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P.3.046 Change in prepulse inhibition after switching schizophrenic patients from zuclopenthixol to long-acting injectable risperidone
P3 Psychotic disorders and antipsychotics age are unlikely to be predictors of antipsychotic-induced weight gain in a group of patients taking part in our study.
References [1] Mfiller, D.J., Muglia, P., Fortune, T., Kennedy, J.L., 2004. Pharmacogenetics of antipsychotic-induced weight gain. Pharmacological Research 49, 30~329.
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Change in prepulse inhibition after switching schizophrenic patients from zuclopenthixol to long-acting injectable risperidone
G. Rubio 1 *, B. Alvarez del Manzano 1, M. Ducaju 1, I. MartlnezGras 1, D. Gimeno 1, J. Borrel 2. 1Mental health Services,
Psychiatty, Madrid, Spain; 2Instituo Cajal, Neuroplasticidad, Spain Background: Individuals with schizophrenia are known to show deficits in prepulse inhibition (PPI) of the startle response [1]. PPI refers to a response suppression in reaction to a strong startling stimulus, if preceded briefly by a weak non-startling stimulus and represents a well-established animal model to investigate information processing deficits in schizophrenia. It has been reported that prepulse inhibition deficits may be responsive to and at least partially reversed by treatment with atypical antipsychotics but not with typical antipsychotics [2]. But in these studies patients treated with typical and atypical were compared, so differences could be related to other variables. This study was designed to determine whether PPI of the startle acoustic response in stable schizophrenic patients who were receiving a conventional depot antipsychotic would change from being switched to long-acting injectable risperidone. Methods: We tested PPI in a sample of 31 male stable chronic schizophrenic patients at two different times: T 1: when they were medicated with zuclopenthixol decanoate; T2: after 12 weeks of being switched to long-acting injectable risperidone. Thirteen healthy subjects were also studied for comparative purposes. Primary dependent measures were startle responsivity and prepulse inhibition (response inhibition with the prepulse preceding the pulse by 30, 60 and 120ms). Results: Patients when treated with typical antipsychotic showed significantly less PPI than healthy subjects and than when they were receiving long-acting injectable risperidone. Risperidone-treated patients did not differ from control subjects for PPI. Conclusions: Risperidone is superior to typical antipsychotics in improving information processing functions, as assessed by PPI of acoustic startle response, in treatment-responsive male patients with schizophrenia.
References [1] BraffDL, Geyer MA, Light GA, Sprock J, Pen2¢ W, Cadenhead, KS, Swerdlow NR, 2001. Impact of prepulse characteristics on the detection of sensorimotor gating deficits in schizophrenia. Schizophr Res 49: 171 178. [2] Kumari V, Soni W, Sharma T, 2002. Prepulse inhibition of startle response in risperidone-treated patients: comparison with typical antipsychotics. Schizophr Res 55: 13%146.
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$475
Partial dopamine agonists as a therapeutic aid for psychosis in the forensic setting
M. Launer*, E. Shillabeer. The Spinney, Partnerships in Care, Manchestet; United Kingdom Introduction: In the U K there are several thousand patients considered a risk to others within the inpatient services. Due to the unreliability of risk assessment many of these patients are difficult to discharge, resulting in an ongoing financial burden and a possible curtailment of civil liberties. Although newer atypical antipsychotics are helping to achieve better symptom control with fewer side effects, we still have problems working with these patients around their index offence and deviant behaviour. Here we present six cases of long term forensic patints who have managed to open a window of opportunity after stating aripiprazole. Methods: Within a medium secure unit, six patients with a variety of DSM-IV diagnoses were prescribed aripiprazole 10 20 mg, either as monotherapy or alongside depot medication. All had a history of many years detention (mean 10 years) in prisons or secure hospitals. None had shown any interest in working on their behavioural problems and their index offences. The medication ws prescribed either as a substitute or an add-on and this was largely due to unacceptable side effects of typical or atypical medication. All agreed to take aripiprazole voluntarily after counselling, and metoclopramide was co-precribed for the first four weeks to avoid potential nausea and vomiting. Previous experience has shown that patients might prefer to non-comply rather than ask for and antiemetic. Results: After commencing aripiprazole, all six became more spontaneous and all actually sought the psychologist for offence related work. All have been placed in a continuing care facility, and it is hoped that if they continue to co-operate then there may be a chance of progression into a rehabilitative setting. Conclusions: All six patients had been classified as intractably ill despite all attempts at therapy. Although, in some cases, they had minimal positive symptoms, they had remained unable or unwilling to tackle psychological work around their core beliefs. Within 7 l0 days of taking aripiprazole, all six expressed a willingness to work with the forensic psycholgist after having previously reisisted this. Although it remains to be seen just how far this change takes them, it represents a significant shift in attitude and a possible pathway out of the secure setting towards community care that was previously thought unattainable. Discussion Aripirazole has been shown to have several unique clinical effects compared with typical and atypical antipsychotics, reducing the drowsiness associated with other antipsychoics; an interesting cognitive effect on secondary verbal learning that could increase patients' ability to concentrate; a significant effect on negative symptoms, which may motivate patients to strive towards acieving more for themselves; and a potential anti-depressant effect that could lead to mood elevation. Any of these changes could have an effect on its own, or in combination, to change these patients' motivation to strive for a better life. We believe that this is a significant development that could have an important effect on service provision. Further research is needed, using larger patient numbers, in a double-blind, placebo-controlled setting to follow up these findings, with more sophisticated psychometric investigations and maybe functional magnetic resonance imaging (fMeI).
References [1] Mfiller, D.J., Muglia, P., Fortune, T., Kennedy, J.L., 2004. Pharmacogenetics of antipsychotic-induced weight gain. Pharmacological Research 49, 30~329.
•
Change in prepulse inhibition after switching schizophrenic patients from zuclopenthixol to long-acting injectable risperidone
G. Rubio 1 *, B. Alvarez del Manzano 1, M. Ducaju 1, I. MartlnezGras 1, D. Gimeno 1, J. Borrel 2. 1Mental health Services,
Psychiatty, Madrid, Spain; 2Instituo Cajal, Neuroplasticidad, Spain Background: Individuals with schizophrenia are known to show deficits in prepulse inhibition (PPI) of the startle response [1]. PPI refers to a response suppression in reaction to a strong startling stimulus, if preceded briefly by a weak non-startling stimulus and represents a well-established animal model to investigate information processing deficits in schizophrenia. It has been reported that prepulse inhibition deficits may be responsive to and at least partially reversed by treatment with atypical antipsychotics but not with typical antipsychotics [2]. But in these studies patients treated with typical and atypical were compared, so differences could be related to other variables. This study was designed to determine whether PPI of the startle acoustic response in stable schizophrenic patients who were receiving a conventional depot antipsychotic would change from being switched to long-acting injectable risperidone. Methods: We tested PPI in a sample of 31 male stable chronic schizophrenic patients at two different times: T 1: when they were medicated with zuclopenthixol decanoate; T2: after 12 weeks of being switched to long-acting injectable risperidone. Thirteen healthy subjects were also studied for comparative purposes. Primary dependent measures were startle responsivity and prepulse inhibition (response inhibition with the prepulse preceding the pulse by 30, 60 and 120ms). Results: Patients when treated with typical antipsychotic showed significantly less PPI than healthy subjects and than when they were receiving long-acting injectable risperidone. Risperidone-treated patients did not differ from control subjects for PPI. Conclusions: Risperidone is superior to typical antipsychotics in improving information processing functions, as assessed by PPI of acoustic startle response, in treatment-responsive male patients with schizophrenia.
References [1] BraffDL, Geyer MA, Light GA, Sprock J, Pen2¢ W, Cadenhead, KS, Swerdlow NR, 2001. Impact of prepulse characteristics on the detection of sensorimotor gating deficits in schizophrenia. Schizophr Res 49: 171 178. [2] Kumari V, Soni W, Sharma T, 2002. Prepulse inhibition of startle response in risperidone-treated patients: comparison with typical antipsychotics. Schizophr Res 55: 13%146.
•
$475
Partial dopamine agonists as a therapeutic aid for psychosis in the forensic setting
M. Launer*, E. Shillabeer. The Spinney, Partnerships in Care, Manchestet; United Kingdom Introduction: In the U K there are several thousand patients considered a risk to others within the inpatient services. Due to the unreliability of risk assessment many of these patients are difficult to discharge, resulting in an ongoing financial burden and a possible curtailment of civil liberties. Although newer atypical antipsychotics are helping to achieve better symptom control with fewer side effects, we still have problems working with these patients around their index offence and deviant behaviour. Here we present six cases of long term forensic patints who have managed to open a window of opportunity after stating aripiprazole. Methods: Within a medium secure unit, six patients with a variety of DSM-IV diagnoses were prescribed aripiprazole 10 20 mg, either as monotherapy or alongside depot medication. All had a history of many years detention (mean 10 years) in prisons or secure hospitals. None had shown any interest in working on their behavioural problems and their index offences. The medication ws prescribed either as a substitute or an add-on and this was largely due to unacceptable side effects of typical or atypical medication. All agreed to take aripiprazole voluntarily after counselling, and metoclopramide was co-precribed for the first four weeks to avoid potential nausea and vomiting. Previous experience has shown that patients might prefer to non-comply rather than ask for and antiemetic. Results: After commencing aripiprazole, all six became more spontaneous and all actually sought the psychologist for offence related work. All have been placed in a continuing care facility, and it is hoped that if they continue to co-operate then there may be a chance of progression into a rehabilitative setting. Conclusions: All six patients had been classified as intractably ill despite all attempts at therapy. Although, in some cases, they had minimal positive symptoms, they had remained unable or unwilling to tackle psychological work around their core beliefs. Within 7 l0 days of taking aripiprazole, all six expressed a willingness to work with the forensic psycholgist after having previously reisisted this. Although it remains to be seen just how far this change takes them, it represents a significant shift in attitude and a possible pathway out of the secure setting towards community care that was previously thought unattainable. Discussion Aripirazole has been shown to have several unique clinical effects compared with typical and atypical antipsychotics, reducing the drowsiness associated with other antipsychoics; an interesting cognitive effect on secondary verbal learning that could increase patients' ability to concentrate; a significant effect on negative symptoms, which may motivate patients to strive towards acieving more for themselves; and a potential anti-depressant effect that could lead to mood elevation. Any of these changes could have an effect on its own, or in combination, to change these patients' motivation to strive for a better life. We believe that this is a significant development that could have an important effect on service provision. Further research is needed, using larger patient numbers, in a double-blind, placebo-controlled setting to follow up these findings, with more sophisticated psychometric investigations and maybe functional magnetic resonance imaging (fMeI).