Physical illness in schizophrenia and the role of tolerability in antipsychotic selection: an expert consensus with a focus on cariprazine.

IF 3.6 3区 医学 Q1 PSYCHIATRY
Alessandro Cuomo, Giovanni B Forleo, Taieb Ghodhbane, Jon Johnsen, Angel L Montejo, Cristina Vilares Oliveira, Toby Pillinger, Jose Antonio Ramos-Quiroga, Myrto Samara, Paul H B Seerden, Thomas Thomas Stoeckl, Andrea Fagiolini
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Abstract

Background: Schizophrenia is a highly heterogeneous disease, and a high percentage of patients are at high risk of developing somatic comorbidities, which must be taken into account in disease management and treatment selection.

Main body: Antipsychotics are often associated with side effects that worsen the somatic comorbidities. Among the different options, cariprazine is generally safe and usually well tolerated in both acute and long-term treatment and is often a good choice when balancing clinical benefits and side effects. Given the lack of consensus on the priority of symptoms to treat and the reasons for switching therapy based on the balance between side effects and symptom resolution, twelve psychiatrists met for an expert meeting to discuss the most common and worrisome antipsychotic side effects leading to switching, the most important somatic comorbidities, and the best way to address specific symptoms in both the acute and maintenance phases of treatment in schizophrenia. Special attention was given to metabolic comorbidities, sexual dysfunction, and cardiovascular disease. This paper aims to examine the relationship between schizophrenia and specific somatic comorbidities, to discuss how the balance between efficacy and tolerability influences treatment choice in the acute and maintenance treatment of schizophrenia, and how these two variables may have different priorities at different stages of treatment.

Conclusion: The choice of treatment is based primarily on efficacy and tolerability. Cariprazine is beneficial in patients with positive and negative symptoms, and it has a side-effect profile with low rates of metabolic side effects, sedation, and sexual dysfunction.

精神分裂症的身体疾病和耐受性在抗精神病药物选择中的作用:专家共识,重点是卡吡嗪。
背景:精神分裂症是一种高度异质性的疾病,很大比例的患者有发生躯体合并症的高风险,在疾病管理和治疗选择中必须考虑到这一点。正文:抗精神病药物常伴有加重躯体共病的副作用。在不同的选择中,卡吡嗪通常是安全的,通常在急性和长期治疗中都具有良好的耐受性,并且在平衡临床益处和副作用时通常是一个不错的选择。鉴于对治疗症状的优先顺序缺乏共识,以及基于副作用和症状缓解之间的平衡而转换治疗的原因,12位精神科医生召开了一次专家会议,讨论导致转换的最常见和最令人担忧的抗精神病药物副作用,最重要的躯体合并症,以及在精神分裂症治疗的急性和维持阶段处理特定症状的最佳方法。特别关注代谢合并症、性功能障碍和心血管疾病。本文旨在探讨精神分裂症与特定躯体合并症之间的关系,探讨疗效和耐受性之间的平衡如何影响精神分裂症急性治疗和维持治疗的治疗选择,以及这两个变量在不同治疗阶段的优先级如何不同。结论:治疗的选择主要基于疗效和耐受性。卡吡嗪对有阳性和阴性症状的患者都是有益的,它的副作用是代谢副作用、镇静作用和性功能障碍发生率低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.60
自引率
2.70%
发文量
43
审稿时长
>12 weeks
期刊介绍: Annals of General Psychiatry considers manuscripts on all aspects of psychiatry, including neuroscience and psychological medicine. Both basic and clinical neuroscience contributions are encouraged. Annals of General Psychiatry emphasizes a biopsychosocial approach to illness and health and strongly supports and follows the principles of evidence-based medicine. As an open access journal, Annals of General Psychiatry facilitates the worldwide distribution of high quality psychiatry and mental health research. The journal considers submissions on a wide range of topics including, but not limited to, psychopharmacology, forensic psychiatry, psychotic disorders, psychiatric genetics, and mood and anxiety disorders.
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