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Subjective response to atypical and typical antipsychotics in schizophrenic inpatients
22. Drug Side Effects & Tardive Dyskinesia PEROSPIRONE-INDUCED M A N I A IN SCHIZOPHRENIA T. Y o k o s h i m a , * N. Takei, K. Tani, M. Kawai, Y. M i n a b e , N. M o r i
Department of Psychiatry and Neurology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan Perospirone is a new atypical antipsychotic recently marketed in Japan. Like other atypical antipsychotics, perospirone is characterized by a high binding affinity for both 5-HT2A and D2 receptors, and has been documented to have autipsychotic efficacy similar to that of conventional antipsychotics, but with fewer extrapyramidal side effects. All of the atypical antipsychotics but clozapine have been reported to occasionally precipitate mania or hypomania. As we have observed the occurrence of perospironeinduced mania in two cases of schizophrenia, we report on these patients. Mr. A was a 16-year-old man with paranoid schizophrenia. He had his first psychotic symptoms at the age of 15. At the age of 16, he was admitted and started on olanzapine. Although the olanzapine was continued for 6 weeks and increased to 30 mg/day, his symptoms did not improve. His olanzapine regimen was then tapered off, and perospirone was initiated and titrated up to 36 mg/day. After administration of perospirone, the patient's psychotic symptoms gradually ameliorated. However, a week after receiving 36 mg/day of perospirone, he developed manic symptoms, including a euphoric mood and an elevated sex drive. We therefore decreased his perospirone to 24 rag/day. The manic episode resolved over the next 2 weeks. Ms. B was a 31-year-old woman with chronic paranoid schizophrenia. She was admitted for clozapine treatment. After clozapine treatment, her psychotic symptoms gradually subsided. However, clozapine was discontinued due to granulocytopenia. After cessation of clozapine, the patient's psychotic symptoms returned; thus, perospirone treatment was begun at 12 mg/day. The following day, the patient became euphoric with frequent laughter. The content of her auditory hallucinations was sexual. To treat her psychotic symptoms, the dose of perospirone was rapidly increased to 36 rag/day. While her psychotic symptoms remained unchanged, her manic symptoms worsened further. Perospirone was therefore discontinued. One week after cessation of perospirone, the patient's manic symptoms resolved. As noted above, we have encountered two schizophrenic patients who developed manic symptoms after administration of perospirone. Although the mechanism by which perospirone precipitate mania is unclear, 5-HT2A receptor blockades may be involved in the effect of perospirone on mood swing. Clinicians need to be alert to a manic switch in using atypical antipsychotics including perospirone.
SUBJECTIVE RESPONSE TO ATYPICAL AND TYPICAL ANTIPSYCHOTICS IN SCHIZOPHRENIC INPATIENTS B. Yoon,* Y. Sea, S. Bae, J. Yoon
Naju National Hospital, Naju City, Jeonnam, South Korea Objective: Drug Attitude Inventory(DAI) was used to compare the subjective response to antipsychotics in schizophrenic inpatients receiving atypical and typical antipsychotics. Methods: Seventy three patients meeting selection criteria and receiving atypical (N=31) and typical (N=42) antipsychotics were examined. All of them were in the stabilized stage of their illnesses. Subjective
371 response to neuroleptics was evaluated using 10-items of DAI. Demographic and clinical data were also analyzed between two groups. Results: Patients taking atypical antipsychotics showed significantly less dysphoric response on the items asking negative aspects of medications. In positive aspects of subjective response items, there were no significant differences between patients with atypical and typical antipsychotics. Conclusion: It seems that atypical antipsychotics partially influenced on the subjective response to neuroleptics and also the patients more concerned about the negative effects of medications.
PREVALENCE AND NATURE OF SIDE EFFECTS DURING CLOZAPINE MAINTENANCE TREATMENT AND THE RELATIONSHIP WITH MEDICATION VARIABLES B. Z. Yusufi,* S. Mukherjee, R. J. Flanagan, G. Dunn, E. Page, T. R. Barnes
Department of Psychological Medicine, hnperial College Faculty of Medicine, London SW7, UnitedKingdom The aim of this study was to investigate the prevalence and nature of side effects during long-term clozapine treatment. Patients (n=83) stabilised on clozapine were recruited from outpatient clinics and inpatient units. Parkinsonism (EPSE), akathisia (BARS), and tardive dyskinesia (AIMS) were assessed in each patient. Nonneurological side effects were identified using the Antipsychotic Non-Neurological Side Effects Rating Scale (ANNSERS), with ratings based on patient report, information from the clinical team, and medical records. Information on dose and duration of clozapine therapy was collected for each patient, and plasma clozapine and N-desmethylclozapine (norclozapine) concentrations were measured. The mean duration of clozapine therapy was 42 months, and the mean clozapine dose was 460 mg/day. The mean plasma concentrations of clozapine and norclozapine were 0.55 and 0.31 mg/L, respectively. Parkinsonism, akathisia, and tardive dyskinesia were present in 17%, 5%, and 11%, of the sample, respectively. More than three-quarters of the patients in the sample (77%) experienced one or more non-neurological side effect rated as moderate or severe according to the ANNSERS criteria, of whom 42% exhibited three or more such side effects. One in five patients complained of one or more severe side effects. Sedation was the most commonly reported problem (72 %), followed by hypersalivation (55 %), difficulty in waking (53 %), loss of energy (45 %), sexual side effects (40 %), and lack of concentration (40 %). Other commonly reported non-neurological side effects included headache, nocturnal enuresis, constipation, tachycardia, weight gain, postural hypotension, dysphoria, and disturbance of night time sleep patterns. Clozapine plasma concentration showed a significant, positive correlation with the ANNSERS sum score, but there was no relation between the ANNSERS score and either current clozapine dose or duration of clozapine treatment. This study highlights the need for systematic inquiry and assessment of neurological and non-neurological side effects in patients maintained on clozapine. The findings challenge the assumption that patients only experience major side effects during clozapine initiation. They also add to the evidence relevant to the consideration of using plasma clozapine assay in clinical practice to help achieve an optimal balance between efficacy and tolerability in individual patients
International Congress on Schizophrenia Research 2003
Department of Psychiatry and Neurology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan Perospirone is a new atypical antipsychotic recently marketed in Japan. Like other atypical antipsychotics, perospirone is characterized by a high binding affinity for both 5-HT2A and D2 receptors, and has been documented to have autipsychotic efficacy similar to that of conventional antipsychotics, but with fewer extrapyramidal side effects. All of the atypical antipsychotics but clozapine have been reported to occasionally precipitate mania or hypomania. As we have observed the occurrence of perospironeinduced mania in two cases of schizophrenia, we report on these patients. Mr. A was a 16-year-old man with paranoid schizophrenia. He had his first psychotic symptoms at the age of 15. At the age of 16, he was admitted and started on olanzapine. Although the olanzapine was continued for 6 weeks and increased to 30 mg/day, his symptoms did not improve. His olanzapine regimen was then tapered off, and perospirone was initiated and titrated up to 36 mg/day. After administration of perospirone, the patient's psychotic symptoms gradually ameliorated. However, a week after receiving 36 mg/day of perospirone, he developed manic symptoms, including a euphoric mood and an elevated sex drive. We therefore decreased his perospirone to 24 rag/day. The manic episode resolved over the next 2 weeks. Ms. B was a 31-year-old woman with chronic paranoid schizophrenia. She was admitted for clozapine treatment. After clozapine treatment, her psychotic symptoms gradually subsided. However, clozapine was discontinued due to granulocytopenia. After cessation of clozapine, the patient's psychotic symptoms returned; thus, perospirone treatment was begun at 12 mg/day. The following day, the patient became euphoric with frequent laughter. The content of her auditory hallucinations was sexual. To treat her psychotic symptoms, the dose of perospirone was rapidly increased to 36 rag/day. While her psychotic symptoms remained unchanged, her manic symptoms worsened further. Perospirone was therefore discontinued. One week after cessation of perospirone, the patient's manic symptoms resolved. As noted above, we have encountered two schizophrenic patients who developed manic symptoms after administration of perospirone. Although the mechanism by which perospirone precipitate mania is unclear, 5-HT2A receptor blockades may be involved in the effect of perospirone on mood swing. Clinicians need to be alert to a manic switch in using atypical antipsychotics including perospirone.
SUBJECTIVE RESPONSE TO ATYPICAL AND TYPICAL ANTIPSYCHOTICS IN SCHIZOPHRENIC INPATIENTS B. Yoon,* Y. Sea, S. Bae, J. Yoon
Naju National Hospital, Naju City, Jeonnam, South Korea Objective: Drug Attitude Inventory(DAI) was used to compare the subjective response to antipsychotics in schizophrenic inpatients receiving atypical and typical antipsychotics. Methods: Seventy three patients meeting selection criteria and receiving atypical (N=31) and typical (N=42) antipsychotics were examined. All of them were in the stabilized stage of their illnesses. Subjective
371 response to neuroleptics was evaluated using 10-items of DAI. Demographic and clinical data were also analyzed between two groups. Results: Patients taking atypical antipsychotics showed significantly less dysphoric response on the items asking negative aspects of medications. In positive aspects of subjective response items, there were no significant differences between patients with atypical and typical antipsychotics. Conclusion: It seems that atypical antipsychotics partially influenced on the subjective response to neuroleptics and also the patients more concerned about the negative effects of medications.
PREVALENCE AND NATURE OF SIDE EFFECTS DURING CLOZAPINE MAINTENANCE TREATMENT AND THE RELATIONSHIP WITH MEDICATION VARIABLES B. Z. Yusufi,* S. Mukherjee, R. J. Flanagan, G. Dunn, E. Page, T. R. Barnes
Department of Psychological Medicine, hnperial College Faculty of Medicine, London SW7, UnitedKingdom The aim of this study was to investigate the prevalence and nature of side effects during long-term clozapine treatment. Patients (n=83) stabilised on clozapine were recruited from outpatient clinics and inpatient units. Parkinsonism (EPSE), akathisia (BARS), and tardive dyskinesia (AIMS) were assessed in each patient. Nonneurological side effects were identified using the Antipsychotic Non-Neurological Side Effects Rating Scale (ANNSERS), with ratings based on patient report, information from the clinical team, and medical records. Information on dose and duration of clozapine therapy was collected for each patient, and plasma clozapine and N-desmethylclozapine (norclozapine) concentrations were measured. The mean duration of clozapine therapy was 42 months, and the mean clozapine dose was 460 mg/day. The mean plasma concentrations of clozapine and norclozapine were 0.55 and 0.31 mg/L, respectively. Parkinsonism, akathisia, and tardive dyskinesia were present in 17%, 5%, and 11%, of the sample, respectively. More than three-quarters of the patients in the sample (77%) experienced one or more non-neurological side effect rated as moderate or severe according to the ANNSERS criteria, of whom 42% exhibited three or more such side effects. One in five patients complained of one or more severe side effects. Sedation was the most commonly reported problem (72 %), followed by hypersalivation (55 %), difficulty in waking (53 %), loss of energy (45 %), sexual side effects (40 %), and lack of concentration (40 %). Other commonly reported non-neurological side effects included headache, nocturnal enuresis, constipation, tachycardia, weight gain, postural hypotension, dysphoria, and disturbance of night time sleep patterns. Clozapine plasma concentration showed a significant, positive correlation with the ANNSERS sum score, but there was no relation between the ANNSERS score and either current clozapine dose or duration of clozapine treatment. This study highlights the need for systematic inquiry and assessment of neurological and non-neurological side effects in patients maintained on clozapine. The findings challenge the assumption that patients only experience major side effects during clozapine initiation. They also add to the evidence relevant to the consideration of using plasma clozapine assay in clinical practice to help achieve an optimal balance between efficacy and tolerability in individual patients
International Congress on Schizophrenia Research 2003