths. Although stimulants have opposing dopamine receptor and adverse effects, it is unclear whether stimulant co-treatment counteracts the therapeutic or side effects of antipsychotics. Methods This was a naturalistic cohort study including 153 antipsychotic trials in youths aged 4–19 (mean, 11.3 ± 3.0) years, started on an SGA for clinically significant aggression or oppositionality associated with oppositional defiant disorder, conduct disorder, disruptive behavior disorder not otherwise specified (NOS), impulse control disorder NOS, intermittent explosive disorder, Tourette's disorder, autistic disorder, and pervasive developmental disorder NOS. Patients underwent fasting assessments of body composition, lipids, glucose, insulin, prolactin, sedation, and general efficacy at baseline, weeks 4, 8, and 12, comparing patients co-prescribed stimulants (n?=?71) with those not co-prescribed stimulants (n?=?82). Results Patients received risperidone (33.3%), aripiprazole (29.4%), quetiapine (18.4%), olanzapine (11.8%), ziprasidone (5.9%), or clozapine (0.7%). With and without adjustment for differences in baseline variables (sex, prior stimulant use, primary Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV] disorders, co-morbid attention-deficit/hyperactivity disorder [ADHD], present in 46.3% of youths not receiving stimulants, and some body composition parameters), patients on versus off stimulants did not differ on any of the assessed outcomes (all p values???0.1). Conclusions In contrast to guidelines, stimulant use did not precede or accompany antipsychotic use during the current episode of aggression/oppositionality in almost half of those youths who had aggressive/oppositional behavior and a DSM-IV diagnosis of ADHD. At the clinically prescribed doses, stimulant co-treatment of SGAs did not seem to significantly reduce antipsychotic effects on body composition, metabolic parameters, prolactin, sedation, and broad efficacy. PMID:19877981

Penzner, Julie B.; Dudas, Melissa; Saito, Ema; Olshanskiy, Vladimir; Parikh, Umesh H.; Kapoor, Sandeep; Chekuri, Raja; Gadaleta, Dominick; Avedon, Jennifer; Sheridan, Eva M.; Randell, Jane; Malhotra, Anil K.; Kane, John M.

2009-01-01

123

Prescribing in prison: minimizing psychotropic drug diversion in correctional practice.  

PubMed

Correctional facilities are a major provider of mental health care throughout the United States. In spite of the numerous benefits of providing care in this setting, clinicians are sometimes concerned about entering into correctional care because of uncertainty in prescribing practices. This article provides an introduction to prescription drug use, abuse, and diversion in the correctional setting, including systems issues in prescribing, commonly abused prescription medications, motivation for and detection of prescription drug abuse, and the use of laboratory monitoring. By understanding the personal and systemic factors that affect prescribing habits, the clinician can develop a more rewarding correctional practice and improve care for inmates with mental illness. PMID:24532812

Pilkinton, Patricia D; Pilkinton, James C

2014-04-01

124

Development of a core drug list towards improving prescribing education and reducing errors in the UK  

PubMed Central

AIM To develop a core list of 100 commonly prescribed drugs to support prescribing education. METHODS A retrospective analysis of prescribing data from primary care in England (2006 and 2008) and from two London Teaching Hospitals (2007 and 2009) was performed. A survey of prescribing by foundation year 1 (FY1) doctors in 39 NHS Trusts across London was carried out. RESULTS A core list of 100 commonly prescribed drugs comprising ?0.1% prescriptions in primary and/or secondary care was developed in 2006/7. The core list remained stable over 2 years. FY1 doctors prescribed 65% drugs on the list at least monthly. Seventy-six% of FY1 doctors did not regularly prescribe any drugs not on the core list. There was a strong correlation between prescribing frequency (prescriptions for each drug class expressed as percentage of all prescriptions written) and error rate described in the EQUIP study (errors made when prescribing each drug class expressed as a percentage of all errors made), n= 39, r= 0.861, P= 0.000. CONCLUSIONS Our core drug list identifies drugs that are commonly used and associated with error and is stable over at least 2 years. This list can now be used to develop learning resources and training programmes to improve prescribing of drugs in regular use. Complementary skills required for prescribing less familiar drugs must be developed in parallel. Ongoing research is required to monitor the effect of new training initiatives on prescribing error and patient safety. PMID:21219399

Baker, Emma; Pryce Roberts, Adele; Wilde, Kirsty; Walton, Hannah; Suri, Sati; Rull, Gurvinder; Webb, Andrew

2011-01-01

125

Adverse Effects and Toxicity of the Atypical Antipsychotics: What is Important for the Pediatric Emergency Medicine Practitioner  

PubMed Central

Medications are being used with greater frequency to address pediatric mental health problems, and in recent years atypical antipsychotic (AAP) prescriptions have increased more than any other class. Acute care practitioners must be aware of the pharmacology of AAPs and the conditions, on- and off-label, for which they are prescribed. This involves identifying and managing side effects that manifest both mentally and physically. Although “atypicality” confers a lower risk of movement side effects compared to conventional agents, children are more sensitive than adults to extrapyramidal reactions. Like adults, they also may present with toxic sedation, confusion, cardiovascular dysfunction, and metabolic derangements. Evaluation and management of these toxicities requires an index of suspicion, a careful symptom and medication history, physical examination, and targeted interventions. This review is designed to orient the emergency practitioner to the challenging task of recognizing and treating adverse effects related to acute and chronic atypical antipsychotic exposure in children. PMID:23471213

Rasimas, J.J.; Liebelt, Erica L.

2012-01-01

126

Mobile phone text message reminders of antipsychotic medication: is it time and who should receive them? A cross-sectional trust-wide survey of psychiatric inpatients  

PubMed Central

Background Poor adherence to antipsychotic medication is a widespread problem, and the largest predictor of relapse in patients with psychosis. Electronic reminders are increasingly used to improve medication adherence for a variety of medical conditions, but have received little attention in the context of psychotic disorders. We aimed to explore the feasibility and acceptability of including short message service (SMS) medication reminders in the aftercare plan of service users discharged from inpatient care on maintenance antipsychotic medication. Methods We conducted a cross-sectional, trust-wide survey in the inpatient units of the Oxleas National Health Service (NHS) Foundation Trust in the UK between June 29 and August 3, 2012. Using a self-report questionnaire and the Drug Attitude Inventory, we examined inpatient attitudes towards antipsychotic drugs, past adherence to antipsychotic medication, frequency of mobile phone ownership, and interest in receiving SMS medication reminders upon discharge from the ward. Predictors of a patient’s interest in receiving electronic reminders were examined using simple logistic regression models. Results Of 273 inpatients, 85 met eligibility criteria for the survey, showed decisional capacity, and agreed to participate. Of the 85 respondents, over a third (31-35%) admitted to have forgotten to take/collect their antipsychotic medication in the past, and approximately half (49%) to have intentionally skipped their antipsychotics or taken a smaller dose than prescribed. Male patients (55%), those with negative attitudes towards antipsychotics (40%), and those unsatisfied with the information they received on medication (35%) were approximately 3 to 4 times more likely to report past intentional poor adherence. The large majority of respondents (80-82%) reported having a mobile phone and knowing how to use SMS, and a smaller majority (59%) expressed an interest in receiving SMS medication reminders after discharge. No variable predicted a patient’s interest in receiving electronic reminders of antipsychotics. Conclusions Automatic SMS reminders of antipsychotic medication were acceptable to the majority of the survey respondents as an optional service offered upon discharge from inpatient care. Automatic electronic reminders deserve further investigation as a flexible, minimally invasive, cost-effective and broadly applicable tool that can potentially improve antipsychotic adherence and clinical outcomes. PMID:24447428

2014-01-01

127

Antibiotic Prescribing Trends in an Omani Paediatric Population  

PubMed Central

Objectives: This study aimed to evaluate antibiotic prescribing patterns for paediatric patients at Sultan Qaboos University Hospital (SQUH), a tertiary care hospital in Muscat, Oman. Methods: This retrospective cross-sectional study included all 1,186 prescriptions issued for 499 patients at the paediatric outpatient clinic and paediatric inpatient ward at SQUH between March and May 2012. Results: Of the 499 patients, 138 (27.6%) were prescribed a total of 28 different antibiotics. A total of 185 (15.6%) antibiotic prescriptions were issued among the total drug prescriptions. Preschool children aged 0–6 years were prescribed antibiotics most frequently (n = 110). Co-amoxiclav was the most commonly prescribed antibiotic in both inpatients and outpatients (27.0% and 33.9%, respectively), followed by cefuroxime in inpatients (13.5%) and azithromycin in outpatients (18.6%). Co-amoxiclav was the most commonly prescribed antibiotic in both 0–6 (31.3%) and 7–11 (23.3%) year-olds, while cefuroxime was most commonly prescribed in children ?12 years old (25.0%). Conclusion: Antibiotic prescription patterns in this population were similar to those in North America, Europe and Asia. To confirm the findings of this study, further research on antibiotic prescription trends across the wider paediatric population of Oman should be initiated. PMID:25364552

Al-Balushi, Khalid; Al-Ghafri, Fatma; Al-Sawafi, Fatma; Al-Zakwani, Ibrahim

2014-01-01

128

Role of atypical antipsychotics in the treatment of generalized anxiety disorder.  

PubMed

Evidence-based treatment approaches for generalized anxiety disorder (GAD) comprise psychotherapy, pharmacotherapy, or a combination of the two. First-line pharmacotherapy agents include selective serotonin reuptake inhibitors, selective serotonin-norepinephrine reuptake inhibitors, and, in certain European guidelines, pregabalin, which gained European Commission approval. Although short- and long-term efficacy have been established for these agents in controlled trials, response rates of 60-70 % are insufficient, remission rates are relatively modest, and relapse rates considerable. Moreover, questions increasingly arise regarding tolerability and side-effect profiles. As an alternative, antipsychotics have long been of interest for the treatment of anxiety disorders, but investigation had been tempered by their potential for irreversible side effects. With the improved side-effect profiles of atypical antipsychotics, these agents are increasingly being investigated across Axis I disorders. Atypical antipsychotics such as quetiapine, aripiprazole, olanzapine, and risperidone have been shown to be helpful in addressing a range of anxiety and depressive symptoms in individuals with schizophrenia and schizoaffective disorders, and have since been used in the treatment of a range of mood and anxiety disorders. In this article, we review the efficacy and tolerability of atypical antipsychotics as adjunctive therapy and/or monotherapy for individuals with GAD, a currently off-label indication. The most evidence has accumulated for quetiapine. Findings suggest that approximately 50 % of participants tolerate the side effects, most commonly sedation and fatigue. Among this subset, those who continue treatment demonstrate significant reductions in anxiety when used as adjunctive therapy or monotherapy. The appropriateness of the use of antipsychotics in the treatment of GAD is discussed. PMID:24794100

Hershenberg, Rachel; Gros, Daniel F; Brawman-Mintzer, Olga

2014-06-01

129

A score for prescribing digoxin.  

PubMed Central

A simple method of selecting a maintenance dose of digoxin, suitable for an adult patient, was derived from data on 129 patients taking digoxin. Eight items of readily available information are required for entry into the prescribing aid: out/inpatient status, sex, age (less/not less than 70 years), weight (allocated to one of four ranges), whether or not chronically house/chair bound, cardiac rhythm (sinus/other), serum creatinine concentration (allocated to one of four ranges), and diuretic therapy (prescribed/not prescribed). The recommended dose is given in terms of size and number of tablets to be prescribed. Using this method 72.3 per cent of patients are expected to achieve mean steady state serum digoxin concentrations within the therapeutic range, 6.5 per cent above and 21.2 per cent below. This performance would be considerably better than that expected from the use of other prescribing aids. If available, routine measurement of the serum digoxin concentration during follow-up is recommended to detect those who might benefit from a change, usually an increase, in dose. PMID:637967

Nicholson, P W; Dobbs, S M; McGill, A P; Rodgers, E M; Slater, E

1978-01-01

130

Methodological Issues in Current Antipsychotic Drug Trials  

PubMed Central

Every year numerous reports on antipsychotic drug trials are being published in neuropsychiatric journals, adding new information to our knowledge in the field. The information however is often hard for the reader to interpret, sometimes contradictory to comparable available studies and leaves more questions open than it actually answers. Although the overall quality of the studies is rather good, there are manifold options for further improvement in the conception, conduct, and reporting of antipsychotic drug trials. In this survey, we address methodological challenges such as the limited generalizability of outcomes due to patient selection and sample size; the vague or even lacking definition of key outcome parameters such as response, remission or relapse, insufficient blinding techniques, the pitfalls of surrogate outcomes and their assessment tools; the varying complex statistical approaches; and the challenge of balancing various ways of reporting outcomes. The authors present practical examples to highlight the current problems and propose a concrete series of suggestions on how to further optimize antipsychotic drug trials in the future. PMID:18234700

Leucht, Stefan; Heres, Stephan; Hamann, Johannes; Kane, John M.

2008-01-01

131

Glutamate agonist activity: implications for antipsychotic drug action and schizophrenia.  

PubMed

Antagonist action at dopamine D2 receptors appears to explain many, but not all of the effects of antipsychotic drugs. Because of the interactions of dopamine with glutamate, and the implication of the latter in the etiology of schizophrenia, possible effects of antipsychotic drugs on glutamate receptors were assessed in the present experiments. These studies showed that, at clinically relevant concentrations, the conventional neuroleptic haloperidol and the atypical antipsychotic clozapine had potent augmenting influences on the NMDA receptor. These data suggest that unique action at glutamate receptors may contribute to antipsychotic efficacy and emphasize the potential importance of glutamatergic dysfunction in the etiology of schizophrenia. PMID:8741750

Banerjee, S P; Zuck, L G; Yablonsky-Alter, E; Lidsky, T I

1995-12-15

132

How can we improve junior doctor prescribing?  

PubMed

The large number of medications available has complicated the learning of drug therapy for medical students at a time when pharmacology training has been substantially reduced. Attempts to remedy this include: improving the pharmaco-therapeutics curriculum; interactive web-based learning and students developing a personal formulary. The approach adopted by the University of Wollongong Medical School is to integrate clinical pharmacology throughout the course, with the Student Preferred-drugs Formulary linking pharmacology and common diseases. Evidence from other countries suggests this should enhance prescribing by medical graduates. PMID:24020344

Gaetani, L; Yeo, W W

2012-09-01

133

Tardive Dyskinesia and Intellectual Disability: An Examination of Demographics and Topography in Adults with Dual Diagnosis and Atypical Antipsychotic Use  

ERIC Educational Resources Information Center

Atypical antipsychotic medications are commonly used in large-scale residential care facilities for adults with developmental disabilities. While the benefits of this class of psychotropics are noted, debate exists whether the side effect profile of these medications outweigh their therapeutic benefit, especially in those who use them long-term.…

Fodstad, Jill C.; Bamburg, Jay W.; Matson, Johnny L.; Mahan, Sara; Hess, Julie A.; Neal, Daniene; Holloway, Jodie

2010-01-01

134

Antipsychotics for the Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD)  

PubMed Central

Behavioral and psychological symptoms of dementia (BPSD), i.e. verbal and physical aggression, agitation, psychotic symptoms (hallucinations and delusions), sleep disturbances, oppositional behavior, and wandering, are a common and potentially severe problem complicating dementia. Their prevalence is very high and it is estimated that up to 90% of patients with Alzheimer’s disease (AD) may present at least one BPSD. Beside the obvious impact on the quality of life of people with dementia, BPSD are responsible for increased risk of patient institutionalization and increased costs. Furthermore, they are associated with caregivers’ stress and depression. Drugs used include antipsychotics, antidepressants, anticonvulsivants, anxiolytics, cholinesterase inhibitors and N-methyl-D-aspartate receptor modulators. Among these, the most commonly used are anti-psychotics. These drugs have been used for many decades, but in the last years new compounds have been marketed with the promise of comparable efficacy but less frequent adverse effects (especially extra-pyramidal side effects). Their safety, however, has been challenged by data showing a potential increase in adverse cerebrovascular side effects and mortality. This review will summarize the pathophysiology and neuropharmacology of BPSD, it will describe the characteristics of the anti-psychotics most commonly used focusing on their efficacy and safety in BPSD. PMID:19305792

Liperoti, Rosa; Pedone, Claudio; Corsonello, Andrea

2008-01-01

135

[Formal criteria for good prescribing in the hospital].  

PubMed

The provision of drugs to hospitalised patients is a complex process with the involvement of different healthcare professionals. As pharmacotherapy is (1) one of the most common medical interventions, (2) a high-risk procedure, and (3) affects the majority of hospitalised patients, medication errors have sustainable impact on patient safety. Although medication errors can occur at different stages of drug use (prescribing, dispensing, administration), they are most likely within the prescribing process. According to the Reason's model of accident causation, these errors can be divided into active failures, error-provoking conditions, and latent conditions. Commonly, the complex interaction between lacking knowledge and/or experience, rule-based mistakes, skill-based slips and memory lapses, inadequate working environment (exessive work load, fatigue) as well as poor communication and safety culture is causative for prescribing errors. Therefore, good prescribing should include the following items: Adherence to formal criteria (e. g. avoidance of abbreviations), performance of medication reconciliation, implementation of an electronic prescribing system (computerised physician order entry, CPOE) - preferably combined with a clinical decision support system (CDSS), education and training as well as the establishment of a positive error management culture. The implementation of recommendations to reduce prescribing errors is described on the basis of established processes in hospitals. PMID:24867349

Langebrake, Claudia; Melzer, Simone; Baehr, Michael

2014-06-01

136

Reducing prescribing error: competence, control, and culture  

Microsoft Academic Search

Medication errors are probably the most prevalent form of medical error, and prescribing errors are the most important source of medication errors. In this article we suggest interventions are needed at three levels to improve prescribing: (1) improve the training, and test the competence, of prescribers; (2) control the environment in which prescribers perform in order to standardise it, have

N Barber; M Rawlins; B Dean Franklin

2003-01-01

137

Prescribing, Professional Identity, and Costs  

Microsoft Academic Search

Prescriptive authority is not a back alley way to the practice of psychiatry, according to this survey of nurse psychologists. Only 5% of the 266 nurse psychologists with an option to pursue prescriptive authority as advanced nurse practitioners or clinical nurse specialists had availed themselves of this opportunity and were prescribing. Liability insurance premiums for advanced nurse practitioners who can

Jack G. Wiggins; Danny Wedding

2004-01-01

138

Exercise: Issues for prescribing psychologists  

Microsoft Academic Search

Exercise has been associated with many psychological and physiological benefits. Increasing numbers of psychologists wish to prescribe exercise for their clients. The article warns that to do so requires special training. The author reviews the issues involved in exercise prescription: benefits and risks, nonadherence, exercise ignorance, safety, professional domain violations, ethical responsibility, and legal liability. The review concludes with recommendations

Mary Clearing-sky

1988-01-01

139

Independent pharmacist prescribing in Canada  

PubMed Central

Background: While pharmacists are trained in the selection and management of prescription medicines, traditionally their role in prescribing has been limited. In the past 5 years, many provinces have expanded the pharmacy scope of practice. However, there has been no previous systematic investigation and comparison of these policies. Methods: We performed a comprehensive policy review and comparison of pharmacist prescribing policies in Canadian provinces in August 2010. Our review focused on documents, regulations and interviews with officials from the relevant government and professional bodies. We focused on policies that allowed community pharmacists to independently continue, adapt (modify) and initiate prescriptions. Results: Pharmacists could independently prescribe in 7 of 10 provinces, including continuing existing prescriptions (7 provinces), adapting existing prescriptions (4 provinces) and initiating new prescriptions (3 provinces). However, there was significant heterogeneity between provinces in the rules governing each function. Conclusions: The legislated ability of pharmacists to independently prescribe in a community setting has substantially increased in Canada over the past 5 years and looks poised to expand further in the near future. Moving forward, these programs must be evaluated and compared on issues such as patient outcomes and safety, professional development, human resources and reimbursement. PMID:23509483

Law, Michael R.; Ma, Tracey; Fisher, Judith; Sketris, Ingrid S.

2012-01-01

140

Prescribing flexibility through prescription compounding  

Microsoft Academic Search

Compounding pharmacists can assist the patients of phy- sicians and other licensed prescribers by providing them with access to unique medications and dosage forms. Phar- macists trained in the art and science of compounding are opening specialty compounding pharmacies to aid those who require individualized medication. A patient in need of a preservative-free medication, a medication that is no longer

Scott Brown

2008-01-01

141

How antipsychotics become anti-‘psychotic’ – from dopamine to salience to psychosis  

Microsoft Academic Search

The relationship between dopamine, psychosis and antipsychotics has been challenged by the suggestion that there is a delay, of weeks, between the onset of dopamine receptor blockade and improvement in psychosis. However, recent data show that there is no significant delay. In light of these new findings, it is proposed that dopamine, through its role in reward prediction and motivational

Shitij Kapur

2004-01-01

142

Can antipsychotic treatment contribute to drug addiction in schizophrenia?  

PubMed

Individuals with schizophrenia are at very high risk for drug abuse and addiction. Patients with a coexisting drug problem fare worse than patients who do not use drugs, and are also more difficult to treat. Current hypotheses cannot adequately account for why patients with schizophrenia so often have a co-morbid drug problem. I present here a complementary hypothesis based on evidence showing that chronic exposure to antipsychotic medications can induce supersensitivity within the brain's dopamine systems, and that this in turn can enhance the rewarding and incentive motivational effects of drugs and reward cues. At the neurobiological level, these effects of antipsychotics are potentially linked to antipsychotic-induced increases in the striatal levels of dopamine D2 receptors and D2 receptors in a high-affinity state for dopamine, particularly at postsynaptic sites. Antipsychotic-induced dopamine supersensitivity and enhanced reward function are not inevitable consequences of prolonged antipsychotic treatment. At least two parameters appear to promote these effects; the use of antipsychotics of the typical class, and continuous rather than intermittent antipsychotic exposure, such that silencing of dopaminergic neurotransmission via D2/3 receptors is unremitting. Thus, by inducing forms of neural plasticity that facilitate the ability of drugs and reward cues to gain control over behaviour, some currently used treatment strategies with typical antipsychotics might contribute to compulsive drug seeking and drug taking behaviours in vulnerable schizophrenia patients. PMID:23793001

Samaha, Anne-Noël

2014-07-01

143

Atypical antipsychotics: Impact on overall health and quality of life  

Microsoft Academic Search

The use of antipsychotic medications for the treatment of schizophrenia requires a detailed assessment of patient history, including comorbidities and concomitant medications. Because all antipsychotics may produce a complex array of adverse effects, the patient's drug therapy may lead to exacerbation of pre-existent health problems and impaired quality of life. The occurrence of drug-related side effects such as cardiac disturbances,

Mary Ann Boyd

2002-01-01

144

The use of second-generation antipsychotics and the changes in physical growth in children and adolescents with perinatally acquired HIV.  

PubMed

Second-generation antipsychotics (SGAs) are increasingly prescribed to treat psychiatric symptoms in pediatric patients infected with HIV. We examined the relationship between prescribed SGAs and physical growth in a cohort of youth with perinatally acquired HIV-1 infection. Pediatric AIDS Clinical Trials Group (PACTG), Protocol 219C (P219C), a multicenter, longitudinal observational study of children and adolescents perinatally exposed to HIV, was conducted from September 2000 until May 2007. The analysis included P219C participants who were perinatally HIV-infected, 3-18 years old, prescribed first SGA for at least 1 month, and had available baseline data prior to starting first SGA. Each participant prescribed an SGA was matched (based on gender, age, Tanner stage, baseline body mass index [BMI] z score) with 1-3 controls without antipsychotic prescriptions. The main outcomes were short-term (approximately 6 months) and long-term (approximately 2 years) changes in BMI z scores from baseline. There were 236 participants in the short-term and 198 in the long-term analysis. In linear regression models, youth with SGA prescriptions had increased BMI z scores relative to youth without antipsychotic prescriptions, for all SGAs (short-term increase = 0.192, p = 0.003; long-term increase = 0.350, p < 0.001), and for risperidone alone (short-term = 0.239, p = 0.002; long-term = 0.360, p = 0.001). Participants receiving both protease inhibitors (PIs) and SGAs showed especially large increases. These findings suggest that growth should be carefully monitored in youth with perinatally acquired HIV who are prescribed SGAs. Future research should investigate the interaction between PIs and SGAs in children and adolescents with perinatally acquired HIV infection. PMID:19827949

Kapetanovic, Suad; Aaron, Lisa; Montepiedra, Grace; Sirois, Patricia A; Oleske, James M; Malee, Kathleen; Pearson, Deborah A; Nichols, Sharon L; Garvie, Patricia A; Farley, John; Nozyce, Molly L; Mintz, Mark; Williams, Paige L

2009-11-01

145

The Use of Second-Generation Antipsychotics and the Changes in Physical Growth in Children and Adolescents with Perinatally Acquired HIV  

PubMed Central

Abstract Second-generation antipsychotics (SGAs) are increasingly prescribed to treat psychiatric symptoms in pediatric patients infected with HIV. We examined the relationship between prescribed SGAs and physical growth in a cohort of youth with perinatally acquired HIV-1 infection. Pediatric AIDS Clinical Trials Group (PACTG), Protocol 219C (P219C), a multicenter, longitudinal observational study of children and adolescents perinatally exposed to HIV, was conducted from September 2000 until May 2007. The analysis included P219C participants who were perinatally HIV-infected, 3–18 years old, prescribed first SGA for at least 1 month, and had available baseline data prior to starting first SGA. Each participant prescribed an SGA was matched (based on gender, age, Tanner stage, baseline body mass index [BMI] z score) with 1–3 controls without antipsychotic prescriptions. The main outcomes were short-term (approximately 6 months) and long-term (approximately 2 years) changes in BMI z scores from baseline. There were 236 participants in the short-term and 198 in the long-term analysis. In linear regression models, youth with SGA prescriptions had increased BMI z scores relative to youth without antipsychotic prescriptions, for all SGAs (short-term increase?=?0.192, p?=?0.003; long-term increase?=?0.350, p?prescribed SGAs. Future research should investigate the interaction between PIs and SGAs in children and adolescents with perinatally acquired HIV infection. PMID:19827949

Aaron, Lisa; Montepiedra, Grace; Sirois, Patricia A.; Oleske, James M.; Malee, Kathleen; Pearson, Deborah A.; Nichols, Sharon L.; Garvie, Patricia A.; Farley, John; Nozyce, Molly L.; Mintz, Mark; Williams, Paige L.

2009-01-01

146

Evidence base for using atypical antipsychotics for psychosis in adolescents.  

PubMed

Atypical antipsychotic medications have been the first line of treatment for adolescents with psychosis in the past couple of decades. Till the late 90s, there were very few randomized controlled trials (RCTs) on the treatment of adolescents with psychosis, although a fifth of schizophrenia starts during adolescence. Most of the treatment guidelines for adolescents with psychosis were derived from data on adults. In the past 10 years, there has been increasing number of studies on adolescents with psychosis. The current paper summarizes the findings of trials on adolescents with psychosis in 4 groups: (a) atypical antipsychotic medications vs placebo, (b) atypical antipsychotic medication vs typical antipsychotic medications, (c) one atypical antipsychotic medication vs another atypical antipsychotic medication, and (d) Low dose vs standard dose of atypical antipsychotic medication. We included 13 RCTs, with a total of 1112 participants. Although our review suggest that atypical antipsychotic medications are as effective as typical antipsychotic medications as regards clinical efficacy, atypical antipsychotic medications have a preferred side effect profile and lesser drop-out rate from trials. Obviously, this is extremely important as treatment adherence is key to successful remission of psychotic symptoms and also in some case prevent relapse of illness. Treatment with olanzapine, risperidone, and clozapine is often associated with weight gain. Aripiprazole is not associated with increased prolactin or with dyslipidemia. Adolescents may respond better to standard-dose as opposed to lower dose risperidone, but for aripiprazole and ziprasidone, lower doses may be equally effective. Future trial should be longer term and have uniform ways of reporting side effects. PMID:24361758

Datta, Soumitra S; Kumar, Ajit; Wright, Stephen D; Furtado, Vivek A; Russell, Paul S

2014-03-01

147

Antipsychotic monotherapy among outpatients with schizophrenia treated with olanzapine or risperidone in Japan: a health care database analysis  

PubMed Central

Purpose Antipsychotic monotherapy is often recommended over antipsychotic polypharmacy because of fewer adverse events, reduced treatment complexity, and lower medication cost. This study compared the rate and the duration of antipsychotic monotherapy following initiation of olanzapine or risperidone in the treatment of outpatients with schizophrenia in Japan. Methods Outpatients diagnosed with schizophrenia in the Japan Medical Data Center database were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, diagnosis codes. Patients were between 20 and 65 years old, initiated on olanzapine or risperidone therapy between August 2003 and July 2008, and continuously enrolled during the 6 months prior to and the 12 months following the initiation date. Antipsychotic polypharmacy was defined as concurrent use of two or more antipsychotics. The probability of monotherapy during the 12-month follow-up period was assessed using a propensity score-adjusted generalized estimating equation model. Duration of monotherapy was contrasted using a propensity score-adjusted bootstrapping model. Results After applying all inclusion and exclusion criteria, the final analytic sample consisted of 332 olanzapine- and 496 risperidone-treated outpatients. At treatment initiation, 61.5% of the olanzapine-treated patients and 45.6% of the risperidone-treated patients received antipsychotic monotherapy (P < 0.001). After correcting for background differences, monotherapy was more common among olanzapine-treated patients (P = 0.001). In addition, olanzapine was used as monotherapy for a longer duration (P = 0.006). Conclusion Consistent with prior global research, this retrospective naturalistic study of schizophrenia outpatients in Japan found that olanzapine is more likely to be used as monotherapy and to be used as monotherapy for a longer duration than risperidone. PMID:22745559

Ye, Wenyu; Ascher-Svanum, Haya; Tanji, Yuka; Flynn, Jennifer A; Takahashi, Michihiro; Conley, Robert R

2012-01-01

148

Study protocol: safety correction of high dose antipsychotic polypharmacy in Japan  

PubMed Central

Background In Japan, combination therapy with high doses of antipsychotic drugs is common, but as a consequence, many patients with schizophrenia report extrapyramidal and autonomic nervous system side effects. To resolve this, we proposed a method of safety correction of high dose antipsychotic polypharmacy (the SCAP method), in which the initial total dose of all antipsychotic drugs is calculated and converted to a chlorpromazine equivalent (expressed as milligrams of chlorpromazine, mg CP). The doses of low-potency antipsychotic drugs are then reduced by???25 mg CP/week, and the doses of high-potency antipsychotics are decreased at a rate of ?50 mg CP/week. Although a randomized, case-controlled comparative study has demonstrated the safety of this method, the number of participants was relatively small and its results required further validation. In this study of the SCAP method, we aimed to substantially increase the number of participants. Methods/design The participants were in- or outpatients treated with two or more antipsychotics at doses of 500–1,500 mg CP/day. Consenting participants were randomized into control and dose reduction groups. In the control group, patients continued with their normal regimen for 3 months without a dose change before undergoing the SCAP protocol. The dose reduction group followed the SCAP strategy over 3–6 months with a subsequent 3-month follow-up period. Outcome measures were measured at baseline and then at 3-month intervals, and included clinical symptoms measured on the Manchester scale, the extent of extrapyramidal and autonomic side effects, and quality of life using the Euro QOL scale. We also measured blood drug concentrations and drug efficacy-associated biochemical parameters. The Brief Assessment of Cognition in Schizophrenia, Japanese version, was also undertaken in centers where it was available. Discussion The safety and efficacy of the SCAP method required further validation in a large randomized trial. The design of this study aimed to address some of the limitations of the previous case-controlled study, to build a more robust evidence base to assist clinicians in their efforts to reduce potentially harmful polypharmacy in this vulnerable group of patients. Trial registration UMIN Clinical Trials Registry 000004511. PMID:24708857

2014-01-01

149

Extrapyramidal Side Effects of Antipsychotic Treatment: Scope of Problem and Impact on Outcome  

Microsoft Academic Search

clinicians worked with antipsychotic drugs (conventional or typical) that almost invariably caused extrapyramidal symptoms (EPS) at clinically effective doses. This led to the false impression that all antipsychotics were the same, and that EPS were an unavoidable consequence of effective antipsychotic therapy. EPS adversely impact several aspects of antipsychotic efficacy and tolerability, thereby worsening outcome of afflicted individuals. EPS reduce

Rajiv Tandon; Michael D. Jibson

2002-01-01

150

Prescribing and partnership with patients.  

PubMed

There have been widespread changes in society and the roles of professionals. This change is also reflected in health care, where there is now acceptance of the need to involve patients in decision making. In prescribing specifically, the concordance agenda was developed alongside these initiatives to encourage improved medication taking and reduce wastage. However the extent to which these partnerships are delivered in practice remains unclear. This paper explores some of the issues to be considered when preparing patients and professionals for partnership and summarizes the limited evidence of barriers to, and benefits of, this approach. Firstly patients must be given the confidence, skills and knowledge to be partners. They need information about medicines, provided in ways known to be acceptable to them. Likewise professionals may need new skills to be partners. They need to understand the patient agenda and may need training and support to change the ways in which they consult with patients. There are also practical issues such as the perceived increase in time taken when consulting in partnership mode, room layout, computer interfaces and record keeping. Health care professionals other than doctors are also expected to behave in partnership mode, whether this is as prescribers in their own right or in supporting the prescribing of others. Whilst much has been claimed for the benefit of partnership approaches, hard evidence is limited. However whilst there is still much more to understand there will be no going back to the paternalistic model of the mid 20th century. PMID:22621201

Bond, Christine; Blenkinsopp, Alison; Raynor, David K

2012-10-01

151

Amisulpride versus other atypical antipsychotics for schizophrenia  

PubMed Central

Background In many countries of the industrialised world second generation (atypical) antipsychotics have become first line drug treatments for people with schizophrenia. The question as to whether, and if so how much, the effects of the various second generation antipsychotics differ is a matter of debate. In this review we examine how the efficacy and tolerability of amisulpride differs from that of other second generation antipsychotics. Objectives To evaluate the effects of amisulpride compared with other atypical antipsychotics for people with schizophrenia and schizophrenia-like psychoses. Search methods We searched the Cochrane Schizophrenia Group Trials Register (April 2007) which is based on regular searches of BIOSIS, CINAHL, EMBASE, MEDLINE and PsycINFO. We updated this search in July 2012 and added 47 new trials to the awaiting classification section. Selection criteria We included randomised, at least single-blind, trials comparing oral amisulpride with oral forms of aripiprazole, clozapine, olanzapine, quetiapine, risperidone, sertindole, ziprasidone or zotepine in people with schizophrenia or schizophrenia-like psychoses. Data collection and analysis We extracted data independently. For continuous data we calculated weighted mean differences (MD), for dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. Main results The review currently includes ten short to medium term trials with 1549 participants on three comparisons: amisulpride versus olanzapine, risperidone and ziprasidone. The overall attrition rate was considerable (34.7%) with no significant difference between groups. Amisulpride was similarly effective as olanzapine and risperidone and more effective than ziprasidone (leaving the study early due to inefficacy: n=123, 1 RCT, RR 0.21 CI 0.05 to 0.94, NNT 8 CI 5 to 50). Amisulpride induced less weight gain than risperidone (n=585, 3 RCTs, MD ?0.99 CI ?1.61 to ?0.37) or olanzapine (n=671, 3 RCTs, MD ?2.11 CI ?2.94 to ?1.29). Olanzapine was also associated with a higher increase of glucose (n=406, 2 RCTs, MD ?7.30 CI ?7.62 to ?6.99). There was no difference in terms of cardiac effects and extra pyramidal symptoms (EPS) compared with olanzapine (akathisia: n= 587, 2 RCTs, RR 0.66 CI 0.36 to 1.21), compared with risperidone (akathisia: n=586, 3 RCTs, RR 0.80 CI 0.58 to 1.11) and compared with ziprasidone (akathisia: n=123, 1 RCT, RR 0.63, CI 0.11 to 3.67). Authors’ conclusions There is little randomised evidence comparing amisulpride with other second generation antipsychotic drugs. We could only find trials comparing amisulpride with olanzapine, risperidone and ziprasidone. We found amisulpride may be somewhat more effective than ziprasidone, and more tolerable in terms of weight gain and other associated problems than olanzapine and risperidone. These data, however, are based on only ten short to medium term studies and therefore too limited to allow for firm conclusions. Note: the 47 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed. PMID:20091599

Komossa, Katja; Rummel-Kluge, Christine; Hunger, Heike; Schmid, Franziska; Schwarz, Sandra; da Mota Neto, Joaquim I Silveira; Kissling, Werner; Leucht, Stefan

2014-01-01

152

Why Does My Dentist Prescribe Medication?  

MedlinePLUS

... your desktop! more... Why Does My Dentist Prescribe Medication? Article Chapters Why Does My Dentist Prescribe Medication? ... dentist or pharmacist. Reviewed: January 2012 Related Articles: Medication Epilepsy, Seizure Meds Have Oral Health Implications How ...

153

Characteristics and occurrence of speech impairment in Huntington's disease: possible influence of antipsychotic medication.  

PubMed

Although motor speech impairment is a common manifestation of Huntington's disease (HD), its description remains limited. The aim of the current study was therefore to estimate the occurrence and characteristics of speech disorder in HD and to explore the influence of antipsychotic medication on speech performance. Speech samples, including reading passage and monologue, were acquired from 40 individuals diagnosed with HD and 40 age- and sex-matched healthy controls. Objective acoustic analyses were used to evaluate key aspects of speech including vowel articulation, intensity, pitch and timing. A predictive model was constructed to detect the occurrence and most prominent patterns of speech dysfunction in HD. We revealed that 93 % of HD patients manifest some degree of speech impairment. Decreased number of pauses, slower articulation rate, imprecise vowel articulation and excess intensity variations were found to be the most salient patterns of speech dysfunction in HD. We further demonstrated that antipsychotic medication may induce excessive loudness and pitch variations perceptually resembling excess patterns of word stress, and may also accentuate general problems with speech timing. Additionally, antipsychotics induced a slight improvement of vowel articulation. Specific speech alterations observed in HD patients indicate that speech production may reflect the pathophysiology of the disease as well as treatment effects, and may therefore be considered a valuable marker of functional disability in HD. PMID:24809686

Rusz, Jan; Klempí?, Ji?í; Tykalová, Tereza; Baborová, Eva; Cmejla, Roman; R?ži?ka, Evžen; Roth, Jan

2014-12-01

154

Modulation of limbic circuitry predicts treatment response to antipsychotic medication: a functional imaging study in schizophrenia  

PubMed Central

The regional neuronal changes taking place in the early and late stages of antipsychotic treatment are still not well characterized in humans. In addition, it is not known whether these regional changes are predictive or correlated with treatment response. Using PET with 15O, we evaluated the time course of regional cerebral blood flow (rCBF) patterns generated by a first (haloperidol) and a second (olanzapine) generation antipsychotic drug (APD) in patients with schizophrenia during a 6 week treatment trial. Patients were initially scanned after withdrawal of all psychotropic medication (two weeks), and then blindly randomized to treatment with haloperidol (n=12) or olanzapine (n=17) for a period of 6 weeks. Patients were scanned again after 1 and 6 weeks of treatment. All assessments, including scanning sessions, were obtained in a double-blind manner. As hypothesized, we observed rCBF changes that were common to both drugs, implicating cortico-subcortical and limbic neuronal networks in antipsychotic action. In addition, in these regions, some patterns seen at week 1 and 6 were distinctive, indexing neuronal changes related to an early (ventral striatum, hippocampus) and consolidated [anterior cingulate/medial frontal cortex (ACC/MFC)] stage of drug response. Finally, both after 1 and 6 weeks of treatment, we observe differential patterns of rCBF activation between good and poor responders. After one week of treatment, greater rCBF increase in ventral striatum and greater decrease in hippocampus were associated with good response. PMID:19675535

Lahti, Adrienne C.; Weiler, Martin A.; Holcomb, Henry H.; Tamminga, Carol A.; Cropsey, Karen L.

2009-01-01

155

Adiposity and insulin sensitivity derived from intravenous glucose tolerance tests in antipsychotic-treated patients.  

PubMed

Cardiovascular disease is more common in schizophrenia patients than in the general population, with a hypothesized contribution from increases in adiposity produced by antipsychotic medications. We sought to test the relationship between adiposity and insulin resistance using frequently sampled intravenous glucose tolerance tests (FSIVGTTs) to quantify whole-body insulin sensitivity in chronically treated patients with schizophrenia or schizoaffective disorder and untreated healthy controls. FSIVGTTs, body mass index (BMI), and waist circumference were obtained in nondiabetic patients (n=63) receiving olanzapine, risperidone, ziprasidone, or first generation antipsychotics, as well as in healthy controls (n=14). Subject groups (including untreated healthy controls) were matched for BMI and all treated patient groups were additionally matched for age. Bergman's minimal model (MinMod) was used to calculate insulin sensitivity (S(I)), as well as secondary measures of interest. BMI and waist circumference significantly predicted insulin sensitivity measured as MinMod S(I) (F(1,62)=35.11, p<0.0001 and F(1,46)=24.48, p<0.0001, respectively). In addition, BMI and waist circumference significantly predicted the acute plasma insulin response to the glucose challenge (AIR(G)), consistent with a beta cell compensatory response to insulin resistance (MinMod AIR(G) F(1,65)=22.42, p<0.0001 and F(1,49)=11.72, p=0.0013, respectively). Adiposity levels occurring during antipsychotic treatment are strongly related to insulin resistance, confirming that antipsychotic-induced weight gain can contribute to increased cardiometabolic risk in this population. PMID:17375138

Haupt, Dan W; Fahnestock, Peter A; Flavin, Karen A; Schweiger, Julie A; Stevens, Angela; Hessler, Martha J; Maeda, Justin; Yingling, Michael; Newcomer, John W

2007-12-01

156

The impact of prescribed psychotropics on youth  

Microsoft Academic Search

Many psychotropics prescribed to children are unlicensed or off-label. This article uses the two most prescribed psychotropics (MPH and SSRIs) to illustrate various concerns about their impact on youth. Many mental illnesses begin in childhood or early adulthood, warranting a treatment of some kind. However, commentators have argued that prescribing is influenced by five myths: (1) children are little adults;

Shaheen E Lakhan; Gareth E Hagger-Johnson

2007-01-01

157

Antipsychotic drug exhibits cancer-fighting properties  

Cancer.gov

In a prime example of finding new uses for older drugs, studies in zebrafish show that a 50-year-old antipsychotic medication called perphenazine can actively combat the cells of a difficult-to-treat form of acute lymphoblastic leukemia (ALL). The drug works by turning on a cancer-suppressing enzyme called PP2A and causing malignant tumor cells to self-destruct.The findings, by a team from the Dana-Farber/Boston Children's Cancer and Blood Disorders Center, the Dana-Farber Cancer Institute, and Brigham and Women's Hospital suggest that developing medications that activate PP2A, while avoiding perphenazine's psychotropic effects, could help clinicians make much-needed headway against T-cell ALL, and perhaps other tumors as well.

158

Prescribing patterns in patients using new antidepressants  

PubMed Central

Aims To study possible selective prescribing (‘channelling’) we compared characteristics of patients using the SSRI sertraline with patients using longer available SSRIs. Methods An observational cohort study in 1251 patients being prescribed an SSRI. Results In contrast to other studies, we found no evidence for channeling of sertraline. Sertraline was mainly prescribed for the labelled indication (depressive disorder), while older SSRIs were more often prescribed also for other indications. Time on the market was inversely associated to the proportion of patients treated for depressive disorder. Conclusions We found no evidence for channeling of sertraline compared with prescribing patterns of older SSRIs. PMID:11259993

Meijer, Welmoed E E; Heerdink, Eibert R; Pepplinkhuizen, Lolke P; van Eijk, Jacques ThM; Leufkens, Hubert G M

2001-01-01

159

Medicolegal aspects of prescribing dermatological medications in pregnancy.  

PubMed

Medications are commonly used during pregnancy; in fact, female patients take an average of 2.9 medications during pregnancy. Due to this high prevalence, malpractice litigation poses a high legal risk to dermatologists who prescribe medications to female patients who are or may become pregnant. This article introduces the medicolegal risks involved in prescribing dermatological medications to a pregnant patient and discusses ways for a dermatologist to mitigate those risks. International safety classification systems are reviewed, and potential high risk dermatologic medications prescribed in acne, psoriasis, atopic dermatitis, and connective tissue disease are discussed. In addition, the article summarizes resources available to patients as well as the important elements for dermatologists to include when documenting their discussion with the patient in the medical record. PMID:24800428

Gupta, Rishu; High, Whitney A; Butler, Daniel; Murase, Jenny E

2013-12-01

160

Utilization of Antihypertensives, Antidepressants, Antipsychotics, and Hormones in Alzheimer Disease  

E-print Network

Utilization of Antihypertensives, Antidepressants, Antipsychotics, and Hormones in Alzheimer) that showed significant changes in use rates over time in patients with Alzheimer disease. Patient accurate modeling of the Alzheimer disease treatment paradigm for certain subgroups of patients should

161

Developing resilient ponderosa pine forests with mechanical thinning and prescribed fire in central Oregon's pumice region  

Microsoft Academic Search

Thinning and prescribed burning are common management practices for reducing fuel buildup in ponderosa pine forests. However, it is not well understood if their combined use is required to lower wildfire risk and to help restore natural ecological function. We compared 16 treatment combinations of thinning, prescribed fire, and slash retention for two decades across a site quality gradient of

Matt D. Busse; P. H. Cochran; William E. Hopkins; William H. Johnson; Gregg M. Riegel; Gary O. Fiddler; Alice W. Ratcliff; Carol J. Shestak

2009-01-01

162

Prescribing Patterns and Safety of Mezclitas for Respiratory Illnesses  

PubMed Central

Objectives To evaluate the prescribing patterns of compound mixtures of cough and cold liquid medications, known as mezclitas, which are prescribed to patients with respiratory illnesses in Puerto Rico. Secondary objectives include assessing the potential safety of these mixtures and patients’ perception of them. Methods Using a cross sectional study approach, a convenience sample was obtained from five pharmacies in Puerto Rico, from October 2008 to October 2009. Patients were asked to complete a 9-item questionnaire of demographic information, in addition to their mezclita prescription data. Results The mean age of patients was 43 years with a range of less than 12 months to 101 years. For children ? four years of age, 71% were prescribed cough and cold medications. Sixty-four percent of the prescriptions were given to females. The most prevalent ingredient employed was guaifenesin, which appeared in about 77% of the mezclitas. ‘Common cold’ was the principal diagnosis for 62% of the prescriptions, of which 75% of these prescriptions contained a corticosteroid and 17% contained a beta2 agonist bronchodilator. The top medical prescribing specialty was general medicine (51%). Thirty-eight percent of hypertensive patients were prescribed a decongestant. The majority of diabetic patients (60%) were dispensed a corticosteroid. Most (74%) patients reported that they had a rapid and good response to their mezclita. Conclusion Mezclitas were most commonly prescribed for acute symptoms of upper respiratory illness by general physicians, despite possible side effects. This study suggests that the prescription patterns of mezclitas do not always consider evidence-based medicine treatment guidelines. PMID:23038886

Quevedo, Juan; Marsh, Wallace; Yulfo, Jessica; Alvarez, Olga; Felici, Marcos; Rojas, Maria E

2012-01-01

163

How antipsychotics work—From receptors to reality  

Microsoft Academic Search

How does a small molecule blocking a few receptors change a patients’ passionately held paranoid belief that the FBI is out\\u000a to get him? To address this central puzzle of anti-psychotic action, we review a framework linking dopamine neurochemistry\\u000a to psychosis, and then link this framework to the mechanism of action of antipsychotics. Normal dopamine transmission has\\u000a a role in

Shitij Kapur; Ofer Agid; Romina Mizrahi; Ming Li

2006-01-01

164

Priapism in Antipsychotic Drug Use: A Rare but Important Side Effect  

PubMed Central

Priapism is a rare but important side effect of antipsychotic drugs which may evolve into a urological emergency. Most antipsychotic drugs are alpha-1 adrenergic antagonists, which is thought to be the principal mechanism involved in antipsychotic-induced priapism. Other aetiologies exist, however. A case is presented with multiple episodes of priapism during the use of several different antipsychotic drugs. The case is representative of many patients treated with antipsychotic drugs, as there were hyperprolactinemia, and illicit drug use, which are known causes of priapism. Moreover, the patient used combinations of antipsychotic drugs. The case thus illustrates the etiological complexity which could delay a diagnosis of antipsychotic-induced priapism, and the problem of establishing a link between priapism and one particular ingredient of a drug combination. The case presents how a treatment regimen was finally established balancing antipsychotic efficacy to acceptable side effects and offers guidance to physicians regarding how antipsychotic-induced priapism may be resolved. PMID:22934218

Sinkeviciute, Igne; Kroken, Rune A.; Johnsen, Erik

2012-01-01

165

Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug.  

PubMed

A high dose of delta9-tetrahydrocannabinol, the main Cannabis sativa (cannabis) component, induces anxiety and psychotic-like symptoms in healthy volunteers. These effects of delta9-tetrahydrocannabinol are significantly reduced by cannabidiol (CBD), a cannabis constituent which is devoid of the typical effects of the plant. This observation led us to suspect that CBD could have anxiolytic and/or antipsychotic actions. Studies in animal models and in healthy volunteers clearly suggest an anxiolytic-like effect of CBD. The antipsychotic-like properties of CBD have been investigated in animal models using behavioral and neurochemical techniques which suggested that CBD has a pharmacological profile similar to that of atypical antipsychotic drugs. The results of two studies on healthy volunteers using perception of binocular depth inversion and ketamine-induced psychotic symptoms supported the proposal of the antipsychotic-like properties of CBD. In addition, open case reports of schizophrenic patients treated with CBD and a preliminary report of a controlled clinical trial comparing CBD with an atypical antipsychotic drug have confirmed that this cannabinoid can be a safe and well-tolerated alternative treatment for schizophrenia. Future studies of CBD in other psychotic conditions such as bipolar disorder and comparative studies of its antipsychotic effects with those produced by clozapine in schizophrenic patients are clearly indicated. PMID:16612464

Zuardi, A W; Crippa, J A S; Hallak, J E C; Moreira, F A; Guimarães, F S

2006-04-01

166

Teaching practical prescribing and therapeutics.  

PubMed

As noted in our editorial in the last issue, continuity in medical education was the subject of a conference organized by the Association of Medical Education, and held in London in June 1982. One of the keynote speakers was Dr Andrew Herxheimer, whose contribution on teaching practical prescribing and therapeutics is printed below. Some will claim that the approach advocated by Dr Herxheimer is already being attempted, while others will wonder how such an increase in the competence of undergraduates is to be achieved in an already overcrowded curriculum. The paper should, at least, lead to discussion. Dr Herxheimer's paper is followed by a description of the Open University course 'Topics in Drug Therapy' (P550), made for the Council for Postgraduate Medical Education in England and Wales and launched in October 1982. It is aimed at all practising doctors, especially trainees and general practitioners. PMID:24476325

Herxheimer, A

1983-01-01

167

General practitioner prescribing patterns in Babol city, Islamic Republic of Iran.  

PubMed

To determine patterns of prescribing in Iranian primary care, we analysed 4000 randomly selected prescriptions from 52 general practitioners (GPs) in Babol city during 1999-2000. The mean number of drugs prescribed per encounter was 4.4 +/- 1.7, with 98% prescribed by generic name. The most commonly prescribed items were non-steroidal anti-inflammatory drugs (62.9% of encounters) and antibiotics (61.9%), followed by central nervous system drugs, gastrointestinal tract drugs, corticosteroids, vitamins and cardiovascular system drugs respectively. Injections were prescribed in 58.0% of encounters. Female and male doctors had significantly different antibiotic prescribing patterns. Our study confirms the tendency of GPs to overprescribe. PMID:15603037

Moghadamnia, A A; Mirbolooki, M R; Aghili, M B

2002-01-01

168

What constitutes a prescribing error in paediatrics?  

PubMed Central

Objective: To develop a practitioner led definition of a prescribing error for use in prevalence/incidence studies in paediatric practice. Design: A two stage Delphi technique was used to obtain the views of a panel of expert health professionals working in the hospital paediatric setting. The extent of their agreement on a definition of a prescribing error, and on 40 scenarios that might be classified as prescribing errors in paediatric practice, was obtained. Results: Response rates were 84% (n = 42) in the first Delphi round and 95% (n = 40) in the second. Consensus was to accept the general definition of a prescribing error. In addition, there was consensus that 27 of the 40 scenarios should be included as prescribing errors, 10 should be excluded, and three may be considered prescribing errors depending on the individual clinical situation. Failure to communicate essential information, transcription errors and the use of drugs, formulations, or doses inappropriate for the individual patient were considered prescribing errors. Deviations from policies or guidelines, use of unlicensed and off-label drugs, and omission of non-essential information were not considered prescribing errors. Conclusion: A general definition of a prescribing error has been developed that is applicable to the paediatric setting, together with more detailed guidance regarding the types of events that should be included. These findings are suitable for use in future research into the incidence and nature of prescribing errors in paediatrics. PMID:16195569

Ghaleb, M; Barber, N; Dean, F; Wong, I

2005-01-01

169

New Generation Antipsychotic Drugs and QTc Interval Prolongation  

PubMed Central

Background: Recent regulatory and clinical concerns have brought into sharp focus antipsychotic drug-induced QTc interval prolongation, torsades de pointes, and sudden cardiac death. Several new generation (atypical) antipsychotic drugs have either been withdrawn from clinical use or delayed in reaching the marketplace due to these concerns. Because torsades de pointes is rarely found, QTc interval prolongation serves as a surrogate marker for this potentially life-threatening arrhythmia. Current methods of calculating this electrocardiographic parameter have limitations. The primary care physician is a key member of the team managing a patient who requires administration of antipsychotic drugs. This article focuses on new generation antipsychotic drugs and principles useful to both the primary care physician and the psychiatrist. Method: PubMed was searched in September 2002 using the terms antipsychotic drug and QT interval. References were examined from review articles describing antipsychotic drugs and the QT interval. The author's files gathered over the past 20 years on the QT interval were also reviewed. Results: Nine cases were available in which drug-induced QTc interval prolongation was associated with new generation antipsychotic drug administration. Eight cases were taken from the literature, and the author added one additional report. The newer agents involved were risperidone, quetiapine, and ziprasidone. In at least 8 cases, there was evidence of other risk factors associated with QTc interval prolongation. In one case frequently referenced in the literature, the authors misunderstood their own data showing that QTc interval prolongation did not relate to delayed ventricular repolarization. In another instance, 2 authors reported on the same patient, with important information missing from both articles. No evidence of torsades de pointes appeared in any of the 9 cases. Conclusions: No evidence is currently available in the literature implicating new generation antipsychotic drugs in the production of torsades de pointes. However, the absence of such evidence does not prove that newer antipsychotic drugs do not cause torsades de pointes. Among patients free of risk factors for QTc interval prolongation and torsades de pointes, current literature does not dictate any specific consultative or laboratory intervention before administering new generation antipsychotic drugs. When risk factors are present, evaluation and intervention specific to those risk factors should dictate the clinician's course of action. More specific guidelines for monitoring the QT interval and risk of torsades de pointes await improved methods of measuring the QTc interval relevant to each patient. PMID:15213787

Vieweg, W. Victor R.

2003-01-01

170

Quetiapine versus other atypical antipsychotics for schizophrenia  

PubMed Central

Background In many countries of the industrialised world second generation (’atypical’) antipsychotic drugs have become the first line drug treatment for people with schizophrenia. It is not clear how the effects of the various second generation antipsychotic drugs differ. Objectives To evaluate the effects of quetiapine compared with other second generation antipsychotic drugs for people with schizophrenia and schizophrenia-like psychosis. Search methods We searched the Cochrane Schizophrenia Group Trials Register (April 2007), inspected references of all identified studies, and contacted relevant pharmaceutical companies, drug approval agencies and authors of trials for additional information. Selection criteria We included all randomised control trials comparing oral quetiapine with oral forms of amisulpride, aripiprazole, clozapine, olanzapine, risperidone, sertindole, ziprasidone or zotepine in people with schizophrenia or schizophrenia-like psychosis. Data collection and analysis We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a random-effects model. Main results The review currently includes 21 randomised control trials (RCTs) with 4101 participants. These trials provided data on four comparisons - quetiapine versus clozapine, olanzapine, risperidone or ziprasidone. A major limitation to all findings is the high number of participants leaving studies prematurely (57.6%) and the substantial risk of biases in studies. Efficacy data favoured olanzapine and risperidone compared with quetiapine (PANSS total score versus olanzapine:10 RCTs, n=1449, WMD 3.66 CI 1.93 to 5.39; versus risperidone: 9 RCTs, n=1953, WMD 3.09 CI 1.01 to 5.16), but clinical meaning is unclear. There were no clear mental state differences when quetiapine was compared with clozapine or ziprasidone. Compared with olanzapine, quetiapine produced slightly fewer movement disorders (6 RCTs, n=1090, RR use of antiparkinson medication 0.49 CI 0.3 to 0.79, NNH 25 CI 14 to 100) and less weight gain (7 RCTs, n=1173, WMD ?2.81 CI ?4.38 to ?1.24) and glucose elevation, but more QTc prolongation (3 RCTs, n=643, WMD 4.81 CI 0.34 to 9.28). Compared with risperidone, quetiapine induced slightly fewer movement disorders (6 RCTs, n=1715, RR use of antiparkinson medication 0.5 CI 0.3 to 0.86, NNH 20 CI 10 to 100), less prolactin increase (6 RCTs, n=1731, WMD ?35.28 CI ?44.36 to ?26.19) and some related adverse effects, but more cholesterol increase (5 RCTs, n=1433, WMD 8.61 CI 4.66 to 12.56). Compared with ziprasidone, quetiapine induced slightly fewer extrapyramidal adverse effects (1 RCT, n=522, RR use of antiparkinson medication 0.43 CI 0.2 to 0.93, NNH not estimable) and prolactin increase. On the other hand quetiapine was more sedating and led to more weight gain (2 RCTs, n=754, RR 2.22 CI 1.35 to 3.63, NNH 13 CI 8 to 33) and cholesterol increase than ziprasidone. Authors’ conclusions Best available evidence from trials suggests that most people who start quetiapine stop taking it within a few weeks. Comparisons with amisulpride, aripiprazole, sertindole and zotepine do not exist. Most data that has been reported within existing comparisons are of very limited value because of assumptions and biases within them. There is much scope for further research into the effects of this widely used drug. PMID:20091600

Komossa, Katja; Rummel-Kluge, Christine; Schmid, Franziska; Hunger, Heike; Schwarz, Sandra; Srisurapanont, Manit; Kissling, Werner; Leucht, Stefan

2014-01-01

171

Mechanisms of Action of Antipsychotic Drugs of Different Classes, Refractoriness to Therapeutic Effects of Classical Neuroleptics, and Individual Variation in Sensitivity to their Actions: PART II  

PubMed Central

Rapid-onset psychotic rebound is uncommon on discontinuation of most antipsychotic drugs, as might be expected for antipsychotic drugs with (hypothetically) indirect actions at their final target receptors. Rapid-onset psychosis is more common on withdrawal of clozapine, which might be expected if its action is direct. Drugs other than clozapine (notably thioridazine) may have hitherto unrecognised similarities to clozapine (but without danger of agranulocytosis), and may be useful in treatment of refractory psychosis. Quetiapine fulfils only some criteria for a clozapine-like drug. Clinical response to neuroleptics varies widely at any given plasma level. Haase’s “neuroleptic threshold” concept suggests that the dose producing the slightest motor side effects produces most or all of the therapeutic benefit, but analyses presented here suggest that antipsychotic actions are not subject to a sharp “all-or-none” threshold but increase over a small dose range. This concept could provide a method for quantitative determination of individualized optimal doses. PMID:20514211

Miller, R

2009-01-01

172

Patterns of prescription of antidepressants and antipsychotics across and within pregnancies in a population-based UK cohort.  

PubMed

Although antidepressant and antipsychotic utilization by gestational trimester has been described, longitudinal prescription patterns within pregnancies have received less attention. All mothers in the Clinical Practice Research Datalink's Mother Baby Link enrolled from 6 months before pregnancy to 3 months after delivery, with delivery date between 01/1989 and 12/2010 were included (n = 421,645). Drug use prevalence was calculated as the number of women with prescriptions for antidepressants or antipsychotics in capsules/tablets in the 3 months before pregnancy (T0), the first (T1), second (T2), or third (T3) pregnancy trimesters, or the 3 months after delivery (T4). In each pregnancy, prescriptions in T0 and T3 were compared to identify treatment discontinuation, simplification (some drugs discontinued or dose lowered), no treatment change, intensification (drugs added to prior treatment or dose increased), and start. Antidepressant use in T0 through T4 was 4.69, 2.81, 1.31, 1.34, and 5.46 %, respectively. Of 19,774 T0 antidepressant users, 79.57 % discontinued, 5.13 % simplified, 9.06 % did not change, and 2.19 % intensified treatment. 0.40 % of non-users in T0 started antidepressants by T3. Antipsychotic use in T0 through T4 was 0.57, 1.34, 0.54, 0.28 and 0.38 %. Excluding prochlorperazine, it was 0.15, 0.13, 0.08, 0.07 and 0.15 %, respectively; of 639 T0 users, 72.30 % discontinued, 7.51 % simplified, 11.11 % did not change, and 4.07 % intensified treatment. 0.03 % of non-users in T0 started antipsychotics by T3. Cross-sectional and longitudinal analyses identified a post-conception decrease in antidepressant and antipsychotic prescribing. Longitudinal treatment assessment additionally captured several treatment patterns among those who do not discontinue treatment that usually stay unrecognized. PMID:24374729

Margulis, Andrea V; Kang, Elizabeth M; Hammad, Tarek A

2014-09-01

173

THE OFF-LABEL USE OF ATYPICAL ANTIPSYCHOTICS AND ITS IMPACT ON ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD).  

E-print Network

??Atypical antipsychotics (AAPs) (also known as second-generation antipsychotics) are the US Food and Drug Administration (FDA) approved medications for schizophrenia, bipolar I disorder, depression and… (more)

Sohn, Minji

2014-01-01

174

Where do we go wrong? Prescribing errors by doctors during induction training?  

Microsoft Academic Search

ObjectiveTo evaluate prescribing errors made during induction training and evaluate these for any common themes.MethodsFour basic questions requiring five or six drugs to be prescribed were administered at the end of the Child Health Induction session for junior doctors. These focused on commonly used medications including analgesics and antibiotics. The doctors were given the BNF for Children (BNFC) and were

C D Nagaraj; R J McArtney; D Tuthill

2011-01-01

175

Barriers to Primary Care Physicians Prescribing Buprenorphine  

PubMed Central

PURPOSE Despite the efficacy of buprenorphine-naloxone for the treatment of opioid use disorders, few physicians in Washington State use this clinical tool. To address the acute need for this service, a Rural Opioid Addiction Management Project trained 120 Washington physicians in 2010–2011 to use buprenorphine. We conducted this study to determine what proportion of those trained physicians began prescribing this treatment and identify barriers to incorporating this approach into outpatient practice. METHODS We interviewed 92 of 120 physicians (77%), obtaining demographic information, current prescribing status, clinic characteristics, and barriers to prescribing buprenorphine. Residents and 7 physicians who were prescribing buprenorphine at the time of the course were excluded from the study. We analyzed the responses of the 78 remaining respondents. RESULTS Almost all respondents reported positive attitudes toward buprenorphine, but only 22 (28%) reported prescribing buprenorphine. Most (95%, n = 21) new prescribers were family physicians. Physicians who prescribed buprenorphine were more likely to have partners who had received a waiver to prescribe buprenorphine. A lack of institutional support was associated with not prescribing the medication (P = .04). A lack of mental health and psychosocial support was the most frequently cited barrier by both those who prescribe and who do not prescribe buprenorphine. CONCLUSION Interventions before and after training are needed to increase the number of physicians who offer buprenorphine for treatment of addiction. Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after they have completed their training, their clinical teams, and their administrations is likely to help more physicians become active providers of this highly effective outpatient treatment. PMID:24615308

Hutchinson, Eliza; Catlin, Mary; Andrilla, C. Holly A.; Baldwin, Laura-Mae; Rosenblatt, Roger A.

2014-01-01

176

Atypical antipsychotics and the neural regulation of food intake and peripheral metabolism  

E-print Network

Atypical antipsychotics and the neural regulation of food intake and peripheral metabolism Karen L: Histamine Vagus Insulin Glucose Weight gain Obesity The atypical antipsychotics (AAPs) are associated, cause the most dramatic weight gain and metabolic impairments including increased fasting glucose

Kim, Sangwon F.

177

Antipsychotic dose modulates behavioral and neural responses to feedback during reinforcement learning in schizophrenia  

E-print Network

whether antipsychotic medication modulates behavioral and neural responses to prediction error coding condition. Specifically, patients taking higher doses of medication showed attenuated prediction error-based learning. However, it remains un- known how treatment with antipsychotic medication impacts the behavioral

Shohamy, Daphna

178

Checking the plausibility of psychiatrists? arguments for not prescribing depot medication.  

PubMed

Treatment with long-acting depot antipsychotics may yield beneficial effects with regard to long-term adherence and long term outcomes in patients with schizophrenia. However, the implementation of depot treatment is rather low in many settings. Research on this issue helped identifying various potential reasons for this pattern including patient refusal and negative attitudes of psychiatrists. Nevertheless no definite conclusion exists as to what actually hinders the wider implementation of depot treatment. To date there are no studies that surveyed this issue with regard to concrete patients and from both perspectives, of the psychiatrists and the related patients. In the present analysis we therefore analyzed psychiatrists? and patients? behavior regarding depot prescription in N=213 individual doctor-inpatient-dyads in German psychiatric hospitals. A high number of patients (30%) were actually prescribed depot at discharge, even more were informed about the possibility of depot treatment by their psychiatrists (47%). Moreover, 50% of the surveyed patients were generally open toward receiving depot antipsychotics. However, for the high number of patients not receiving depot (70%) the psychiatrists? arguments against depot were often implausible and therefore many more patients might be suitable for receiving depot treatment. Psychiatrists? hesitation to discuss and implement depot might also be founded in concerns regarding patients? acceptance of depot medication. Here doctors should be empowered by teaching communication strategies that may help to convince patients accept treatment. PMID:25037772

Hamann, Johannes; Kissling, Werner; Heres, Stephan

2014-09-01

179

Prescribing pattern of medicines in chronic kidney disease with emphasis on phosphate binders  

PubMed Central

Objectives: Patients with chronic kidney disease (CKD) suffer with multiple comorbidities and complications like secondary hyperparathyroidism and hyperphosphotemia. Altered mineral metabolism contributes to bone disease and cardiovascular disease. In patients of CKD, despite dietary phosphorus restriction, phosphate binders (PBs) are recommended to control phosphorous level. No studies about the utilization pattern of PBs in CKD patients have been reported from India. This study analyses the current prescribing trends in the management of CKD patients undergoing tertiary care with focus on PBs. Materials and Methods: This cross-sectional, observational study was conducted in nephrology department of a government super speciality hospital over 8-month period from January to August 2011. Demographic, clinical, and medication details were collected in a specially designed proforma. Results: A total 111 prescriptions were included in the study. Average number of drugs per prescription was 9.47. About 41.53% of the prescribed drugs were from the World Health Organization essential medicines list. Out of total prescribed drugs (1052), most commonly prescribed were vitamins and minerals (24.71%), cardiovascular drugs, (22.14%), and hematopoietic agents (20.15%). Considering individual drugs, five most commonly prescribed drugs were multivitamins (14.82%), iron (8.65%), folic acid (8.55%), calcium carbonate (8.17%), and calcitriol (5.60%). A total of 11.02% of prescribed drug were PBs. Among PBs, calcium carbonate was the most frequently prescribed and sevelamer was the least prescribed PB. No patient was prescribed lanthanum carbonate. Conclusion: This study identified a wide variety of drug classes including PBs prescribed in CKD patients. Although sevelamer hydrochloride has less side effects as compared to calcium salts, it was less prescribed since it is costlier. PMID:24550582

Bajait, Chaitali S; Pimpalkhute, Sonali A; Sontakke, Smita D; Jaiswal, Kavita M; Dawri, Amruta V

2014-01-01

180

Demographics of international contact lens prescribing  

Microsoft Academic Search

Knowledge of differences in the demographics of contact lens prescribing between nations, and changes over time, can assist (a) the contact lens industry in developing and promoting various product types in different world regions, and (b) practitioners in understanding their prescribing habits in an international context. Data that we have gathered from annual contact lens fitting surveys conducted in Australia,

Philip B. Morgan; Nathan Efron; Magne Helland; Motozumi Itoi; Deborah Jones; Jason J. Nichols; Eef van der Worp; Craig A. Woods

2010-01-01

181

Applying Stand Replacement Prescribed Fire in Alaska  

Microsoft Academic Search

Stand replacement prescribed burning has been applied in Alaska on several occasions. Based on that experience, perspectives can be provided, issues can be discussed, and keys to success can be identified that are applicable to stand replacement prescribed burning activities in areas outside Alaska. There are approximately 220 million fire-prone acres in Alaska. Suppression of wildilres on a widespread basis

Larry A. Vanderlinden

182

Tailoring materials with prescribed elastic properties  

Microsoft Academic Search

This paper describes a method to design the periodic microstructure of a material to obtain prescribed constitutive properties. The microstructure is modelled as a truss or thin frame structure in 2 and 3 dimensions. The problem of finding the simplest possible microstructure with the prescribed elastic properties can be called an inverse homogenization problem, and is formulated as an optimization

Ole Sigmund

1995-01-01

183

Sex-dependent antipsychotic capacity of 17?-estradiol in the latent inhibition model: a typical antipsychotic drug in both sexes, atypical antipsychotic drug in males.  

PubMed

The estrogen hypothesis of schizophrenia suggests that estrogen is a natural neuroprotector in women and that exogenous estrogen may have antipsychotic potential, but results of clinical studies have been inconsistent. We have recently shown using the latent inhibition (LI) model of schizophrenia that 17?-estradiol exerts antipsychotic activity in ovariectomized (OVX) rats. The present study sought to extend the characterization of the antipsychotic action of 17?-estradiol (10, 50 and 150??g/kg) by testing its capacity to reverse amphetamine- and MK-801-induced LI aberrations in gonadally intact female and male rats. No-drug controls of both sexes showed LI, ie, reduced efficacy of a previously non-reinforced stimulus to gain behavioral control when paired with reinforcement, if conditioned with two but not five tone-shock pairings. In both sexes, amphetamine (1?mg/kg) and MK-801 (50??g/kg) produced disruption (under weak conditioning) and persistence (under strong conditioning) of LI, modeling positive and negative/cognitive symptoms, respectively. 17?-estradiol at 50 and 150??g/kg potentiated LI under strong conditioning and reversed amphetamine-induced LI disruption in both males and females, mimicking the action of typical and atypical antipsychotic drugs (APDs) in the LI model. 17?-estradiol also reversed MK-induced persistent LI, an effect mimicking atypical APDs and NMDA receptor enhancers, but this effect was observed in males and OVX females but not in intact females. These findings indicate that in the LI model, 17?-estradiol exerts a clear-cut antipsychotic activity in both sexes and, remarkably, is more efficacious in males and OVX females where it also exerts activity considered predictive of anti-negative/cognitive symptoms. PMID:20613719

Arad, Michal; Weiner, Ina

2010-10-01

184

Initiatives to improve appropriate antibiotic prescribing in primary care.  

PubMed

Influencing clinicians' prescribing behaviour is important because inappropriate use and overuse of antibiotics are major drivers of antibiotic resistance. A systematic review of interventions for promoting prudent prescribing of antibiotics by general practitioners suggests that multifaceted interventions will maximize acceptability. This article reports how this type of approach has been used successfully in Derbyshire, UK over the last 4 years. The range of interventions that have been used includes educational meetings (both open group events and others targeted at higher prescribers in the surgery) using a supportive and guiding ethos; the provision of support materials aimed at empowering avoidance or delayed antibiotic prescribing, where appropriate, and improving patients' knowledge and confidence in self-management; and the production of different treatment guidelines incorporating key messages with evidence, indicating where antibiotics are unlikely to be of benefit. Education on antibiotics in schools was a novel approach, which was developed in North Derbyshire to increase public awareness of the appropriate treatment for common illnesses without using antibiotics. PMID:24030546

Harris, Diane J

2013-11-01

185

Prescribing practices and attitudes toward giving children antibiotics.  

PubMed Central

OBJECTIVE: To investigate whether overprescribing is common in treatment of pediatric upper respiratory infections and to examine factors that influence prescribing antibiotics for children. DESIGN: A random, stratified sample of practising family physicians was surveyed with a mailed questionnaire. Initial nonresponders were mailed a second questionnaire. SETTING: British Columbia. PARTICIPANTS: A total of 608 general and family physicians. Response rate was 64%; 392/612 surveys were completed. MAIN OUTCOME MEASURES: Physicians' self-reported prescribing practices and knowledge of and attitudes toward using antibiotics for children's upper respiratory tract infections. RESULTS: Relative to treatment guidelines developed for the study, most physicians responded appropriately to the cough (94%) and lobar pneumonia (99.1%) vignettes. More than half the physicians (56.5%) reported they would immediately prescribe antibiotics for tympanic membrane dysfunction, and 79.4% indicated they would prescribe antibiotics for pharyngitis without obtaining a laboratory culture. Approximately 25% of physicians in the study did not believe that prior antibiotic use increased personal risk for acquiring drug-resistant infection, and 23.1% did not believe that antibiotic use was an important factor in promoting resistance in their communities. CONCLUSION: Education in current treatment of pediatric upper respiratory tract illnesses and antimicrobial drug resistance is required. The high response to the questionnaire (64%) and the many requests from physicians to receive the project's educational materials (45%) indicate a high level of interest in this subject. PMID:11281085

Paluck, E.; Katzenstein, D.; Frankish, C. J.; Herbert, C. P.; Milner, R.; Speert, D.; Chambers, K.

2001-01-01

186

Quality of Life and New Antipsychotics in Schizophrenia Are Patients Better Off?  

Microsoft Academic Search

The recent introduction of several antipsychotic medications has raised expectations for better pharmacological management of schizophrenia. Although conventional and new neuroleptics (Risperidone, Olanzapine, Seroquel and soon to be released Ziprasidone) are generally comparable in terms of efficacy; the new antipsychotic medications possess a better side-effects profile and are overall, much better tolerated. The reintroduction of Clozapine as an effective antipsychotic

A. George Awad; Lakshmi N. P. Voruganti

1999-01-01

187

Pharmacologic Treatment of Posttraumatic Stress Disorder: A Focus on Antipsychotic Use  

Microsoft Academic Search

To review the literature on the pharmacologic treatment of posttraumatic stress disorder (PTSD), with a focus on reports of antipsychotic use for this illness. A MEDLINE search (1966-Oct 2002) for English only articles about pharmacologic treatment of PTSD. Antipsychotic medications are being used with some frequency for PTSD. There are few studies and scant evidence to recommend the traditional antipsychotics.

Eileen P. Ahearn; Amy Krohn; Kathryn M. Connor; Jonathan R. T. Davidson

2003-01-01

188

Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis  

Microsoft Academic Search

Objective To develop an evidence base for recommendations on the use of atypical antipsychotics for patients with schizophrenia. Design Systematic overview and meta›regression analyses of randomised controlled trials, as a basis for formal development of guidelines. Subjects 12 649 patients in 52 randomised trials comparing atypical antipsychotics (amisulpride, clozapine, olanzapine, quetiapine, risperidone, and sertindole) with conventional antipsychotics (usually haloperidol or

J. Geddes; N. Freemantle; P. Harrison; P. Bebbington

2000-01-01

189

Metabolic side effects of atypical antipsychotics in children: a literature review  

Microsoft Academic Search

The objective of this review is to summarize the data about metabolic side effects of atypical antipsychotics in children.Original research articles about side effects of atypical antipsychotics used in children were reviewed. The data was obtained mainly through Medline searches, identifying articles focusing on the use of atypical antipsychotics in children. Forty studies that addressed the issue of metabolic side

Valérie J. Fedorowicz; Eric Fombonne

2005-01-01

190

Fatty Acid desaturase gene polymorphisms and metabolic measures in schizophrenia and bipolar patients taking antipsychotics.  

PubMed

Atypical antipsychotics have become a common therapeutic option in both schizophrenia and bipolar disorder. However, these medications come with a high risk of metabolic side effects, particularly dyslipidemia and insulin resistance. Therefore, identification of patients who are at increased risk for metabolic side effects is of great importance. The genetics of fatty acid metabolism is one area of research that may help identify such patients. Therefore, in this present study, we aimed to determine the effect of one commonly studied genetic polymorphism from both fatty acid desaturase 1 (FADS1) and FADS2 gene on a surrogate measure of insulin resistance and lipid levels in a metabolically high-risk population of patients largely exposed to atypical antipsychotics. This study used a cross-sectional design, fasting blood draws, and genetic analysis to investigate associations between polymorphisms, haplotypes, and metabolic measures. A total of 320 subjects with schizophrenia (n = 226) or bipolar disorder (n = 94) were included in this study. The mean age of the population was 42.5 years and 45% were male. A significant association between FADS1 and FADS2 haplotypes was found with insulin resistance while controlling for confounders. Further investigation is required to replicate this finding. PMID:24455201

Burghardt, Kyle J; Gardner, Kristen N; Johnson, Joshua W; Ellingrod, Vicki L

2013-01-01

191

Fatty Acid Desaturase Gene Polymorphisms and Metabolic Measures in Schizophrenia and Bipolar Patients Taking Antipsychotics  

PubMed Central

Atypical antipsychotics have become a common therapeutic option in both schizophrenia and bipolar disorder. However, these medications come with a high risk of metabolic side effects, particularly dyslipidemia and insulin resistance. Therefore, identification of patients who are at increased risk for metabolic side effects is of great importance. The genetics of fatty acid metabolism is one area of research that may help identify such patients. Therefore, in this present study, we aimed to determine the effect of one commonly studied genetic polymorphism from both fatty acid desaturase 1 (FADS1) and FADS2 gene on a surrogate measure of insulin resistance and lipid levels in a metabolically high-risk population of patients largely exposed to atypical antipsychotics. This study used a cross-sectional design, fasting blood draws, and genetic analysis to investigate associations between polymorphisms, haplotypes, and metabolic measures. A total of 320 subjects with schizophrenia (n = 226) or bipolar disorder (n = 94) were included in this study. The mean age of the population was 42.5 years and 45% were male. A significant association between FADS1 and FADS2 haplotypes was found with insulin resistance while controlling for confounders. Further investigation is required to replicate this finding. PMID:24455201

Burghardt, Kyle J.; Gardner, Kristen N.; Johnson, Joshua W.; Ellingrod, Vicki L.

2013-01-01

192

Aggresiveness in institutionalised schizophrenic patients and the selection of antipsychotics.  

PubMed

The selection of antipsychotics as medications used primarily for treating schizophrenia and disorders similar to schizophrenia is an important aspect of the treatment of forensicpatients. This study examines the effect of antipsychotics selection (typical or atipycal) on the level of aggressiveness, side effects and the hospitalisation length. The research is conducted on 98 psychiatric patients diagnosed with schizophrenia or similar disorders (F 20-F 29) in two forensic psychiatric institutions. The patients committed aggressive criminal offence in state of insanity. The patients are currently treated in inpatient psychiatric institutions. The research was conducted by using the Aggressiveness Questionnaire (AG-87), the Simpson-Angus Scale for the assessment of extrapyramidal side effects, the Barnes Akathisia Rating Scale for the assesment of akathisia and the Abnormal Involuntary Movement Scale. The results show no significant difference between the groups of patients treated with typical and atypical antipsychotics in all the variables. PMID:21648345

Ruzi?, Klementina; Franciskovi?, Tanja; Sukovi?, Zoran; Hero, Elizabeta Dadi?; Roncevi?-Grzeta, Ika; Graovac, Mirjana; Palijan, Tija Zarkovi?

2011-01-01

193

Use of atypical antipsychotics in the elderly: a clinical review.  

PubMed

The use of atypical antipsychotic drugs in the elderly has become wider and wider in recent years; in fact, these agents have novel receptor binding profiles, good efficacy with regard to negative symptoms, and reduced extrapyramidal symptoms. However, in recent years, the use of both conventional and atypical antipsychotics has been widely debated for concerns about their safety in elderly patients affected with dementia and the possible risks for stroke and sudden death. A MEDLINE search was made using the words elderly, atypical antipsychotics, use, schizophrenia, psychosis, mood disorders, dementia, behavioral disorders, and adverse events. Some personal studies were also considered. This paper reports the receptor binding profiles and the main mechanism of action of these drugs, together with their main use in psychiatry and the possible adverse events in elderly people. PMID:25170260

Gareri, Pietro; Segura-García, Cristina; Manfredi, Valeria Graziella Laura; Bruni, Antonella; Ciambrone, Paola; Cerminara, Gregorio; De Sarro, Giovambattista; De Fazio, Pasquale

2014-01-01

194

Reevaluation of the mesolimbic hypothesis of antipsychotic drug action.  

PubMed

Conventional neuroleptic drugs are thought to derive their antipsychotic efficacy through influences on the mesolimbic dopamine (DA) system. In contrast, motor side effects of these drugs are suggested to follow from influences on the nigrostriatal DA system. This conceptualization is based on the assumption that behaviors mediated by the mesolimbic DA system are involved in schizophrenia while behaviors controlled by the nigrostriatal system are not. In this article, it is argued that although assumptions about mesolimbic activities may indeed be correct, those concerning the nigrostriatal system certainly are not. This being the case, drugs with mesolimbic-specific activity may not have significant antipsychotic potency and probably will not be free of motor side effects. The current thrust of neuropharmacology, which emphasizes development of drugs with pharmacological specificity rather than anatomical selectivity, is more likely to generate new antipsychotic agents with a reduced risk of motor side effects. PMID:7770742

Lidsky, T I

1995-01-01

195

Weight gain and glucose dysregulation with second-generation antipsychotics and antidepressants: a review for primary care physicians.  

PubMed

Second-generation antipsychotics (SGAPs) and second-generation antidepressants (SGADs) have multiple US Food and Drug Administration-approved indications and are frequently prescribed by primary care physicians. We review the relative potential of these drugs to cause weight gain and glucose dysregulation, and offer clinical guidance to minimize and manage this risk. Among SGAPs, clozapine and olanzapine have a high risk for causing weight gain and glucose dysregulation; iloperidone, paliperidone, quetiapine, and risperidone have a medium risk; and aripiprazole, asenapine, lurasidone, and ziprasidone have a low risk. Young, drug-naïve patients are particularly vulnerable to weight gain associated with SGAPs. With the exception of clozapine, SGAPs have modest differences in their efficacy; however, their side effect profiles may influence selection. Using SGAPs with high metabolic liability conservatively and limiting their off-label use are important means to minimize risk. Patients should be screened before initiating any SGAP (or any antipsychotic medication) and monitored subsequently following standard guidelines, such as those provided by the American Diabetes Association. Healthy lifestyle counseling should be offered to all patients. Patients showing evidence of significant weight gain should be switched to an SGAP with a lower metabolic liability. Metformin may have some utility in young patients with limited exposure to antipsychotic drugs if lifestyle interventions fail and switching the SGAP is not an option. This option should be tried sooner than later for the best possible result. For SGADs, paroxetine and mirtazapine are associated with weight gain, and bupropion may cause modest weight loss. Other SGADs are mostly weight neutral, but individual variations may occur. Depression is associated with weight change and is a risk factor for glucose dysregulation. Treatment of depression improves glucose metabolism. We recommend that all patients taking SGADs be screened using anthropometric measures and metabolic assessment at baseline. Monitoring should be guided individually based on weight gain and other risk factors. PMID:22913904

Hasnain, Mehrul; Vieweg, W Victor R; Hollett, Bruce

2012-07-01

196

Plantar Fasciitis: Prescribing Effective Treatments.  

ERIC Educational Resources Information Center

Plantar fasciitis is an extremely common, painful injury seen among people in running and jumping sports. While prognosis for recovery with conservative care is excellent, prolonged duration of symptoms affects sports participation. Studies on treatment options show mixed results, so finding effective treatments can be challenging. A logical…

Shea, Michael; Fields, Karl B.

2002-01-01

197

Should full adherence be a necessary goal in schizophrenia? Full versus non-full adherence to antipsychotic treatment.  

PubMed

There is solid evidence of negative consequences of non-adherence in schizophrenia, and recently adherence has been defined as taking more than 80% of prescribed medication. However, the clinical relevance of different degrees of adherence in adherent patients has not been studied. We evaluated sociodemographic, clinical, treatment-related and psychopathological variables in 78 adherent outpatients with schizophrenia, who were classified into two groups: full-adherence (100% adherence) and non-full adherence (80-99.9%). Adherence was evaluated using electronic monitoring (MEMS®), and the injection record in case of injectable antipsychotics. Non-full adherence patients showed more extensive delusions and guilt feelings, as well as trends toward greater somatic concern, disorientation, general psychopathology, and lower number of prior psychiatric hospitalizations. These finding suggest that the 'fullness' of adherence to antipsychotic treatment is a relevant issue, impacting the psychopathological state of adherent patients with schizophrenia. We found that a large proportion of patients can achieve full adherence, and while 'adherence' is an appropriate objective to be pursued with non-adherent patients, 'full adherence' should be the goal among adherent patients. PMID:24183886

Acosta, Francisco J; Ramallo-Fariña, Yolanda; Siris, Samuel G

2014-01-01

198

Electronic pharmacopoeia: a missed opportunity for safe opioid prescribing information?  

PubMed

Errors in prescribing of dangerous medications, such as extended release or long acting (ER/LA) opioid forlmulations, remain an important cause of patient harm. Prescribing errors often relate to the failure to note warnings regarding contraindications and drug interactions. Many prescribers utilize electronic pharmacopoeia (EP) to improve medication ordering. The purpose of this study is to assess the ability of commonly used apps to provide accurate safety information about the boxed warning for ER/LA opioids. We evaluated a convenience sample of six popular EP apps available for the iPhone and an online reference for the presence of relevant safety warnings. We accessed the dosing information for each of six ER/LA medications and assessed for the presence of an easily identifiable indication that a boxed warning was present, even if the warning itself was not provided. The prominence of precautionary drug information presented to the user was assessed for each app. Provided information was classified based on the presence of the warning in the ordering pathway, located separately but within the prescribers view, or available in a separate screen of the drug information but non-highlighted. Each program provided a consistent level of warning information for each of the six ER/LA medications. Only 2/7 programs placed a warning in line with dosing information (level 1); 3/7 programs offered level 2 warning and 1/7 offered level 3 warning. One program made no mention of a boxed warning. Most EP apps isolate important safety warnings, and this represents a missed opportunity to improve prescribing practices. PMID:24081616

Lapoint, Jeff; Perrone, Jeanmarie; Nelson, Lewis S

2014-03-01

199

Effects of prescribed fire and season of burn on direct and indirect levels of tree mortality in Ponderosa and Jeffrey Pine Forests in California, USA  

Microsoft Academic Search

Many forests that historically experienced frequent low-intensity wildfires have undergone extensive alterations during the past century. Prescribed fire is now commonly used to restore these fire-adapted forest ecosystems. In this study, we examined the influence of prescribed burn season on levels of tree mortality attributed to prescribed fire effects (direct mortality) and bark beetles (Coleoptera: Curculionidae, Scolytinae) (indirect mortality) in

Christopher J. Fettig; Stephen R. McKelvey; Daniel R. Cluck; Sheri L. Smith; William J. Otrosina

2010-01-01

200

Outpatient antibiotic prescribing in the United States: 2000 to 2010  

PubMed Central

Background The use of antibiotics is the single most important driver in antibiotic resistance. Nevertheless, antibiotic overuse remains common. Decline in antibiotic prescribing in the United States coincided with the launch of national educational campaigns in the 1990s and other interventions, including the introduction of routine infant immunizations with the pneumococcal conjugate vaccine (PCV-7); however, it is unknown if these trends have been sustained through recent measurements. Methods We performed an analysis of nationally representative data from the Medical Expenditure Panel Surveys from 2000 to 2010. Trends in population-based prescribing were examined for overall antibiotics, broad-spectrum antibiotics, antibiotics for acute respiratory tract infections (ARTIs) and antibiotics prescribed during ARTI visits. Rates were reported for three age groups: children and adolescents (<18 years), adults (18 to 64 years), and older adults (?65 years). Results An estimated 1.4 billion antibiotics were dispensed over the study period. Overall antibiotic prescribing decreased 18% (risk ratio (RR) 0.82, 95% confidence interval (95% CI) 0.72 to 0.94) among children and adolescents, remained unchanged for adults, and increased 30% (1.30, 1.14 to 1.49) among older adults. Rates of broad-spectrum antibiotic prescriptions doubled from 2000 to 2010 (2.11, 1.81 to 2.47). Proportions of broad-spectrum antibiotic prescribing increased across all age groups: 79% (1.79, 1.52 to 2.11) for children and adolescents, 143% (2.43, 2.07 to 2.86) for adults and 68% (1.68, 1.45 to 1.94) for older adults. ARTI antibiotic prescribing decreased 57% (0.43, 0.35 to 0.52) among children and adolescents and 38% (0.62, 0.48 to 0.80) among adults; however, it remained unchanged among older adults. While the number of ARTI visits declined by 19%, patients with ARTI visits were more likely to receive an antibiotic (73% versus 64%; P <0.001) in 2010 than in 2000. Conclusions Antibiotic use has decreased among children and adolescents, but has increased for older adults. Broad-spectrum antibiotic prescribing continues to be on the rise. Public policy initiatives to promote the judicious use of antibiotics should continue and programs targeting older adults should be developed. PMID:24916809

2014-01-01

201

Repeated asenapine treatment produces a sensitization effect in two preclinical tests of antipsychotic activity.  

PubMed

Among several commonly used atypical antipsychotic drugs, olanzapine and risperidone cause a sensitization effect in the conditioned avoidance response (CAR) and phencyclidine (PCP)-induced hyperlocomotion paradigms--two well established animal tests of antipsychotic drugs, whereas clozapine causes a tolerance effect. Asenapine is a novel antipsychotic drug recently approved for the treatment of schizophrenia and manic disorders. It shares several receptor binding sites and behavioral features with other atypical antipsychotic drugs. However, it is not clear what type of repeated effect (sensitization or tolerance) asenapine would induce, and whether such an effect is transferrable to other atypicals. In this study, male adult Sprague-Dawley rats were first repeatedly tested with asenapine (0.05, 0.10 or 0.20 mg/kg, sc) for avoidance response or PCP (3.20 mg/kg, sc)-induced hyperlocomotion daily for 5 consecutive days. After 2-3 days of retraining/drug-free recovery, they were then challenged with asenapine (0.10 mg/kg, sc), followed by olanzapine (0.50 mg/kg, sc) and clozapine (2.50 mg/kg, sc). During the 5-day drug test period (the induction phase), repeated asenapine treatment progressively increased its inhibition of avoidance response and PCP-induced hyperlocomotion in a dose-dependent fashion. On the asenapine and olanzapine challenge tests (the expression phase), rats previously treated with asenapine still showed significantly lower avoidance response and lower PCP-induced hyperlocomotion than those previously treated with vehicle. An increased reactivity to clozapine challenge in prior asenapine-treated rats was also found in the PCP-induced hyperlocomotion test. These findings suggest that asenapine is capable of inducing a sensitization effect and a cross-sensitization to olanzapine and clozapine (to a lesser extent). Because the behavioral profile of asenapine in both tests is similar to that of olanzapine, but different from that of clozapine, we suggest that asenapine resembles olanzapine to a greater extent than clozapine in its therapeutic and side effect profiles. PMID:23954676

Qin, Rongyin; Chen, Yingzhu; Li, Ming

2013-12-01

202

Repeated asenapine treatment produces a sensitization effect in two preclinical tests of antipsychotic activity  

PubMed Central

Among several commonly used atypical antipsychotic drugs, olanzapine and risperidone cause a sensitization effect in the conditioned avoidance response (CAR) and phencyclidine (PCP)-induced hyperlocomotion paradigms – two well established animal tests of antipsychotic drugs, whereas clozapine causes a tolerance effect. Asenapine is a novel antipsychotic drug recently approved for the treatment of schizophrenia and manic disorders. It shares several receptor binding sites and behavioral features with other atypical antipsychotic drugs. However, it is not clear what type of repeated effect (sensitization or tolerance) asenapine would induce, and whether such an effect is transferrable to other atypicals. In this study, male adult Sprague-Dawley rats were first repeatedly tested with asenapine (0.05, 0.10 or 0.20 mg/kg, sc) for avoidance response or PCP (3.20 mg/kg, sc)-induced hyperlocomotion daily for 5 consecutive days. After 2–3 days of retraining/drug-free recovery, they were then challenged with asenapine (0.10 mg/kg, sc), followed by olanzapine (0.50 mg/kg, sc) and clozapine (2.50 mg/kg, sc). During the 5-day drug test period (the induction phase), repeated asenapine treatment progressively increased its inhibition of avoidance response and PCP-induced hyperlocomotion in a dose-dependent fashion. On the asenapine and olanzapine challenge tests (the expression phase), rats previously treated with asenapine still showed significantly lower avoidance response and lower PCP-induced hyperlocomotion than those previously treated with vehicle. An increased reactivity to clozapine challenge in prior asenapine-treated rats was also found in the PCP-induced hyperlocomotion test. These findings suggest that asenapine is capable of inducing a sensitization effect and a cross-sensitization to olanzapine and clozapine (to a lesser extent). Because the behavioral profile of asenapine in both tests is similar to that of olanzapine, but different from that of clozapine, we suggest that asenapine resembles olanzapine to a greater extent than clozapine in its therapeutic and side effect profiles. PMID:23954676

Qin, Rongyin; Chen, Yingzhu; Li, Ming

2013-01-01

203

A crash course in Chinese herbology for the psychopharmocological prescriber.  

PubMed

Given the unparalleled popularity of botanicals in the United States, it is safe to say that almost every psychopharmacological prescriber will see some patients using Chinese herbs. Data show that between 36% and 42% of Americans use complementary and alternative medicine (CAM) each year and that persons suffering from depression and anxiety (67%) use CAM services significantly more than do their nonanxious and nondepressed counterparts (39%). This article gives an overview of several classical Chinese medical single herbs and herbal formulas commonly used for persons with psychiatric disorders and discusses some of the herbs that have the potential to interact with various pharmaceutical drugs. In addition, the article reviews scientific evidence and, at times, the lack thereof to validate the use of Chinese herbs and formulas in treating psychiatric conditions. Overall, the article seeks to prepare the pharmacological prescriber for working with patients concomitantly taking psychiatric medications and Chinese herbs. PMID:19968403

White, Kathryn P

2009-12-01

204

Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia.  

PubMed

Most prescription pattern surveys have found a high rate of antipsychotic polypharmacy. To date few studies have investigated antipsychotic polypharmacy in Chinese patients with schizophrenia in general and outpatients in particular. This study examined the frequency and sociodemographic and clinical correlates of antipsychotic polypharmacy in Hong Kong (HK) and Beijing (BJ), China. Three hundred and ninety-eight clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Antipsychotic polypharmacy was found in 17.6% ( N=70) of the whole sample and in 28% and 7.1% of the HK and BJ samples, respectively. Polypharmacy was associated with monthly income, severity of negative symptoms and extrapyramidal side effects (EPS), use of depot antipsychotic and anticholinergic drugs, doses of antipsychotics, and the number of hospitalizations. In multiple logistic regression analysis, younger age, number of hospitalizations, site (HK vs. BJ), and the use of depot antipsychotics were all significantly associated with antipsychotic polypharmacy. Although the ethnic and clinical characteristics of the two cohorts were nearly identical, there was a wide variation in the prescription frequency of antipsychotic polypharmacy between HK and BJ, suggesting that sociocultural and economical factors and traditions of psychiatric practice all played a role in determining antipsychotic polypharmacy. Clinicians should bear in mind that, at least for clinically stable patients, no scientifically sound therapeutic principles for antipsychotic polypharmacy exist. PMID:17447172

Xiang, Y-T; Weng, Y-Z; Leung, C-M; Tang, W-K; Ungvari, G S

2007-03-01

205

Self-prescribing among young Norwegian doctors: a nine-year follow-up study of a nationwide sample  

Microsoft Academic Search

BACKGROUND: Self-prescribing among doctors is common, but no longitudinal studies have documented this issue. We studied the self-prescribing behaviour among young Norwegian physicians and the predictors of self-prescribing. METHODS: We conducted a nationwide, prospective and longitudinal study following young Norwegian physicians from internship through the subsequent nine years using three postal questionnaires. Chi-square tests and logistic regression models were applied.

Erlend Hem; Guro Stokke; Reidar Tyssen; Nina T Grønvold; Per Vaglum; Øivind Ekeberg

2005-01-01

206

The comparison of glucose and lipid metabolism parameters in drug-na?ve, antipsychotic-treated, and antipsychotic discontinuation patients with schizophrenia  

PubMed Central

Background Although many studies have reported that glucose and lipid metabolism disorders are a significant side effect associated with the use of antipsychotic drugs, the characteristics of glucose and lipid metabolism disorders in patients with schizophrenia who are taking antipsychotic drugs remain poorly understood, and the possible effects that antipsychotic discontinuation may have on glucose and lipid metabolism remain unclear. Methods The sample consisted of 131 Chinese patients with schizophrenia, including 70 first-episode, drug-naïve patients; 33 patients who had received continuous antipsychotic drug treatment for ?1 year prior to the beginning of the study; and 28 patients who had discontinued antipsychotic drug treatment for ?3 months prior to the beginning of study. We compared the glucose and lipid metabolic parameter levels among the three groups of patients with schizophrenia. All assessments were performed upon hospital admission. Results The characteristics of glucose and lipid metabolism disorders in Chinese patients with schizophrenia who are taking antipsychotic drugs included significant augmentation of the body mass index and waist circumference, significantly higher levels of fasting plasma insulin and insulin resistance, and significantly lower plasma high-density lipoprotein cholesterol levels. Antipsychotic discontinuation appeared to not significantly improve any plasma glucose and lipid metabolic parameter levels. Conclusion The results suggest that antipsychotic drugs aggravate glucose and lipid metabolism disorders and that antipsychotic discontinuation is generally not associated with improvements in the parameters that indicate glucose and lipid metabolism disorders in Chinese patients with schizophrenia. PMID:25092981

Wu, Xiaoli; Huang, Zeping; Han, Hongying; Zhong, Zhiyong; Gan, Zhaoyu; Guo, Xiaofeng; Diao, Feici; Han, Zili; Zhao, Jingping

2014-01-01

207

Quinoline- and isoquinoline-sulfonamide analogs of aripiprazole: novel antipsychotic agents?  

PubMed

The introduction of typical antipsychotics over six decades ago signaled an important milestone in psychiatry. However, second-generation antipsychotics ameliorated the positive symptoms of schizophrenia but displayed limited effectiveness for the negative and cognitive symptoms. In addition, while the newer antipsychotics produced fewer motor side effects, the atypical antipsychotics still induced weight gain and endocrinopathies. In recent years, a third generation of antipsychotics was identified. Aripiprazole was the first approved drug acting as a D2 partial agonist/functionally selective ligand. This review presents the state of the development of novel antipsychotic dopaminergic and non-dopaminergic agents, supported by an overview of the compounds evaluated under advanced preclinical and clinical development (e.g., cariprazine and brexpiprazole). In line with the recent trends in the development of modern atypical antipsychotics, we present our strategic development of long-chain arylpiperazine-derived quinoline- and isoquinoline-sulfonamide displaying a multireceptor binding profile and partial D2 receptor agonism. PMID:24358948

Zajdel, Pawel; Partyka, Anna; Marciniec, Krzysztof; Bojarski, Andrzej J; Pawlowski, Maciej; Wesolowska, Anna

2014-01-01

208

16 CFR 315.5 - Prescriber verification.  

Code of Federal Regulations, 2010 CFR

...the patient or prescriber directly or by facsimile; or (2) Verified by direct communication...at the seller's company, including facsimile and telephone numbers; and (7...seller: the prescription itself, or the facsimile version thereof (including an...

2010-01-01

209

16 CFR 315.5 - Prescriber verification.  

Code of Federal Regulations, 2011 CFR

...the patient or prescriber directly or by facsimile; or (2) Verified by direct communication...at the seller's company, including facsimile and telephone numbers; and (7...seller: the prescription itself, or the facsimile version thereof (including an...

2011-01-01

210

16 CFR 315.5 - Prescriber verification.  

Code of Federal Regulations, 2012 CFR

... REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CONTACT LENS RULE § 315.5 Prescriber verification. (a) Prescription...address; (2) The contact lens power, manufacturer, base curve or appropriate designation, and diameter when...

2012-01-01

211

16 CFR 315.5 - Prescriber verification.  

... REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CONTACT LENS RULE § 315.5 Prescriber verification. (a) Prescription...address; (2) The contact lens power, manufacturer, base curve or appropriate designation, and diameter when...

2014-01-01

212

16 CFR 315.5 - Prescriber verification.  

Code of Federal Regulations, 2013 CFR

... REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CONTACT LENS RULE § 315.5 Prescriber verification. (a) Prescription...address; (2) The contact lens power, manufacturer, base curve or appropriate designation, and diameter when...

2013-01-01

213

Modeling of outpatient prescribing process in iran: a gateway toward electronic prescribing system.  

PubMed

Implementation of electronic prescribing system can overcome many problems of the paper prescribing system, and provide numerous opportunities of more effective and advantageous prescribing. Successful implementation of such a system requires complete and deep understanding of work content, human force, and workflow of paper prescribing. The current study was designed in order to model the current business process of outpatient prescribing in Iran and clarify different actions during this process. In order to describe the prescribing process and the system features in Iran, the methodology of business process modeling and analysis was used in the present study. The results of the process documentation were analyzed using a conceptual model of workflow elements and the technique of modeling "As-Is" business processes. Analysis of the current (as-is) prescribing process demonstrated that Iran stood at the first levels of sophistication in graduated levels of electronic prescribing, namely electronic prescription reference, and that there were problematic areas including bottlenecks, redundant and duplicated work, concentration of decision nodes, and communicative weaknesses among stakeholders of the process. Using information technology in some activities of medication prescription in Iran has not eliminated the dependence of the stakeholders on paper-based documents and prescriptions. Therefore, it is necessary to implement proper system programming in order to support change management and solve the problems in the existing prescribing process. To this end, a suitable basis should be provided for reorganization and improvement of the prescribing process for the future electronic systems. PMID:25237369

Ahmadi, Maryam; Samadbeik, Mahnaz; Sadoughi, Farahnaz

2014-01-01

214

Nurse prescribing ethics and medical marketing.  

PubMed

This article suggests that nurse prescribers require an awareness of key concepts in ethics, such as deontology and utilitarianism to reflect on current debates and contribute to them. The principles of biomedical ethics have also been influential in the development of professional codes of conduct. Attention is drawn to the importance of the Association of the British Pharmaceutical Industry's code of practice for the pharmaceutical industry in regulating marketing aimed at prescribers. PMID:21500692

Adams, J

215

Analgesic Prescribing Errors and Associated Medication Characteristics  

Microsoft Academic Search

Medication errors involving analgesics, including mistakes in prescribing, are a major contributor to suboptimal therapeutic outcomes and preventable adverse patient events. A systematic evaluation of 2,044 prevented (near-miss) analgesic prescribing errors detected in a teaching hospital was performed to better understand these errors and contributing error-prone analgesic medication characteristics. The overall detected error rate was 2.87 errors per 1,000 analgesic

Howard S. Smith; Timothy S. Lesar

2011-01-01

216

Utilization of Antihypertensives, Antidepressants, Antipsychotics, and Hormones in Alzheimer's Disease  

PubMed Central

This study explores the longitudinal relationship between patient characteristics and use of four drug classes (antihypertensives, antidepressants, antipsychotics, and hormones) that showed significant changes in use rates over time in patients with Alzheimer’s disease (AD). Patient/caregiver-reported prescription medication usage was categorized by drug class for 201 patients from the Predictors Study. Patient characteristics included use of cholinesterase inhibitors and/or memantine, function, cognition, living situation, baseline age, and gender. Assessment interval, year of study entry, and site were controlled for. Before adjusting for covariates, use increased for antihypertensives (47.8% to 62.2%), antipsychotics (3.5% to 27.0%), and antidepressants (32.3% to 40.5%); use of hormones decreased (19.4% to 5.4%). After controlling for patient characteristics, effects of time on the use of antidepressants were no longer significant. Antihypertensive use was associated with poorer functioning, concurrent use of memantine, and older age. Antipsychotic use was associated with poorer functioning and poorer cognition. Antidepressant use was associated with younger age, poorer functioning, and concurrent use of cholinesterase inhibitors and memantine. Hormone use was associated with being female and younger age. Findings suggest accurate modeling of the AD treatment paradigm for certain subgroups of patients should include antihypertensives and antipsychotics in addition to cholinesterase inhibitors and memantine. PMID:20975515

Zhu, Carolyn W.; Livote, Elayne E.; Kahle-Wrobleski, Kristin; Scarmeas, Nikolaos; Albert, Marilyn; Brandt, Jason; Blacker, Deborah; Sano, Mary; Stern, Yaakov

2010-01-01

217

Use of atypical antipsychotics in a Veterans Affairs hospital  

Microsoft Academic Search

In a retrospective chart review, efficacy and drug costs were compared in 91 consecutive outpatients receiving risperidone (n=70) or olanzapine (n=21) at the Veterans Affairs Medical Center in Syracuse, NY. Between-group differences in background characteristics, diagnoses (schizophrenia in more than half of each group) and antipsychotic efficacy [Clinical Global Impressions (CGI) scale scores] were not significant. The mean doses were

Thomas L Schwartz; Mercy Saba; William Hardoby; Subhdeep Virk; Prakash S Masand

2002-01-01

218

Development of a Patient-Centered Antipsychotic Medication Adherence Intervention  

ERIC Educational Resources Information Center

Objective: A substantial gap exists between patients and their mental health providers about patient's perceived barriers, facilitators, and motivators (BFMs) for taking antipsychotic medications. This article describes how we used an intervention mapping (IM) framework coupled with qualitative and quantitative item-selection methods to…

Pyne, Jeffrey M.; Fischer, Ellen P.; Gilmore, LaNissa; McSweeney, Jean C.; Stewart, Katharine E.; Mittal, Dinesh; Bost, James E.; Valenstein, Marcia

2014-01-01

219

Antipsychotic treatment modulates glutamate transport and NMDA receptor expression.  

PubMed

Schizophrenia patients often suffer from treatment-resistant cognitive and negative symptoms, both of which are influenced by glutamate neurotransmission. Innovative therapeutic strategies such as agonists at metabotropic glutamate receptors or glycin reuptake inhibitors try to modulate the brain's glutamate network. Interactions of amino acids with monoamines have been described on several levels, and first- and second-generation antipsychotic agents (FGAs, SGAs) are known to exert modulatory effects on the glutamatergic system. This review summarizes the current knowledge on effects of FGAs and SGAs on glutamate transport and receptor expression derived from pharmacological studies. Such studies serve as a control for molecular findings in schizophrenia brain tissue and are clinically relevant. Moreover, they may validate animal models for psychosis, foster basic research on antipsychotic substances and finally lead to a better understanding of how monoaminergic and amino acid neurotransmissions are intertwined. In the light of these results, important differences dependent on antipsychotic substances, dosage and duration of treatment became obvious. While some post-mortem findings might be confounded with multifold drug effects, others are unlikely to be influenced by antipsychotic treatment and could represent important markers of schizophrenia pathophysiology. In similarity to the convergence of toxic and psychotomimetic effects of dopaminergic, serotonergic and anti-glutamatergic substances, the therapeutic mechanisms of SGAs might merge on a yet to be defined molecular level. In particular, serotonergic effects of SGAs, such as an agonism at 5HT1A receptors, represent important targets for further clinical research. PMID:25214389

Zink, Mathias; Englisch, Susanne; Schmitt, Andrea

2014-11-01

220

MEETING ABSTRACT Open Access Effects of atypical antipsychotics on  

E-print Network

, depressed, and euthymic states in bipolar disorder. Am J Psychiatry 2004, 161:262-270. 2. Torres IJ bipolar patients Carla Torrent1* , Anabel Martinez-Arán1 , Claire Daban2 , Benedikt Amann3 , Vicent bipolar patients, 63 were treated with one atypical antipsychotic, quetiapine (n = 12), olanza- pine (n

Boyer, Edmond

221

Antipsychotic Therapy During Early and Late Pregnancy. A Systematic Review  

PubMed Central

Objective: Both first- (FGAs) and second-generation antipsychotics (SGAs) are routinely used in treating severe and persistent psychiatric disorders. However, until now no articles have analyzed systematically the safety of both classes of psychotropics during pregnancy. Data sources and search strategy: Medical literature information published in any language since 1950 was identified using MEDLINE/PubMed, TOXNET, EMBASE, and The Cochrane Library. Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from companies developing drugs. Search terms were pregnancy, psychotropic drugs, (a)typical-first-second-generation antipsychotics, and neuroleptics. A separate search was also conducted to complete the safety profile of each reviewed medication. Searches were last updated on July 2008. Data selection: All articles reporting primary data on the outcome of pregnancies exposed to antipsychotics were acquired, without methodological limitations. Conclusions: Reviewed information was too limited to draw definite conclusions on structural teratogenicity of FGAs and SGAs. Both classes of drugs seem to be associated with an increased risk of neonatal complications. However, most SGAs appear to increase risk of gestational metabolic complications and babies large for gestational age and with mean birth weight significantly heavier as compared with those exposed to FGAs. These risks have been reported rarely with FGAs. Hence, the choice of the less harmful option in pregnancy should be limited to FGAs in drug-naive patients. When pregnancy occurs during antipsychotic treatment, the choice to continue the previous therapy should be preferred. PMID:18787227

Gentile, Salvatore

2010-01-01

222

Reevaluation of the Mesolimbic Hypothesis of Antipsychotic Drug Action  

Microsoft Academic Search

Conventional neuroleptic drugs are thought to derive their antipsychotic efficacy through influences on the mesolimbic dopamine (DA) system. In contrast, motor side effects of these drugs are suggested to follow from influences on the nigrostriatal DA system. This conceptualization is based on the assumption that behaviors mediated by the mesolimbic DA system are involved in schizophrenia while behaviors controlled by

Theodore I. Lidsky

1995-01-01

223

Antipsychotic Drug Treatment of Schizophrenic Patients with Substance Abuse Disorders  

Microsoft Academic Search

Background\\/Aim: In recent years, there has been a growing interest in developing adequate treatments for patients with a diagnosis of schizophrenia and a comorbid substance use disorder (SUD). In the present paper we aim to critically review published reports on the use of conventional and second-generation antipsychotics in the treatment of patients with schizophrenia and comorbid SUD, to provide clinicians

Luis San; Belen Arranz; Jose Martinez-Raga

2007-01-01

224

Atypical antipsychotics for people with both schizophrenia and depression  

PubMed Central

Background Many people (up to 50%) with schizophrenia also have co-morbid depression. It has been suggested that new atypical antipsychotic drugs are beneficial for people with the two diagnoses. Objectives To assess the effects of atypical antipsychotic drugs on people who have a diagnosis of both schizophrenia and depression. Search methods We searched the Cochrane Schizophrenia’s Group Register (to March 2006). We supplemented this by citation searching and personal contact with authors and relevant pharmaceutical companies. Selection criteria We included randomised clinical trials of atypical antipsychotic drugs used specifically for the treatment of people with a diagnosis of both schizophrenia and depression. Data collection and analysis We extracted data independently. For homogenous dichotomous data we calculated random effects, relative risk (RR), 95% confidence intervals (CI) and, where appropriate, numbers needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD). Main results We found 878 citations but were only able to include three studies (five reports). One trial found no significant difference between quetiapine and haloperidol for the outcome of ‘less than 50% reduction in PANSS score’ (n=180, RR 0.91 CI 0.8 to 1.0). Those allocated sulpiride had significantly lower depression scores compared with people given chlorpromazine (1 RCT, n=36, WMD CPRS ?0.70 CI ?1.2 to ?0.2). Again, however, in the quetiapine versus haloperidol comparison, the continuous scoring did not highlight differences (1 RCT, n=180, WMD PANSS depression change ?0.57 CI ?1.4 to 0.30). When clozapine was compared with any other antipsychotic drug plus an antidepressant or placebo, clozapine constantly scored better on Hamilton scores (1 RCT, n=29, WMD vs antipsychotic + mianserin ?5.53 CI ?8.23 to ?2.8; 1 RCT, n=32, WMD vs antipsychotic + meclobemide ?4.35 CI ?6.7 to ?2.03; 1 RCT, n=33, WMD vs antipsychotic + placebo ?6.35 CI ?8.6 to ?4.1). Authors’ conclusions There are too few data to guide patients, carers, clinicians or policy makers. Current practice has to be guided by evidence other than that derived from randomised trials and more trials in this important area are indicated. PMID:18254078

Furtado, Vivek A; Srihari, Vinod; Kumar, Ajit

2014-01-01

225

Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia  

PubMed Central

Background Medication error is common and preventable cause of medical errors and occurs as a result of either human error or a system flaw. The consequences of such errors are more harmful and frequent among pediatric patients. Objective To assess medication prescribing errors and associated factors in the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. Methods A cross-sectional study was carried out in the pediatric wards of Dessie Referral Hospital from February 17 to March 17, 2012. Data on the prescribed drugs were collected from patient charts and prescription papers among all patients who were admitted during the study period. Descriptive statistics was used to determine frequency, prevalence, means, and standard deviations. The relationship between dependent and independent variables were computed using logistic regression (with significance declared at p-value of 0.05 and 95% confidence interval). Results Out of the 384 Medication order s identified during the study, a total of 223 prescribing errors were identified. This corresponds to an overall medication prescribing error rate of 58.07%. Incomplete prescriptions and dosing errors were the two most common types of prescribing errors. Antibiotics (54.26%) were the most common classes of drugs subjected to prescribing error. Day of the week and route of administration were factors significantly associated with increased prescribing error. Conclusions Medication prescribing errors are common in the pediatric wards of Dessie Referral Hospital. Improving quick access to up to date reference materials, providing regular refresher trainings and possibly including a clinical pharmacist in the healthcare team are recommended. PMID:24826198

2014-01-01

226

Metabolic drug interactions - the impact of prescribed drug regimens on the medication safety  

Microsoft Academic Search

Background and objective: Risk\\/benefit profile of prescribed drug regimens is unkown. Over 60% of\\u000acommonly used medications interact on metabolic pathways (cytochrom P450 (CYP450), uridyl-glucuronyl\\u000atranferasis (UGT I, II) and P-glycoprotein (PGP) transport). Using an up-to-date knowledge on metabolic drug interactions, we aimed the study to determine the medication risk of commonly prescribed drug combinations. Design: A mathematical model was

D. Fialova; K. Vrbensky; E. Topinkova; J. Vlcek; L. W. Soerbye; C. Wagner; R. Bernabei

2005-01-01

227

Soil respiration responses to topography, canopy cover, and prescribed burning in an oak-hickory forest in southeastern Ohio  

Microsoft Academic Search

Soil respiration (Rs) is an important component of carbon loss from forest ecosystems. As forest management (e.g. prescribed burning) is becoming increasingly more common, it is important to understand the relationship between Rs and prescribed fire. Unfortunately, this relationship is still misunderstood due to the heterogeneity of physical and biological factors over the landscape and between ecosystems. To examine the

Dawn R. McCarthy; Kim J. Brown

2006-01-01

228

Using scenarios to test the appropriateness of pharmacist prescribing in asthma management  

PubMed Central

Objective To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. Results In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusions Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way. PMID:24644524

Hanna, Tamer; Bajorek, Beata; LeMay, Kate; Armour, Carol L.

229

Antipsychotic Drugs and Neuroplasticity: Insights into the Treatment and Neurobiology of Schizophrenia  

PubMed Central

This paper reviews the evidence that antipsychotic drugs induce neuroplasticity. We outline how the synaptic changes induced by the antipsychotic drug haloperidol may help our understanding of the mechanism of action of antipsychotic drugs in general, and how they may help to elucidate the neurobiology of schizophrenia. Studies have provided compelling evidence that haloperidol induces anatomical and molecular changes in the striatum. Anatomical changes have been documented at the level of regional brain volume, synapse morphology, and synapse number. At the molecular level, haloperidol has been shown to cause phosphorylation of proteins and to induce gene expression. The molecular responses to conventional antipsychotic drugs are predominantly observed in the striatum and nucleus accumbens, whereas atypical anti-psychotic drugs have a subtler and more widespread impact. We conclude that the ability of antipsychotic drugs to induce anatomical and molecular changes in the brain may be relevant for their antipsychotic properties. The delayed therapeutic action of antipsychotic drugs, together with their promotion of neuroplasticity suggests that modification of synaptic connections by antipsychotic drugs is important for their mode of action. The concept of schizophrenia as a disorder of synaptic organization will benefit from a better understanding of the synaptic changes induced by antipsychotic drugs. PMID:11720691

Konradi, Christine; Heckers, Stephan

2014-01-01

230

Susceptibility genes for the side effect of antipsychotics on body weight and obesity.  

PubMed

Antipsychotic-induced body weight gain is becoming a major health concern since the increasing use of this medication in different mental disorders with a high prevalence in different populations. The percentage of patients gaining weight following antipsychotic medication can reach up to 80% according to the antipsychotic used, with around 30% developing obesity. The origins of this adverse effect of antipsychotics are probably multifactorial with the environment (food and exercise habits, medication) and the genetics coming into play. We have compiled the available genetic results on the antipsychotic-induced body weight gain and obesity. Candidate genes analysis showed that six genes have been associated with this adverse effect of antipsychotics. Among these, the associations with the serotonin receptor 2C and the leptin genes have been observed in more then one study. Thirteen other genes, mainly antipsychotic known receptors, have shown negative results. To find informative gene variations, we have also compared the effects of some polymorphisms of the serotonin receptor 2C and 2A in mental disorders, for antipsychotic therapeutic effect, for antipsychotic neuronal side effects, and for obesity. We have found results for six polymorphisms in each of the two genes. When association was observed for more then one phenotype, the same genotype or allele was generally involved identifying those sensitive to environmental pressures and to genetic background. Animal transgenic models of knockout or overexpressed genes of antipsychotic receptors have been evaluated for changes in obesity-related phenotypes. Seventeen out of the twenty-three antipsychotic receptors with transgenic models showed some effects on obesity-related phenotypes. Ten of these receptors have not been tested yet for antipsychotic-induced body weight gain, while the others have been tested only once with negative results, or is already associated to the effect such as the serotonin receptor 2C. Finally, pharmacogenomic approaches have allowed to detect more then 300 possible candidate genes for antipsychotic-induced body weight gain. PMID:17168843

Chagnon, Yvon C

2006-12-01

231

e-Learning initiatives to support prescribing  

PubMed Central

Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. PMID:22509885

Maxwell, Simon; Mucklow, John

2012-01-01

232

e-Learning initiatives to support prescribing.  

PubMed

Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. PMID:22509885

Maxwell, Simon; Mucklow, John

2012-10-01

233

Chlorpromazine versus every other antipsychotic for schizophrenia: a systematic review and meta-analysis challenging the dogma of equal efficacy of antipsychotic drugs.  

PubMed

It is one of the major psychiatric dogmas that the efficacy of all antipsychotic drugs is same. This statement originated from old, narrative reviews on first-generation antipsychotics, but this old literature has never been meta-analysed. We therefore conducted a meta-analysis of randomised controlled trials on the efficacy of chlorpromazine versus any other antipsychotic in the treatment of schizophrenia. If the benchmark drug chlorpromazine were significantly more or less effective than other antipsychotics, the notion of equal efficacy would have to be rejected. We searched the Cochrane Schizophrenia Group?s specialized register, MEDLINE, EMBASE, PsychInfo and reference lists of relevant articles. The primary outcome was response to treatment. We also analyzed mean values of schizophrenia rating scales at endpoint and drop-out rates. 128, mostly small, RCTs with 10667 participants were included. Chlorpromazine was compared with 43 other antipsychotics and was more efficacious than four (butaperazine, mepazine, oxypertine and reserpine) and less efficacious than other four antipsychotics (clomacran, clozapine, olanzapine and zotepine) in the primary outcome. There were no statistically significant efficacy differences between chlorpromazine and the remaining 28 antipsychotics. The most important finding was that, due to low numbers of participants (median 50, range 8-692), most comparisons were underpowered. Thus we infer that the old antipsychotic drug literature was inconclusive and the claim for equal efficacy of antipsychotics was never evidence-based. Recent meta-analyses on second-generation antipsychotics were in a better position to address this question and small, but consistent differences between drugs were found. PMID:24766970

Samara, Myrto T; Cao, Haoyin; Helfer, Bartosz; Davis, John M; Leucht, Stefan

2014-07-01

234

Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy.  

PubMed

Insufficient treatment of psychosis often manifests as violent and aggressive behaviors that are dangerous to the patient and others, and that warrant treatment strategies which are not considered first-line, evidence-based practices. Such treatment strategies include both antipsychotic polypharmacy (simultaneous use of 2 antipsychotics) and high-dose antipsychotic monotherapy. Here we discuss the hypothesized neurobiological substrates of various types of violence and aggression, as well as providing arguments for the use of antipsychotic polypharmacy and high-dose monotherapy to target dysfunctional neurocircuitry in the subpopulation of patients that is treatment-resistant, violent, and aggressive. In this review, we focus primarily on the data supporting the use of second-generation, atypical antipsychotics both at high doses and in combination with other antipsychotics. PMID:25119976

Morrissette, Debbi A; Stahl, Stephen M

2014-10-01

235

Opioids for Back Pain Patients: Primary Care Prescribing Patterns and Use of Services  

PubMed Central

Background Opioid prescribing for non-cancer pain has increased dramatically. We examined whether the prevalence of unhealthy lifestyles, psychological distress, healthcare utilization, and co-prescribing of sedative-hypnotics increased with increasing duration of prescription opioid use. Methods We analyzed electronic data for 6 months before and after an index visit for back pain in a large managed care plan. Use of opioids was characterized as “none”, “acute” (? 90 days), “episodic”, or “long-term.” Associations with lifestyle factors, psychological distress, and utilization were adjusted for demographics and comorbidity. Results There were 26,014 eligible patients. Among these, 61% received a course of opioid therapy, and 19% were long-term users. Psychological distress, unhealthy lifestyles, and utilization were associated in stepwise fashion with duration of opioid prescribing, not just with chronic use. Among long-term opioid users, 59% received only short-acting drugs; 39% received both long and short acting drugs; 44% received a sedative-hypnotic. Of those with any opioid use, 36% had an emergency visit. Conclusions Opioid prescribing was common among patients with back pain. The prevalence of psychological distress, unhealthy lifestyles, and healthcare utilization increased incrementally with duration of opioid use. Despite safety concerns, co-prescribing of sedative-hypnotics was common. These data may help in predicting long-term opioid use and improving the safety of opioid prescribing. PMID:22086815

Deyo, Richard A.; Smith, David H.M; Johnson, Eric S.; Donovan, Marilee; Tillotson, Carrie J.; Yang, Xiuhai; Petrik, Amanda; Dobscha, Steven K.

2013-01-01

236

Clozapine, a fast-off-D2 antipsychotic.  

PubMed

Ever since clozapine was first synthesized and tested, it showed the unique property of having antipsychotic action but no Parkinson-like motor side effects. The antipsychotic basis of clozapine is to transiently occupy dopamine D2 receptors in the human striatum, in contrast to haloperidol and chlorpromazine, which have a prolonged occupation of D2 receptors. The chemical structure of clozapine facilitates a relatively rapid dissociation from D2 receptors. After short-term occupation of D2 receptors, peak neural activity raises synaptic dopamine, which then displaces clozapine. While clozapine also occupies other types of receptors, they may not have a significant role in preventing parkinsonism. Clozapine's transient occupation of D2 receptors permits patients to move easily and comfortably. PMID:24219174

Seeman, Philip

2014-01-15

237

Antipsychotic-induced hyponatremia: case report and literature review.  

PubMed

We report a case of hyponatremia in a patient that occurred 3 days after initiation of treatment with aripiprazole. The patient was a 50-year-old man admitted to an inpatient psychiatric unit for exacerbation of schizophrenia. He was started on aripiprazole and developed hyponatremia that resolved when the medication was stopped. We postulate that the hyponatremia was due to an aripiprazole-induced syndrome of inappropriate secretion of antidiuretic hormone. There have been numerous case reports in the literature of hyponatremia in the literature associated with atypical antipsychotics. We caution clinicians to be aware that the potential hyponatremic-inducing effects of atypical antipsychotics can occur rapidly after initiation of the medications. PMID:18806526

Kohen, Izchak; Voelker, Suzanne; Manu, Peter

2008-01-01

238

A program for managing weight gain associated with atypical antipsychotics.  

PubMed

This study assessed the efficacy of a weight control program for patients taking atypical antipsychotics. Thirty-one patients with schizophrenia or schizoaffective disorder participated in a 12-week weight control program that incorporated nutrition, exercise, and behavioral interventions. Changes in patients' weight and in body mass index (BMI) were recorded and compared with those of 15 patients in a control group. The intervention group had a mean weight loss of 2.7 kg (six pounds) and a mean reduction of.98 BMI points, compared with a mean weight gain of 2.9 kg (6.4 pounds) and a mean gain of 1.2 BMI points in the control group. These data suggest that the intervention was effective in this group of patients. Professionals treating persons who are taking atypical antipsychotics should encourage them to engage in weight control activities. PMID:12883145

Vreeland, Betty; Minsky, Shula; Menza, Matthew; Rigassio Radler, Diane; Roemheld-Hamm, Beatrix; Stern, Robert

2003-08-01

239

Seroquel: electrophysiological profile of a potential atypical antipsychotic  

Microsoft Academic Search

Extracellular single unit recording techniques were employed to compare the effects of seroquel with the reference antipsychotic (AP) agents clozapine and haloperidol in electrophysiological tests that may predict AP activity. Seroquel and clozapine were differentially more active in reversing the inhibitory actions ofd-amphetamine on mesolimbic (A10) than nigrostriatal (A9) dopamine (DA)-containing neurons, whereas haloperidol exhibited the opposite selectivity. In cell

Jeffrey M. Goldstein; Linda C. Litwin; Evelynjean B. Sutton; Jeffrey B. Malick

1993-01-01

240

Third generation antipsychotic drugs: partial agonism or receptor functional selectivity?  

PubMed Central

Functional selectivity is the term that describes drugs that cause markedly different signaling through a single receptor (e.g., full agonist at one pathway and antagonist at a second). It has been widely recognized recently that this phenomenon impacts the understanding of mechanism of action of some drugs, and has relevance to drug discovery. One of the clinical areas where this mechanism has particular importance is in the treatment of schizophrenia. Antipsychotic drugs have been grouped according to both pattern of clinical action and mechanism of action. The original antipsychotic drugs such as chlorpromazine and haloperidol have been called typical or first generation. They cause both antipsychotic actions and many side effects (extrapyramidal and endocrine) that are ascribed to their high affinity dopamine D2 receptor antagonism. Drugs such as clozapine, olanzapine, risperidone and others were then developed that avoided the neurological side effects (atypical or second generation antipsychotics). These compounds are divided mechanistically into those that are high affinity D2 and 5-HT2A antagonists, and those that also bind with modest affinity to D2, 5-HT2A, and many other neuroreceptors. There is one approved third generation drug, aripiprazole, whose actions have been ascribed alternately to either D2 partial agonism or D2 functional selectivity. Although partial agonism has been the more widely accepted mechanism, the available data are inconsistent with this mechanism. Conversely, the D2 functional selectivity hypothesis can accommodate all current data for aripiprazole, and also impacts on discovery compounds that are not pure D2 antagonists. PMID:19909227

Mailman, Richard B.; Murthy, Vishakantha

2010-01-01

241

Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer's Disease  

Microsoft Academic Search

Background: Atypical antipsychotics are widely used for psychosis and aggression in AD patients but their benefits are uncertain and safety is of concern. We assessed their effectiveness in AD outpatients. Methods: 421 AD outpatients with psychosis, aggression, or agitation were randomly assigned to olanzapine (mean, 5.5 mg\\/d), quetiapine (56.5 mg\\/d), risperidone (1.0 mg\\/d), or placebo with doses adjusted as needed

Lon S. Schneider; Pierre N. Tariot; Karen S. Dagerman; Sonia M. Davis; John K. Hsiao; M. Saleem Ismail; Barry D. Lebowitz; Constantine G. Lyketsos; J. Michael Ryan; T. Scott Stroup; David L. Sultzer; Daniel Weintraub; Jeffrey A. Lieberman

2006-01-01

242

Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug  

Microsoft Academic Search

A high dose of ?9-tetrahydrocannabinol, the main Cannabis sativa (cannabis) component, induces anxiety and psychotic-like symptoms in healthy volunteers. These effects of ?9-tetrahydrocannabinol are significantly reduced by cannabidiol (CBD), a cannabis constituent which is devoid of the typical effects of the plant. This observation led us to suspect that CBD could have anxiolytic and\\/or antipsychotic actions. Studies in animal models

A. W. Zuardi; J. A. S. Crippa; J. E. C. Hallak; F. A. Moreira; F. S. Guimarães

2006-01-01

243

Radioreceptor Binding Profile of the Atypical Antipsychotic Olanzapine  

Microsoft Academic Search

The affinities of olanzapine, clozapine, haloperidol, and four potential antipsychotics were compared on binding to the neuronal receptors of a number of neurotransmitters. In both rat tissues and cell lines transfected with human receptors olanzapine had high affinity for dopamine D1, D2, D4, serotonin (5HT)2A, 5HT2C, 5HT3, ?1-adrenergic, histamine H1, and five muscarinic receptor subtypes. Olanzapine had lower affinity for

Frank P Bymaster; David O Calligaro; Julie F Falcone; Richard D Marsh; Nicholas A Moore; Nicholas C Tye; Philip Seeman; David T Wong

1996-01-01

244

Social Welfare Loss in Antidepressant and Antipsychotic Pharmaceutical Markets  

Microsoft Academic Search

We study allocative inefficiency under monopoly using a two-good general-equilibrium mo- nopoly production model. Individuals are heterogeneous with respect to preferences. We com- pare social welfare under monopoly with welfare under perfect competition. We then apply this model to the antidepressant and antipsychotic pharmaceutical markets. We find that, for nine specific drugs, annual social-welfare losses ranged from $63 million to

CHRISTINA M. L. KELTON; ROBERT P. REBELEIN

2005-01-01

245

Secondary Effects of Antipsychotics: Women at Greater Risk Than Men  

Microsoft Academic Search

Context: The health burden of antipsychotic medication is well known, but the disproportionate effect on women as compared with men is underappreciated. Objective: The goal of this article is preventive—to better inform clinicians so that the risks to women and to their offspring can be di- minished.Method:All PubMed sources in which the search term gender (or sex) was linked to

Mary V. Seeman; M. Parelman; B. Stoecker; A. Baker; D. Medeiros; D. Gaddy; D. S. Perrien; N. S. Akel; E. E. Dupont-Versteegden; R. A. Skinner; E. R. Siegel; A. Alberich-Bayarri; L. Marti-Bonmati; R. Sanz-Requena; E. Belloch; T MRI; Schizophr Bull

2008-01-01

246

Sleepwalking, A Possible Side Effect of Antipsychotic Medication  

Microsoft Academic Search

Two case examples and a review of the sleep literature illustrate the potential of antipsychotic medication to trigger sleepwalking\\u000a episodes in the context of schizophrenia. Causative hypotheses are briefly reviewed, as well as risk factors, differential\\u000a diagnosis, and management. Sleepwalking may contribute to delusions, aggression, and accidental suicide. It is important to\\u000a investigate sleep disorders in schizophrenia. They are not

Mary V. Seeman

2011-01-01

247

E-Prescribing Errors in Community Pharmacies: Exploring Consequences and Contributing Factors  

PubMed Central

Objective To explore types of e-prescribing errors in community pharmacies and their potential consequences, as well as the factors that contribute to e-prescribing errors. Methods Data collection involved performing 45 total hours of direct observations in five pharmacies. Follow-up interviews were conducted with 20 study participants. Transcripts from observations and interviews were subjected to content analysis using NVivo 10. Results Pharmacy staff detected 75 e-prescription errors during the 45 hour observation in pharmacies. The most common e-prescribing errors were wrong drug quantity, wrong dosing directions, wrong duration of therapy, and wrong dosage formulation. Participants estimated that 5 in 100 e-prescriptions have errors. Drug classes that were implicated in e-prescribing errors were antiinfectives, inhalers, ophthalmic, and topical agents. The potential consequences of e-prescribing errors included increased likelihood of the patient receiving incorrect drug therapy, poor disease management for patients, additional work for pharmacy personnel, increased cost for pharmacies and patients, and frustrations for patients and pharmacy staff. Factors that contribute to errors included: technology incompatibility between pharmacy and clinic systems, technology design issues such as use of auto-populate features and dropdown menus, and inadvertently entering incorrect information. Conclusion Study findings suggest that a wide range of e-prescribing errors are encountered in community pharmacies. Pharmacists and technicians perceive that causes of e-prescribing errors are multidisciplinary and multifactorial, that is to say e-prescribing errors can originate from technology used in prescriber offices and pharmacies. PMID:24657055

Stone, Jamie A.; Chui, Michelle A.

2014-01-01

248

Predicting pharmacokinetic stability by multiple oral administration of atypical antipsychotics.  

PubMed

Lower fluctuation, i.e., lower peak-to-trough plasma-concentration variation at steady-state pharmacokinetics, has several advantages for the treatment of schizophrenia with antipsychotics. The reduction of peak concentration can decrease the risk of dose-dependent side effects, such as extrapyramidal symptom and somnolence, and by contrast the increase in trough concentration can decrease the incidence of lack of efficacy due to subtherapeutic drug concentration. Using a one-compartment simulation technique with pharmacokinetic parameters of each atypical antipsychotic collected from package inserts, the fluctuation index was calculated. Among the antipsychotics, the indices varied from 0.018 to 1.9, depending on dosing regimens, formulations and several pharmacokinetic properties. The order of simulated fluctuation index is active-moiety aripiprazole (b.i.d.)

Wakamatsu, Akihide; Aoki, Kazuo; Sakiyama, Yojiro; Ohnishi, Takashi; Sugita, Makoto

2013-03-01

249

Antipsychotic-like effect of minocycline in a rat model  

PubMed Central

Objectives: Tetracycline antibiotic drug minocycline has strongly neuroprotective and anti-inflammatory effects. Minocycline has also remarkable brain tissue penetration, is clinically entirely tolerated and properly absorbed when taken orally. In our study, we class with the effects of minocycline and chlorpromazine, a conventional antipsychotic drug, by evaluating the novelty-induced rearing, apomorphine-induced stereotypic behavior, and brain MDA levels in rats. Materials and Methods: Four groups of rat (n = 7) were applied with minocycline (50 and 100 mg/kg, i.p.), chlorpromazine (1 mg/kg, i.p.), or isotonic saline (1 mL/kg, i.p.). One hour later, apomorphine (2 mg/kg, s.c.) was applied to each rat. Result: Our results showed that both doses of minocycline significantly decreased the rearing behavior in rats, whereas the decrease with chlorpromazine was higher. Minocycline also decreased the stereotypy scores in a dose-dependent manner. Conclusion: We concluded that minocycline has beneficial effects on rearing behavior and stereotypy, which are accepted to be indicators of antipsychotic effect. Taken together, minocycline, as an anti-oxidant and cytoprotective agent, can be useful in neuroprotection especially on early stages of psychosis or prepsychotic patients with insignificant symptoms. Minocycline is worthy of being investigated for its anti-psychotic effects as a primary or an adjunctive drug.

Dokuyucu, Recep; Kokacya, Hanifi; Inanir, Sema; Copoglu, Umit Sertan; Erbas, Oytun

2014-01-01

250

Reforms and initiatives in Scotland in recent years to encourage the prescribing of generic drugs, their influence and implications for other countries.  

PubMed

Scotland has introduced a number of initiatives to enhance the prescribing of low-cost generic drugs versus originators and patent products in a class where these are seen as similar. The objective of this review is to appraise the influence of the various measures on subsequent utilization patterns and expenditure in high-volume classes to provide guidance. This review is principally a narrative review of published studies. The authors' found supply-side measures resulted in generic prices as low as 3% of pre-patent loss prices. Multiple demand-side measures resulted in high international non-proprietary name prescribing, and a considerable increase in prescribing efficiency for the proton pump inhibitors, statins, renin-angiotensin inhibitor drugs and selective serotonin reuptake inhibitors. There were no specific activities encouraging the prescription of losartan versus other angiotensin receptor blockers or risperidone versus other atypical antipsychotic drugs following generics and no change in their utilization patterns post generics. The authors can conclude multiple measures are needed to change physician prescribing habits. Authorities cannot rely on any 'spillover' effects to affect future prescribing, even in closely related classes. PMID:23977975

Godman, Brian; Bishop, Iain; Finlayson, Alexander E; Campbell, Stephen; Kwon, Hye-Young; Bennie, Marion

2013-08-01

251

Antipsychotics and associated risk of out-of-hospital cardiac arrest.  

PubMed

Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out-of-hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear. We identified all OHCAs in Denmark (2001-2010). The risk of OHCA associated with antipsychotic drug use was evaluated by conditional logistic regression analysis in case-time-control models. In total, 2,205 (7.6%) of 28,947 OHCA patients received treatment with an antipsychotic drug at the time of the event. Overall, treatment with any antipsychotic drug was associated with OHCA (odds ratio (OR) = 1.53, 95% confidence interval (CI): 1.23-1.89), as was use with typical antipsychotics (OR = 1.66, CI: 1.27-2.17). By contrast, overall, atypical antipsychotic drug use was not (OR = 1.29, CI: 0.90-1.85). Two individual typical antipsychotic drugs, haloperidol (OR = 2.43, CI: 1.20-4.93) and levomepromazine (OR = 2.05, CI: 1.18-3.56), were associated with OHCA, as was one atypical antipsychotic drug, quetiapine (OR = 3.64, CI: 1.59-8.30). PMID:24960522

Weeke, P; Jensen, A; Folke, F; Gislason, G H; Olesen, J B; Fosbøl, E L; Wissenberg, M; Lippert, F K; Christensen, E F; Nielsen, S L; Holm, E; Kanters, J K; Poulsen, H E; Køber, L; Torp-Pedersen, C

2014-10-01

252

Atypical antipsychotics as enhancement therapy in rapid cycling mood states: a case study.  

PubMed

Rapid cycling is not an uncommon occurrence in patients with bipolar affective disorder. This variant of the disease is notorious for its treatment resistance, in particular, lithium resistance. A full spectrum of cycloid mood states has been described. The author presents five cases in which the addition of atypical antipsychotics resulted in significant symptom relief. An argument for a preferential use of atypical antipsychotics, with their low risk of tardive dyskinesia, is made. General guidelines for the use of atypical antipsychotics in rapid cycling patients are discussed. Atypical antipsychotic medications in "cycloid disorders," including rapid cycling bipolar disease, are discussed. PMID:9781473

Novac, A

1998-09-01

253

Galois Representations with Prescribed Restriction to Inertia  

E-print Network

Galois Representations with Prescribed Restriction to Inertia Jared Weinstein, UC Berkeley Red Ip Gal( ¯Fp/Fp) be the inertia group. Given a family of continuous complex representations p : Ip-Deligne representations A,p : WQp GL2(C) for each prime p. The restrictions to inertia A,p|IQp : IQp GL2(C) are trivial

Fried, Michael

254

Evaluation of Satellite Detected Prescribed Burns  

E-print Network

source of fine particles in southeastern US ­ 250K tons/yr primary emissions. Prescribed burns number x 1 km2. Landsat data have high noises ­ still need to tune the algorithm for noise reduction 0 fires (probably even lower in winter ­ also vary by season Need joint distribution

Jacob, Daniel J.

255

Energy-storage of a prescribed impedance  

NASA Technical Reports Server (NTRS)

General mathematical expression found for energy storage shows that for linear, passive networks there is a minimum possible energy storage corresponding to a prescribed impedance. The electromagnetic energy storage is determined at different excitation frequencies through analysis of the networks terminal and reactance characteristics.

Smith, W. E.

1969-01-01

256

Teacher Aide Individually Prescribed Instructional Modules.  

ERIC Educational Resources Information Center

This document contains 59 individually prescribed instructional modules for use in teacher aide education programs. Each module has six sections: 1) Behavioral objectives, 2) purpose, 3) performance criteria, 4) experiences, 5) resources, and 6) taxonomy. The subjects covered include the use of instructional equipment such as language master,…

Livingston Univ., AL. Coll. of Education.

257

Prescribed masturbation in sex therapy: A critique  

Microsoft Academic Search

The goal of this paper is to show from a n interactional or systemic perspective how intimacy may be damaged through traditional sex therapy approaches. This is in opposition to stated claims sex therapists, who have, since the pionem'ng work of Masters and Johnson, sought to improve intimacy Ly removing the impediment of poor sexual response. Prescribed masturbation in sex

Clark Christensen

1995-01-01

258

Electronic Prescribing: Improving the Efficiency and Accuracy of Prescribing in the Ambulatory Care Setting  

PubMed Central

Electronic prescribing (e-prescribing) is an important part of the nation's push to enhance the safety and quality of the prescribing process. E-prescribing allows providers in the ambulatory care setting to send prescriptions electronically to the pharmacy and can be a stand-alone system or part of an integrated electronic health record system. The methodology for this study followed the basic principles of a systematic review. A total of 47 sources were referenced. Results of this research study suggest that e-prescribing reduces prescribing errors, increases efficiency, and helps to save on healthcare costs. Medication errors have been reduced to as little as a seventh of their previous level, and cost savings due to improved patient outcomes and decreased patient visits are estimated to be between $140 billion and $240 billion over 10 years for practices that implement e-prescribing. However, there have been significant barriers to implementation including cost, lack of provider support, patient privacy, system errors, and legal issues. PMID:24808808

Porterfield, Amber; Engelbert, Kate; Coustasse, Alberto

2014-01-01

259

The effect of atypical antipsychotics on brain N-acetylaspartate levels in antipsychotic-naïve first-episode patients with schizophrenia: a preliminary study  

PubMed Central

Purpose To investigate the correlates of a clinical therapeutic response by using the parameters measured by proton magnetic resonance spectroscopy after the administration of atypical antipsychotics. Patients and methods Twenty-five antipsychotic-naïve first-episode patients with schizophrenia were monitored for 12 months. The patients were evaluated using 1H magnetic resonance spectroscopy in the dorsolateral prefrontal cortex and Positive and Negative Syndrome Scale, Clinical Global Impression Scale of Severity, Tower of London – Drexel University, Letter–Number Span Test, Trail Making Test A, and Personal and Social Performance Scale. They were administered atypical antipsychotics, starting with quetiapine. In the absence of a therapeutic response, another antipsychotic was introduced. Results After 12 study months, the N-acetylaspartate/creatine (NAA/Cr) level did not significantly change at the whole-group level. Additional analysis revealed a significant rise in the NAA/Cr level in the study group that stayed on the same antipsychotic throughout the study course (P=0.008) and a significant drop in NAA/Cr in the study group that switched antipsychotics (P=0.005). On the whole-group level, no significant correlations between NAA/Cr values and other scores were found at either baseline or after 12 study months. Conclusion One-year treatment with atypical antipsychotics administered to antipsychotic-naïve patients didn’t result in a significant rise in the NAA/Cr ratio. However, a significant rise was witnessed in the study group in which a satisfactory therapeutic response had been achieved with a single antipsychotic administration. PMID:25045268

Groši?, Vladimir; Folnegovi? Groši?, Petra; Kalember, Petra; Bajs Janovi?, Maja; Radoš, Marko; Mihanovi?, Mate; Henigsberg, Neven

2014-01-01

260

Effects of antipsychotics on D3 receptors: a clinical PET study in first episode antipsychotic naive patients with schizophrenia using [11C]-(+)-PHNO.  

PubMed

Most antipsychotics are thought to have an effect on D(2) and D(3) receptors, although their D(3), versus D(2) binding has not been clearly established in vivo in humans. However, the development of [(11)C]-(+)-PHNO now permits the differentiation of antipsychotic activity on these two receptor subtypes. In this study we examined the effects of antipsychotics on D(2) and D(3) receptors by comparing [(11)C]-(+)-PHNO in D(2)-rich (caudate, CAU and putamen, PUT), mixed (ventral striatum) and D(3)-rich (globus-pallidus, GP and substantia nigra, SN) regions before and after the initiation of antipsychotic medication. The investigation therefore represents a longitudinal within-subject follow-up design wherein antipsychotic-naive patients with schizophrenia spectrum disorders were first scanned in a drug-naïve state and then again after ~2.5 weeks of antipsychotic treatment (risperidone or olanzapine). Binding potential (non displaceable or BP(ND)) was obtained to derive estimates of drug occupancy in the identified brain regions. Antipsychotic treatment was associated with the expected occupancies in the D(2)-rich regions; unexpectedly though, patients showed a higher, rather than the expected lower, [(11)C]-(+)-PHNO BP(ND) in the GP and SN despite simultaneous evidence for ongoing D(2) blockade in the other regions (CAU and PUT). In conclusion, patients treated with atypical antipsychotics demonstrated no evidence of D(3) receptor occupancy, but instead possible D(3) up-regulation following short-term treatment. The present findings add to a very limited body of evidence related to D(3) binding in vivo. [(11)C]-(+)-PHNO offer new opportunities for exploring the potential therapeutic significance of the D(3) receptor in schizophrenia and the action of antipsychotics. PMID:21684721

Mizrahi, Romina; Agid, Ofer; Borlido, Carol; Suridjan, Ivonne; Rusjan, Pablo; Houle, Sylvain; Remington, Gary; Wilson, Alan A; Kapur, Shitij

2011-09-01

261

E-prescribing errors identified in a compounding pharmacy: a quality-improvement project.  

PubMed

Errors during the prescribing process can cause problems for patients. When the pharmacist intercepts a prescribing error, it can cause a delay, as the patient may not receive the medication until the problem is resolved. Electronic prescriptions are purported to reduce prescribing errors. However, studies have shown that electronic prescriptions can be prone to certain types of errors. Compounding pharmacies may present an additional obstacle for e-prescribing, as the prescribed medications are not commercially available and may not be listed in the e-prescribing software. The objectives of this study were to estimate the electronic prescription error rate in a compounding pharmacy, determine the most common error types, list the most common interventions pharmacists made, and estimate how long it took to resolve these errors. The study design was quality improvement with descriptive data. During the four weeks of data collection, the pharmacists were trained to complete a standardized data collection form when they identified an electronic prescription error. Percentages were calculated for new prescriptions, electronic prescriptions with errors, error types, and error resolution methods. In the four-week period of the study, there were 982 new prescriptions, 111 of which were electronic prescriptions. Of those 111 electronic prescriptions, 70 had errors. The electronic prescriptions error rate was 63%. The most common type of error was wrong entry field (70.3%). For this project, wrong entry field was defined to mean that the drug name was in the wrong field (81%) or that multiple entries were in the wrong field (7%). Pharmacists usually used their own judgment to resolve an error (67%). Many e-prescription errors were identified in this compounding pharmacy. When prescription errors happen, workflow and patient care are disrupted. Our goal is to discuss these findings with Surescripts and e-prescribing software companies to seek systems-based solutions. PMID:24881345

Reed-Kane, Dana; Kittell, Katrina; Adkins, Jacquelyn; Flocks, Sarah; Nguyen, Thu

2014-01-01

262

An evaluation of prescribing practices for community-acquired pneumonia (CAP) in Mongolia  

PubMed Central

Background Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality in all age groups worldwide. It may be classified as mild/moderate or severe, the latter usually requiring hospitalisation. Although, there are many studies reported in relation to CAP, there is relatively little known about the treatment of CAP and its antibiotic use in Mongolia. The study aim was to evaluate prescribing practices for the treatment of mild/moderate CAP in Mongolia with respect to national prescribing guidelines. Methods Written prescriptions with a written diagnosis of CAP included were collected prospectively and sequentially for ten weeks from a purposefully selected sample of community pharmacies in rural and urban areas of Mongolia. The data collected included the patient’s age, gender, medication details, frequency and number of doses prescribed. Evaluation was with respect to the Mongolian Standard Treatment Guidelines (2005, 2008). Statistical differences between groups were tested using the Chi-squared and Fisher’s exact tests. Results Prescriptions were collected from 22 pharmacies and represented the prescribing practices of 118 doctors. The study enrolled 394 (193 adults and 201 children) patients, with a median age for children of 2.0 years (range: 0.03-12) and adults of 33.0 years (range: 13–92). The most commonly prescribed drugs were aminopenicillins, vitamins, and mucolytics, with the median number of drugs being three per prescription. Inappropriate drug selection was similar for adults (57.7%) and children (56.6%), and the major reason for an overall frequency of inappropriate prescribing for adults was 89.0% and for children 78.0%. Doctors in urban areas prescribed more inappropriate drugs than those in rural areas for both children and adults, p = .0014. The proportion of prescribed injections was 28.4% for adults and 9.0% for children, and for adults was significantly higher in urban areas. The prescribing standard for non-hospitalized patients in Mongolia states that injections should not be prescribed. Conclusions The high level of inappropriate prescribing for mild/moderate CAP highlights the need to develop comprehensive and reliable procedures nationwide to improve prescribing practices in Mongolia. PMID:24088338

2013-01-01

263

Educational interventions to improve prescribing competency: a systematic review  

PubMed Central

Objective To review the literature on educational interventions to improve prescribing and identify educational methods that improve prescribing competency in both medical and non-medical prescribers. Design A systematic review was conducted. The databases Medline, International Pharmaceutical Abstracts (IPA), EMBASE and CINAHL were searched for articles in English published between January 1990 and July 2013. Setting Primary and secondary care. Participants Medical and non-medical prescribers. Intervention Education-based interventions to aid improvement in prescribing competency. Primary outcome Improvements in prescribing competency (knows how) or performance (shows how) as defined by Miller's competency model. This was primarily demonstrated through prescribing examinations, changes in prescribing habits or adherence to guidelines. Results A total of 47 studies met the inclusion criteria and were included in the systematic review. Studies were categorised by their method of assessment, with 20 studies assessing prescribing competence and 27 assessing prescribing performance. A wide variety of educational interventions were employed, with different outcome measures and methods of assessments. In particular, six studies demonstrated that specific prescribing training using the WHO Guide to Good Prescribing increased prescribing competency in a wide variety of settings. Continuing medical education in the form of academic detailing and personalised prescriber feedback also yielded positive results. Only four studies evaluated educational interventions targeted at non-medical prescribers, highlighting that further research is needed in this area. Conclusions A broad range of educational interventions have been conducted to improve prescribing competency. The WHO Guide to Good Prescribing has the largest body of evidence to support its use and is a promising model for the design of targeted prescribing courses. There is a need for further development and evaluation of educational methods for non-medical prescribers. PMID:23996821

Kamarudin, Gritta; Penm, Jonathan; Chaar, Betty; Moles, Rebekah

2013-01-01

264

Half a century of antipsychotics and still a central role for dopamine D2 receptors.  

PubMed

A review of the history of antipsychotics reveals that while the therapeutic effects of chlorpromazine and reserpine were discovered and actively researched almost concurrently, subsequent drug development has been restricted to drugs acting on postsynaptic receptors rather than modulation of dopamine release. The fundamental property of atypical antipsychotics is their ability to produce an antipsychotic effect in the absence of extrapyramidal side effects (EPS) or prolactin elevation. Modulation of the dopamine D2 receptor remains both necessary and sufficient for antipsychotic drug action, with affinity to the D2-receptor being the single most important discriminator between a typical and atypical drug profile. Most antipsychotics, including atypical antipsychotics, show a dose-dependent threshold of D2 receptor occupancy for their therapeutic effects, although the precise threshold is different for different drugs. Some atypical antipsychotics do not appear to reach the threshold for EPS and prolactin elevation, possibly accounting for their atypical nature. To link the biological theories of antipsychotics to their psychological effects, a hypothesis is proposed wherein psychosis is a state of aberrant salience of stimuli and ideas, and antipsychotics, via modulation of the mesolimbic dopamine system, dampen the salience of these symptoms. Thus, antipsychotics do not excise psychosis: they provide the neurochemical platform for the resolution of symptoms. Future generations of antipsychotics may need to move away from a "one-size-fits-all polypharmacy-in-a-pill" approach to treat all the different aspects of schizophrenia. At least in theory a preferred approach would be the development of specific treatments for the different dimensions of schizophrenia (e.g., positive, negative, cognitive, and affective) that can be flexibly used and titrated in the service of patients' presenting psychopathology. PMID:14642968

Kapur, Shitij; Mamo, David

2003-10-01

265

E-Prescribing collaboration in Massachusetts: early experiences from regional prescribing projects.  

PubMed

Massachusetts payers and providers have encouraged clinician usage of e-Prescribing technology to improve patient safety, enhance office practice efficiencies, and reduce medical costs. This report describes three early pilot e-Prescribing projects as case studies. These projects identified the e-Prescribing needs of clinicians, illustrated key issues that made implementation difficult, and clarified the impact of various types of functionality. The authors identified ten key barriers: (1) previous negative technology experiences, (2) initial and long-term cost, (3) lost productivity, (4) competing priorities, (5) change management issues, (6) interoperability limitations, (7) information technology (IT) requirements, (8) standards limitations, (9) waiting for an "all-in-one solution," and (10) confusion about competing product offerings including hospital/Integrated Delivery System (IDN)-sponsored projects. In Massachusetts, regional projects have helped to address these barriers, and e-Prescribing activities are accelerating rapidly within the state. PMID:16501174

Halamka, John; Aranow, Meg; Ascenzo, Carl; Bates, David W; Berry, Kate; Debor, Greg; Fefferman, Jessica; Glaser, John; Heinold, Jerilyn; Stanley, John; Stone, Diane L; Sullivan, Thomas E; Tripathi, Micky; Wilkinson, Bruce

2006-01-01

266

More than a prescriber: gerontological nurse practitioners' perspectives on prescribing and pharmaceutical marketing.  

PubMed

The purpose of this study was to gain understanding about nurse practitioners' (NPs') prescriptive decision making for geriatric patients with attention to pharmaceutical marketing influences. Prior research has focused on physician prescribers and identified suboptimal practices. Because the majority of medications are prescribed to older adults, NPs in geriatric practice were targeted as an information-rich group to interview about prescribing issues. Given the exploratory nature of this research, qualitative focus group methods were employed using content analysis. Fifteen NPs were recruited at an annual national geriatric NP conference. They worked in all regions of the United States, had an average of 9 years prescribing experience, and participated in 1 of the 2 focus groups. The key theme that emerged was that they were more than a prescriber. Findings revealed overwhelming consistency among the NP participants that their nursing background instilled a holistic approach that encompassed both nondrug and therapeutic drug options and skepticism about drug marketing, as well as offered a positive difference by tailoring to their patients' biophysical, psychological, and economic needs with an involvement in the interplay of geriatric care issues not typically addressed by physicians. The participants' reported approaches were in alignment with geriatric prescribing recommendations. PMID:20159350

Mahoney, Diane Feeney; Ladd, Elissa

2010-01-01

267

Anticipatory prescribing at the end of life in Lothian care homes.  

PubMed

Common symptoms at the end of life include pain, breathlessness, anxiety, respiratory secretions and nausea. National end-of-life care strategies advocate anticipatory prescribing for timely management of these symptoms to enhance patient care by preventing unnecessary distress. This study investigated the extent to which residents in eight Lothian care homes had anticipatory medications prescribed prior to death. Data were collected as part of a service development project to improve palliative care in nursing care homes in Edinburgh. Of the 77 residents who died in the care homes, 54% had anticipatory medicines prescribed. Only 15% had prescriptions for all four nationally recommended anticipatory medications. Many care home residents do not have the recommended anticipatory medications in place in the last days of life and thus may experience inadequate symptom control. Interventions that increase the availability of anticipatory medicines to manage common symptoms at the end of life for care home residents are required. PMID:25381850

Finucane, Anne M; Stevenson, Barbara; Gardner, Hilary; McArthur, Dorothy; Murray, Scott A

2014-11-01

268

Pharmacy compounding primer for physicians: prescriber beware.  

PubMed

Since the development of federal standards for drug approval, the practice of medicine has historically involved the compounding of medications based on a physician's determination that a US FDA-approved product either did not exist, or could not be used for medical reasons. Today, prescriptions for non-FDA-approved compounded drugs may be driven by fanciful and largely unregulated pharmacy advertisements to physicians and patients and/or payer reimbursement policies, thus placing prescribers in the backseat for clinical decision making. This article outlines essential differences between FDA-approved drugs and compounded drugs and reasserts the primary medical role of physicians for determining what medical circumstances may necessitate treatment with non-FDA-approved products. In addition, liability concerns when prescribing non-FDA-approved drugs are discussed. While representing a US perspective, underlying principles apply globally in the setting of magistral and extemporaneous formulations produced outside national regulatory frameworks. PMID:23039281

Sellers, Sarah; Utian, Wulf H

2012-11-12

269

Potentially Inappropriate Prescribing in Older Primary Care Patients  

PubMed Central

Objectives The aim of the study was to determine the rate of Potentially Inappropriate Medicines (PIM) and Potential Prescription Omissions (PPO) according to Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START) criteria. Study Design A cross-sectional survey in community pharmacy. Method A prospective cross-sectional study was performed, during March-May 2012, in five community pharmacies. Patients aged ?65 years, who collected one or more prescribed medications, were asked to participate in the study, and an interview was scheduled. Patients were asked to provide their complete medical and biochemical record from their general practitioner. Results 509 patients, mean age 74.8±6.5 years, 57.4% female, participated in the study. 164 PIM were identified in 139 patients (27.3%). The most common were: long-term use of long-acting benzodiazepines (20.7%), use of non-steroidal antiinflammatory drugs (NSAID) in patients with moderate-severe hypertension (20.1%), use of theophylline as monotherapy for chronic obstructive pulmonary disease (COPD, 15.9%) and use of aspirin without appropriate indication (15.2%). Patients with more than four prescpritions had a higher risk for PIM (OR 2.85, 95% CI 1.97–4.14, p<0.001). There were 439 PPO, identified in 257, (50.5%) patients. Predictors for PPO were older age, presence of diabetes, myocardial infarction, osteoporosis, stroke, COPD and/or angina pectoris. Conclusion STOPP/START criteria may be useful in identifying inappropriate prescribing and improving the current prescribing practices. Pharmacists should focus more on patients with more than four medications and/or patients with gout or pain accompanied with arterial hypertension because those patient may be at higher risk of PIM. Additionlly, patients older than 74 years with diabetes, osteoporosis, myocardial infarction, stroke, angina pectoris and/or COPD may have an increased risk of PPO. PMID:24763332

Vezmar Kovacevic, Sandra; Simisic, Mika; Stojkov Rudinski, Svetlana; Culafic, Milica; Vucicevic, Katarina; Prostran, Milica; Miljkovic, Branislava

2014-01-01

270

Poor Antipsychotic Adherence Among Patients With Schizophrenia: Medication and Patient Factors  

Microsoft Academic Search

Many patients with schizophrenia are poorly adherent with antipsychotic medications. The newer, atypical antipsychotics may be more acceptable to patients and result in increased adherence. We used national Department of Veterans Affairs (VA) pharmacy data to examine whether patients receiving atypical agents are more adherent with their medication and explored patient factors associated with adherence. Patients who received a diagnosis

Marcia Valenstein; Frederic C. Blow; Laurel A. Copeland; John F. McCarthy; John E. Zeber; Leah Gillon; C. Raymond Bingham; Thomas Stavenger

2004-01-01

271

Brain structural changes associated with chronicity and antipsychotic treatment in schizophrenia  

Microsoft Academic Search

Accumulating evidence suggest a life-long impact of disease related mechanisms on brain structure in schizophrenia which may be modified by antipsychotic treatment. The aim of the present study was to investigate in a large sample of patients with schizophrenia the effect of illness duration and antipsychotic treatment on brain structure. Seventy-one schizophrenic patients and 79 age and gender matched healthy

Luisa Tomelleri; Jigar Jogia; Cinzia Perlini; Marcella Bellani; Adele Ferro; Gianluca Rambaldelli; Michele Tansella; Sophia Frangou; Paolo Brambilla

2009-01-01

272

Use of antipsychotics — An analysis of lifetime treatment in 66 patients with psychoses  

Microsoft Academic Search

Only a minority of patients treated with antipsychotics in clinical studies continue their treatments throughout a longer study period. Few studies address this issue from a lifetime perspective. In this naturalistic study, we aimed at analysing the prescription pattern of antipsychotic drugs among a sample of Swedish patients with a diagnosis of psychotic illness, from the first contact with psychiatry

Erik G. Jönsson; Peter Saetre; Maria Vares; Pontus Strålin; Sten Levander; Eva Lindström

2011-01-01

273

Trends in the Use of Typical and Atypical Antipsychotics in Children and Adolescents.  

ERIC Educational Resources Information Center

Objective: To estimate prevalence rates of antipsychotic use in children and adolescents from 1996 to 2001 in three state Medicaid programs (midwestern [MM], southern [SM], and western [WM]) and one private managed care organization (MCO). Method: Prescription claims were used to evaluate antipsychotic prevalence, defined as the number of children…

Patel, Nick C.; Crismon, M. Lynn; Hoagwood, Kimberly; Johnsrud, Michael T.; Rascati, Karen L.; Wilson, James P.; Jensen, Peter S.

2005-01-01

274

Atypical Antipsychotic Use in the Treatment of Psychosis in Primary Care  

PubMed Central

Atypical antipsychotics are a class of novel agents increasingly employed for the treatment of psychotic disorders. The pharmacodynamic properties of the atypicals appear to impact a broader spectrum of psychotic symptoms than had been appreciated with older generation antipsychotics. In addition, the atypical agents appear to have a reduced risk of neurologic side effects compared with conventional antipsychotic use. Both of these features enhance the appeal of the atypical antipsychotics and may be associated with enhanced patient compliance. The atypical antipsychotics appear to be effective for schizophrenia as well as other psychotic disorders, including schizoaffective disorder and mood disorders with psychotic features. Consequently, atypical antipsychotics are now considered to be the first-line treatment for schizophrenia, with the exception of clozapine, which is considered a second-line agent because of risks associated with its use. This review will discuss the literature on atypical antipsychotic efficacy in psychotic disorders. Issues related to antipsychotic use, dosing, adverse effects, and drug interactions are also discussed. PMID:15014629

Leo, Raphael J.; Regno, Paula Del

2000-01-01

275

Effects of Long-Term Antipsychotic Treatment on NMDA Receptor Binding and Gene Expression of Subunits  

Microsoft Academic Search

Postmortem studies in schizophrenic patients revealed alterations in NMDA receptor binding and gene expression of specific subunits. Because most of the patients had been treated with antipsychotics over long periods, medication effects might have influenced those findings. We treated animals with haloperidol and clozapine in clinical doses to investigate the effects of long-term antipsychotic treatment on NMDA receptor binding and

Andrea Schmitt; Mathias Zink; Bettina Müller; Brigitte May; Anne Herb; Alexander Jatzko; Dieter F. Braus; Fritz A. Henn

2003-01-01

276

A comparison of electronic monitoring vs. clinician rating of antipsychotic adherence in outpatients with schizophrenia  

Microsoft Academic Search

Antipsychotic non-adherence rates of outpatients with schizophrenia or schizoaffective disorder was assessed by electronic monitoring and clinician rating. Antipsychotic adherence was determined monthly over 3 consecutive months with (1) the Medication Event Monitoring System (MEMS®) cap and (2) the Clinician Rating Scale. Non-adherence was defined as daily adherence of

Matthew Byerly; Robert Fisher; Katrina Whatley; Rhiannon Holland; Femina Varghese; Thomas Carmody; Brianne Magouirk; A. John Rush

2005-01-01

277

Antipsychotic therapy and short-term serious events in older adults with dementia  

Microsoft Academic Search

BACKGROUND: Antipsychotic therapy is widely used to treat behavioral problems in older adults with dementia. Cohort studies evaluating the safety of antipsychotic therapy generally focus on a single adverse event. We compared the rate of developing any serious event, a composite outcome defined as an event serious enough to lead to an acute care hospital admission or death within 30

Paula A. Rochon; Sharon-Lise T. Normand; Tara Gomes; Sudeep S. Gill; Geoffrey M. Anderson; Magda Melo; Kathy Sykora; Lorraine Lipscombe; Chaim M. Bell; Jerry H. Gurwitz

2008-01-01

278

Effects of antipsychotic drugs on the expression of neurotransmitter receptors in the rat brain  

Microsoft Academic Search

Currently, the control of schizophrenia symptoms is primarily through pharmacological intervention. However, antipsychotics can cause several side effects, such as extrapyramidal symptoms (EPS) and body weight gain\\/obesity, which severely affect patient compliance to continue with medication. In addition, due to the effects of antipsychotics on neurotransmission, it is unclear whether central pathological changes observed in post-mortem tissue in schizophrenia are

Mei Han

2010-01-01

279

Catalepsy as a rodent model for detecting antipsychotic drugs with extrapyramidal side effect liability  

Microsoft Academic Search

The predictive validity of catalepsy as a rodent model for detecting the extrapyramidal side effects (EPS) of antipsychotic drugs was recently questioned when the novel antipsychotic savoxepine produced little catalepsy in rodents while producing significant EPS in schizophrenic patients. Because catalepsy is viewed as an important model for predicting EPS, we decided to re-evaluate the effects of savoxepine. Savoxepine, clozapine,

D. C. Hoffman; H. Donovan

1995-01-01

280

Antipsychotic Treatment Patterns and Aggressive Behavior Among Adolescents in Residential Facilities  

PubMed Central

This study examined the association between acute aggressive behavior patterns of 145 adolescents in residential treatment facilities with use of and changes in antipsychotic medication for the chronic management of aggression. Seclusion/restraint (S/R) frequency over 12 months was used to categorize youth into none, low, moderate, and high S/R groups. Data were analyzed using longitudinal mixed effects logistic regression models that allowed for intra-subject variability over time. The high and moderate S/R groups were significantly more likely to receive antipsychotics, get higher doses, and have changes in medication compared with the none S/R group. Increases in antipsychotic dose were associated with a lower likelihood of changes in antipsychotic medication over time. Despite persistent antipsychotic use at higher doses, youth in the high and moderate S/R groups continued to be secluded/restrained frequently. The findings question the adequacy of these medications in managing aggressive behavior. PMID:23319375

Miller, Leslie; Riddle, Mark A.; Pruitt, David; Zachik, Al

2013-01-01

281

The role of prescribed burn associations in the application of prescribed fires in rangeland ecosystems.  

PubMed

Risk and liability concerns regarding fire affect people's attitudes toward fire and have led to human-induced alterations of fire regimes. This has, in turn, contributed to brush encroachment and degradation of many grasslands and savannas. Efforts to successfully restore such degraded ecosystems at the landscape scale in regions of the United States with high proportions of private lands require the reintroduction of fire. Prescribed Burn Associations (PBA) provide training, equipment, and labor to apply fire safely, facilitating the application of this rangeland management tool and thereby reducing the associated risk. PBAs help build networks and social capital among landowners who are interested in using fire. They can also change attitudes toward fire and enhance the social acceptability of using prescribed fire as a management practice. PBAs are an effective mechanism for promoting the widespread use of prescribed fire to restore and maintain the biophysical integrity of grasslands and savannas at the landscape scale. We report findings of a project aimed at determining the human dimensions of using prescribed fire to control woody plant encroachment in three different eco-regions of Texas. Specifically, we examine membership in PBAs as it relates to land manager decisions regarding the use of prescribed fire. Perceived risk has previously been identified as a key factor inhibiting the use of prescribed fire by landowners. Our results show that perceived constraints, due to lack of skill, knowledge, and access to equipment and membership in a PBAs are more important factors than risk perceptions in affecting landowner decisions about the use of fire. This emphasizes the potential for PBAs to reduce risk perceptions regarding the application of prescribed fire and, therefore, their importance for restoring brush-encroached grasslands and savannas. PMID:24333743

Toledo, David; Kreuter, Urs P; Sorice, Michael G; Taylor, Charles A

2014-01-01

282

What do we really know about the treatment of delirium with antipsychotics? Ten key issues for delirium pharmacotherapy.  

PubMed

Despite the significant burden of delirium among hospitalized adults, no pharmacologic intervention is approved for delirium treatment. Antipsychotic agents are the best studied but there are uncertainties as to how these agents can be optimally applied in everyday practice. We searched Medline and PubMed databases for publications from 1980 to April 2012 to identify studies of delirium treatment with antipsychotic agents. Studies of primary prevention using pharmacotherapy were not included. We identified 28 prospective studies that met our inclusion criteria, of which 15 were comparison studies (11 randomized), 2 of which were placebo-controlled. The quality of comparison studies was assessed using the Jadad scale. The DRS (N = 12) and DRS-R98 (N = 9) were the most commonly used instruments for measuring responsiveness. These studies suggest that around 75% of delirious patients who receive short-term treatment with low-dose antipsychotics experience clinical response. Response rates appear quite consistent across different patient groups and treatment settings. Studies do not suggest significant differences in efficacy for haloperidol versus atypical agents, but report higher rates of extrapyramidal side effects with haloperidol. Comorbid dementia may be associated with reduced response rates but this requires further study. The available evidence does not indicate major differences in response rates between clinical subtypes of delirium. The extent to which therapeutic effects can be explained by alleviation of specific symptoms (e.g. sleep or behavioral disturbances) versus a syndromal effect that encompasses both cognitive and noncognitive symptoms of delirium is not known. Future research needs to explore the relationship between therapeutic effects and changes in pathophysiological markers of delirium. Less than half of reports were rated as reasonable quality evidence on the Jadad scale, highlighting the need for future studies of better quality design, and in particular incorporating placebo-controlled work. PMID:23567421

Meagher, David J; McLoughlin, Lisa; Leonard, Maeve; Hannon, Noel; Dunne, Colum; O'Regan, Niamh

2013-12-01

283

Potentially inappropriate prescribing among older people in the United Kingdom  

PubMed Central

Background Potentially inappropriate prescribing (PIP) in older people is associated with increases in morbidity, hospitalisation and mortality. The objective of this study was to estimate the prevalence of and factors associated with PIP, among those aged ?70 years, in the United Kingdom, using a comprehensive set of prescribing indicators and comparing these to estimates obtained from a truncated set of the same indicators. Methods A retrospective cross-sectional study was carried out in the UK Clinical Practice Research Datalink (CPRD), in 2007. Participants included those aged???70 years, in CPRD. Fifty-two PIP indicators from the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria were applied to data on prescribed drugs and clinical diagnoses. Overall prevalence of PIP and prevalence according to individual STOPP criteria were estimated. The relationship between PIP and polypharmacy (?4 medications), comorbidity, age, and gender was examined. A truncated, subset of 28 STOPP criteria that were used in two previous studies, were further applied to the data to facilitate comparison. Results Using 52 indicators, the overall prevalence of PIP in the study population (n?=?1,019,491) was 29%. The most common examples of PIP were therapeutic duplication (11.9%), followed by use of aspirin with no indication (11.3%) and inappropriate use of proton pump inhibitors (PPIs) (3.7%). PIP was strongly associated with polypharmacy (Odds Ratio 18.2, 95% Confidence Intervals, 18.0-18.4, P?common in those aged 70–74 years vs. 85 years or more and in males. Application of the smaller subset of the STOPP criteria resulted in a lower PIP prevalence at 14.9% (95% CIs 14.8-14.9%) (n?=?151,598). The most common PIP issues identified with this subset were use of PPIs at maximum dose for?>?8 weeks, NSAIDs for?>?3 months, and use of long-term neuroleptics. Conclusions PIP was prevalent in the UK and increased with polypharmacy. Application of the comprehensive set of STOPP criteria allowed more accurate estimation of PIP compared to the subset of criteria used in previous studies. These findings may provide a focus for targeted interventions to reduce PIP. PMID:24919523

2014-01-01

284

Effects of antipsychotic medications on appetite, weight, and insulin resistance.  

PubMed

Although clozapine, olanzapine, and other atypical antipsychotic drugs (APDs) have fewer extrapyramidal side effects, they have serious metabolic side effects such as substantial weight gain, intra-abdominal obesity, and type 2 diabetes mellitus. Given that most patients with mental disorders face chronic, even life-long, treatment with APDs, the risks of weight gain/obesity and other metabolic symptoms are major considerations for APD maintenance treatment. This review focuses on the effects of APDs on weight gain, appetite, insulin resistance, and glucose dysregulation, and the relevant underlying mechanisms that may be help to prevent and treat metabolic side effects caused by APD therapy. PMID:24011886

Deng, Chao

2013-09-01

285

Why do paediatricians prescribe antibiotics? Results of an Italian regional project  

Microsoft Academic Search

BACKGROUND: To investigate determinants of antibiotic prescription in paediatric care, as a first step of a multilevel intervention to improve prescribing for common respiratory tract infections (RTIs) in a northern Italian region with high antibiotic prescription rate. METHODS: A two-step survey was performed: in phase I, knowledge, and attitudes were explored involving all family and hospital paediatricians of Emilia-Romagna and

Maria Luisa Moro; Massimiliano Marchi; Carlo Gagliotti; Simona Di Mario; Davide Resi

2009-01-01

286

Pezizalean mycorrhizas and sporocarps in ponderosa pine ( Pinus ponderosa ) after prescribed fires in eastern Oregon, USA  

Microsoft Academic Search

Post-fire Pezizales fruit commonly in many forest types after fire. The objectives of this study were to determine which Pezizales appeared as sporocarps after a prescribed fire in the Blue Mountains of eastern Oregon, and whether species of Pezizales formed mycorrhizas on ponderosa pine, whether or not they were detected from sporocarps. Forty-two sporocarp collections in five genera (Anthracobia, Morchella,

K. E. Fujimura; J. E. Smith; T. R. Horton; N. S. Weber; J. W. Spatafora

2005-01-01

287

Antipsychotic doses among community-dwelling persons with Alzheimer disease in Finland.  

PubMed

Use of antipsychotics for treatment of behavioral and psychological symptoms of dementia is frequent among persons with Alzheimer disease (AD). Doses used in long-term therapy have not been previously reported. We describe antipsychotic doses used among community-dwelling persons with AD and investigate factors associated with high-dose use. The MEDALZ-2005 (Medication use and Alzheimer disease) cohort is a nationwide sample including all persons with clinically diagnosed AD at the end of year 2005 in Finland (n = 28,093). Data including prescriptions, comorbidities, and hospital discharge diagnoses were collected from nationwide registers. Antipsychotic doses in monotherapy were investigated during 2006 to 2009. Among 8920 antipsychotic users, 4% (n = 336) used antipsychotics with high dose. Typical antipsychotics were more often used with high dose than atypical antipsychotics. High-dose use was associated with younger age (<80 years) (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.36-2.15]), male sex (OR, 1.52; CI, 1.21-1.91), history of psychiatric disorder (OR, 3.25; CI, 2.54-4.15), and inversely associated with Charlson Comorbidity Index score (score 1: OR, 0.74; CI, 0.57-0.97; score ?2: OR, 0.68; CI, 0.47-0.97). In conclusion, the majority of persons with AD used antipsychotics with low or medium dose. Typical antipsychotics were more often used with high dose than atypical antipsychotics, which indicates a need for precise dosing instructions in the treatment of behavioral and psychological symptoms of dementia. Clinicians should regularly assess dosing levels especially among men and those with history of psychiatric disorder. PMID:24875073

Taipale, Heidi; Koponen, Marjaana; Tanskanen, Antti; Tolppanen, Anna-Maija; Tiihonen, Jari; Hartikainen, Sirpa

2014-08-01

288

20 CFR 220.115 - Need to follow prescribed treatment.  

Code of Federal Regulations, 2012 CFR

... § 220.115 Need to follow prescribed treatment. (a) What treatment the claimant must follow. In order to get a...contrary to the established teaching and tenets of the claimant's religion. (2) The prescribed treatment would be cataract...

2012-04-01

289

20 CFR 220.115 - Need to follow prescribed treatment.  

Code of Federal Regulations, 2013 CFR

... § 220.115 Need to follow prescribed treatment. (a) What treatment the claimant must follow. In order to get a...contrary to the established teaching and tenets of the claimant's religion. (2) The prescribed treatment would be cataract...

2013-04-01

290

20 CFR 220.115 - Need to follow prescribed treatment.  

... § 220.115 Need to follow prescribed treatment. (a) What treatment the claimant must follow. In order to get a...contrary to the established teaching and tenets of the claimant's religion. (2) The prescribed treatment would be cataract...

2014-04-01

291

20 CFR 220.115 - Need to follow prescribed treatment.  

Code of Federal Regulations, 2011 CFR

... § 220.115 Need to follow prescribed treatment. (a) What treatment the claimant must follow. In order to get a...contrary to the established teaching and tenets of the claimant's religion. (2) The prescribed treatment would be cataract...

2011-04-01

292

7 CFR 354.2 - Administrative instructions prescribing commuted traveltime.  

Code of Federal Regulations, 2010 CFR

...Administrative instructions prescribing commuted traveltime.354.2 Section 354.2Agriculture Regulations of the Department of...SERVICES RELATING TO IMPORTS AND EXPORTS; AND USER FEES§ 354.2 Administrative instructions prescribing...

2010-01-01

293

Effect of Physician Tutorials on Prescribing Patterns of Graduate Physicians.  

ERIC Educational Resources Information Center

Physicians in an experimental group were surveyed to assess their knowledge of the effectiveness, cost, and side effects of antibiotics, and a tutorial was developed to modify some prescribing patterns. Prescribing patterns were statistically different. (Author/MLW)

Klein, Lawrence E.; And Others

1981-01-01

294

Neurocognitive effects of first- and second-generation antipsychotic drugs in early-stage schizophrenia: a naturalistic 12-month follow-up study.  

PubMed

The study aimed to assess the cognitive effects of first- and second-generation antipsychotics on neurocognition under naturalistic treatment conditions. In a 12-month, open-label, multicenter study, 698 patients with early-stage schizophrenia (duration of illness ?5 years) were prescribed chlorpromazine, sulpiride, clozapine, risperidone, olanzapine, quetiapine, or aripiprazole monotherapy. A neuropsychological battery including tests of attention, processing speed, learning/memory, and executive functioning was administered at baseline, 6- and 12-months. The primary outcome was change in a cognitive composite score after 12-months of treatment. At 12 months, treatment resulted in mild to moderate neurocognitive improvements of z=0.32 for chlorpromazine, 0.33 for sulpiride, 0.43 for clozapine, 0.51 for risperidone, 0.69 for olanzapine, 0.64 for quetiapine and 0.46 for aripiprazole. However, the olanzapine and quetiapine groups demonstrated greater improvement in the composite score and processing speed than did the chlorpromazine and sulpiride groups. Both first- and second-generation antipsychotics may improve cognitive function in patients with early-stage schizophrenia. Given that some neurocognitive improvement is attributable to a practice effect, any improvement is likely to be in the range of a small effect size. PMID:21888948

Guo, Xiaofeng; Zhai, Jinguo; Wei, Qinling; Twamley, Elizabeth W; Jin, Hua; Fang, Maosheng; Hu, Maorong; Zhao, Jingping

2011-10-01

295

Combined treatment of quetiapine with haloperidol in animal models of antipsychotic effect and extrapyramidal side effects: comparison with risperidone and chlorpromazine  

Microsoft Academic Search

Rationale Quetiapine, an atypical neuroleptic, has beneficial antipsychotic effects in schizophrenic patients, but with a lower incidence of extrapyramidal symptoms (EPS) compared with typical antipsychotics. While typical antipsychotics are often switched to atypical agents when adverse effects become limiting, there is little preclinical information to support this strategy, both in terms of efficacy and side effects. Objectives The antipsychotic effects

Miho Tada; Kiyoharu Shirakawa; Nobuya Matsuoka; Seitaro Mutoh

2004-01-01

296

Physical activity referrals in Swedish primary health care – prescriber and patient characteristics, reasons for prescriptions, and prescribed activities  

PubMed Central

Background Over the past decade, practitioners in primary health care (PHC) settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR) scheme implemented in a routine PHC setting in Östergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries. Methods Prospective prescription data were obtained for 90% of the primary health care centres in Östergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff. Results During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45–64 years. Half of the patients (50.8%) who received PARs were recommended a home-based activity, such as walking. One third (33%) of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1–2 days per week. The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38%) and nurses (31%). Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1%) and overweight (35.4%), followed by high blood pressure (23.3%) and diabetes (23.2%). Conclusion Östergötland County's PAR scheme reached a relatively high proportion of physically inactive people visiting local PHC centres for other health reasons. PAR-related statistics, including PAR-rates by individual PHC centres and PAR- rates per health professional category, show differences in prescribing activities, both by patient categories, and by prescribing professionals. PMID:18828898

Leijon, ME; Bendtsen, P; Nilsen, P; Ekberg, K; Ståhle, A

2008-01-01

297

Pschotropic prescribing for the elderly in office-based practice  

Microsoft Academic Search

This study employed data from the National Ambulatory Medical Care Survey (NAMCS) 1995 to (1) determine the prevalence of the prescribing of psychotropic drugs for elderly patients by office-based physicians in the United States; (2) estimate the prevalence of the prescribing of potentially inappropriate psychotropic drugs in this patient population; and (3) identify any factors that predict such prescribing. For

Rajender R. Aparasu; Jane R. Mort; Scott Sitzman

1998-01-01

298

RESEARCH ARTICLE Open Access Chronology of prescribing error during the  

E-print Network

and prescribing errors during 18 days in 7 medical wards' using computerized physician order entry. We described. The prevention of prescribing errors implies that the physician captures his/her prescriptions in the CPOERESEARCH ARTICLE Open Access Chronology of prescribing error during the hospital stay

Boyer, Edmond

299

Edinburgh Research Explorer Prevalence and Causes of Prescribing Errors  

E-print Network

London, London, United Kingdom, 6 Medical Statistics Team, University of Aberdeen, Aberdeen, UnitedEdinburgh Research Explorer Prevalence and Causes of Prescribing Errors Citation for published of Prescribing Errors: The PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) Study

Hall, Christopher

300

78 FR 42455 - Medications Prescribed by Non-VA Providers  

Federal Register 2010, 2011, 2012, 2013

...AFFAIRS 38 CFR Part 17 RIN 2900-AO77 Medications Prescribed by Non-VA Providers AGENCY...current and future conflicts receive medications prescribed by non-VA physicians when...a statutory mandate that VA provide medications prescribed by non-VA providers...

2013-07-16

301

Differential effects of antipsychotic medications on polyunsaturated fatty acid biosynthesis in rats: Relationship with liver delta6-desaturase expression.  

PubMed

Polyunsaturated fatty acids (PUFA), a lipid family comprised of omega-3 (n-3) and n-6 fatty acids, are a critical component of cellular membranes, and recent in vitro studies have found that antipsychotic medications up-regulate genes responsible for PUFA biosynthesis. To evaluate this effect in vivo, rats were treated with risperidone (1.5, 3, 6mg/kg/day), paliperidone (1.5, 3, 6mg/kg/day), olanzapine (2.5, 5, 10mg/kg/day), quetiapine (5, 10, 20mg/kg/day), haloperidol (1, 3mg/kg/day) or vehicle through their drinking water for 40day. Effects on liver Fads1, Fads2, Elovl2, and Elovl5 mRNA expression, plasma indices of n-3 (plasma 22:6/18:3 and 20:5/18:3 ratios) and n-6 (plasma 20:4/18:2 and 20:3/18:2 ratios) biosynthesis, and peripheral (erythrocyte, heart) and central (frontal cortex) membrane PUFA composition were determined. Only risperidone and its metabolite paliperidone significantly and selectively up-regulated liver delta-6 desaturase (Fads2) mRNA expression, and robustly increased plasma indices of n-3 and n-6 fatty acid biosynthesis. In risperidone- and paliperidone-treated rats, plasma indices of n-3 and n-6 fatty acid biosynthesis were all positively correlated with liver Fads2 mRNA expression, but not Fads1, Elovl2, or Elovl5 mRNA expression. All antipsychotics at specific doses increased erythrocyte docosahexaenoic acid (DHA, 22:6n-3) composition, and all except quetiapine increased arachidonic acid (AA, 20:4n-6) composition. Risperidone, paliperidone, and olanzapine increased heart DHA and AA composition, and no antipsychotic altered frontal cortex DHA or AA composition. These in vivo data demonstrate that augmentation of PUFA biosynthesis is not common to all antipsychotic medications, and that risperidone and paliperidone uniquely increase delta-6 desaturase (Fads2) mRNA expression and most robustly increase PUFA biosynthesis and peripheral membrane composition. PMID:21458237

McNamara, Robert K; Jandacek, Ronald; Rider, Therese; Tso, Patrick; Cole-Strauss, Allyson; Lipton, Jack W

2011-06-01

302

Effects of antipsychotic drugs on insight in schizophrenia.  

PubMed

Lack of insight is predominant in schizophrenia though the causes are still unclear. The present study was carried on to investigate the effect of three Second Generation Antipsychotics (SGAs) and Haloperidol on insight and the associations among different clusters of symptoms and insight. Fifty-five patients have been recruited at the moment of pharmacological switch needed for psychotic exacerbation, from other antipsychotic drugs to Olanzapine, Aripiprazole, Ziprasidone and Haloperidol. Patients have been followed for 6 months and evaluated at baseline, after 3 months and after 6 months. Regarding the insight improvement, all SGAs resulted more effective than Haloperidol, while no difference was detected among different SGAs. Concerning psychopathology, all SGAs showed a better efficacy than Haloperidol, positive symptoms apart. All SGAs showed a similar efficacy on all domains, except for negative symptoms which resulted less responsive to ziprasidone and haloperidol. An association between improvement of insight and psychopathology was detected. Furthermore, insight appears to be related to psychopathology severity, particularly to negative symptoms. However, the observed different effectiveness of Ziprasidone on negative symptoms and insight suggests that these psychopathological features may be not strictly related and, thus, they may be sustained by different psychopathological processes. PMID:24768251

Bianchini, Oriana; Porcelli, Stefano; Nespeca, Claudia; Cannavò, Dario; Trappoli, Angela; Aguglia, Eugenio; De Ronchi, Diana; Serretti, Alessandro

2014-08-15

303

Beyond Dopamine: Glutamate as a Target for Future Antipsychotics  

PubMed Central

The dopamine hypothesis of schizophrenia remains the primary theoretical framework for the pharmacological treatment of the disorder. Despite various lines of evidence of dopaminergic abnormalities and reasonable efficacy of current antipsychotic medication, a significant proportion of patients show suboptimal treatment responses, poor tolerability, and a subsequent lack of treatment concordance. In recent decades, intriguing evidence for the critical involvement of other neurotransmitter systems in the pathophysiology of schizophrenia has emerged, most notably of dysfunctions within the glutamate pathways. Consequently, the glutamate synapse has arisen as a promising target for urgently needed novel antipsychotic compounds—particularly in regards to debilitating negative and cognitive symptoms poorly controlled by currently available drugs. In this paper, recent findings integrating glutamatergic and dopaminergic abnormalities in schizophrenia and their implications for novel pharmacological targets are discussed. An overview of compounds in various stages of development is given: drugs enhancing NMDA receptor function as well as metabotropic glutamate receptor (mGluR) agonist and positive allosteric modulators (PAMs) are emphasised. Together with other agents more indirectly affecting glutamatergic neurotransmission, their potential future role in the pharmacotherapy of schizophrenia is critically evaluated. PMID:22830044

Sendt, Kyra-Verena; Giaroli, Giovanni; Tracy, Derek K.

2012-01-01

304

Antipsychotic-Like Effect of Trimetazidine in a Rodent Model  

PubMed Central

Trimetazidine (TMZ) has been used as an anti-ischemic agent for angina pectoris, chorioretinal disturbances, and vertigo. Also, it can induce extrapyramidal type adverse reaction such as parkinsonism, gait disorder, and tremor via blockade of D2 receptors. In the present study, we evaluated the effect of TMZ on novelty-induced rearing behavior and apomorphine-induced stereotypy behavior in male rats. Four groups of rat (n = 7) were administrated with TMZ (10 and 20?mg/kg, i.p.), chlorpromazine (1?mg/kg, i.p.), or isotonic saline. One hour later, apomorphine (2?mg/kg, s.c.) was administrated to each rat. Our results showed that both doses of TMZ significantly decreased the rearing behavior in rats, whereas the decrease with chlorpromazine was higher. TMZ also decreased the stereotypy scores in a dose-dependent manner. We concluded that TMZ has beneficial effects on rearing behavior and stereotypy, which are accepted to be indicators of antipsychotic effect. Taken together, with its antioxidative and cytoprotective properties, TMZ is worthy of being investigated for its anti-psychotic effects as a primary or an adjunctive drug. PMID:24250273

Erbas, Oytun; Akseki, Huseyin Serdar; Elikucuk, Betul; Task?ran, Dilek

2013-01-01

305

Current status of atypical antipsychotics for the treatment of fibromyalgia.  

PubMed

The treatment of fibromyalgia requires pharmacological and nonpharmacological therapies. The pharmacological treatment of fibromyalgia is limited to a few drugs that have been demonstrated to be moderately effective in some but not all dimensions of the disease. Therefore, the search for new drugs to treat this condition is warranted. Atypical antipsychotics offered an attractive alternative because they had been shown to be active against several key symptoms of fibromyalgia. The results of open-label studies, however, appear to indicate that atypical antipsychotics are poorly tolerated in patients with fibromyalgia, and only quetiapine XR has been studied in randomized controlled trials. Quetiapine XR has demonstrated effectiveness in treating comorbid major depression, anxiety and sleep disturbance. However, in two randomized controlled trials, quetiapine XR was not differentiated from placebo and failed to demonstrate noninferiority to amitriptyline in terms of improving overall symptomatology. The effect of quetiapine XR on pain and its usefulness as part of a combination pharmacological regimen should be further evaluated. Overall, the use of quetiapine (initiated at a low dose and slowly titrated) in fibromyalgia should be limited to patients with comorbid major depression or patients who are currently receiving other treatments and have unresolved and disabling depressive and/or anxiety symptoms. PMID:24983591

Rico-Villademoros, F; Calandre, E P; Slim, M

2014-06-01

306

Pharmacogenetics and Antipsychotics: Therapeutic Efficacy and Side Effects Prediction  

PubMed Central

Importance of the field Antipsychotic drug is the mainstay of treatment for schizophrenia, and there are large inter-individual differences is clinical response and side effects. Pharmacogenetics provides a valuable tool to fulfill the promise of personalized medicine by tailoring treatment based on one's genetic markers. Areas covered in this review This article reviews the pharmacogenetic literature from early 1990s to 2010, focusing on two aspects of drug action: pharmacokinetics and pharmacodynamics. Genetic variants in the neurotransmitter receptors including dopamine and serotonin, and metabolic pathways of drugs including CYP2D6 and COMT, were discussed in association with clinical drug response and side effects. What the reader will gain Readers are expected to learn the up-to-date evidence in pharmacogenetic research, and to gain familiarity to the issues and challenges facing the field. Take home message Pharmacogenetic research of antipsychotic drugs is both promising and challenging. There is consistent evidence that some genetic variants can affect clinical response and side effects. However, more studies that are designed specifically to test pharmacogenetic hypotheses are clearly needed to advance the field. PMID:21162693

Zhang, Jian-Ping; Malhotra, Anil K.

2010-01-01

307

An ethnographic exploration of influences on prescribing in general practice: why is there variation in prescribing practices?  

PubMed Central

Background Prescribing is a core activity for general practitioners, yet significant variation in the quality of prescribing has been reported. This suggests there may be room for improvement in the application of the current best research evidence. There has been substantial investment in technologies and interventions to address this issue, but effect sizes so far have been small to moderate. This suggests that prescribing is a decision-making process that is not sufficiently understood. By understanding more about prescribing processes and the implementation of research evidence, variation may more easily be understood and more effective interventions proposed. Methods An ethnographic study in three Scottish general practices with diverse organizational characteristics. Practices were ranked by their performance against Audit Scotland prescribing quality indicators, incorporating established best research evidence. Two practices of high prescribing quality and one practice of low prescribing quality were recruited. Participant observation, formal and informal interviews, and a review of practice documentation were employed. Results Practices ranked as high prescribing quality consistently made and applied macro and micro prescribing decisions, whereas the low-ranking practice only made micro prescribing decisions. Macro prescribing decisions were collective, policy decisions made considering research evidence in light of the average patient, one disease, condition, or drug. Micro prescribing decisions were made in consultation with the patient considering their views, preferences, circumstances and other conditions (if necessary). Although micro prescribing can operate independently, the implementation of evidence-based, quality prescribing was attributable to an interdependent relationship. Macro prescribing policy enabled prescribing decisions to be based on scientific evidence and applied consistently where possible. Ultimately, this influenced prescribing decisions that occur at the micro level in consultation with patients. Conclusion General practitioners in the higher prescribing quality practices made two different ‘types’ of prescribing decision; macro and micro. Macro prescribing informs micro prescribing and without a macro basis to draw upon the low-ranked practice had no effective mechanism to engage with, reflect on and implement relevant evidence. Practices that recognize these two levels of decision making about prescribing are more likely to be able to implement higher quality evidence. PMID:23799906

2013-01-01

308

Does prescribed fire benefit wetland vegetation?  

USGS Publications Warehouse

The effects of fire on wetland vegetation in the mid-Atlantic region of the United States are poorly known, despite the historical use of fire by federal, state, and private landowners in the Chesapeake Bay Region. Prescribed fire is widely used by land managers to promote vegetation that is beneficial to migratory waterfowl, muskrats, and other native wildlife and to reduce competition from less desirable plant species. We compared vegetative response to two fire rotations, annual burns and 3-year burns, and two control sites, Control 1 and Control 2. We tested the effects of fire within six tidal marsh wetlands at Blackwater National Wildlife Refuge and Fishing Bay Wildlife Management Area in Maryland. We examined changes in total live biomass (all species), total stem density, litter, and changes in live biomass and stem density of four dominant wetland plant species (11 variables). Our results suggest that annual prescribed fires will decrease the accumulation of litter, increase the biomass and stem densities of some wetland plants generally considered less desirable for wildlife, and have little or no effect on other wetland plants previously thought to benefit from fire. ?? 2011 US Government.

Flores, C.; Bounds, D.L.; Ruby, D.E.

2011-01-01

309

E-Prescribing: History, Issues, and Potentials  

PubMed Central

Electronic-Prescribing, Computerized Prescribing, or E-RX has increased dramatically of late in the American health care system, a long overdue alternative to the written form for the almost five billion drug treatments annually. This paper examines the history and selected issues in the rise of E-RX by a review of salient literature, interviews, and field observations in Pharmacy. Pharmacies were early adopters of computerization for a variety of factors. The profession in its new corporate forms of chain drug stores and pharmacy benefits firms has sought efficiencies, profit enhancements, and clinical improvements through managed care strategies that rely upon data automation. E-RX seems to be a leading factor in overall physician acceptance of Electronic Medical Records (EMRs), although the Centers for Medicare and Medicaid (CMS) incentives seem to be the propelling force in acceptance. We conclude that greater research should be conducted by public health professionals to focus on resolutions to pharmaceutical use, safety, and cost escalation, which persist and remain dire following health reform. PMID:23569654

Salmon, J. Warren; Jiang, Ruixuan

2012-01-01

310

Prescribing for older patients with cancer.  

PubMed

Pharmacotherapy in the elderly is very complex owing to age-related physiologic changes, the presence of multiple comorbidities, the use of multiple medications, the involvement of multiple prescribers and pharmacies, and an increased prevalence of cognitive deficits. The treatment of cancer and the management of symptoms related to therapy-induced toxicity significantly add to this complexity, with an increased risk of drug interactions, using potentially inappropriate medications (PIMs), and adverse drug reactions. There are several ways to evaluate inappropriate prescribing, with various levels of support for their use. We review the most widely used. Older adults are more susceptible than younger ones to chemotherapy toxicity, and may require dose modifications. Before starting therapy, the goals of care should be clearly defined and the general state of the patient should be assessed using some form of geriatric evaluation. Changes in the pharmacokinetics of the drugs related to aging and the possibility of end-organ dysfunction must be taken into consideration, particularly the age-related decline of glomerular filtration rate that is not always reflected by an increase in serum creatinine. The treatment plan for the older adult needs to be carefully defined in order to prevent adverse events, and allow the patient to benefit from treatment without a major impact on quality of life. PMID:25003487

Korc-Grodzicki, Beatriz; Boparai, Manpreet K; Lichtman, Stuart M

2014-05-01

311

E-prescribing: history, issues, and potentials.  

PubMed

Electronic-Prescribing, Computerized Prescribing, or E-RX has increased dramatically of late in the American health care system, a long overdue alternative to the written form for the almost five billion drug treatments annually. This paper examines the history and selected issues in the rise of E-RX by a review of salient literature, interviews, and field observations in Pharmacy. Pharmacies were early adopters of computerization for a variety of factors. The profession in its new corporate forms of chain drug stores and pharmacy benefits firms has sought efficiencies, profit enhancements, and clinical improvements through managed care strategies that rely upon data automation. E-RX seems to be a leading factor in overall physician acceptance of Electronic Medical Records (EMRs), although the Centers for Medicare and Medicaid (CMS) incentives seem to be the propelling force in acceptance. We conclude that greater research should be conducted by public health professionals to focus on resolutions to pharmaceutical use, safety, and cost escalation, which persist and remain dire following health reform. PMID:23569654

Salmon, J Warren; Jiang, Ruixuan

2012-01-01

312

Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims  

PubMed Central

Objectives To estimate the frequency and characteristics of opioid prescribing by multiple providers in Medicare and the association with hospital admissions related to opioid use. Design Retrospective cohort study. Setting Database of prescription drugs and medical claims in 20% random sample of Medicare beneficiaries in 2010. Participants 1?808?355 Medicare beneficiaries who filled at least one prescription for an opioid from a pharmacy in 2010. Main outcome measures Proportion of beneficiaries who filled opioid prescriptions from multiple providers; proportion of these prescriptions that were concurrently supplied; adjusted rates of hospital admissions related to opioid use associated with multiple provider prescribing. Results Among 1?208?100 beneficiaries with an opioid prescription, 418?530 (34.6%) filled prescriptions from two providers, 171?420 (14.2%) from three providers, and 143?344 (11.9%) from four or more providers. Among beneficiaries with four or more opioid providers, 110?671 (77.2%) received concurrent opioid prescriptions from multiple providers, and the dominant provider prescribed less than half of the mean total prescriptions per beneficiary (7.9/15.2 prescriptions). Multiple provider prescribing was highest among beneficiaries who were also prescribed stimulants, non-narcotic analgesics, and central nervous system, neuromuscular, and antineoplastic drugs. Hospital admissions related to opioid use increased with multiple provider prescribing: the annual unadjusted rate of admission was 1.63% (95% confidence interval 1.58 to 1.67%) for beneficiaries with one provider, 2.08% (2.03% to 2.14%) for two providers, 2.87% (2.77% to 2.97%) for three providers, and 4.83% (4.70% to 4.96%) for four or more providers. Results were similar after covariate adjustment. Conclusions Concurrent opioid prescribing by multiple providers is common in Medicare patients and is associated with higher rates of hospital admission related to opioid use. PMID:24553363

2014-01-01

313

Rheumatological prescribing in athletes: a review of the new World Anti-Doping Agency guidelines.  

PubMed

Rheumatologists, with their musculoskeletal background, often care for athletes. The effect of a positive anti-doping test, whether through illegitimate use or accidental prescribing of banned drugs, is devastating to an athlete's career. It is therefore incumbent upon rheumatologists to be aware of issues relating to drugs in sport. This involves both therapeutic drugs and doping. It is vital to ensure that any substance prescribed should be approved for use and should not adversely affect (or benefit) the athlete's performance. In March 2004, 5 months prior to the 2004 Olympic Games in Athens, the joint World Anti-Doping Agency/International Olympic Committee published the revised list of banned substances in athletes. This article aims to provide an overview of the current status of medications commonly prescribed in rheumatological practice. PMID:15292526

Smith, R; Barnsley, L; Kannangara, S; Mace, A

2004-12-01

314

Technology diffusion in the antipsychotic market: a comparison of France and the USA between 1998 and 2008  

PubMed Central

Objective Second generation antipsychotics captured the majority of the US antipsychotic market shortly after their introduction. Little is known about how second generation antipsychotics diffused in other countries with different health systems. The objective was to describe trends in antipsychotic use in the US and France from 1998 to 2008. Methods After presenting a brief background section on pharmaceutical policies in France and the US, descriptive data on quarterly prescriptions dispensed between 01/1998–09/2008 for oral antipsychotics from Xponent™ for the US, and sales recorded in the GERS database for France are presented. Trends in the share of antipsychotic use for first vs. second generation antipsychotics, and in ingredient-level of second generation antipsychotics use are reported. Results In the US, between 1998 and 2008, total antipsychotic use increased by 78%. Total use was consistently higher in France despite a 9% decrease during the period. By 2008, second generation antipsychotics represented 90% of the antipsychotic US market vs. only 40% in France. However, average annual growth rates in second generation antipsychotics use were similar in the two countries. In France, there was a steady increase in use of all but one second generation antipsychotic; whereas trends in the use of newer drugs varied substantially by drug in the US (e.g. use of olanzapine decreased after 2003 whereas use of quetiapine increased). Conclusions These results highlight markedly divergent trends in the diffusion of new antipsychotics in France and the US. Some of these differences may be explained by differences in health systems, while others may reflect physicians’ preferences and norms of practice. PMID:23584568

Gallini, Adeline; Huskamp, Haiden A.; Donohue, Julie M.

2014-01-01

315

Lipid-Lowering Effects of Tetradecylthioacetic Acid in Antipsychotic-Exposed, Female Rats: Challenges with Long-Term Treatment  

PubMed Central

Background Psychiatric patients often require chronic treatment with antipsychotic drugs, and while rats are frequently used to study antipsychotic-induced metabolic adverse effects, long-term exposure has only partially mimicked the appetite-stimulating and weight-inducing effects found in the clinical setting. Antipsychotic-induced effects on serum lipids are also inconsistent in rats, but in a recent study we demonstrated that subchronic treatment with the orexigenic antipsychotic olanzapine resulted in weight-independent increase in serum triglycerides and activation of lipogenic gene expression in female rats. In addition, a recent long-term study in male rats showed that chronic treatment with antipsychotic drugs induced dyslipidemic effects, despite the lack of weight gain. Aims In the current study, we sought to examine long-term effects of antipsychotic drugs on weight gain, lipid levels and lipid composition after twice-daily administration of antipsychotics to female rats, and to investigate potential beneficial effects of the lipid-lowering agent tetradecylthioacetic acid (TTA), a modified fatty acid. Methods Female rats were exposed to orexigenic antipsychotics (olanzapine or clozapine), metabolically neutral antipsychotics (aripiprazole or ziprasidone), or TTA for 8 weeks. Separate groups received a combination of clozapine and TTA or olanzapine and TTA. The effects of TTA and the combination of olanzapine and TTA after 2 weeks were also investigated. Results The antipsychotic-induced weight gain and serum triglyceride increase observed in the subchronic setting was not present after 8 weeks of treatment with antipsychotics, while lipid-lowering effect of TTA was much more pronounced in the chronic than in the subchronic setting, with concomitant upregulation of key oxidative enzymes in the liver. Unexpectedly, TTA potentiated weight gain in rats treated with antipsychotics. Conclusion TTA is a promising candidate for prophylactic treatment of antipsychotic-induced dyslipidemic effects, but a more valid long-term rat model for antipsychotic-induced metabolic adverse effects is required. PMID:23226405

Skrede, Silje; Fern?, Johan; Bj?rndal, Bodil; Brede, Wenche R?dseth; Bohov, Pavol; Berge, Rolf Kristian; Steen, Vidar Martin

2012-01-01

316

Patient perspectives in the development and use of long-acting antipsychotics in schizophrenia: focus on olanzapine long-acting injection  

PubMed Central

Schizophrenia is a chronic mental disorder generally treated with antipsychotic medication. However, non-adherence and partial adherence to antipsychotic medication treatment is common and long-acting injectable “depot” preparations of antipsychotic medications have been used as an alternative to oral medication therapy for patients for whom adherence is a clinically significant problem, as well as for the sake of convenience and in response to patient preference. Olanzapine long-acting injection (OLAI) is a new treatment option and has been approved by several regulatory agencies for the treatment of schizophrenia. OLAI is a crystalline salt formulation of olanzapine and pamoic acid. Efficacy was established in 2 double-blind randomized clinical trials of OLAI for the treatment of acute schizophrenia and for the maintenance of response. The therapeutic OLAI dosages are 150 mg q2 weeks, 210 mg q2 weeks, 300 mg q2 weeks or q4 weeks, and 405 mg q4 weeks, administered by deep intramuscular gluteal injection with a 19-gauge needle. Injection volume ranges from 1 to 2.7 mL. OLAI has essentially the same general tolerability as that of oral olanzapine; however with the depot there is the additional risk of a post-injection delirium sedation syndrome occurring at a rate of 0.07% of injections, requiring a risk management plan that includes observing the patient for 3 hours post injection. PMID:20016798

Citrome, Leslie

2009-01-01

317

Efficacy, quality of life, and acceptability outcomes of atypical antipsychotic augmentation treatment for treatment-resistant depression: protocol for a systematic review and network meta-analysis  

PubMed Central

Background Major depressive disorder (MDD) is a debilitating and costly mental disorder. Although commercially available antidepressants have proliferated over the last 20 years, a substantial number of patients either do not respond adequately to these drugs or are unable to tolerate their adverse effects. One common approach has been to augment conventional antidepressants with an adjunctive agent, but the optimal selection of atypical antipsychotic agents for adjunctive treatment of treatment-resistant depression (TRD) remains controversial. Methods/Design An electronic literature search of PubMed, the Cochrane Library, Embase, Web of Science, LiLACS, CINAHL, and PsycINFO for studies will be conducted with no restrictions on language, publication year, or publication type. Several clinical trial registry agencies, pharmaceutical company websites, and FDA reports will also be reviewed. Randomized clinical trials (RCTs) with atypical antipsychotic augmentation treatment for treatment-resistant depression will be considered. Data will be independently extracted by two reviewers. Traditional pairwise meta-analyses will be performed for RCTs that directly compare different treatment arms. Then, Bayesian network meta-analyses will be performed to compare the relative efficacy and acceptability of different atypical antipsychotic agents (and doses). A sensitivity analysis will be performed by excluding studies classified as a small sample size, having a high placebo effect. Discussion This systematic review and network meta-analysis will comparatively analyze the efficacy, quality of life, and acceptability profiles of atypical antipsychotic medications used for the adjunctive treatment of TRD. The findings should provide clinically relevant implications for comprehensively understanding the risk–benefit profiles of these adjunctive treatments. Systematic review registration PROSPERO CRD 42014009666. PMID:25373601

2014-01-01

318

Prescribing behavior for the elderly in the United Arab Emirates: psychotropic medication use remains low despite rising overall appropriate and inappropriate medication use  

Microsoft Academic Search

Inappropriate prescribing, especially for psychotropic agents, is a common and significant cause of morbidity in older people. This cross sectional survey was conducted in the United Arab Emirates (UAE), a country with a rapidly developing economy. Prescribing behavior for people aged 65+ years acutely admitted via a university teaching hospital was examined for 1994 and 1999. All 474 patients (which

Stephen Andrew Margolis; Tom Carter; Richard Lewis Reed

2002-01-01

319

Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes  

PubMed Central

Background Atypical antipsychotic medications are widely prescribed for the adjunctive treatment of depression, yet their total risk–benefit profile is not well understood. We thus conducted a systematic review of the efficacy and safety profiles of atypical antipsychotic medications used for the adjunctive treatment of depression. Methods and Findings We included randomized trials comparing adjunctive antipsychotic medication to placebo for treatment-resistant depression in adults. Our literature search (conducted in December 2011 and updated on December 14, 2012) identified 14 short-term trials of aripiprazole, olanzapine/fluoxetine combination (OFC), quetiapine, and risperidone. When possible, we supplemented published literature with data from manufacturers' clinical trial registries and US Food and Drug Administration New Drug Applications. Study duration ranged from 4 to 12 wk. All four drugs had statistically significant effects on remission, as follows: aripiprazole (odds ratio [OR], 2.01; 95% CI, 1.48–2.73), OFC (OR, 1.42; 95% CI, 1.01–2.0), quetiapine (OR, 1.79; 95% CI, 1.33–2.42), and risperidone (OR, 2.37; 95% CI, 1.31–4.30). The number needed to treat (NNT) was 19 for OFC and nine for each other drug. All drugs with the exception of OFC also had statistically significant effects on response rates, as follows: aripiprazole (OR, 2.07; 95% CI, 1.58–2.72; NNT, 7), OFC (OR, 1.30, 95% CI, 0.87–1.93), quetiapine (OR, 1.53, 95% CI, 1.17–2.0; NNT, 10), and risperidone (OR, 1.83, 95% CI, 1.16–2.88; NNT, 8). All four drugs showed statistically significant effects on clinician-rated depression severity measures (Hedges' g ranged from 0.26 to 0.48; mean difference of 2.69 points on the Montgomery–Asberg Depression Rating Scale across drugs). On measures of functioning and quality of life, these medications produced either no benefit or a very small benefit, except for risperidone, which had a small-to-moderate effect on quality of life (g?=?0.49). Treatment was linked to several adverse events, including akathisia (aripiprazole), sedation (quetiapine, OFC, and aripiprazole), abnormal metabolic laboratory results (quetiapine and OFC), and weight gain (all four drugs, especially OFC). Shortcomings in study design and data reporting, as well as use of post hoc analyses, may have inflated the apparent benefits of treatment and reduced the apparent incidence of adverse events. Conclusions Atypical antipsychotic medications for the adjunctive treatment of depression are efficacious in reducing observer-rated depressive symptoms, but clinicians should interpret these findings cautiously in light of (1) the small-to-moderate-sized benefits, (2) the lack of benefit with regards to quality of life or functional impairment, and (3) the abundant evidence of potential treatment-related harm. Please see later in the article for the Editors' Summary PMID:23554581

Spielmans, Glen I.; Berman, Margit I.; Linardatos, Eftihia; Rosenlicht, Nicholas Z.; Perry, Angela; Tsai, Alexander C.

2013-01-01

320

DNA brick crystals with prescribed depths  

NASA Astrophysics Data System (ADS)

The ability to assemble functional materials with precise spatial arrangements is important for applications ranging from protein crystallography to photovoltaics. Here, we describe a general framework for constructing two-dimensional crystals with prescribed depths and sophisticated three-dimensional features. The crystals are self-assembled from single-stranded DNA components called DNA bricks. We demonstrate the experimental construction of DNA brick crystals that can grow to micrometre size in their lateral dimensions with precisely controlled depths up to 80?nm. They can be designed to pack DNA helices at angles parallel or perpendicular to the plane of the crystal and to display user-specified sophisticated three-dimensional nanoscale features, such as continuous or discontinuous cavities and channels.

Ke, Yonggang; Ong, Luvena L.; Sun, Wei; Song, Jie; Dong, Mingdong; Shih, William M.; Yin, Peng

2014-11-01

321

Prescribing, recording, and reporting photon beam therapy  

SciTech Connect

When treating a patient with radiotherapy, the radiation oncologist normally prescribes doses to both the malignant disease and to relevant normal tissues. The therapist also records doses delivered during treatment within various volumes or at various points in the tissues for the purpose of documentation. Doses will also have to be specified for the purpose of reporting. The recommendations in this report are intended to be applicable to most clinical situations, past or present, and to most radiotherapy centers. This report is an update of the recommendations given in 1978, and this is the purpose of the report. It largely repeats the previous recommendations, but some definitions and recommendations have been clarified or modified (e.g., definitions on volume, and general principles for target dose specification). The recommendations apply to reporting but they are useful in all steps of the radiotherapy procedure. It is hoped that they will be adopted in day-to-day practice.

Not Available

1993-01-01

322

DNA brick crystals with prescribed depths.  

PubMed

The ability to assemble functional materials with precise spatial arrangements is important for applications ranging from protein crystallography to photovoltaics. Here, we describe a general framework for constructing two-dimensional crystals with prescribed depths and sophisticated three-dimensional features. The crystals are self-assembled from single-stranded DNA components called DNA bricks. We demonstrate the experimental construction of DNA brick crystals that can grow to micrometre size in their lateral dimensions with precisely controlled depths up to 80?nm. They can be designed to pack DNA helices at angles parallel or perpendicular to the plane of the crystal and to display user-specified sophisticated three-dimensional nanoscale features, such as continuous or discontinuous cavities and channels. PMID:25343605

Ke, Yonggang; Ong, Luvena L; Sun, Wei; Song, Jie; Dong, Mingdong; Shih, William M; Yin, Peng

2014-11-01

323

Risk and liabilities of prescribing compounded medications.  

PubMed

Complications resulting from the use of compounded medications have become a troubling trend nationwide. There is a significant potential for patients to suffer serious harm from the use of substandard medications prepared by compounding pharmacies, and the reality of this problem has been demonstrated in several well-publicized incidences of serious medical complications, including patient deaths, that directly resulted from the use of medications prepared at compounding pharmacies. Unlike US Food and Drug Administration (FDA)-approved drugs, compounded products are not required to meet evidentiary standards for establishing safety and efficacy. Moreover, these products are not held to Good Manufacturing Practices, which require regular inspections, quality control testing, and rejection of material not meeting specifications. Physicians, as well as other prescribers, need to be aware that when a patient suffers harm from using a compounded medication, those injured patients may bring negligence and malpractice claims, not only against the pharmacy and the pharmacist responsible for preparing the medication, but also against the prescribing physician and the physician’s practice. Consequently, the best way for physicians to manage professional risk and avoid both litigation and potential negative patient outcomes related to compounded pharmaceuticals is to not use these products if there is an FDA-approved product available. However, if the use of a compounded medication is medically necessary, then physicians should adhere to the FDA guidance concerning traditional compounding. Moreover, it would be prudent for any physician who intends to either resell or participate in the distribution of compounded products beyond the direct treatment of their patients to consider obtaining the appropriate insurance coverage for this activity. PMID:25276868

Randell, Michael D; Duffy, Phillip J

2014-07-01

324

Psychotropic prescribing for the elderly in office-based practice.  

PubMed

This study employed data from the National Ambulatory Medical Care Survey (NAMCS) 1995 to (1) determine the prevalence of the prescribing of psychotropic drugs for elderly patients by office-based physicians in the United States; (2) estimate the prevalence of the prescribing of potentially inappropriate psychotropic drugs in this patient population; and (3) identify any factors that predict such prescribing. For the purposes of this study, previously developed consensus criteria were adopted defining inappropriate psychotropic drugs as those that should be avoided in the elderly. According to the NAMCS data, psychotropic medications were prescribed in an estimated 12.02 million visits by elderly patients (95% confidence interval [CI], 11.07-12.97 million). The psychotropic medications most frequently prescribed for elderly patients by office-based physicians were antidepressants and antianxiety agents. The occurrence of visits at which psychotropic medications were prescribed was greater in patients who were over 84 years of age, female, white, or from the western United States. Primary care physicians prescribed the majority of these psychotropic drugs, and most visits to psychiatrists by elderly patients resulted in the prescribing of psychotropic drugs. Office-based physicians prescribed at least one potentially inappropriate psychotropic medication in 2.03 million visits by the elderly (95% CI, 1.70-2.36 million), or 16.87% of visits by the elderly involving prescriptions for psychotropic drugs. The most frequently prescribed potentially inappropriate psychotropic drugs were amitriptyline and long-acting benzodiazepines such as diazepam, chlordiazepoxide, and flurazepam. Logistic regression analyses revealed that inappropriate prescribing of psychotropic drugs for elderly patients was associated with particular patient characteristics (visit due to an injury), drug characteristics (number of medications prescribed and the drug being an antidepressant or antianxiety agent), and physician characteristics (psychiatric specialty and location in the South or Northeast). The patterns of psychotropic prescribing found in the ambulatory setting raise concerns about the quality of care being received by elderly patients with psychiatric illnesses. PMID:9663374

Aparasu, R R; Mort, J R; Sitzman, S

1998-01-01

325

Atypical antipsychotic-induced metabolic disturbances in the elderly.  

PubMed

The metabolic side effects of atypical antipsychotics (AAPs) have been widely studied in younger populations, but research investigating these sequelae in the elderly is lacking. This article reviews the available literature examining the use of AAPs in the elderly, evaluating their association with weight gain and changes in blood glucose and lipid parameters. We find a relative paucity of studies in this area; while some data highlight significant, collective changes in metabolic parameters, the majority suggests an apparent low vulnerability to these side effects. We conclude that the risk and clinical implications of unfavorable metabolic changes in the elderly being treated with AAP medications remain largely undetermined, and we caution against drawing firm conclusions based on the available data. The conflicting evidence leaves us recommending that metabolic monitoring be implemented, with regular follow-up as advocated in other populations. PMID:24477569

Guenette, Melanie Dawn; Chintoh, Araba; Remington, Gary; Hahn, Margaret

2014-03-01

326

A prototype approach toward antipsychotic medication adherence in schizophrenia.  

PubMed

Antipsychotic nonadherence in psychotic disorders is a vexing clinical problem. While many risk factors are associated with nonadherence, a risk factor model per se is a poor guide for clinical decisions. We propose a pragmatic clinical prototype approach that incorporates two variables, medication drug attitude and worldview (with regard to mental illness and psychiatric treatment), to create five patient prototypes of adherence: patients with good adherence for the right reasons ("True Believer"), with good adherence for the wrong reasons ("Clinic Trouper"), with reluctant and tenuous adherence ("Reluctant Recruit"), with passive adherence ("The Coffee Guy"), and with unwillingness to take medications ("Constitutional Combatant"). Actual patients can be compared and assigned to one of the prototypes, with the group membership predicting level and character of adherence, and suggesting specific interventions. In this scheme, drug attitude and worldview are key variables for adherence; both can be ascertained during the clinical interview and quantified with rating scales. PMID:19205965

Freudenreich, Oliver; Tranulis, Constantin

2009-01-01

327

Int J Neuropsychopharmacol . Author manuscript Acute administration of typical and atypical antipsychotics reduces EEG  

E-print Network

and psychosis, and aggravates schizophrenia symptoms in patients. In conscious rats an equivalent dose of ketamine induces key features of animal models of acute psychosis, including abnormal behaviour Keywords Antipsychotic ; EEG ; gamma power ; ketamine ; schizophrenia Introduction High-frequency neuronal

Paris-Sud XI, Université de

328

Selective deficit of hippocampal N-acetylaspartate in antipsychotic-naive patients with schizophrenia  

Microsoft Academic Search

BackgroundStudies using proton magnetic resonance spectroscopy in schizophrenia have demonstrated abnormality of N-acetylaspartate but are confounded by the effects of phase of illness and medication. There is mounting evidence that antipsychotic medication influences N-acetylaspartate.

Dominic Fannon; Andrew Simmons; Lakshika Tennakoon; Seamus O’Céallaigh; Alex Sumich; Victor Doku; Carl Shew; Tonmoy Sharma

2003-01-01

329

Metabolic complications of schizophrenia and antipsychotic medications--an updated review.  

PubMed

Metabolic syndrome is a cluster of risk factors comprising obesity, dyslipidaemias, glucose intolerance, insulin resistance (or hyperinsulinaemia), and hypertension, and is highly predictive of type 2 diabetes mellitus and cardiovascular disease. The life expectancy of people with schizophrenia is reduced by 20%, with 60% of the excess mortality due to physical illness. Schizophrenia itself may be a risk factor for metabolic syndrome and there is also increasing concern that antipsychotic drugs, particularly second-generation antipsychotics, have metabolic consequences that contribute to the risk. Various diagnostic guidelines, updated facts with regard to epidemiology, pathophysiology, risk factors, and complications of metabolic syndrome are discussed in this review. Moreover, the impact of various antipsychotics on metabolic syndrome and their possible mechanisms are comprehensively reviewed. The authors emphasise that, while many adults with schizophrenia receive little or no medical care, such care is important given the risk of metabolic abnormalities associated not only with antipsychotic medications, but also with schizophrenia in general. PMID:23535629

Yogaratnam, J; Biswas, N; Vadivel, R; Jacob, R

2013-03-01

330

Antipsychotic Medicines for Schizophrenia and Bipolar Disorder: What You Should Know  

MedlinePLUS

... and risperidone— come as generics. Our advice: For schizophrenia: In general, almost everyone who is diagnosed with ... Should Know Antipsychotic drugs can help people with schizophrenia lead more stable lives and spend less time ...

331

Antipsychotic Medicines for Children and Teens: A Review of the Research for Parents and Caregivers  

MedlinePLUS

... 1 through 18) has one of these conditions: Schizophrenia and related psychosis Bipolar disorder Developmental disorders, including ... Researchers found that: Antipsychotics improve the symptoms of schizophrenia. Olanzapine (Zyprexa®), risperidone (Risperdol®), and clozapine (Clozaril® or ...

332

Guidelines for the use and management of long-acting injectable antipsychotics in serious mental illness  

PubMed Central

Background Long-acting injectable (LAI) formulations are not widely used in routine practice even though they offer advantages in terms of relapse prevention. As part of a process to improve the quality of care, the French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) elaborated guidelines for the use and management of antipsychotic depots in clinical practice. Methods Based on a literature review, a written survey was prepared that asked about 539 options in 32 specific clinical situations concerning 3 fields: target-population, prescription and use, and specific populations. We contacted 53 national experts, 42 of whom (79%) completed the survey. The options were scored using a 9-point scale derived from the Rand Corporation and the University of California in the USA. According to the answers, a categorical rank (first-line/preferred choice, second-line/alternate choice, third-line/usually inappropriate) was assigned to each option. The first-line option was defined as a strategy rated as 7–9 (extremely appropriate) by at least 50% of the experts. The following results summarize the key recommendations from the guidelines after data analysis and interpretation of the results of the survey by the scientific committee. Results LAI antipsychotics are indicated in patients with schizophrenia, schizoaffective disorder, delusional disorder and bipolar disorder. LAI second-generation antipsychotics are recommended as maintenance treatment after the first episode of schizophrenia. LAI first-generation antipsychotics are not recommended in the early course of schizophrenia and are not usually appropriate in bipolar disorder. LAI antipsychotics have long been viewed as a treatment that should only be used for a small subgroup of patients with non-compliance, frequent relapses or who pose a risk to others. The panel considers that LAI antipsychotics should be considered and systematically proposed to any patients for whom maintenance antipsychotic treatment is indicated. Recommendations for medication management when switching oral antipsychotics to LAI antipsychotics are proposed. Recommendations are also given for the use of LAI in specific populations. Conclusion In an evidence-based clinical approach, psychiatrists, through shared decision-making, should be systematically offering to most patients that require long-term antipsychotic treatment an LAI antipsychotic as a first-line treatment. PMID:24359031

2013-01-01

333

Potential to Enhance the Prescribing of Generic Drugs in Patients with Mental Health Problems in Austria; Implications for the Future  

PubMed Central

Background: Scrutiny over pharmaceutical expenditure is increasing leading to multiple reforms. This includes Austria with measures to lower generic prices and enhance their utilization. However the situation for newer antidepressants and atypical antipsychotic medicines (AAPs) is different to PPIs, statins, and renin-angiotensin inhibitor drugs with greater tailoring of therapy and no wish to switch products in stable patients. Authorities welcome generics though given the high costs particularly of single-sourced AAPs. Objective: Assess (a) changes in utilization of venlafaxine versus other newer antidepressants before and after availability of generics, (b) utilization of generic versus originator venlafaxine, (c) price reductions of venlafaxine over time and their influence on total expenditure, (d) utilization of risperidone versus other AAPs, (e) suggest potential additional reforms that could be introduced if pertinent to further enhance the use of generics. Methodology: A quasi-experimental study design with a segmented time series and an observational study. Utilization measured in defined daily doses (DDDs) and total expenditure per DDD and over time. Results: No appreciable changes in the utilization of venlafaxine and risperidone after generics. The reduction in expenditure/DDD for venlafaxine decreased overall expenditure on newer antidepressants by 5% by the end of the study versus just before generics despite a 37% increase in utilization. Expenditure will further decrease if reduced prescribing of duloxetine. Conclusion: Depression, schizophrenia, and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic risperidone and venlafaxine when multiple choices are appropriate. Authorities cannot rely on a “Hawthorne” effect between classes to enhance the use of generics. Measures may include prescribing restrictions for duloxetine. No specific measures planned for AAPs with more multiple-sourced AAPs becoming available. PMID:23308071

Godman, Brian; Bucsics, Anna; Burkhardt, Thomas; Piessnegger, Jutta; Schmitzer, Manuela; Barbui, Corrado; Raschi, Emanuel; Bennie, Marion; Gustafsson, Lars L.

2013-01-01

334

Antipsychotic treatment adherence and associated mental health care use among individuals with bipolar disorder  

Microsoft Academic Search

Background: Up to 48% of patients with bipolar disorder are either nonadherent or partially adherent to antipsychotic drug treatment. Medication adherence may differ by bipolar disorder subtype.Objective: This study evaluated the association between antipsychotic treatment adherence and mental health care use among individuals with bipolar disorder with predominantly manic\\/mixed symptoms or predominantly depressive symptoms.Methods: Individuals with bipolar or manic disorder

Frank D. Gianfrancesco; Martha Sajatovic; Krithika Rajagopalan; Ruey-Hua Wang

2008-01-01

335

Management of psychiatric disorders in children and adolescents with atypical antipsychotics  

Microsoft Academic Search

We aimed to provide a descriptive review of treatment studies of atypical antipsychotics in paediatric psychiatric disorders.\\u000a A systematic review of the literature used Medline and EMBASE databases to identify clinical trials of atypical antipsychotics\\u000a in children and adolescents between 1994 and 2006. Trials were limited to double-blind studies and open-label studies of ?8 weeks\\u000a duration that included ?20 patients. Nineteen

Peter S. Jensen; Jan Buitelaar; Gahan J. Pandina; Carin Binder; Magali Haas

2007-01-01

336

A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder  

Microsoft Academic Search

As many as half of obsessive-compulsive disorder (OCD) patients treated with an adequate trial of serotonin reuptake inhibitors (SRIs) fail to fully respond to treatment and continue to exhibit significant symptoms. Many studies have assessed the effectiveness of antipsychotic augmentation in SRI-refractory OCD. In this systematic review, we evaluate the efficacy of antipsychotic augmentation in treatment-refractory OCD. The electronic databases

M H Bloch; A Landeros-Weisenberger; B Kelmendi; V Coric; M B Bracken; J F Leckman

2006-01-01

337

Effect of antipsychotic drugs on DISC1 and dysbindin expression in mouse frontal cortex and hippocampus  

Microsoft Academic Search

Summary.  Altered expression of Disrupted-In-Schizophrenia-1 (DISC1) and dysbindin (DTNBP1), susceptibility genes for schizophrenia,\\u000a in schizophrenic brain has been reported; however, the possible effect of antipsychotics on the expression levels of these\\u000a genes has not yet been studied. We measured the mRNA expression levels of these genes in frontal cortex and hippocampus of\\u000a mice chronically treated with typical and atypical antipsychotics by

S. Chiba; R. Hashimoto; S. Hattori; M. Yohda; B. Lipska; D. R. Weinberger; H. Kunugi

2006-01-01

338

Impact of generic substitution decision support on electronic prescribing behavior  

Microsoft Academic Search

ObjectiveTo evaluate the impact of generic substitution decision support on electronic (e-) prescribing of generic medications.DesignThe authors analyzed retrospective outpatient e-prescribing data from an academic medical center and affiliated network for July 1, 2005–September 30, 2008 using an interrupted time-series design to assess the rate of generic prescribing before and after implementing generic substitution decision support. To assess background secular

Shane P. Stenner; Qingxia Chen; Kevin B. Johnson

2010-01-01

339

Skin infections and antibiotic prescribing: a comparison of surveillance and prescribing data  

PubMed Central

Background Reductions in the number of dispensed antibiotics and the incidence of respiratory infections presented to GPs and have been reported. Whether this trend applies to skin infections requires further investigation. Aim To examine trends in the incidence of skin infections in relation to trends in dispensed prescriptions for flucloxacillin, topical fusidic acid, mupirocin, and corticosteroids with fusidic acid. Design of study Population-based analysis of patients presenting to GPs (1999–2005) contrasted with national prescribing data. Setting A sentinel practice network covering a population of 700 000 in England and Wales. Method Quarterly incidence rates of skin infections and of impetigo reported over the years 1999–2005 were compared with quarterly data on dispensed prescriptions reported by the Prescription Pricing Authority for England. Results In children (aged 0–14 years) the incidence of skin infections decreased slightly between 1999 and 2003 and more sharply from 2004 to 2005. In adults (aged ?15 years) incidence was reasonably constant from year to year. In every year examined, and in both age groups, there were autumnal incidence peaks. There were annual increases in dispensed prescriptions for flucloxacillin capsules, but there was little change in the use of flucloxacillin syrups and topical antibiotic prescriptions. All prescribing data sets showed increases in the third quarter: topical corticosteroids with fusidic acid were prescribed more frequently in summer than winter. Conclusion In spite of slight reductions in the incidence of skin infections, flucloxacillin capsule-dispensed prescriptions have increased, suggesting that doctors have not limited their antibiotic prescribing behaviour for skin conditions. PMID:17727750

Fleming, Douglas M; Elliot, Alex J; Kendall, Helen

2007-01-01

340

48 CFR 52.232-6 - Payment Under Communication Service Contracts With Common Carriers.  

Code of Federal Regulations, 2010 CFR

...Under Communication Service Contracts With Common Carriers. 52.232-6 Section 52...Under Communication Service Contracts With Common Carriers. As prescribed in 32...for regulated communication services by common carriers: Payment Under...

2010-10-01

341

Assertive community treatment in veterans affairs settings: impact on adherence to antipsychotic medication.  

PubMed

OBJECTIVES Assertive community treatment (ACT) programs may improve patients' outcomes, in part by increasing adherence to antipsychotic medication. This study assessed the association between ACT enrollment and subsequent antipsychotic adherence. METHODS The authors identified a national sample of 763 Veterans Affairs (VA) patients with schizophrenia who were newly enrolled in ACT in fiscal years 2001 to 2004 and had valid antipsychotic medication possession ratios (MPRs) for five sequential six-month periods, the first occurring before ACT enrollment. Propensity scores were used to match ACT patients 1:1 with eligible veterans who did not initiate ACT. Logistic regression analyses and generalized estimating equations (GEE) were used to assess the association between ACT enrollment and subsequent antipsychotic adherence. Antipsychotic adherence was compared among ACT enrollees with high, partial, or no participation in ACT services. RESULTS Before the index date, there was no significant difference in rates of good adherence (MPR ?.8) among subsequent ACT enrollees (72%) and patients in the control group (70%). However, in each of the four periods after enrollment, ACT enrollees were more likely to have MPRs ?.8. In GEE analyses, ACT enrollment was associated with 2.3 greater odds of MPRs ?.8 (95% confidence interval=1.9-2.7). Among ACT enrollees, higher levels of participation were associated with MPRs ?.8. CONCLUSIONS In this large, national study, ACT enrollment was associated with higher levels of antipsychotic adherence among VA patients with schizophrenia. This association persisted over time and was greatest among those with higher levels of ACT use. PMID:23412131

Valenstein, Marcia; McCarthy, John F; Ganoczy, Dara; Bowersox, Nicholas W; Dixon, Lisa B; Miller, Richard; Visnic, Stephanie; Slade, Eric P

2013-05-01

342

Socioeconomic factors influencing antipsychotic prescription for schizophrenia inpatients in China: a cross-sectional study.  

PubMed

Medication is critical in schizophrenia therapy, and prescription patterns have changed considerably over the past 20 years in China. This study attempts to evaluate the prescription patterns of antipsychotics for inpatients with schizophrenia in China and to identify factors influencing these patterns. Claims data of inpatients diagnosed with schizophrenia in 2010 were derived from the reimbursement database of Wuhan and Wuxi. A total of 5251 inpatients received antipsychotic medications, of whom 29.0% received second-generation antipsychotics apart from clozapine (SGAs#), 13.7% received clozapine (CLO), 13.5% received first-generation antipsychotics (FGAs), 43.8% received at least both drug classes, and 5.1% used FGAs, CLO as well as SGAs#. Multinomial logistic regression for 2904 identified inpatients showed that factors of drug reimbursement policy, duration of hospitalization, age group, and municipality were statistically significant in antipsychotic medication. Drug list B and the 25-45 age group presented a significant relationship with SGAs# prescription (FGAs vs. SGAs#). Furthermore, the 12-30-day duration of hospitalization and the 25-45 age group showed a significant relationship with SGAs# prescription (CLO vs. SGAs#). Socioeconomic factors such as health insurance policies, especially reimbursement policy of drugs and payment system, as well as mental health resource distribution are important in antipsychotic prescription in China. PMID:24323200

Xue, Qiuji; Xiong, Xianjun; Feng, Yi; Yao, Lan; Chen, Shanquan; Xiang, Li

2014-09-01

343

Antipsychotic Drug Effects in Schizophrenia: A Review of Longitudinal fMRI Investigations and Neural Interpretations  

PubMed Central

The evidence that antipsychotics improve brain function and reduce symptoms in schizophrenia is unmistakable, but how antipsychotics change brain function is poorly understood, especially within neuronal systems. In this review, we investigated the hypothesized normalization of the functional magnetic resonance imaging (fMRI) blood oxygen level dependent signal in the context of antipsychotic treatment. First, we conducted a systematic PubMed search to identify eight fMRI investigations that met the following inclusion criteria: case-control, longitudinal design; pre- and post-treatment contrasts with a healthy comparison group; and antipsychotic-free or antipsychotic-naïve patients with schizophrenia at the start of the investigation. We hypothesized that aberrant activation patterns or connectivity between patients with schizophrenia and healthy comparisons at the first imaging assessment would no longer be apparent or “normalize” at the second imaging assessment. The included studies differed by analysis method and fMRI task but demonstrated normalization of fMRI activation or connectivity during the treatment interval. Second, we reviewed putative mechanisms from animal studies that support normalization of the BOLD signal in schizophrenia. We provided several neuronal-based interpretations of these changes of the BOLD signal that may be attributable to long-term antipsychotic administration. PMID:23157635

Abbott, C.C.; Jaramillo, A.; Wilcox, C.E.; Hamilton, D.A.

2013-01-01

344

Reasons for not prescribing guideline-recommended medications to adults with heart failure  

PubMed Central

Background Little is known about how often contextual factors such as patient preferences and competing priorities impact prescribing of guideline-recommended medications, or about the extent to which these factors are documented in medical records and available to performance measurement systems. Methods Mixed-methods study of 295 veterans age 50 years and older in 4 VA health care systems who had systolic heart failure and were not prescribed a beta blocker and/or an ACE inhibitor (ACE-I) or angiotensin receptor blocker (ARB). Reasons for non-treatment were identified from clinic notes and from interviews with 62 primary care clinicians caring for these patients. These reasons were classified using a published taxonomy. Results Among 295 patients not receiving guideline-recommended drugs for heart failure, chart review identified biomedical reasons for non-prescribing in 42-58% of patients and contextual reasons in 11-17%. Clinician interviews identified twice as many reasons for non-prescribing as chart review (mean 1.6 vs. 0.8 reasons per patient, P < .001). In these interviews, biomedical reasons for non-prescribing were cited in 50-70% of patients, and contextual reasons in 64-70%. The most common contextual reasons were co-management with other clinicians (32-35% of patients), patient preferences and non-adherence (15-24%), and clinician belief that the medication is not indicated in the patient (12-20%). Conclusions Contextual reasons for not prescribing ACE-I/ARBs and beta blockers are present in two-thirds of patients with heart failure who did not receive these medications, yet are poorly documented in medical records. The structure of medical records should be improved to facilitate documentation of contextual reasons for not providing guideline-recommended care. PMID:23969589

Steinman, Michael A.; Dimaano, Liezel; Peterson, Carolyn A.; Heidenreich, Paul A.; Knight, Sara J.; Fung, Kathy Z.; Kaboli, Peter J.

2013-01-01

345

Exploring the views of nurse prescribing among Macmillan nurses.  

PubMed

Nurse prescribing is a key government initiative which aims to enhance patient care. The aim of this study was to investigate the prescribing practice of specialist nurses working in cancer and palliative care and to explore the benefits of and barriers to uptake of nurse prescribing training. A national postal survey of 2252 Macmillan nurses was undertaken using a structured questionnaire with open-ended questions. Data were analyzed using thematic content analysis for 1575 respondents (70% response rate). Only 13% (203) had undergone prescribing training and of these 105 provided responses to the open questions concerning training and of the 87% (1372) who had not undergone the training, 423 provided details on barriers to nurse prescribing training. The data presented in this paper draw from this data. The findings indicate that those who prescribed gave the prospect of improving care as the main reason for undertaking nurse prescribing training. The main reasons why these specialist nurses did not undertake training were: resource issues particularly with respect to backfill while training, lack of medical support and mentorship, concerns about the relevance of prescribing as a nursing role and prioritizing other courses. If nurse prescribing is to be more widely available for cancer and palliative care patients it is important in both primary and secondary care to address the resource and support issues. PMID:18595310

Ryan-Woolley, Bernadette; McHugh, Gretl; Luker, Karen

2008-04-01

346

Inhibitory effects on the discriminative stimulus properties of d -amphetamine by classical and newer antipsychotics do not correlate with antipsychotic activity. Relation to effects on the reward system?  

Microsoft Academic Search

Classical antipsychotics exemplified by haloperidol (0.30), fluphenazine (0.070) andcis(Z)-flupentixol (0.088; ED50 values in µmol\\/kg are given in parentheses for all compounds) potently block the discriminative stimulus properties ofd-amphetamine (1.0 mg\\/kg, IP) in rats. Newer antipsychotics have very different profiles: clozapine (7.2) and olanzapine (5.9) induce dose-dependent inhibition, while risperidone (>6.1) and remoxipride (>47) show weak inhibitory effects and sertindole (>23),

J. Arnt

1996-01-01

347

Explicit, evidence-based criteria to assess the quality of prescribing to elderly nursing home residents  

Microsoft Academic Search

Background: prescribing in nursing homes is frequently suboptimal. Indicators to measure prescribing quality, including appropriateness of prescribing certain drugs or combinations of drugs, to hospital inpatients have been developed previously. Objective: to modify prescribing indicators, including appropriateness of prescribing algorithms developed in the hospital setting, for use in nursing homes. Design: an audit of prescribing to patients resident in a

C. Alice Oborne; R ICHARD HOOPER; C AMERON G. SWIFT; H. D. JACKSON

2003-01-01

348

Detection of prescribed burn on National Forest  

NASA Technical Reports Server (NTRS)

The author has identified the following significant results. The effects of a prescribed burn in the Sam Houston National Forest have been detected from ERTS-1 coverage of November 27, 1972. The burn was first identified on aircraft underflight photography of November 7, 1972. On color infrared aircraft photography it appeared as a green patch, indicating stressed vegetation, in an area of red coloration, indicating vigorous vegetation. It was later detected on the color composite of ERTS-1 bands 4, 5, and 7, as a black area in otherwise red vegetation. The fire, covering approximately 40 hectares (100 acres), was intentionally started to clear out heavy underbrush so that trees could be marked prior to harvesting. The significance of this observation is that a light burn of this type and its subsequent effects on vegetation could be detected on ERTS-1 imagery. Continued observation of this type of phenomenon under various conditions may provide a means of identifying such an occurrence without a prior knowledge of the event.

Erb, R. B. (principal investigator)

1973-01-01

349

Prescribed Travel Schedules for Fatigue Management  

NASA Technical Reports Server (NTRS)

The NASA Fatigue Management Team is developing recommendations for managing fatigue during travel and for shift work operations, as Clinical Practice Guidelines for the Management of Circadian Desynchrony in ISS Operations. The Guidelines provide the International Space Station (ISS ) flight surgeons and other operational clinicians with evidence-based recommendations for mitigating fatigue and other factors related to sleep loss and circadian desynchronization. As much international travel is involved both before and after flight, the guidelines provide recommendations for: pre-flight training, in-flight operations, and post-flight rehabilitation. The objective of is to standardize the process by which care is provided to crewmembers, ground controllers, and other support personnel such as trainers, when overseas travel or schedule shifting is required. Proper scheduling of countermeasures - light, darkness, melatonin, diet, exercise, and medications - is the cornerstone for facilitating circadian adaptation, improving sleep, enhancing alertness, and optimizing performance. The Guidelines provide, among other things, prescribed travel schedules that outline the specific implementation of these mitigation strategies. Each travel schedule offers evidence based protocols for properly using the NASA identified countermeasures for fatigue. This presentation will describe the travel implementation schedules and how these can be used to alleviate the effects of jet lag and/or schedule shifts.

Whitmire, Alexandra; Johnston, Smith; Lockley, Steven

2011-01-01

350

[Prescribe clean intermittent self-catheterization].  

PubMed

Clean intermittent self-catheterization is the recommended mode of voiding in patients with urinary retention. CISC is a non-sterile catheterization, done by the patient himself to insure complete emptying of the bladder several times per day. Its prescription rests on well-established recommendations with a sufficient frequency of self-catheterization (minimum 4), collected volumes less than 400 mL and a diuresis higher than 1.5 L. Clean intermittent self-catheterization allows a reduction in complications of infection, protects the upper urinary tract and provides urinary continence for the patient. Asymptomatic bacteriuria is very frequent in patients treated with intermittent catheterization and does not justify antibiotic therapy. Only symptomatic urinary tract infections have to be treated by a short course of antibiotics. Patient education and personalized medical follow-up must ensure adapted management dependant on this voiding mode and its risk factors. A guideline is provided to prescribe clean intermittent self-catheterization with its indications, its advantages and complications, its medical surveillance and treatment of urinary tract infection. This procedure should be well-known to general practitioners who are responsible for the follow up of these patients. PMID:19152777

Bonniaud, Véronique; Leroy, Joël; Kleinclauss, François; Look, Pierre-Yves; Bévalot, Julien; Parratte, Bernard

2009-03-01

351

[Rational antibiotic prescribing. Challenges and successes].  

PubMed

Rational and prudent antibiotic prescribing strategies are important both for the hospital sector as well as for ambulatory medicine. Prerequisites are the availability of antibiotic use and antibiotic resistance data and of infrastructure and trained personnel needed for implementing and evaluating antibiotic policies. Currently, these requirements are not being met sufficiently in Germany. A major challenge in this country is the lack of adequately trained and experienced personnel. On the other hand there are several projects and initiatives supported in part within the national antibiotic resistance control program which have produced some progress and success. One example is GERMAP, the national antibiotic use and resistance atlas covering both human medicine and the veterinary field. Other examples are the recently improved program for continuous hospital antibiotic use, surveillance and feedback and the Antibiotic Stewardship (ABS) training program with establishment of an ABS expert network. Future perspectives include programs for evaluation of practice guideline adherence and the development and evaluation of quality of care indicators. Intermediate and long-term investment is needed in specialty training and certification of a sufficient number of infectious disease physicians, medical microbiologists and infection control doctors/hospital epidemiologists and hospital pharmacists. PMID:23114441

Kern, W V; de With, K

2012-11-01

352

Occupational PAH Exposures during Prescribed Pile Burns  

PubMed Central

Wildland firefighters are exposed to particulate matter and gases containing polycyclic aromatic hydrocarbons (PAHs), many of which are known carcinogens. Our objective was to evaluate the extent of firefighter exposure to particulate and PAHs during prescribed pile burns of mainly ponderosa pine slash and determine whether these exposures were correlated with changes in urinary 1-hydroxypyrene (1-HP), a PAH metabolite. Personal and area sampling for particulate and PAH exposures were conducted on the White Mountain Apache Tribe reservation, working with 21 Bureau of Indian Affairs/Fort Apache Agency wildland firefighters during the fall of 2006. Urine samples were collected pre- and post-exposure and pulmonary function was measured. Personal PAH exposures were detectable for only 3 of 16 PAHs analyzed: naphthalene, phenanthrene, and fluorene, all of which were identified only in vapor-phase samples. Condensed-phase PAHs were detected in PM2.5 area samples (20 of 21 PAHs analyzed were detected, all but naphthalene) at concentrations below 1 ?g m?3. The total PAH/PM2.5 mass fractions were roughly a factor of two higher during smoldering (1.06 ± 0.15) than ignition (0.55 ± 0.04 ?g mg?1). There were no significant changes in urinary 1-HP or pulmonary function following exposure to pile burning. In summary, PAH exposures were low in pile burns, and urinary testing for a PAH metabolite failed to show a significant difference between baseline and post-exposure measurements. PMID:18515848

Robinson, M. S.; Anthony, T. R.; Littau, S. R.; Herckes, P.; Nelson, X.; Poplin, G. S.; Burgess, J. L.

2008-01-01

353

Moderation of antipsychotic-induced weight gain by energy balance gene variants in the RUPP autism network risperidone studies  

PubMed Central

Second-generation antipsychotic exposure, in both children and adults, carries significant risk for excessive weight gain that varies widely across individuals. We queried common variation in key energy balance genes (FTO, MC4R, LEP, CNR1, FAAH) for their association with weight gain during the initial 8 weeks in the two NIMH Research Units on Pediatric Psychopharmacology Autism Network trials (N=225) of risperidone for treatment of irritability in children/adolescents aged 4–17 years with autism spectrum disorders. Variants in the cannabinoid receptor (CNR)-1 promoter (P=1.0 × 10?6), CNR1 (P=9.6 × 10?5) and the leptin (LEP) promoter (P=1.4 × 10?4) conferred robust-independent risks for weight gain. A model combining these three variants was highly significant (P=1.3 × 10?9) with a 0.85 effect size between lowest and highest risk groups. All results survived correction for multiple testing and were not dependent on dose, plasma level or ethnicity. We found no evidence for association with a reported functional variant in the endocannabinoid metabolic enzyme, fatty acid amide hydrolase, whereas body mass index-associated single-nucleotide polymorphisms in FTO and MC4R showed only trend associations. These data suggest a substantial genetic contribution of common variants in energy balance regulatory genes to individual antipsychotic-associated weight gain in children and adolescents, which supersedes findings from prior adult studies. The effects are robust enough to be detected after only 8 weeks and are more prominent in this largely treatment naive population. This study highlights compelling directions for further exploration of the pharmacogenetic basis of this concerning multifactorial adverse event. PMID:23799528

Nurmi, E L; Spilman, S L; Whelan, F; Scahill, L L; Aman, M G; McDougle, C J; Arnold, L E; Handen, B; Johnson, C; Sukhodolsky, D G; Posey, D J; Lecavalier, L; Stigler, K A; Ritz, L; Tierney, E; Vitiello, B; McCracken, J T

2013-01-01

354

Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study  

PubMed Central

Objective To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Design Ethnographic case study. Setting Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. Participants 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Main outcome measures Potential threats to patient safety and characteristics of good practice. Methods Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as “exceptions” by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge. Clinicians were often unaware of this input and it did not feature in policy documents or previous research. Yet it was sometimes critical to getting the job done and contributed in subtle ways to safeguarding patients. Conclusion Receptionists and administrative staff make important “hidden” contributions to quality and safety in repeat prescribing in general practice, regarding themselves accountable to patients for these contributions. Studying technology-supported work routines that seem mundane, standardised, and automated, but which in reality require a high degree of local tailoring and judgment from frontline staff, opens up a new agenda for the study of patient safety. PMID:22053317

2011-01-01

355

Searching For Answers: Proper Prescribing of Controlled Prescription Drugs  

Microsoft Academic Search

Prescription drug abuse is increasing at alarming rates in this country. Most often drugs are obtained through relatives or friends. An important step in addressing this problem is educating healthcare providers in the proper prescribing of scheduled drugs. Physicians and other healthcare workers receive little training in proper screening for substance abuse, proper prescribing of scheduled drugs, and referral for

Martha E. Brown; William H. Swiggart; Charlene M. Dewey; Marine V. Ghulyan

2012-01-01

356

Kids Prescribed Antibiotics Twice as Often as Needed, Study Finds  

MedlinePLUS

... page, please enable JavaScript. Kids Prescribed Antibiotics Twice as Often as Needed, Study Finds More than 11 million prescriptions ... 2014 (HealthDay News) -- Pediatricians prescribe antibiotics about twice as often as they're actually needed for children ...

357

Unlicensed and off label prescribing of drugs in general practice  

Microsoft Academic Search

AIMTo determine the incidence and nature of unlicensed and off label prescribing of drugs for children in general practice.METHODSA retrospective analysis of all prescriptions for one year involving children (aged 12 years or under) from a single suburban general practice in the English Midlands. Prescribed drugs were categorised as licensed, unlicensed (without a product licence), or used in an off

J McIntyre; S Conroy; A Avery; H Corns; I Choonara

2000-01-01

358

SOURCE ASSESSMENT: PRESCRIBED BURNING, STATE OF THE ART  

EPA Science Inventory

This report summarizes reported data on air emissions from prescribed burning, which is defined as the skillful application of fire in forest and range management under conditions that will confine the fire to a predetermined area and accomplish certain planned benefits. Prescrib...

359

Anti Hypertensive Prescribing Patterns and Cost Analysis for Primary Hypertension: A Retrospective Study  

PubMed Central

Objective: The present study was conducted to analyze the current prescription pattern and cost analysis of antihypertensive drugs in hypertensive patients in a tertiary care hospital. Materials and Methods: A retrospective cross-sectional study was conducted in tertiary care hospital, Bangalore for three months and utilized 300 prescriptions for the analysis. The data analysed from the prescription included patients demographics, stage of hypertension according to JNC VII guidelines, type of drug therapy, class of anti-hypertensive, and cost effectiveness of therapy. Drug acquisition costs was calculated, using the cost of the cheapest available drug and the most commonly prescribed dosage, for each drug on a daily and annual basis. Total annual drug expenditure on buying required doses of all antihypertensive prescribed in the study population for a year was calculated. Results: Monotherapy (48.94%) was leading trends of antihypertensive therapy followed by fixed dose combination (35.04%) and polytherapy (16.01%). The most frequent antihypertensive class to be prescribed were CCBs (38.59%) followed by beta blockers (24.07%). The ranking in terms of cost utilized per year from the highest to the lowest found in this study was: alpha blockers> ACE-inhibitors> ARBs> CCBs> beta blockers > diuretics. The diuretics were most cost-effective (Cost per day: 5.89 ± 2.87; Cost per year: 2129.02 ± 1080.49) in relation to the other antihypertensive prescribed. PMID:25386458

HV, Anuradha; Shivamurthy, MC

2014-01-01

360

Common Wart  

MedlinePLUS

newsletter | contact Share | Common Wart A parent's guide to condition and treatment information A A A This image displays a large wart on ... over 100 types of the human papillomavirus (HPV). Common warts are usually found on areas of the ...

361

The Role of Atypical Antipsychotics for Treatment of Tourette's Syndrome: An Overview.  

PubMed

Tourette's syndrome (TS) is a neuropsychiatric disorder of childhood onset characterized by multiple motor and phonic tics that fluctuate over time. Tic symptoms often improve by late adolescence, but some children and adults with TS may experience significant tic-related morbidity, including social and family problems, academic difficulties, and pain. When more conservative interventions are not successful, and when certain psychiatric co-morbidities further complicate the clinical profile, treating TS with an atypical antipsychotic medication may be a reasonable second-tier approach. However, the evidence supporting efficacy and safety of the atypical antipsychotics for treatment of tics is still very limited. The objective of this paper is to provide an updated overview of the role of atypical antipsychotics for treatment of TS, with evidence-based guidance on their use. Evidence for efficacy of different typical and atypical antipsychotics for treatment of tics was examined by conducting a systematic, keyword-related search of 'atypical antipsychotics' and 'Tourette's syndrome' in PubMed (National Library of Medicine, Washington, DC, USA). Four recent treatment consensus publications were also reviewed. This review focused on literature published from 2000 to 2013 and on available randomized controlled trials in TS. Evidence supporting the use of atypical antipsychotics for treatment of TS is limited. There are few randomized medication treatment trials in TS (i.e. risperidone, aripiprazole, ziprasidone), which employed varying methodologies, thereby restricting meaningful comparisons among studies. Future collaborations among clinical sites with TS expertise employing high-quality study design may better elucidate the role of atypical antipsychotics for treatment of TS. PMID:25034359

Budman, Cathy L

2014-07-01

362

Antipsychotics--history of development and field of indication, new wine--old glassess.  

PubMed

More than half a century ago, Delay and colleagues have discovered, quite accidentally, that antihistamine (chlorpromazine) relieves psychotic symptoms. This discovery prompted further investigation through a series of performed experiments aimed to elucidate the antipsychotic mechanism of action. Initial results have shown that antipsychotic drugs in experimental animals lead to "neuroleptic effect" (indifference). However, not until the end of 1960s, it becomes clear that all previously known antipsychotics block dopamine receptors, particularly postsynaptic D2 receptors. The next three decades marked the development and application of these so-called classic neuroleptics in the treatment of psychotic patients. During the nineteen nineties, as a result of ongoing efforts to achieve greater efficiency and reduce the scope of side effects, novel antipsychotics were synthesized (second generation antipsychotics--SGA). As a result the notion of serotonin-dopamine antagonist (SDA) was formulated. According to one of the hypothesis, "new", so called atypical antipsychotic drugs strongly block the serotonin (5-HT2), and weakly block the dopamine (D2) receptors. Yet, there is still a debate as to the molecular basis of atypicality, whether it is in dopaminergic and serotonergic antagonism of neurotransmission or it lays exclusively in the modulation of dopaminergic system and dissociation rate at the level of D2 receptors in specific brain regions. Although the synthesis and use of antipsychotics in clinical practice have radically changed not only the basic approach to the patient, but also the quality of life of millions of people, the question remains whether this is just "old wine in new glasses". PMID:23114814

Jašovi?-Gaši?, Miroslava; Vukovi?, Olivera; Pantovi?, Maja; Cveti?, Tijana; Mari?-Bojovi?, Nadja

2012-10-01

363

Antipsychotic drugs rapidly induce dopamine neuron depolarization block in a developmental rat model of schizophrenia  

PubMed Central

Repeated administration of antipsychotic drugs to normal rats has been shown to induce a state of dopamine neuron inactivation known as depolarization block, which correlates with the ability of the drugs to exhibit antipsychotic efficacy and extrapyramidal side-effects in schizophrenia patients. Nonetheless, in normal rats depolarization block requires weeks of antipsychotic drug administration, whereas schizophrenia patients exhibit initial effects soon after initiating antipsychotic drug treatment. We now report that, in a developmental disruption rat model of schizophrenia (methyl-azoxymethanol acetate (20 mg/kg i.p.) injected into G17 pregnant female rats, with offspring tested as adults), the extant hyperdopaminergic state combines with the excitatory actions of a first (haloperidol; 0.6 mg/kg, i.p.)- and second (sertindole; 2.5 mg/kg, i.p.)-generation antipsychotic drug to rapidly induce depolarization block in ventral tegmental area dopamine neurons. Acute injection of either antipsychotic drug induced an immediate reduction in the number of spontaneously active dopamine neurons (cells per electrode track; termed population activity). Repeated administration of either antipsychotic drug for 1 day, 3 days, 7 days, 15 days, and 21 days continued to reduce dopamine neuron population activity. Both acute and repeated effects on population activity were reversed by acute apomorphine injections, which is consistent with the reversal of dopamine neuron depolarization block. Although this action may account for the effects of D2 antagonist drugs on alleviating psychosis and the lack of development of tolerance in humans, the drugs appear to do so by inducing an offsetting deficit rather than attacking the primary pathology present in schizophrenia. PMID:21865475

Valenti, Ornella; Cifelli, Pierangelo; Gill, Kathryn M.; Grace, Anthony A.

2011-01-01

364

Antipsychotic drugs rapidly induce dopamine neuron depolarization block in a developmental rat model of schizophrenia.  

PubMed

Repeated administration of antipsychotic drugs to normal rats has been shown to induce a state of dopamine neuron inactivation known as depolarization block, which correlates with the ability of the drugs to exhibit antipsychotic efficacy and extrapyramidal side effects in schizophrenia patients. Nonetheless, in normal rats depolarization block requires weeks of antipsychotic drug administration, whereas schizophrenia patients exhibit initial effects soon after initiating antipsychotic drug treatment. We now report that, in a developmental disruption rat model of schizophrenia [methyl-azoxymethanol acetate (20 mg/kg, i.p.) injected into G17 pregnant female rats, with offspring tested as adults], the extant hyperdopaminergic state combines with the excitatory actions of a first- (haloperidol; 0.6 mg/kg, i.p.) and a second- (sertindole; 2.5 mg/kg, i.p.) generation antipsychotic drug to rapidly induce depolarization block in ventral tegmental area dopamine neurons. Acute injection of either antipsychotic drug induced an immediate reduction in the number of spontaneously active dopamine neurons (cells per electrode track; termed population activity). Repeated administration of either antipsychotic drug for 1, 3, 7, 15, and 21 d continued to reduce dopamine neuron population activity. Both acute and repeated effects on population activity were reversed by acute apomorphine injections, which is consistent with the reversal of dopamine neuron depolarization block. Although this action may account for the effects of D2 antagonist drugs on alleviating psychosis and the lack of development of tolerance in humans, the drugs appear to do so by inducing an offsetting deficit rather than attacking the primary pathology present in schizophrenia. PMID:21865475

Valenti, Ornella; Cifelli, Pierangelo; Gill, Kathryn M; Grace, Anthony A

2011-08-24

365

Common Cold  

MedlinePLUS

... nose, coughing - everyone knows the symptoms of the common cold. It is probably the most common illness. In the course of a year, people ... avoid colds. There is no cure for the common cold. For relief, try Getting plenty of rest ...

366

Substituted ergolines: potential antipsychotics with unique profile. II. Neurochemical characterization.  

PubMed

A series of lumilysergol and lysergol derivatives were studied with a number of neurochemical methods. The compounds investigated showed heterogenous profiles on receptor binding tests. They were mostly active on D-2 receptors, but some alpha-1, alpha-2 and 5-HT-2 affinity could also be demonstrated. None of the drugs showed remarkable D-1 activities tested on basal and DA-stimulated adenylate cyclase (AC) enzyme in vitro. On the basis of the effects of the drugs on the mouse whole brain monoamine neurotransmitter and metabolite levels and neurotransmitter biosynthesis rates along with the receptor binding data we conclude that their actions are mainly related to the central dopaminergic system(s). The 2-halo-lumilysergole derivatives were less potent than the 2-halo-lysergoles with respect to their dopaminergic actions. We found the substitution at position 8 to be substantial to achieve agonistic or antagonistic properties, and, interestingly, 2,8-dihalo-lysergoles have proven to be DA agonists. The neurochemical findings are in good agreement with the behavioral results presented in the accompanying paper. We confirmed the behavioral data in that there are two subgroups among 2-halo-lysergoles possessing antipsychotic activity with opposite effects on DA receptors. PMID:2479935

Auth, F; Kiss, B; Laszlovszky, I; Lapis, E

1988-01-01

367

Quality of life measurement during antipsychotic drug therapy of schizophrenia.  

PubMed Central

The strategy for measuring quality of life and the choice of a rating scale should follow a rational scheme aimed at capturing the key components of quality of life of a specified clinical population. This is achieved through defining the purpose of the study, identifying the clinical population and its needs, developing a situation-specific quality of life model, and choosing a battery of psychometrically sound and user-friendly rating scales based on the model. Patients' self-reports and subjective feelings should be central to quality of life measurement, which should also monitor symptom severity, drug side effects, and psychosocial adjustment. This article describes the application of these principles in the context of antipsychotic drug therapy of schizophrenia and identifies potential problems that may arise from the conceptual, psychometric, clinical, and other feasibility issues. The highly subjective nature of the disorder, together with the poor insight, lack of motivation, and neurocognitive deficits of those who are afflicted, poses special difficulties for obtaining and interpreting patients' quality of life appraisals in schizophrenia. PMID:9262049

Voruganti, L N; Heslegrave, R J; Awad, A G

1997-01-01

368

Arrestin Times for Developing Antipsychotics and {beta}-Blockers  

NSDL National Science Digital Library

Heterotrimeric guanine nucleotide–binding protein (G protein)–coupled receptors (GPCRs) are the largest group of structurally related proteins encoded by the human genome. As signal effectors and allosteric regulators, GPCRs dynamically recruit not only specific heterotrimeric G proteins but also the cytosolic scaffold proteins, β-arrestin 1 and 2, which were originally thought only to serve as negative regulators of GPCR signaling. Although about half of currently available therapeutics target GPCR function, usually at the ligand-binding, orthosteric site, evidence suggests that β-arrestins may be therapeutic targets themselves. Indeed, a hitherto undiscovered action of various antipsychotics is to inhibit the ability of the dopamine D2 receptor to engage β-arrestin 2 and activate glycogen synthase kinase 3, which may be a target for developing therapeutics for schizophrenia. Also, certain β-antagonists (blockers) used to treat heart failure, such as carvedilol, have the added effect of promoting activation of extracellular signal-regulated kinase through β-arrestin. It seems likely that the structure of β-arrestins allows them to detect different types and conformational states of GPCRs and to respond in functionally distinct fashions by using separate cohorts of signaling proteins, thus generating additional possibilities for therapeutic intervention.

Miles D. Houslay (University of Glasgow;Faculty of Biomedical and Life Sciences REV)

2009-04-14

369

Relationships between the use of second-generation antipsychotics and changes in total cholesterol levels in children and adolescents perinatally infected with HIV  

PubMed Central

Purpose Perinatally HIV-infected children, who are increasingly aging into adolescence and early adulthood, have significant rates of psychiatric co-morbidities, some of which are treated with second-generation antipsychotics (SGAs). SGAs have been associated with elevated total cholesterol (TC) in youth, but no studies have examined this association in perinatally HIV-infected youth. This study examined changes in TC levels of youth with perinatally acquired HIV infection and co-morbid psychiatric conditions treated with SGAs. Patients and methods Long-term changes in TC levels were examined using data from the US multisite prospective Pediatric AIDS Clinical Trials Group 219C cohort study. The change in TC levels from baseline to 12 months after initiating SGA use was compared between 52 SGA-exposed and 148 matched SGA-unexposed perinatally HIV-infected youth, using generalized estimating equation models adjusting for other covariates. The prevalence and time to incident hypercholesterolemia were also compared between these 2 groups. Results After adjustment for confounders, 52 youth with prescriptions for SGAs had a larger increase in TC levels than 148 matched youth without antipsychotic prescriptions (mean difference = 9 mg/dL, z = 1.96, df = 1, P = 0.0496). Among youth with TC below 220 mg/dL at baseline, 27% of SGA-exposed youth developed hypercholesterolemia (defined as two consecutive TC measurements ?220 mg/dL), compared with 13% of SGA-unexposed patients (Fisher's exact test, P = 0.046). Conclusions Caution should be used in prescribing SGAs to perinatally HIV-infected youth with psychiatric co-morbidities due to increased risk of hypercholesterolemia. Patients should be monitored, and alternative evidence-based treatments considered when available. PMID:20865061

Kapetanovic, Suad; Aaron, Lisa; Williams, Paige L; Farley, John; Sirois, Patricia A; Garvie, Patricia A; Pearson, Deborah A; Oleske, James M; Montepiedra, Grace

2010-01-01

370

Long-acting injectable formulations of antipsychotic drugs for the treatment of schizophrenia.  

PubMed

Antipsychotic drugs have been used to treat patients with schizophrenia and other psychotic disorders. Long-acting injectable antipsychotic drugs are useful for improving medication compliance with a better therapeutic option to treat patients who lack insight or adhere poorly to oral medication. Several long-acting injectable antipsychotic drugs are clinically available. Haloperidol decanoate and fluphenazine decanoate are first-generation depot drugs, but the use of these medicines has declined since the advent of second-generation depot agents, such as long-acting risperidone, paliperidone palmitate, and olanzapine pamoate. The second-generation depot drugs are better tolerated and have fewer adverse neurological side effects. Long-acting injectable risperidone, the first depot formulation of an atypical antipsychotic drug, was prepared by encapsulating risperidone into biodegradable microspheres. Paliperidone palmitate is an aqueous suspension of nanocrystal molecules, and olanzapine pamoate is a microcrystalline salt of olanzapine and pamoic acid suspended in aqueous solution. This review summarizes the characteristics and recent research of formulations of each long-acting injectable antipsychotic drug. PMID:23543652

Park, Eun Ji; Amatya, Sarmila; Kim, Myung Sun; Park, Jong Hoon; Seol, Eunyoung; Lee, Heeyong; Shin, Young-Hee; Na, Dong Hee

2013-06-01

371

Increased incidence of autoimmune thyroiditis in patients with antipsychotic-induced hyperprolactinemia.  

PubMed

Prolactin (PRL) elevation in patients with prolactin-secreting pituitary tumors has been linked to increased prevalence of thyroid autoantibodies. However, the effects of antipsychotic drug-induced hyperprolactinemia (HPRL) on development of thyroid autoimmunity and also of other autoimmune phenomena have not been previously studied. To examine whether serum PRL levels were associated with the prevalence of thyroid autoantibodies in patients with schizophrenia receiving long-term antipsychotic treatment, we determined serum PRL, thyrotropin, free thyroxine levels, and the presence of antithyroid peroxidase and antithyroglobulin antibodies in 75 consecutive, clinically stable schizophrenic outpatients who had been on stable doses of antipsychotics for at least 3 months, and had no history of overt thyroid disease. We found that the prevalence of hyperprolactinemia was significantly higher in patients positive for thyroid autoantibodies, when compared with patients negative for them (p=0.045). Serum levels of prolactin were also significantly higher in patients with positivity for thyroid autoantibodies (p=0.039). In separate analyses for genders, a trend-level relationship was observed in females between increased levels of prolactin and the presence of thyroid autoantibodies (p=0.060). Our findings suggest that through the associated HPRL, long-term antipsychotic treatment can induce thyroid autoimmunity. Future research is required to investigate, whether other autoimmune processes might be triggered by antipsychotic drug-induced HPRL, and to what extent the immune alterations reported in patients with schizophrenia are related with this phenomenon. PMID:18539008

Poyraz, Burç C; Aksoy, Cana; Balcio?lu, Ibrahim

2008-09-01

372

Atypical antipsychotics as noncompetitive inhibitors of ?4?2 and ?7 neuronal nicotinic receptors  

PubMed Central

It has been suggested that the interaction of antipsychotic medications with neuronal nicotinic receptors may increase the cognitive dysfunction associated with schizophrenia and may explain why current therapies only partially address this core feature of the illness. In the present studies we compared the effects of the atypical antipsychotics quetiapine, clozapine and N-desmethylclozapine to those of the typical antipsychotics haloperidol and chlorpromazine on the ?4?2 and ?7 nicotinic receptor subtypes. The binding of [3H]-nicotine to rat cortical ?4?2 receptors and [3H]-methyllycaconitine to rat hippocampal ?7 receptors was not affected by any of the compounds tested. However, Rb+ efflux evoked either by nicotine or the selective ?4?2 agonist TC-1827 from ?4?2 receptors expressed in SH-EP1 cells and nicotine-evoked [3H]-dopamine release from rat striatal synaptosomes were non-competitively inhibited by all of the antipsychotics. Similarly, ?-bungarotoxin-sensitive epibatidine-evoked [3H]-norepinephrine release from rat hippocampal slices and acetylcholine-activated currents of ?7 nicotinic receptors expressed in oocytes were inhibited by haloperidol, chlorpromazine, clozapine and N-desmethylclozapine. The inhibitory effects on nicotinic receptor function produced by the antipsychotics tested occurred at concentrations similar to plasma levels achieved in schizophrenia patients, suggesting that they may lead to clinically relevant effects on cognition. PMID:19481556

Grinevich, Vladimir P.; Papke, Roger L.; Lippiello, Patrick M.; Bencherif, Merouane

2010-01-01

373

Cannabidiol exhibits anxiolytic but not antipsychotic property evaluated in the social interaction test.  

PubMed

Cannabidiol (CBD), a non-psychotomimetic compound of the Cannabis sativa, has been reported to have central therapeutic actions, such as antipsychotic and anxiolytic effects. We have recently reported that Spontaneously Hypertensive Rats (SHRs) present a deficit in social interaction that is ameliorated by atypical antipsychotics. In addition, SHRs present a hyperlocomotion that is reverted by typical and atypical antipsychotics, suggesting that this strain could be useful to study negative symptoms (modeled by a decrease in social interaction) and positive symptoms (modeled by hyperlocomotion) of schizophrenia as well as the effects of potential antipsychotics drugs. At the same time, an increase in social interaction in control animals similar to that induced by benzodiazepines is used to screen potential anxiolytic drugs. The aim of this study was to investigate the effects of CBD on social interaction presented by control animals (Wistar) and SHRs. The lowest dose of CBD (1mg/kg) increased passive and total social interaction of Wistar rats. However, the hyperlocomotion and the deficit in social interaction displayed by SHRs were not altered by any dose of CBD. Our results do not support an antipsychotic property of cannabidiol on symptoms-like behaviors in SHRs but reinforce the anxiolytic profile of this compound in control rats. PMID:23127569

Almeida, Valéria; Levin, Raquel; Peres, Fernanda Fiel; Niigaki, Suzy T; Calzavara, Mariana B; Zuardi, Antônio W; Hallak, Jaime E; Crippa, José A; Abílio, Vanessa C

2013-03-01

374

Recent developments in the discovery of novel antipsychotic agents modualating dopamine and serotonin receptors.  

PubMed

Currently, schizophrenia, as a serious psychiatric disorder, continues affecting the quality of life in the psychotics. This disease is often debilitating and chronic, showing broad symptoms at one end by hallucinations, delusions, thought disorder and the other end by affective flattening, catatonia, social isolation. In order to combat this disease, many antipsychotic drugs have been developed and introduced into clinical practice in the past half century. However, only a small minority of them can treat effectively schizophrenia without side effects. In view of this situation, high attention has been given to the exploration of desired antipsychotic agents influential especially through the modulation of dopamine and serotonin receptors with substantial strides made in recent years, leading to the discovery of many novel chemical entities with intriguing profiles. In this review, we summarize novel structural antipsychotics in development and discuss the future direction of ideal antipsychotic drug candiates. In particular, the promising atypical antipsychotic profiles of new molecules and the inspirations for their design are highlighted. PMID:23701299

Li, Xin; Ma, Shutao

2013-07-01

375

Association of the PPAR-? Gene with Altered Glucose Levels and Psychosis Profile in Schizophrenia Patients Exposed to Antipsychotics  

PubMed Central

Objective Metabolic abnormalities, e.g., diabetes, are common among schizophrenia patients. Peroxisome proliferator activated receptor-? (PPAR-?) regulates glucose/lipid metabolisms, and schizophrenia like syndrome may be induced by actions involving retinoid X receptor-?/PPAR-? heterodimers. We examined a possible role of the PPAR-? gene in metabolic traits and psychosis profile in schizophrenia patients exposed to antipsychotics. Methods Single nucleotide polymorphisms (SNPs) of the PPAR-? gene and a serial of metabolic traits were determined in 394 schizophrenia patients, among which 372 were rated with Positive and Negative Syndrome Scale (PANSS). Results SNP-10, -12, -18, -19, -20 and -26 were associated with glycated hemoglobin (HbA1c) whereas SNP-18, -19, -20 and -26 were associated with fasting plasma glucose (FPG). While SNP-23 was associated with triglycerides, no associations were identified between the other SNPs and lipids. Further haplotype analysis demonstrated an association between the PPAR-? gene and psychosis profile. Conclusion Our study suggests a role of the PPAR-? gene in altered glucose levels and psychosis profile in schizophrenia patients exposed to antipsychotics. Although the Pro12Ala at exon B has been concerned an essential variant in the development of obesity, the lack of association of the variant with metabolic traits in this study should not be treated as impossibility or a proof of error because other factors, e.g., genes regulated by PPAR-?, may have complicated the development of metabolic abnormalities. Whether the PPAR-? gene modifies the risk of metabolic abnormalities or psychosis, or causes metabolic abnormalities that lead to psychosis, remains to be examined. PMID:24843374

Liu, Yun-Ru; Hu, Tsung-Ming; Lan, Tsuo-Hung; Chiu, Hsien-Jane; Chang, Yung-Han; Chen, Shuo-Fei; Yu, Yen-Hsin; Chen, Cheng-Chung

2014-01-01

376

Estimating cost-offsets of new medications: Use of new antipsychotics and mental health costs for schizophrenia  

PubMed Central

Estimation of the effect of one treatment compared to another in the absence of randomization is a common problem in biostatistics. An increasingly popular approach involves instrumental variables—variables that are predictive of who received a treatment yet not directly predictive of the outcome. When treatment is binary, many estimators have been proposed: method-of-moments estimators using a two-stage least-squares procedure, generalized-method-of-moments estimators using two-stage predictor substitution or two-stage residual inclusion procedures, and likelihood-based latent variable approaches. The critical assumptions to the consistency of two-stage procedures and of the likelihood-based procedures differ. Because neither set of assumptions can be completely tested from the observed data alone, comparing the results from the different approaches is an important sensitivity analysis. We provide a general statistical framework for estimation of the casual effect of a binary treatment on a continuous outcome using simultaneous equations to specify models. A comparison of health care costs for adults with schizophrenia treated with newer atypical antipsychotics and those treated with conventional antipsychotic medications illustrates our methods. Surprisingly large differences in the results among the methods are investigated using a simulation study. Several new findings concerning the performance in terms of precision and robustness of each approach in different situations are obtained. We illustrate that in general supplemental information is needed to determine which analysis, if any, is trustworthy and reaffirm that comparing results from different approaches is a valuable sensitivity analysis. Copyright © 2011 John Wiley & Sons, Ltd. PMID:21520217

O'Malley, A James; Frank, R G; Normand, S-L T

2011-01-01

377

Prescribing patterns of glucosamine in an older population: a national cohort study  

PubMed Central

Background Glucosamine is commonly prescribed as a disease modulating agent in osteoarthritis. However, the evidence to date suggests that it has a limited impact on the clinical symptoms of the disease including joint pain, radiological progression, function and quality of life. The aim of this study was to examine the prescribing patterns of glucosamine from 2002–2011 in an elderly Irish national population cohort using data from the Health Service Executive Primary Care Reimbursement (HSE-PCRS) General medical services (GMS) Scheme. Methods Patients aged???70 years on the HSE-PCRS pharmacy claims database between January 2002 and December 2011 were included. ATC code M01AX05 (glucosamine) was extracted. Prevalence rates per 1000 eligible population with 95% confidence intervals were calculated for all years and age groups (70–74 years, ?75 years). A negative binomial regression analysis was used to determine longitudinal usage trends and compare prevalence rates across years, sex and age groups. Results The annual patient rate of glucosamine prescribing increased significantly from 13.0/1000 eligible population (95% CI 12.6-13.4) in 2002 to 68.7/1000 population (95% CI 67.8-69.5) in 2009 before decreasing to 62.4/1000 population (95% CI 61.6-63.2) in 2011. The rate of prescribing of glucosamine varied with sex, with women receiving significantly more prescriptions than men. The cost of glucosamine also increased from 2002–2008. In 2008 total expenditure reached a high of €4.6 million before decreasing to €2.6 million in 2011. Conclusion The national trend in prescribing of glucosamine increased significantly from 2002 to 2009 before decreasing in 2010 and 2011, in keeping with current international guidelines. There is a need for awareness among healthcare professionals and patients alike of the best available evidence to inform decision making relating to the prescription and consumption of such supplements. PMID:24219123

2013-01-01

378

Modeling the effects of environmental disturbance on wildlife communities: avian responses to prescribed fire.  

PubMed

Prescribed fire is a management tool used to reduce fuel loads on public lands in forested areas in the western United States. Identifying the impacts of prescribed fire on bird communities in ponderosa pine (Pinus ponderosa) forests is necessary for providing land management agencies with information regarding the effects of fuel reduction on sensitive, threatened, and migratory bird species. Recent developments in occupancy modeling have established a framework for quantifying the impacts of management practices on wildlife community dynamics. We describe a Bayesian hierarchical model of multi-species occupancy accounting for detection probability, and we demonstrate the model's usefulness for identifying effects of habitat disturbances on wildlife communities. Advantages to using the model include the ability to estimate the effects of environmental impacts on rare or elusive species, the intuitive nature of the modeling, the incorporation of detection probability, the estimation of parameter uncertainty, the flexibility of the model to suit a variety of experimental designs, and the composite estimate of the response that applies to the collection of observed species as opposed to merely a small subset of common species. Our modeling of the impacts of prescribed fire on avian communities in a ponderosa pine forest in Washington indicate that prescribed fire treatments result in increased occupancy rates for several bark-insectivore, cavity-nesting species including a management species of interest, Black-backed Woodpeckers (Picoides arcticus). Three aerial insectivore species, and the ground insectivore, American Robin (Turdus migratorius), also responded positively to prescribed fire, whereas three foliage insectivores and two seed specialists, Clark's Nutcracker (Nucifraga columbiana) and the Pine Siskin (Carduelis pinus), declined following treatments. Land management agencies interested in determining the effects of habitat manipulations on wildlife communities can use these methods to provide guidance for future management activities. PMID:19688932

Russell, Robin E; Royle, J Andrew; Saab, Victoria A; Lehmkuhl, John F; Block, William M; Sauer, John R

2009-07-01

379

Clays, common  

USGS Publications Warehouse

Part of a special section on the state of industrial minerals in 1997. The state of the common clay industry worldwide for 1997 is discussed. Sales of common clay in the U.S. increased from 26.2 Mt in 1996 to an estimated 26.5 Mt in 1997. The amount of common clay and shale used to produce structural clay products in 1997 was estimated at 13.8 Mt.

Virta, R.L.

1998-01-01

380

Effects of Prescribed Fire on Nutrient Pools and Losses from Glades Occurring Within Oak-Hickory Forests of Central Kentucky  

Microsoft Academic Search

Forest openings, also known as glades, arise through a variety of mechanisms including disturbance (fire and blow downs) and local variation in soil or bedrock geology. They are common in many forest types and are often dominated by locally rare herbaceous species. Prescribed burning is increasingly used as a management approach for maintaining glades although little is known about the

T. L. E. Trammell; C. C. Rhoades; P. A. Bukaveckas

2004-01-01

381

The impact of side-effects of antipsychotic agents on life satisfaction of schizophrenia patients: a naturalistic study  

Microsoft Academic Search

This study compared the impact of side-effects of antipsychotic treatment, clinical and psychosocial factors on the subjective quality of life (QOL) of hospitalized patients. We surveyed 161 patients meeting DSM-IV criteria for schizophrenia stabilized on conventional and atypical antipsychotic drugs using standardized measures of adverse events, psychopathology, psychosocial variables, and perceived QOL. We found that patients with adverse events reported

Michael Ritsner; Alexander Ponizovsky; Jean Endicott; Yakov Nechamkin; Boris Rauchverger; Henry Silver; Ilan Modai

2002-01-01

382

Differential Effects of Atypical versus Typical Antipsychotic Medication on Earnings of Schizophrenia Patients: Estimates from a Prospective Naturalistic Study  

Microsoft Academic Search

Background: Rising public and private expenditure on antipsychotic medications is concentrated on the cost of second generation or `atypical' medications, which are more expensive than first generation medications and make up a rapidly growing share of all antipsychotic prescriptions. Previous studies have examined whether the higher acquisition costs of atypicals are offset by other cost and\\/or utilisation benefits. This paper

David Salkever; Eric Slade; Mustafa Karakus

2006-01-01

383

Attitudes to antipsychotic drugs and their side effects: a comparison between general practitioners and the general population  

Microsoft Academic Search

BACKGROUND: Attitudes towards antipsychotic medication play an important part in the treatment for schizophrenia and related disorders. We aimed measuring general practitioners' attitudes to antipsychotic drugs and their adverse side effects and comparing these with the attitudes of the general population. METHODS: Analysis and comparison of two representative samples, one comprising 100 General Practitioners (GPs), the other 791 individuals randomly

Josef Helbling; Vladeta Ajdacic-Gross; Christoph Lauber; Ruth Weyermann; Tom Burns; Wulf Rössler

2006-01-01

384

Use of Antipsychotic Drugs in Individuals with Intellectual Disability (ID) in the Netherlands: Prevalence and Reasons for Prescription  

ERIC Educational Resources Information Center

Background: We investigated antipsychotic drug prescription practice of Dutch ID physicians, studying prevalence of antipsychotic drug use, reasons for prescription and the relationship between these reasons and patient characteristics. Methods: A cross-sectional study of medical and pharmaceutical records in a population living in residential…

de Kuijper, G.; Hoekstra, P.; Visser, F.; Scholte, F. A.; Penning, C.; Evenhuis, H.

2010-01-01

385

The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Project: Schizophrenia Trial Design and Protocol Development  

Microsoft Academic Search

The National Institute of Mental Health initiated the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) program to evaluate the effectiveness of antipsychotic drugs in typical settings and populations so that the study results will be maximally useful in routine clinical situations. The CATIE schizophrenia trial blends features of efficacy studies and large, simple trials to create a pragmatic trial that

T. Scott Stroup; Joseph P. McEvoy; Marvin S. Swartz; Matthew J. Byerly; Ira D. Glick; Jose M. Canive; Mark F. McGee; George M. Simpson; Michael C. Stevens; Jeffrey A. Lieberman

2003-01-01

386

Effects of antipsychotic D2 antagonists on long-term potentiation in animals and implications for human studies.  

PubMed

In people with schizophrenia, cognitive abilities - including memory - are strongly associated with functional outcome. Long-term potentiation (LTP) is a form of neuroplasticity that is believed to be the physiological basis for memory. It has been postulated that antipsychotic medication can impair long-term potentiation and cognition by altering dopaminergic transmission. Thus, a systematic review was performed in order to assess the relationship between antipsychotics and D2 antagonists on long-term potentiation. The majority of studies on LTP and antipsychotics have found that acute administration of antipsychotics was associated with impairments in LTP in wild-type animals. In contrast, chronic administration and acute antipsychotics in animal models of schizophrenia were not. Typical and atypical antipsychotics and other D2 antagonists behaved similarly, with the exception of clozapine and olanzapine. Clozapine caused potentiation independent of tetanization, while olanzapine facilitated tetanus-induced potentiation. These studies are limited in their ability to model the effects of antipsychotics in patients with schizophrenia as they were largely performed in wild-type animals as opposed to humans with schizophrenia, and assessed after acute rather than chronic treatment. Further studies using patients with schizophrenia receiving chronic antipsychotic treatment are needed to better understand the effects of these medications in this population. PMID:24819820

Price, Rae; Salavati, Bahar; Graff-Guerrero, Ariel; Blumberger, Daniel M; Mulsant, Benoit H; Daskalakis, Zafiris J; Rajji, Tarek K

2014-10-01

387

Activity of “Seroquel” (ICI 204,636) in Animal Models for Atypical Properties of Antipsychotics: A Comparison with Clozapine  

Microsoft Academic Search

The pharmacologic treatment of schizophrenia still suffers from two major problems: (1) most antipsychotic drugs still induce severe neurologic (extrapyramidal) side effects; (2) few antipsychotic drugs are effective in treating the negative symptoms of schizophrenia. In the present study, we have evaluated the effects of ICI 204,636 in the rat paw test and the amphetamine-induced social isolation in monkeys and

Bart A Ellenbroek; Luuk J Lubbers; Alexander R Cools

1996-01-01

388

Antipsychotic drugs which elicit little or no Parkinsonism bind more loosely than dopamine to brain D2 receptors, yet occupy high levels of these receptors  

Microsoft Academic Search

This review addresses two questions. First, why does clozapine apparently occupy low levels of dopamine D2 receptors in patients, in contrast to all other antipsychotic drugs wh