Is it worth while changing clinically stable schizophrenic out-patients with mild to moderate residual symptoms and/or side effects from conventional to atypical antipsychotics? A prospective, randomised study with olanzapine

2004 ◽  
Vol 19 (8) ◽  
pp. 516-518 ◽  
Author(s):  
Björn Appelberg ◽  
Katinka Tuisku ◽  
Grigori Joffe
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotics ◽  
Residual Symptoms ◽  
Randomised Study ◽  
Conventional Antipsychotics ◽  
Schizophrenic Outpatients ◽  
Prospective Randomised Study

AbstractFifty clinically stable, schizophrenic outpatients, suffering from residual schizophrenic symptoms and/or neurological side effects, were randomised to either continue their conventional neuroleptic(s) or change it to olanzapine. After 12 weeks patients on olanzapine exhibited significant improvement in neurological side effects and psychotic symptomatology as compared to patients on conventional antipsychotics.

Current use of atypical antipsychotics

2002 ◽  
Vol 17 (S4) ◽  
pp. 377s-384s ◽  
Author(s):  
F. Müller-Spahn
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Term Treatment ◽  
Dopamine Neurons ◽  
Positive Symptoms ◽  
Onset Of Action ◽  
Conventional Antipsychotics ◽  
Long Term Treatment ◽  
Insufficient Response

SummaryIn terms of the phenomenology of schizophrenia, there are four targets for drug treatments: positive symptoms, negative symptoms, affective dysfunction, and cognitive dysfunction. Because of the side-effects of both conventional antipsychotics and the new atypicals, there still is a need to search for better-tolerated antipsychotics. Conventional antipsychotics have two principal limitations: 30–40% of patients have an insufficient response to them, and they have a large variety of adverse effects. Side-effects will reduce patients’ compliance with treatment, as well as their immediate quality of life, and may therefore unfavorably affect rehabilitation. Four principal features differentiate atypical from conventional antipsychotics, yet have not been established for all atypicals: fewer extrapyramidal side-effects, greater efficacy in the treatment of negative symptoms, specific pharmacological receptor binding profiles, and greater selective effect on the mesolimbic dopamine neurons than on nigrostriatal neurons. The pharmacological profile of amisulpride is completely different to that of other atypical antipsychotics. It has a high selectivity for D2 and D3 dopamine receptors, and thus would be expected to be devoid of unwanted side-effects associated with action on other neurotransmitter systems. It acts preferentially on the mesocortical and mesolimbic systems. It has an earlier onset of action than haloperidol. Amisulpride is a compound with a dual mode of action. At low doses it blocks presynaptic dopamine autoreceptors, inducing an increased dopaminergic neurotransmission, and at high doses it blocks postsynaptic dopaminergic activity. It is at least as effective as haloperidol, flupenthixol, and risperidone in controlling positive symptoms, as well as having efficacy for negative symptoms. It has less propensity to induce weight gain than do other atypical antipsychotics. For the 60–80% of patients with schizophrenia who require long-term treatment, drug tolerability is crucially important, as it will improve compliance, and therefore reduce relapse rate.

First-line atypical antipsychotics for schizophrenia are appropriate – with psychosocial interventions

2001 ◽  
Vol 25 (8) ◽  
pp. 287-288 ◽  
Author(s):  
A. M. Mortimer
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Treatment Resistance ◽  
Psychosocial Interventions ◽  
First Line ◽  
Conventional Antipsychotics ◽  
Increased Risk ◽  
Loss Of Libido ◽  
The Individual

Conventional antipsychotics, historically the mainstay of schizophrenia treatment, were ineffective in many patients, at least 30% fitting treatment-resistance criteria (Kane & Lieberman, 1987). All had the same mechanism of action: none was any more effective in the individual than any other. Therapeutic nihilism accepted poorly controlled positive symptoms and disabling negative symptoms: nearly all patients suffered side-effects (Barnes & Edwards, 1993), particularly extrapyramidal side-effects (EPS) and hyperprolactinaemia. Conventional antipsychotics raise prolactin to a range associated with sexual dysfunction or even macroprolactinoma: effects in men include erectile dysfunction and hypospermatogenesis; in women, galactorrhoea, oligo- or amenorrhoea, hirsutism and increased risk of osteoporosis. In both men and women there is loss of libido, and a link between hyperprolactinaemia and weight gain.

China rubra for side-effects of quinine: a prospective, randomised study in pregnant women with malaria in Cotonou, Benin

Homeopathy ◽  
2014 ◽  
Vol 103 (3) ◽  
pp. 165-171 ◽  
Author(s):  
Karine Danno ◽  
Frédéric Rerolle ◽  
Sylvie de Sigalony ◽  
Aurélie Colas ◽  
Laurence Terzan ◽  
...  
Keyword(s):  
Side Effects ◽  
Pregnant Women ◽  
Randomised Study ◽  
Prospective Randomised Study

Comparison of intranasal midazolam, intranasal ketamine, and oral chloral hydrate for conscious sedation during paediatric echocardiography: results of a prospective randomised study

2019 ◽  
Vol 29 (09) ◽  
pp. 1189-1195
Author(s):  
Hayrullah Alp ◽  
Ahmet M. Elmacı ◽  
Esma K. Alp ◽  
Bülent Say
Keyword(s):  
Side Effects ◽  
Transthoracic Echocardiography ◽  
Chloral Hydrate ◽  
Conscious Sedation ◽  
Study Groups ◽  
Rapid Onset ◽  
Success Rates ◽  
Randomised Study ◽  
Intranasal Midazolam ◽  
Prospective Randomised Study

AbstractObjective:There are several agents used for conscious sedation by various routes in children. The aim of this prospective randomised study is to compare the effectiveness of three commonly used sedatives: intranasal ketamine, intranasal midazolam, and oral chloral hydrate for children undergoing transthoracic echocardiography.Methods:Children who were referred to paediatric cardiology due to a heart murmur for transthoracic echocardiography were prospectively randomised into three groups. Seventy-three children received intranasal midazolam (0.2 mg/kg), 72 children received intranasal ketamine (4 mg/kg), and 72 children received oral chloral hydrate (50 mg/kg) for conscious sedation. The effects of three agents were evaluated in terms of intensity, onset, and duration of sedation. Obtaining high-quality transthoracic echocardiography images (i.e. absence of artefacts) were regarded as successful sedation. Side effects due to medications were also noted.Results:There was no statistical difference in terms of sedation success rates between three groups (95.9, 95.9, and 94.5%, respectively). The median onset of sedation in the midazolam, ketamine, and chloral hydrate was 14 minutes (range 7–65), 34 minutes (range 12–56), and 40 minutes (range 25–57), respectively (p < 0.001 for all). However, the median duration of sedation in study groups was 68 minutes (range 20–75), 55 minutes (range 25–75), and 61 minutes (range 34–78), respectively (p = 0.023, 0.712, and 0.045). Gastrointestinal side effects such as nausea and vomiting were significantly higher in the chloral hydrate group (11.7 versus 0% for midazolam and 2.8% for ketamine, respectively, p = 0.002).Conclusion:Results of our prospectively randomised study indicate that all three agents provide adequate sedation for successful transthoracic echocardiography. When compared the three sedatives, intranasal midazolam has a more rapid onset of sedation while intranasal ketamine has a shorter duration of sedation. Intranasal ketamine can be used safely with fewer side effects in children undergoing transthoracic echocardiography.

Impact of Side-Effects of Atypical Antipsychotics on Non-Compliance, Relapse and Cost

2003 ◽  
Vol 31 (3) ◽  
pp. 188-196 ◽  
Author(s):  
A Mortimer ◽  
P Williams ◽  
D Meddis
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Atypical Antipsychotics ◽  
Antipsychotic Agents ◽  
Conventional Antipsychotics ◽  
State Transition Model ◽  
Cost Implications ◽  
The Cost ◽  
The Impact ◽  
Relapse Rates

Atypical antipsychotics generally have milder side-effects than conventional antipsychotics, but also differ among themselves in this respect. This study aimed to compare the impact of different side-effect profiles of individual atypical antipsychotics on non-compliance, relapse and cost in schizophrenia. A state-transition model was built using literature data supplemented by expert opinion. The model found that quetiapine and ziprasidone were similar in estimated non-compliance and relapse rates. Olanzapine and risperidone had higher estimated non-compliance and relapse rates, and incremental, 1-year, per-patient direct costs, using US-based cost data, of ~$530 (95% confidence interval [CI] ~$275, $800), and ~$485 (95% CI ~$235, $800), respectively, compared with quetiapine. Incremental costs attributable to different side-effect profiles were highly significant. This study shows that differing side-effect profiles of the newer antipsychotic agents are likely to lead to different compliance rates, and consequent variation in relapse rates. The cost implications of these heterogenous clinical outcomes are substantial.

scholarly journals Extrapyramidal syndromes caused by antipsychotics

2012 ◽  
Vol 65 (11-12) ◽  
pp. 521-526 ◽  
Author(s):  
Milana Poznic-Jesic ◽  
Aleksandar Jesic ◽  
Jasmina Babovic-Filipovic ◽  
Olga Zivanovic
Keyword(s):  
Adverse Effect ◽  
Side Effects ◽  
Atypical Antipsychotics ◽  
Antipsychotic Therapy ◽  
Conventional Antipsychotics ◽  
Repetitive Movements ◽  
Extrapyramidal Syndromes ◽  
The One ◽  
The Individual ◽  
Continuous Use

Introduction. Extrapyramidal syndromes are significant side effects of antipsychotic therapy due to their severity, frequent occurrence and complications. This paper gives a brief summary of the literature with the emphasis on epidemiology, etiology, diagnosis and differential diagnosis, as well as the treatment of extrapyramidal disorders induced by antipsychotics. Dystonia. Sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It may appear either as an acute or delayed, i.e. tardive sign. The incidence of dystonia is 2-3% among the patients treated with antipsychotics, and 50% among the ones cured with conventional antipsychotics. Akathisia. The main feature of this curious adverse effect is the psychomotor restlessness and the inability to remain motionless. Although akathisia is not very frequent, its incidence and prevalence ranges from 5 to 50% among the treated patients. It is most probably a result of the blockage of dopaminergic receptors. Parkinsonism. The most frequent secondary Parkinsonism is the one caused by drugs. The characteristic parkinsonian signs regress 4 to 16 weeks after the discontinuation of antipsychotic therapy. In the era of atypical antipsychotics this adverse effect appears less frequently. Tardive dyskinesia. Involuntary choreatic movements may appear days and months after the introduction of continuous use of antipsychotics. The individual susceptibility may play the major role in the development of this side effect. Conclusion. Numerous studies have compared conventional and atypical antipsychotics as well as atypical ones with one another in order to decrease the risk of development of extrapyramical side effects as well as to prevent their occurrence and improve their treatment.

Critical analysis and comparison of the side-effect and safety profiles of the new antipsychotics*

1999 ◽  
Vol 174 (S38) ◽  
pp. 34-43 ◽  
Author(s):  
Thomas R. E. Barnes ◽  
Mike A. McPhillips
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Individual Case ◽  
New Drugs ◽  
Risks And Benefits ◽  
Conventional Antipsychotics ◽  
Wide Range ◽  
New Antipsychotics

The conventional antipsychotic drugs are associated with a wide range of unwanted effects (Barnes & Guy Edwards, 1993; Guy Edwards & Barnes, 1993). These side-effects represent part of the burden of patients given antipsychotic medication, affect compliance with treatment, and contribute to the prescribing clinician's weigh-ing-up of the risks and benefits of a particular antipsychotic in an individual case. The conventional drugs show differences in their side-effect profiles, particularly with regard to sedation and extrapyramidal problems, and it is probably a reasonable generalisation to state that these have largely governed clinicians' choice. The newer ‘atypical’ antipsychotics (such as clozapine, risperidone, sertindole, olanzapine, quetiapine and amisulpride) are less liable to cause extrapyramidal symptoms than the conventional antipsychotics. However, this advantage is greater for some of the new drugs than for others, and their safety profiles also differ in other key respects. Thus, in terms of side-effects and safety, each of these newer drugs must be evaluated individually.

Quetiapine-induced neuroleptic malignant syndrome

2011 ◽  
Vol 26 (S2) ◽  
pp. 1239-1239
Author(s):  
R.M. Freire Lucas
Keyword(s):  
Side Effects ◽  
Neuroleptic Malignant Syndrome ◽  
Atypical Antipsychotic ◽  
Autonomic Dysfunction ◽  
Antipsychotic Medication ◽  
Atypical Antipsychotics ◽  
Scientific Literature ◽  
Recent Literature ◽  
Altered Consciousness ◽  
Conventional Antipsychotics

Neuroleptic Malignant Syndrome (NMS) is the most serious of acute neurological side effects produced by antipsychotic medication, the prevalence of which varies from 0,4–1,4%. It is typically characterized by hyperthermia, rigidity, altered consciousness and autonomic dysfunction. NMS is induced less by atypical antipsychotics than by conventional antipsychotics, and one particular atypical antipsychotic - quetiapine - rarely causes NMS. In this work, we describe a case of quetiapine-induced NMS, while reviewing the recent literature on this condition.We searched for scientific articles about this topic on the databases MEDLINE, LILACS and PsycINFO, using the search words “neuroleptic malignant syndrome” and “quetiapine”. We chose to preferentially include original articles and recent reviews, or those considered classical articles in the scientific literature.

Sign in / Sign up

Export Citation Format

Share Document