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clinicaltrials.gov Identifiers: NCT00095823, NCT00095758, and NCT00105196.
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We enrolled 21 patients in group I and 19 patients in group II. Groups did not differ regarding age, sex, education or severity of psychotic symptoms. Frequency and severity of OCS were significantly higher in group I and were associated with pronounced deficits in specific cognitive abilities. Whereas brain activation patterns did not differ during working memory, group I showed significantly increased activation in the orbitofrontal cortex (OFC) during response inhibition. Alterations in OFC activation were associated with the severity of obsessions and mediated the association between SGA treatment and co-occurring OCS on a trend level.
Use of atypical antipsychotics (AA) in combination with an antidepressant is recommended as an augmentation strategy for patients with depression. However, there is a paucity of data comparing aripiprazole and other AAs in terms of patient reported outcomes. Therefore, the objective of this study was to examine the levels of HRQoL and health utility scores in patients with depression using aripiprazole compared with patients using olanzapine, quetiapine, risperidone and ziprasidone.
These results support a partial agonist activity for aripiprazole at 5-HT(1A) receptors in vitro and in vivo, and suggest important interactions with other 5-HT-receptor subtypes. This receptor activity profile may contribute to the antipsychotic activity of aripiprazole in humans.
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The analysis was conducted from the societal and payer perspectives in the US, using a Markov model. The model simulated a cohort of 1000 stabilized BPD I patients and estimated the quarterly risk in three health states: euthymia, mania and depression. Efficacy data were derived from two randomized, double-blind trials comparing quetiapine + lithium/divalproex with placebo + lithium/divalproex for up to 2 years, as well as other published literature. Resource data were extracted from published literature. Drug costs, hospitalizations and physician visits were among the direct costs. Indirect costs included absenteeism, and mortality rates included suicide. Benefits and costs were discounted at 3% and the price reference year was 2009. Endpoints included number of acute mood episodes, hospitalizations due to an acute mood event and costs per QALY. Probabilistic sensitivity analysis (PSA) was conducted to evaluate uncertainty in the model inputs.
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Coprolalia is one of the most distressing symptoms in Gilles de la Tourette syndrome. We report on a 28-year-old man with severe coprolalia at the forefront of symptoms, which had a dramatic impact on his social and professional life and that did not fluctuate for years. Moreover, he presented hypersensitivity to neuroleptics. The use of aripiprazole, as a last resort, induced a 75% of improvement of his symptoms with good tolerance. This suggests that aripiprazole constitutes a valuable therapeutic in coprolalia. Moreover, its biochemical class specificity makes it an alternative for patients hypersensitive to other classes of neuroleptics.
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Patients with schizophrenia show low employment rates and low Quality of Life (QoL), and rehabilitation aims to maximise daily functioning, improve social interactions, and develop employment prospects. Evaluation of long-term treatment effectiveness should address these issues. Choice of medication can influence patient compliance and adverse experience of side effects may act as a barrier to rehabilitation. The Schizophrenia Trial of Aripiprazole (STAR), in which patients were randomised to receive 26 weeks of the atypical antipsychotic, aripiprazole (n=284) or standard of care medication (n=271) showed that aripiprazole demonstrated significantly better effectiveness in terms of Investigator Assessment Questionnaire (IAQ) total score. Like other atypical antipsychotic agents, aripiprazole shows a low rate of extrapyramidal adverse events. In addition, unlike the majority of other agents, aripiprazole treatment has a low risk of weight gain, translating into health-related QoL benefits. In summary, newer, atypical agents may improve efficacy, patient satisfaction, and aid long-term rehabilitation.
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Second-generation antipsychotics (SGAs) are a mainstay in the treatment of patients with schizophrenia. However, continuity in intake of the prescribed medication has been one of the greatest challenges in these patients. One option to improve medication adherence is to prescribe depot or long-acting injectable formulations (LAIs) of antipsychotics. Following risperidone, several other SGAs have been introduced as LAIs. Olanzapine pamoate, paliperidone palmitate, and aripiprazole are the new-generation LAIs, which are available for 2- to 4-week intervals of application in many countries. The literature shows a clear advantage of these drugs over placebo regarding symptom reduction and relapse prevention. LAIs show a similar safety profile to oral formulations of the relevant drug, with the exception of olanzapine pamoate, which can lead to rare cases of post-injection delirium/sedation syndrome (PDSS). PDSS is characterized by heavy sedation (possibly including coma) and/or delirium after injection. During PDSS events, patients show higher plasma concentrations of olanzapine, leading to the assumption that unintended partial intravascular injection or blood vessel injury during the injection is causative of PDSS. Therefore, a risk-management plan proposing an observation period of 3 h was introduced. In August 2013, a new proposal by the European Medicines Agency terminated the requirement to accompany these patients to their next destination, although this requirement remains in place according to US FDA recommendations.
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There is some evidence to support the use of psychosocial interventions for behavioral symptoms, including those utilizing sensory interventions such as aromatherapy and calming music; behavioral management techniques; cognitive stimulation; physical activity; and staff training. There is also some evidence to support the use of psychotherapies such as reminiscence therapy and cognitive behavior therapy for depression. Recent literature on the pharmacological management of behavioral symptoms of dementia have included studies of the antipsychotic aripiprazole, prazosin, and medication-discontinuation trials along with two negative studies involving melatonin and oxcarbazepine.
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The rates of high-dose antipsychotic prescription were 61.7% and 53.8% in 2005 and 2010, respectively. The rates of antipsychotic polypharmacy were 34.6% in 2005 and 34.0% in 2010. The most common first-prescribed antipsychotics were (in descending order of prescription frequency) olanzapine, risperidone, aripiprazole, and haloperidol in 2005 and risperidone, quetiapine, paliperidone, and olanzapine in 2010. High-dose antipsychotics were significantly associated with antipsychotic polypharmacy (odds ratio=23.97; p<0.01). More individuals were treated with mood stabilizers in 2010 than in 2005 (p=0.003).
There were no significant effects for time (p = 0.346) or time × group interaction (p = 0.27) on the changes of positive and negative syndrome scale (PANSS) total score, although blonanserin decreased PANSS scores. We observed negative correlation between pHVA at baseline and the change in PANSS total score (rs = -0.450, p = 0.046). We also found positive correlation between the changes in pHVA and the changes in PANSS total (rs = 0.536, p = 0.015) and positive (rs = 0.572, p = 0.008) scores.
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It is known that psychotropic medications have an impact on the readings found in Electroencephalogram (EEG). In the field of psychiatry, there are several psychotropics utilized by clinicians. This review seeks to investigate all the available data for psychotropic drugs and their impact on EEG changes.
Given the multiple cardiovascular risk factors seen in patients with schizophrenia, great care must be exercised in the choice of antipsychotic therapy to minimize the medical burden of additional risk imposed by hyperlipidemia. It is recommended that a lipid panel be obtained at baseline in all patients with schizophrenia, annually thereafter for patients on agents associated with lower risk of hyperlipidemia and quarterly in patients on agents associated with higher risk for hyperlipidemia. All patients with persistent dyslipidemia should be referred for lipid-lowering therapy or switched to a less lipid-offending antipsychotic agent.
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Patient non-adherence increases the risk for relapse and the long-term care of schizophrenia. Long-acting injectable (LAI) antipsychotics can decrease this risk by ensuring adherence. An extended formulation, aripiprazole 400 mg once-monthly (AOM 400) LAI (AOM LAI), received regulatory approval in the year 2013 for the treatment of schizophrenia. AOM LAI is the first dopamine D2 partial agonist available in a long-acting formulation for the treatment of schizophrenia.
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La dépression du sujet âgé est un problème croissant de santé publique et mondiale dont l'étiologie et les manifestations cliniques sont variées. Cette revue de la littérature résume les résultats de neuro-imagerie associés à la dépression chez les personnes âgées ainsi que la variabilité de la réponse au traitement. La dépression du sujet âgé s'associe à une atrophie cérébrale, à une perte d'intégrité de la myéline et à des lésions cérébrales dans les régions fronto-striato-limbiques. Ces associations permettent d'expliquer le syndrome de dysfonction exécutive observé dans la dépression du sujet âgé et sont en faveur d'une charge cérébrovasculaire comme mécanisme pathogène. De plus, d'après cet article, les facteurs de la résistance au traitement en neuro-imagerie reflètent aussi cette charge. Selon les étiologies théoriques de la dépression du sujet âgé, cette charge cérébrovasculaire jouerait un rôle de médiateur dans la résistance au traitement. Cet article propose que la neuro-imagerie en soit la traduction clinique. Des études contrôlées peuvent déterminer des biomarqueurs de neuro-imagerie qui renseigneraient le traitement en identifiant les adultes déprimés susceptibles de guérir avec un traitement médicamenteux, en précisant la dose thérapeutique personnalisée et en facilitant les mesures précoces de réponse au traitement. La neuro-imagerie peut également informer de la même façon sur la variabilité de la réponse au traitement avec l'aripiprazole (modulateur de la dopamine) et avec la buprénorphine (modulateur opiacé).
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The TEA trial is a Danish investigator-initiated, independently funded, multi-centre, randomised, blinded clinical trial. Based on sample size estimation, 112 patients aged 12-17 years with psychosis, antipsychotic-naïve or treated for a limited period are, 1:1 randomised to a 12- week, double-blind intervention with quetiapine versus aripiprazole. Effects on psychopathology, cognition, health-related quality of life, and adverse events are assessed 2, 4, and 12 weeks after randomisation. The primary outcome is change in the positive symptom score of the Positive and Negative Syndrome Scale. The recruitment period is 2010-2014.
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Some atypical antipsychotics clinically used to treat schizophrenia induce weight gain by unknown mechanisms. The dorsal vagal complex (DVC) of the brainstem and the endogenous cannabinoid system are implicated in the regulation of appetite signalling and food intake. We investigated whether antipsychotic drugs alter cannabinoid receptor-binding density in the DVC. Female Spraguewk (short-term) or 120.83, p=0.01). In addition, only chronic olanzapine treatment increased food intake. These results show that olanzapine, an antipsychotic with a high risk of weight gain as a side-effect, significantly decreased cannabinoid receptor binding in the DVC, whilst aripiprazole and haloperidol, antipsychotics with a low risk of weight gain had little or no effect on binding. These results suggest that a mechanism for antipsychotic-induced weight gain may be through the modulation of cannabinoid receptors in the DVC.
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Health service providers increasingly need to consider not only the efficacy and safety of a therapy, but also its cost. Our hypothesis was that in our previously reported aripiprazole add-on or switching study, the improved outcomes would be associated with reduced costs. We here report data from this study, now to 52-week follow-up, with 27 total recruits (outpatients partially refractory or intolerant of their current antipsychotic regime). Serial clinical ratings included the Quality of Life Scale and Client Service Receipt Inventory, applied at baseline (N = 24), week 26 (N = 21) and 52 (N = 18). Cost data were unavailable for the drop outs. On last observation carried forward (LOCF) analysis, there was a significant increase in the Quality of Life Scale between baseline and one year (p = 0.007). There were also reductions over time in total direct and indirect costs. For study completers, the total costs at the one-year follow-up period were £ 482 less than those for the corresponding baseline period, with the Quality of Life Scale score at one year being 21.6 points (or 16.4 on LOCF analysis) higher. Therefore, in the completers, improved outcome was associated with reduced costs. Cost-effectiveness could be similarly investigated in a controlled trial.