Therapeutic Advances in Psychopharmacology最新文献

{"title":"Increased amisulpride serum concentration in a patient treated with concomitant pregabalin and trazodone: a case report.","authors":"Petr Potměšil,&nbsp;Lenka Kostýlková,&nbsp;Miloslav Kopeček","doi":"10.1177/20451253221136754","DOIUrl":"https://doi.org/10.1177/20451253221136754","url":null,"abstract":"<p><p>We report on the case of a 46-year-old woman with generalized anxiety disorder, paranoid personality disorder, and mild reduction in glomerular filtration rate (GFR). She was treated with pregabalin, trazodone, hydroxyzine, and clonazepam before hospital admission. Pharmacotherapy for the patient was changed during her first week in the hospital. Dosing of hydroxyzine and clonazepam was gradually decreased, and then these two drugs were withdrawn. Treatment with amisulpride was started on the fourth day after admission, and amisulpride serum levels were then measured three times as a part of therapeutic drug monitoring (TDM). The serum concentration of amisulpride detected during concurrent use of trazodone and pregabalin was approximately twice the therapeutic range for amisulpride. When the dose of pregabalin was reduced by half, the serum concentration of amisulpride decreased to therapeutic serum levels. We hypothesize that an interaction between amisulpride and pregabalin was responsible for the increased amisulpride concentration since both drugs are almost exclusively excreted from the body by the renal route. Pregabalin-amisulpride interaction might also be influenced by concomitant therapy with trazodone or a mild reduction in GFR. However, we only have clinical evidence for an interaction between amisulpride and pregabalin because after we halved the dose of pregabalin, the amisulpride concentration decreased, and the C/D ratio normalized. This could be helpful information for psychiatrists in order to avoid drug-drug interactions between amisulpride and pregabalin. We recommend TDM of amisulpride in patients treated concomitantly with other drugs eliminated mainly by the kidneys.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":"20451253221136754"},"PeriodicalIF":4.2,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/59/4b/10.1177_20451253221136754.PMC9716442.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35256036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of cariprazine augmentation in patients treated with clozapine: a pilot study.","authors":"Sofia Pappa,&nbsp;Arturas Kalniunas,&nbsp;Hitendra Sharma,&nbsp;Ali Raza-Syed,&nbsp;Manzar Kamal,&nbsp;Fintan Larkin","doi":"10.1177/20451253221132087","DOIUrl":"https://doi.org/10.1177/20451253221132087","url":null,"abstract":"<p><strong>Background: </strong>Cariprazine, a novel antipsychotic drug, is a partial agonist of dopamine D2/D3 receptors with preferential binding to the D3 receptor. There has been an increasing interest in cariprazine augmentation to clozapine; however, the evidence thus far has been only limited to case reports and case series.</p><p><strong>Objectives: </strong>To evaluate the efficacy and safety of the augmentation of clozapine with cariprazine in patients with sub-optimal treatment response.</p><p><strong>Methods: </strong>Demographic and clinical information of the study population were collected from the electronic records and PANSS scale administered at baseline and 3 months. Tolerability and discontinuation reasons where applicable were also recorded.</p><p><strong>Results: </strong>Ten patients (four men and six women) with a mean age of 36.5 years (range = 26-45) were included. Reasons for cariprazine initiation included inadequate treatment response, persistent negative symptoms and/or tolerability issues with clozapine or previous augmentation options. Two patients discontinued cariprazine within the first 6 weeks due to restlessness and poor response, respectively. There was a significant reduction in the median total PANSS score from baseline to 3 months (from 59 to 22.5, <i>p</i> < 0.05), median positive PANSS score (from 11.5 to 5.5, <i>p</i> < 0.05) and in the median negative PANSS score (from 15.5 to 3, <i>p</i> < 0.05) which correspond to a 48%, 33.8% and 65.8% mean score reduction, respectively.</p><p><strong>Conclusion: </strong>This is the first pilot study evaluating the effectiveness of clozapine augmentation. The preliminary evidence suggests that this may be a safe and effective practice in patients failing to adequately respond to or tolerate clozapine and/or previous augmentation strategies.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":"20451253221132087"},"PeriodicalIF":4.2,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/6b/10.1177_20451253221132087.PMC9685211.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40499730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased left dorsolateral prefrontal cortex density following escitalopram intake during relearning: a randomized, placebo-controlled trial in healthy humans.","authors":"Thomas Vanicek, Murray B Reed, René Seiger, Godber M Godbersen, Manfred Klöbl, Jakob Unterholzner, Benjamin Spurny-Dworak, Gregor Gryglewski, Patricia Handschuh, Clemens Schmidt, Christoph Kraus, Thomas Stimpfl, Rainer Rupprecht, Siegfried Kasper, Rupert Lanzenberger","doi":"10.1177/20451253221132085","DOIUrl":"10.1177/20451253221132085","url":null,"abstract":"<p><strong>Background: </strong>Serotonergic agents affect brain plasticity and reverse stress-induced dendritic atrophy in key fronto-limbic brain areas associated with learning and memory.</p><p><strong>Objectives: </strong>The aim of this study was to investigate effects of the antidepressant escitalopram on gray matter during relearning in healthy individuals to inform a model for depression and the neurobiological processes of recovery.</p><p><strong>Design: </strong>Randomized double blind placebo control, monocenter study.</p><p><strong>Methods: </strong>In all, 76 (44 females) healthy individuals performed daily an associative learning task with emotional or non-emotional content over a 3-week period. This was followed by a 3-week relearning period (randomly shuffled association within the content group) with concurrent daily selective serotonin reuptake inhibitor (i.e., 10 mg escitalopram) or placebo intake.</p><p><strong>Results: </strong>Via voxel-based morphometry and only in individuals that developed sufficient escitalopram blood levels over the 21-day relearing period, an increased density of the left dorsolateral prefrontal cortex was found. When investigating whether there was an interaction between relearning and drug intervention for all participants, regardless of escitalopram levels, no changes in gray matter were detected with either surfaced-based or voxel-based morphometry analyses.</p><p><strong>Conclusion: </strong>The left dorsolateral prefrontal cortex affects executive function and emotional processing, and is a critical mediator of symptoms and treatment outcomes of depression. In line, the findings suggest that escitalopram facilitates neuroplastic processes in this region if blood levels are sufficient. Contrary to our hypothesis, an effect of escitalopram on brain structure that is dependent of relearning content was not detected. However, this may have been a consequence of the intensity and duration of the interventions.</p><p><strong>Registration: </strong>ClinicalTrials.gov Identifier: NCT02753738; Trial Name: <i>Enhancement of learning associated neural plasticity by Selective Serotonin Reuptake Inhibitors</i>; URL: https://clinicaltrials.gov/ct2/show/NCT02753738.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":"12 ","pages":"20451253221132085"},"PeriodicalIF":3.4,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9677158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9163749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-life effectiveness of transitioning from paliperidone palmitate 1-monthly to paliperidone palmitate 3-monthly long-acting injectable formulation.","authors":"Olivier Corbeil,&nbsp;Anne-Marie Essiambre,&nbsp;Laurent Béchard,&nbsp;Audrey-Anne Roy,&nbsp;Maxime Huot-Lavoie,&nbsp;Sébastien Brodeur,&nbsp;Ranjith Chandrasena,&nbsp;Chantale Thériault,&nbsp;Candice Crocker,&nbsp;Jean-Pierre Melun,&nbsp;Phil Tibbo,&nbsp;Marie-France Demers,&nbsp;Marc-André Roy","doi":"10.1177/20451253221136021","DOIUrl":"https://doi.org/10.1177/20451253221136021","url":null,"abstract":"<p><strong>Background: </strong>Non-adherence to antipsychotics in schizophrenia is associated with an increased risk of psychotic relapse and hospitalization, a risk that is reduced with the use of long-acting injectable (LAI) antipsychotics. Randomized clinical trials (RCTs) have demonstrated the efficacy of paliperidone palmitate 3-monthly (PP3M) for psychotic relapse prevention in schizophrenia, but it remains poorly documented among individuals treated in real-life settings who can benefit the most out of LAIs.</p><p><strong>Objectives: </strong>The objective of this study was to evaluate the effectiveness of PP3M in relapse prevention among patients with schizophrenia.</p><p><strong>Methods: </strong>This is a multicentre retrospective study conducted in four outpatients' clinics across Canada. All consecutive patients with a main diagnosis of schizophrenia who initiated PP3M between June 2016 and March 2020 were included. The primary outcome was psychotic relapse, defined using broad and clinically relevant criteria.</p><p><strong>Results: </strong>Among 178 consecutive patients who were switched to PP3M, the 12-month relapse rate was 18.5% and the relapse-free survival probability was 0.788 (95% confidence interval [CI] = 0.725-0.856). Comorbid diagnoses of personality disorders and substance use disorders were associated with hazard rates (HRs) of 3.6 (95% CI = 1.8-7.3, <i>p</i> < 0.001) and 3.1 (95% CI = 1.6-6.2), respectively. Increased psychopathology severity was associated with an increased likelihood of relapse, while having a job or being in school was protective.</p><p><strong>Conclusion: </strong>These findings reinforce the necessity of conducting research in patients with comorbid psychiatric disorders who are typically underrepresented in RCTs, yet overrepresented in real-life settings, in order to better inform and guide clinical practice.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":"20451253221136021"},"PeriodicalIF":4.2,"publicationDate":"2022-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/17/10.1177_20451253221136021.PMC9666838.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40502467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability of cannabidiol in patients with psychosis.","authors":"Edward Chesney, Doga Lamper, Millie Lloyd, Dominic Oliver, Emily Hird, Philip McGuire","doi":"10.1177/20451253221128445","DOIUrl":"10.1177/20451253221128445","url":null,"abstract":"<p><strong>Background: </strong>Cannabidiol (CBD) is a promising novel candidate treatment for psychosis. It has a more benign side effect profile than antipsychotic medications, and being treated with CBD is not perceived as being stigmatising. These observations suggest that patients with psychosis would find CBD to be a relatively acceptable treatment.</p><p><strong>Objective: </strong>This study tested the above hypothesis by assessing the views of a sample of patients.</p><p><strong>Methods: </strong>Patients with a psychotic disorder were invited to complete a survey exploring their expectations about the efficacy and side effects of CBD.</p><p><strong>Results: </strong>Seventy patients completed the survey. The majority (86%) were willing to try CBD as a treatment. Most patients believed that CBD would improve their psychotic symptoms (69%) and that it would have fewer side effects than their current medication (64%; mainly antipsychotics). A minority of patients (10%) were concerned that CBD might exacerbate their psychotic symptoms. This, however, appeared to reflect confusion between the effects of CBD and those of cannabis.</p><p><strong>Conclusion: </strong>Most patients with psychosis regard CBD as an acceptable treatment. Although CBD has not yet been approved as a treatment for psychosis, many patients are aware of it through the presence of CBD in cannabis and in health supplements. When added to the emerging evidence of its efficacy and the low risk of side effects, the high acceptability of CBD underlines its therapeutic potential.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":"12 ","pages":"20451253221128445"},"PeriodicalIF":3.4,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10566590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of long-acting injectable antipsychotics on hospitalizations and global functioning in schizophrenia: a naturalistic mirror-image study.","authors":"Cristiana Montemagni,&nbsp;Elisa Del Favero,&nbsp;Elena Cocuzza,&nbsp;Flavio Vischia,&nbsp;Paola Rocca","doi":"10.1177/20451253221122526","DOIUrl":"https://doi.org/10.1177/20451253221122526","url":null,"abstract":"<p><strong>Background: </strong>Partial adherence to antipsychotics is the most common cause of relapses and rehospitalization in patients with schizophrenia (SZ), leading to higher health care costs and psychosocial disability. The use of long-acting injectable (LAI) antipsychotics may improve therapeutic continuity and adherence to treatment.</p><p><strong>Objective: </strong>To assess the effectiveness of switching from oral antipsychotics (OAs) to long-acting antipsychotics.</p><p><strong>Methods: </strong>This 1-year mirror-image study evaluated the effect of switching from OAs to LAIs on the reduction of psychiatric hospitalizations and the improvement of global functioning in patients with schizophrenia. Differences in outcomes between second-generation (SGA) LAIs and first-generation (FGA) LAIs were also analyzed.</p><p><strong>Results: </strong>In all, 166 patients were included: 32.5% treated by FGA-LAIs and 67.5% by SGA-LAIs. There was an overall reduction of 71% in the average number of hospital admissions and an overall improvement of 29.3% in the Global Assessment of Functioning (GAF) score between the previous 12 months and the 12 months following the switching to LAIs. Patients who switched to SGA-LAIs had no significant differences in hospitalization occurrences but a significant improvement in GAF scores when compared with patients who switched to FGA-LAIs.</p><p><strong>Conclusion: </strong>Our results suggest that using LAIs could be the most adequate treatment choice for SZ patients with a high risk of relapse and low adherence rate. Patients with poorer social functioning may be ideal candidates for SGA-LAIs treatment. Our findings may be of particular interest from a clinical and health care management perspective.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":"20451253221122526"},"PeriodicalIF":4.2,"publicationDate":"2022-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/82/f4/10.1177_20451253221122526.PMC9549097.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33503149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcome analysis of patients with autism spectrum disorder: analysis from the UK Medical Cannabis Registry.","authors":"Simon Erridge,&nbsp;Jess Kerr-Gaffney,&nbsp;Carl Holvey,&nbsp;Ross Coomber,&nbsp;Daniela A Riano Barros,&nbsp;Urmila Bhoskar,&nbsp;Gracia Mwimba,&nbsp;Kavita Praveen,&nbsp;Chris Symeon,&nbsp;Simmi Sachdeva-Mohan,&nbsp;Mikael H Sodergren,&nbsp;James J Rucker","doi":"10.1177/20451253221116240","DOIUrl":"https://doi.org/10.1177/20451253221116240","url":null,"abstract":"<p><strong>Introduction: </strong>Cannabis-based medicinal products (CBMPs) have been identified as a promising novel therapeutic for symptoms and comorbidities related to autism spectrum disorder (ASD). However, there is a paucity of clinical evidence of their efficacy and safety. Objective: This case series aims to assess changes to health-related quality of life and the incidence of adverse events in patients treated with CBMPs for associated symptoms of ASD enrolled on the UK Medical Cannabis Registry (UKMCR).</p><p><strong>Methods: </strong>Patients treated with CBMPs for ASD-related symptoms for a minimum of 1 month were identified from the UKMCR. Primary outcomes were changes in validated patient-reported outcome measures [Generalised Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), 5-level version of the EQ-5D (EQ-5D-5L) index values] at 1, 3 and 6 months compared with baseline. Adverse events were recorded and analysed. Statistical significance was determined by <i>p</i> < 0.050.</p><p><strong>Results: </strong>Seventy-four patients with ASD were included in the analysis. The mean age of participants was 32.7 (±11.6) years. There were significant improvements in general health-related quality of life and sleep as assessed by the EQ-5D-5L, SQS and GAD-7 at 1 and 3 months, with sustained changes in EQ-5D-5L and SQS at 6 months (<i>p</i> < 0.010). There were 180 (243.2%) adverse events reported by 14 (18.9%) participants. If present, adverse events were commonly mild (<i>n</i> = 58; 78.4%) or moderate (<i>n</i> = 81; 109.5%), rather than severe (<i>n</i> = 41; 55.4%).</p><p><strong>Conclusion: </strong>This study demonstrated an associated improvement in general health-related quality of life, and anxiety- and sleep-specific symptoms following initiation of treatment with CBMPs in patients with ASD. These findings, while promising, are limited by the confines of the study which lacks a control arm and is subject to attrition bias. Therefore, further evaluation is required with randomised controlled trials.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":"20451253221116240"},"PeriodicalIF":4.2,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9500308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33484763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risperidone-induced priapism: a case report and literature review.","authors":"Sarra Ateb,&nbsp;Taoufik Fourati,&nbsp;Hammadi Ben Rejeb,&nbsp;Dominique Januel,&nbsp;Noomane Bouaziz","doi":"10.1177/20451253221113246","DOIUrl":"https://doi.org/10.1177/20451253221113246","url":null,"abstract":"<p><p>Priapism is a rare pathological condition defined as painful and persistent penile erection that is unrelated to sexual stimulation. It can be classified as ischaemic or non-ischaemic. Many causes have been attributed to ischaemic priapism, including the use of some medications such as antipsychotics. The mechanism of priapism associated with antipsychotics is thought to be related to alpha-adrenergic blockage that is mediated by the alpha receptors in the corpora cavernosa of the penis. In this paper, we describe a case of a patient who suffered from Risperidone-induced priapism, and how this adverse effect was resolved by switching to olanzapine followed by olanzapine pamoate. A literature search on PubMed/Medline up to 2011 was conducted by some doctors from London and found 30 cases of priapism associated with risperidone. Based on this work, we searched PubMed through 2021, using the keywords 'priapism' and 'risperidone' and found a total of 43 cases of priapism involving risperidone. Priapism is not correlated with the dosage of this psychotropic drug, and has also occasionally occurred when risperidone has been used in conjunction with another drug. The question of choosing a replacement antipsychotic after the first one has induced priapism, remains problematic. It would be preferable to switch to a drug with less marked alpha1-blocking properties, but no consensus has been reached as to the best choice of medication. Finally, any prescription of an antipsychotic treatment must be preceded by a careful interrogation in search of risk factors for priapism, and the patient should be made aware of the possible occurrence of this side effect and the need to then seek urgent medical advice.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":"20451253221113246"},"PeriodicalIF":4.2,"publicationDate":"2022-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/27/37/10.1177_20451253221113246.PMC9424871.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40344056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antipsychotic polypharmacy and clozapine prescribing patterns: evolution and correlates before and after a psychiatric hospitalisation.","authors":"Juliette Lagreula,&nbsp;Philippe de Timary,&nbsp;Laure Elens,&nbsp;Olivia Dalleur","doi":"10.1177/20451253221112587","DOIUrl":"https://doi.org/10.1177/20451253221112587","url":null,"abstract":"<p><strong>Background: </strong>Antipsychotic polypharmacy (APP) prescribing and clozapine underuse are considered inappropriate prescribing in schizophrenia. Psychiatric hospitalisations may be suitable occasions to re-evaluate patient pharmacotherapy and to switch to monotherapy.</p><p><strong>Objectives: </strong>To explore the evolution of APP and other psychotropic prescribing patterns during psychiatric hospitalisations, to detect characteristics associated with APP on admission and at discharge, and to examine clozapine prescribing patterns.</p><p><strong>Design: </strong>We performed a retrospective observational study based on electronic health records.</p><p><strong>Methods: </strong>Data on adult inpatients diagnosed with schizophrenia spectrum disorders were collected retrospectively from 6 Belgian hospitals in 2020-2021.</p><p><strong>Results: </strong>Of the 516 patients included, APP prescribing increased significantly from 47.9% on hospital admission to 59.1% at discharge. On admission and at discharge, APP was associated with prior clozapine use (OR_admission = 2.53, CI = 1.1-5.84, OR_discharge = 11.01, CI = 4.45-27.28), treatment with a first-generation antipsychotic (OR_admission = 26.79, CI = 13.08-54.86, OR_discharge = 25.2, CI = 12.2-52.04), increased antipsychotic exposure (OR_admission = 8.93, CI = 5.13-15.56, OR_discharge = 19.89, CI = 10-39.54), and a greater number of hypno-sedatives (OR_admission = 1.88, CI = 1.23-2.88, OR_discharge = 4.18, CI = 2.53-6.91). APP was negatively associated with involuntary admission (OR_admission = 0.31, CI = 0.14-0.7, OR_discharge = 0.3, CI = 0.13-0.68). When using an alternative definition of monotherapy (i.e. including patients with an add-on low-dose antipsychotic for sleep disorders), alcohol use disorder (OR_admission = 0.26, CI = 0.13-0.54) and higher age (OR_discharge = 0.53, CI = 0.29-0.95) were negatively associated with APP, and living in a residential facility (OR_discharge = 2.39 CI = 1.21-4.71) and a higher daily dosage of benzodiazepines during the stay (OR_discharge = 1.32 CI = 1.03-1.69) increased the odds of being discharged on APP. On admission, 9.3% of patients were being treated with clozapine. Although 28.1% of patients were eligible for clozapine treatment, only 11% of patients were discharged with a clozapine prescription. For 7 of the 10 patients with a new clozapine prescription, it was directly prescribed in combination with another antipsychotic, without a prior trial of clozapine monotherapy.</p><p><strong>Conclusion: </strong>Suboptimal prescriptions of antipsychotics in patients with schizophrenia persist after psychiatric hospitalisations and are associated with identifiable characteristics.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":"20451253221112587"},"PeriodicalIF":4.2,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/07/0d/10.1177_20451253221112587.PMC9425880.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40344055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who is prescribed valproate and how carefully is this treatment reviewed in UK mental health services? Data from a clinical audit.","authors":"Carol Paton,&nbsp;Leslie Citrome,&nbsp;Emilio Fernandez-Egea,&nbsp;Olivia Rendora,&nbsp;Thomas R E Barnes","doi":"10.1177/20451253221110016","DOIUrl":"https://doi.org/10.1177/20451253221110016","url":null,"abstract":"<p><strong>Background: </strong>The licensed indications for valproate are narrow, yet this medication is commonly prescribed in mental health services.</p><p><strong>Objectives: </strong>To explore the target symptoms/behaviours for which valproate is prescribed and how well the efficacy and tolerability of this treatment are monitored in routine clinical practice.</p><p><strong>Design: </strong>An audit-based quality improvement (QI) programme in UK mental health services.</p><p><strong>Methods: </strong>Information on valproate prescribing was collected from clinical records using a bespoke data collection tool.</p><p><strong>Results: </strong>Sixty-four NHS mental health Trusts/healthcare organisations submitted data on valproate treatment for 5320 patients. Valproate was clearly prescribed for a licensed indication in 1995 (38%) patients, off-label in 1987 (37%) while the indication was uncertain/not available in 1338 (25%). Of the 919 patients started on valproate treatment within the past year, between a half and two-thirds had each of the relevant baseline physical health checks documented. In 539 (59%) of these patients, valproate was prescribed for an unlicensed indication; the prescription was recognised as off-label in 363 (67%), 20 (6%) of whom were documented as having had this explained to them. Of 631 patients prescribed valproate for between 3 months and a year, early on-treatment assessments of response and side effects were documented in 441 (70%) and 332 (53%), respectively. Of 4401 patients treated for more than a year, annual on-treatment reviews of clinical response and side effects were documented in 2771 (63%) and 2140 (49%), respectively.</p><p><strong>Conclusion: </strong>Our data suggest the majority of prescriptions for valproate in mental health services are not for a licensed indication. Furthermore, patients rarely receive an explanation that their valproate prescription is off-label, perhaps partly because the licensed indications are not widely understood by prescribers. Given the very limited evidence for efficacy for the off-label uses of valproate, failure to routinely conduct early on-treatment and annual reviews of the benefits and side effects of this medication may result in patients remaining on ineffective and poorly tolerated treatment by default.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":" ","pages":"20451253221110016"},"PeriodicalIF":4.2,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9d/b5/10.1177_20451253221110016.PMC9425878.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40344057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}