Mu-Hong Chen, Tung-Ping Su, Wei-Chen Lin, Cheng-Ta Li, Hui-Ju Wu, Shih-Jen Tsai, Ya-Mei Bai, Wei-Chung Mao, Pei-Chi Tu
{"title":"Rapid Antidepressant and Antisuicidal Effects of Low-Dose Ketamine Infusion in Patients With Treatment-Resistant Depression With or Without Low-Grade Inflammation.","authors":"Mu-Hong Chen, Tung-Ping Su, Wei-Chen Lin, Cheng-Ta Li, Hui-Ju Wu, Shih-Jen Tsai, Ya-Mei Bai, Wei-Chung Mao, Pei-Chi Tu","doi":"10.1055/a-2499-7207","DOIUrl":"https://doi.org/10.1055/a-2499-7207","url":null,"abstract":"<p><p>Low-grade inflammation (LGI) contributes to resistance against traditional antidepressants. However, whether the antidepressant and antisuicidal effects of ketamine on patients with treatment-resistant depression (TRD) differ between those with LGI and those without LGI remains unknown.This study included 167 patients with TRD, among whom 46 had LGI and 121 did not have LGI. The patients received a single infusion of either low-dose ketamine or a placebo. A C-reactive protein level of≥3 mg/L indicated LGI. Depressive symptoms were measured from baseline to day 3 by using the 17-item Hamilton Depression Rating Scale (HDRS) and the Montgomery-Asberg Depression Rating Scale (MADRS).Generalized estimating equation models revealed antidepressant effect of ketamine in patients with no LGI (HDRS scores: <i>p</i><0.001; MADRS scores: <i>p</i><0.001) but not in patients with LGI (all <i>p</i>>0.05). The antisuicidal effect of ketamine (indicated by the score on item 10 of the MADRS) was observed in both groups of patients with (<i>p</i>=0.046) and without LGI (<i>p</i><0.001). However, ketamine was effective for TRD regardless of whether inflammation levels were high or low, while the placebo response was notably greater only in patients with LGI.This study suggests that among patients with TRD, only those without LGI respond to low-dose ketamine infusion. Whether the negative findings of the antidepressant effect of ketamine among patients with LGI may be because of the effect of the placebo infusion needs further investigation. Further randomized, placebo-controlled studies are needed to validate these findings.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Exposure to Psychotropic Drugs and Colorectal Cancer Risk in Patients with Affective Disorder: A Nested Case-Control Study.","authors":"Tien-Wei Hsu, Shih-Jen Tsai, Tzeng-Ji Chen, Mu-Hong Chen, Chih-Sung Liang","doi":"10.1055/a-2479-9430","DOIUrl":"https://doi.org/10.1055/a-2479-9430","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the association between the risk of colorectal cancer (CRC) and exposure to mood stabilizers, antidepressants, and antipsychotics in patients with affective disorders.</p><p><strong>Methods: </strong>This nested case-control study used data from the National Health Insurance Database of Taiwan collected between 2001 and 2011. All participants in this study had affective disorders. Then, 1209 patients with CRC and 1:10 matched controls were identified based on their demographic and clinical characteristics. A logistic regression model adjusted for demographic and clinical characteristics was used to determine the risk of developing CRC after exposure to psychotropic drugs.</p><p><strong>Results: </strong>Among patients with affective disorders, exposure to mood stabilizers (reported as odds ratio; 95% confidence interval; 0.75; 0.57-0.98), antidepressants (0.83; 0.70-0.97), second-generation antipsychotics (0.67; 0.52-0.86), and first-generation antipsychotics (0.65; 0.52-0.81) were associated with a reduced risk of CRC compared to patients who were not exposed. When considering specific drugs, carbamazepine (0.34; 0.12-0.95), valproic acid (0.66; 0.46-0.95), gabapentin (0.44; 0.20-0.99), fluoxetine (0.82; 0.68-0.99), paroxetine (0.63; 0.45-0.87), and venlafaxine (0.72; 0.55-0.95) were associated with a lower risk of CRC.</p><p><strong>Conclusion: </strong>Exposure to psychotropic drugs in patients with affective disorders is associated with a lower risk of CRC compared to those who were not exposed. Although the causal relationship between psychotropic drug exposure and reduced risk of CRC could not be inferred directly, these findings may help clinicians and patients in clinical decision-making.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tainá C Ferreira, Arthur H de Alencar Quirino, Samuel C Aguiar Alves, Guilherme Nobre Nogueira, Fabio G de Matos E Souza, Luísa Weber Bisol
{"title":"How to Improve Methodological Issues in Clinical Trials to Confirm that Pentoxifylline is Useful as an Add-on Therapy for Major Depressive Disorder.","authors":"Tainá C Ferreira, Arthur H de Alencar Quirino, Samuel C Aguiar Alves, Guilherme Nobre Nogueira, Fabio G de Matos E Souza, Luísa Weber Bisol","doi":"10.1055/a-2487-7084","DOIUrl":"https://doi.org/10.1055/a-2487-7084","url":null,"abstract":"","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jan Haeckert, Astrid Roeh, Susanne Karch, Thomas Koeglsperger, Alkomiet Hasan, Irina Papazova
{"title":"Impact of Parkinson Medication on Neuropsychiatric and Neurocognitive Symptoms in Patients with Advanced Parkinson Disease Prior to Deep Brain Stimulation.","authors":"Jan Haeckert, Astrid Roeh, Susanne Karch, Thomas Koeglsperger, Alkomiet Hasan, Irina Papazova","doi":"10.1055/a-2446-6877","DOIUrl":"https://doi.org/10.1055/a-2446-6877","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluates the impact of Parkinson disease (PD) medication in advanced PD on neuropsychological performance, psychiatric symptoms, impulsivity and the quality of life. In the 4-year period 27 patients with advanced PD, scheduled for deep brain stimulation (DBS) surgery (N=27, mean age: 58.9±7.1, disease duration: 10.0 years±4.2) were examined preoperatively. We hypothesized that a high dosage of PD medication or current use of dopamine agonists affect cognitive functioning and psychiatric wellbeing.</p><p><strong>Methods: </strong>We performed two subgroup analyses with low versus high levodopa-equivalent Dosage (LED) medication and without versus with dopaminagonistic medication.</p><p><strong>Results: </strong>The neuropsychological testing revealed significant differences in the verbal learn- and memory-test (VLMT) during the learning passage (U=36.500, Z=- 2.475, p=0.012) and in the subtest of the semantic fluency of Regensburg verbal fluency test (RWT) (t(25)=- 2.066, p=0.049) with better results for patients without dopaminagonistic medication. Pearson correlation analyses of LED in correlation with the clinical and cognitive dependent variables showed a significant higher PANSS total score in patients with higher LED medication (r=0.491, p=0.009). In addition, lower LED treatment was associated with significant higher scores in the impulsivity perseverance subtest (r=- 0.509, p=0.008).</p><p><strong>Discussion: </strong>In conclusion, we found lower LEDs to be correlated with a better perseverance in the impulsivity test and additional treatment with a dopamine agonist influenced some verbal learning tasks and the PANSS total score in patients with advanced PD. This should be considered prior to DBS surgery.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tabea Bauman, David R Kolar, Christoph U Correll, Verena Haas, Ulrich Voderholzer
{"title":"Impact of Antipsychotic Medications on Weight Gain and Eating Disorder-Related Psychopathology in Adult Inpatients with Anorexia Nervosa.","authors":"Tabea Bauman, David R Kolar, Christoph U Correll, Verena Haas, Ulrich Voderholzer","doi":"10.1055/a-2436-9552","DOIUrl":"https://doi.org/10.1055/a-2436-9552","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of antipsychotic use on weight gain and eating disorder-related psychopathology in adult inpatients with anorexia nervosa (AN) is unclear.</p><p><strong>Methods: </strong>Consecutively hospitalized adults with AN were retrospectively analyzed. Co-primary outcomes were body mass index (BMI) and weekly weight change. Secondary outcomes were Eating Disorder Inventory-2 (EDI-2) subscale scores 'drive for thinness' and 'body dissatisfaction'. Admission-to-discharge changes were compared in patients continuing pre-admission antipsychotics (APcont), starting antipsychotics (APnew) and patients without psychopharmacotherapy (noMed) using linear mixed models. Sensitivity analyses were conducted in subgroups matched for age, length of stay, baseline BMI and baseline EDI-2 scores. Subgroups were also compared regarding BMI trajectories, using non-linear growth curve models. Within-group analyses compared weight gain before vs. after the median antipsychotic onset week.</p><p><strong>Results: </strong>Of 775 adult inpatients (mean length of stay =103.5±48.0 days), 21.7% received antipsychotics (APcont =7.7%; APnew=13.9%), i. e., olanzapine (n=127, dose =5.5±3.1 mg/day) or quetiapine (n=41, dose=100.0±97.7 mg/day), while 78.3% did not receive any medication. Comparing all three groups, a significant time×group interaction was found for noMed and APnew vs. APcont (<i>p</i>=0.011), but this effect disappeared when comparing matched subgroups. However, in matched subgroups (n=54 each) APnew showed steeper weight gain vs. APcont both overall (<i>p</i>=0.011) and after median antipsychotic initiation (5.8±5.0 weeks) (<i>p</i>≤0.001). No significant group differences emerged in EDI-2 subscale scores.</p><p><strong>Discussion: </strong>In this naturalistic study, 22% of adult inpatients received antipsychotics. However, neither weight gain nor AN-related psychopathology changed differently in patients treated with vs. without antipsychotics. Newly initiated antipsychotic treatment vs. continuation from pre-admission had better weight gain outcomes.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Piyumi Fernando, Johanna Strauss, Elias Wagner, Lisa Löhrs, Mattia Campana, Peter Falkai, Alkomiet Hasan, Irina Papazova
{"title":"Early Treatment-Resistance in First Episode Psychosis.","authors":"Piyumi Fernando, Johanna Strauss, Elias Wagner, Lisa Löhrs, Mattia Campana, Peter Falkai, Alkomiet Hasan, Irina Papazova","doi":"10.1055/a-2421-2411","DOIUrl":"https://doi.org/10.1055/a-2421-2411","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 30% of individuals with schizophrenia experience treatment resistance (TR), with 70% exhibiting it from the onset. Most research fails to distinguish between acquired and innate resistance, with limited data on TR in first episode psychosis (FEP). However, FEP patients with TR experience progressively worse outcomes compared to those with initial response. To further understand these findings, clinical and demographic data of FEP patients with and without TR were compared in this naturalistic study.</p><p><strong>Methods: </strong>Information was extracted on FEP patients who were antipsychotic-naive at the time of admission from a retrospective database on F2x diagnosed patients admitted to the LMU psychiatric clinic between 2008 and 2018. Clozapine was used at discharge as a marker of TR in the FEP cohort. A similarly antipsychotic-naïve FEP control group without clozapine at discharge, was generated by matching for gender and age. Thirty clinical and demographic variables were analyzed to identify differences.</p><p><strong>Results: </strong>Two-hundred forty antipsychotic-naive FEPs were included: 33 with clozapine at discharge (TRC group), and 207 in the control group (non-TRC). Significant differences were observed in inpatient stay duration, chlorpromazine-equivalent dosage, number of antipsychotics, and anticholinergic medication at discharge.</p><p><strong>Discussion: </strong>The findings indicate that longer inpatient stay, an increased number of antipsychotics, and possibly a more extended prodrome may serve as markers for non-clozapine TR in FEP. Further research is necessary to establish the robustness of these variables as early-stage TR markers.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Activation of Hippocampal Neuronal NADPH Oxidase NOX2 Promotes Depressive-Like Behaviour and Cognition Deficits in Chronic Restraint Stress Mouse Model.","authors":"Zejie Zuo, Hongyang Zhang, Zhihui Li, Fangfang Qi, Haojie Hu, Junhua Yang, Zhibin Yao","doi":"10.1055/a-2429-4023","DOIUrl":"https://doi.org/10.1055/a-2429-4023","url":null,"abstract":"<p><strong>Background: </strong>Nicotinamide adenosine dinucleotide phosphate oxidases (NOX) play important roles in mediating stress-induced depression. Three NOX isotypes are expressed mainly in the brain: NOX2, NOX3 and NOX4. In this study, the expression and cellular sources of these NOX isoforms was investigated in the context of stress-induced depression.</p><p><strong>Methods: </strong>Chronic restraint stress (CRS)-induced depressive-like behaviour and cognitive deficits were evaluated by tail suspension tests, forced swimming tests and the Morris water maze test. Hippocampal NOX expression was determined by immunofluorescence staining and western blotting. The hippocampal levels of the brain-derived neurotrophic factor (BDNF) mRNA were determined via quantitative real-time -polymerase chain reaction. Glucocorticoid levels in the hippocampus were measured using ELISA kits.</p><p><strong>Results: </strong>In the mouse CRS model, a significant increase in NOX2 expression was observed in the hippocampus, whereas no significant changes in NOX3 and NOX4 expression were detected. Next, NOX2 expression was primarily localised to neurons (NeuN<sup>+</sup>) but not microglia (Iba-1<sup>+</sup>) or astrocytes (GFAP<sup>+</sup>). Treatment with gp91ds-tat, a specific NOX2 inhibitor, effectively mitigated the behavioural deficits induced by CRS. The decreased expression of the BDNF mRNA in the hippocampus of CRS mice was restored upon gp91ds-tat treatment. A positive correlation was identified between neuronal NOX2 expression and serum glucocorticoid levels.</p><p><strong>Conclusions: </strong>Our study indicated that neuronal NOX2 may be a critical mediator of depression-like behaviours and spatial cognitive deficits in mice subjected to CRS. Blockade of NOX2 signalling may be a promising therapeutic strategy for depression.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meijiang Jin, Lei Ji, Maojia Ran, Zhujun Wang, Yan Bi, Hang Zhang, Yuanmei Tao, Hanmei Xu, Shoukang Zou, Hong Zhang, Tao Yu, Li Yin
{"title":"ABC Family Gene Polymorphisms and Cognitive Functions Interact to Influence Antidepressant Efficacy.","authors":"Meijiang Jin, Lei Ji, Maojia Ran, Zhujun Wang, Yan Bi, Hang Zhang, Yuanmei Tao, Hanmei Xu, Shoukang Zou, Hong Zhang, Tao Yu, Li Yin","doi":"10.1055/a-2437-1751","DOIUrl":"https://doi.org/10.1055/a-2437-1751","url":null,"abstract":"<p><strong>Introduction: </strong>The importance of identifying relevant indicators of antidepressant efficacy is highlighted by the low response rates to antidepressant treatment for depression. The ABC gene family, encoding ATP-dependent transport proteins facilitating the transport of psychotropic drugs, has drawn attention. This study delved into the relationship between antidepressant efficacy and seven single nucleotide polymorphisms of ABCB1 and ABCB6 genes.</p><p><strong>Methods: </strong>A total of 549 depressed patients participated in the study, and all completed a 6-week course of antidepressant treatment. Cognitive function was assessed at baseline and post-treatment. Patients were categorized based on post-treatment HAMD-17 scores (with HAMD≤7 indicating remission), and comparisons were made between different groups in terms of allelic gene frequencies and genotypes. Logistic regression was used to explore the interaction between cognitive function and genotype on efficacy. Dual-luciferase reporter assays were performed to compare the regulatory effects of rs1109866 allele variants on the ABCB6 promoter.</p><p><strong>Results: </strong>There were no notable differences in allelic gene frequencies and genotypes between the remission and non-remission groups. Nonetheless, a significant interaction was identified between the rs1109866 genotype and language fluency-related indicators concerning efficacy (p=0.029) before correction. The dual-luciferase reporter assays demonstrated markedly higher fluorescence intensity of rs1109866-C compared to that of rs1109866-T (p<0.001).</p><p><strong>Discussion: </strong>Relying solely on genetic polymorphisms of ABC family genes as predictors of antidepressant treatment response may not be sufficient. However, the interaction between the rs1109866 and cognition plays a pivotal role. The potentially enhanced transcriptional activity of rs1109866-C might offer insight into its impact on antidepressant efficacy.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jaqueline K Eserian, Vinícius P Blanco, Lucildes P Mercuri, Jivaldo R Matos, Eugênia A Kalleian, José C F Galduróz
{"title":"Strategies and Management for Psychiatric Drug Withdrawal: A Systematic Review of Case Reports and Series.","authors":"Jaqueline K Eserian, Vinícius P Blanco, Lucildes P Mercuri, Jivaldo R Matos, Eugênia A Kalleian, José C F Galduróz","doi":"10.1055/a-2443-1189","DOIUrl":"https://doi.org/10.1055/a-2443-1189","url":null,"abstract":"<p><p>In recent years, an increasing number of case reports on psychiatric drug withdrawal have emerged, offering detailed clinical insights and valuable real-world evidence on the withdrawal process. The objective of this review was to evaluate the strategies and management for withdrawing psychiatric drugs, as detailed in case reports and series. A systematic review of case reports and series published between 2013 and 2023 was conducted to capture the latest trends in psychiatric drug withdrawal. Cases were identified following the PRISMA guidelines by searching electronic databases Medline and Scopus. Finally, 47 case reports and series were included. The primary reason for drug withdrawal was attributed to the emergence of adverse events, followed by medication dependence or abuse, and clinical decision-making or symptom resolution. Gradual reduction of doses was implemented through various management approaches as the primary strategy for drug withdrawal, and drug substitution emerged as the second most employed strategy. Also, patients were mostly undergoing polypharmacy. Favorable treatment outcomes were reported in the majority of cases, suggesting that psychiatric drug withdrawal is feasible - though quite challenging in some situations. However, the remarkably low number of unsuccessful cases may create a misleading impression of the significant difficulty associated with withdrawing psychiatric drugs.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alberto Parabiaghi, Alessia A Galbussera, Barbara D'Avanzo, Mauro Tettamanti, Ida Fortino, Angelo Barbato
{"title":"2001-2021 Comparative Persistence of Oral Antipsychotics in Patients Initiating Treatment: Superiority of Clozapine in Time-to-Treatment Discontinuation.","authors":"Alberto Parabiaghi, Alessia A Galbussera, Barbara D'Avanzo, Mauro Tettamanti, Ida Fortino, Angelo Barbato","doi":"10.1055/a-2437-4366","DOIUrl":"https://doi.org/10.1055/a-2437-4366","url":null,"abstract":"<p><strong>Background: </strong>Continuous antipsychotic (AP) therapy is crucial for managing psychotic disorders, and its early interruption reflects the drug's failure. Real-world epidemiological research is essential for confirming experimental data and generating new research hypotheses.</p><p><strong>Methods: </strong>The persistence of oral APs in a large population sample from 2000 to 2021 was analyzed by comparing AP prescriptions over this period across four Italian provinces, using dispensing data linked via a record-linkage procedure among regional healthcare utilization databases. We calculated personalized daily dosages and assessed time-to-treatment discontinuation over a 3-month period for patients initiating AP treatment. Treatment persistence was evaluated using Kaplan-Meier curves and Cox regression, with adjustments for age and sex.</p><p><strong>Results: </strong>Second-generation antipsychotics (SGAs) were favored over first-generation antipsychotics (FGAs), with olanzapine as the most prescribed. Within the study time frame, 42,434 individuals were prescribed a new continuous AP regimen. The analysis revealed 24 significant differences within 28 comparisons. As a class, SGAs demonstrated better treatment persistence than FGAs (HR: 0.76; 95%CI: 0.73, 0.79). Clozapine stood out for its superior persistence, surpassing all other SGAs, notably olanzapine (HR: 0.85; 95%CI: 0.79-0.91) and risperidone (HR: 0.80; 95%CI: 0.74-0.87). Olanzapine and aripiprazole showed better results than both risperidone and quetiapine. Quetiapine showed inferior 3-month persistence in all pairwise comparisons.</p><p><strong>Conclusion: </strong>The study results provide insight into the performance dynamics among SGAs: clozapine, despite being one of the less frequently dispensed APs in our sample, emerged as a significant prescription choice. The significance of pharmacoepidemiological studies in complementing experimental findings is also underscored.</p>","PeriodicalId":19783,"journal":{"name":"Pharmacopsychiatry","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}