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Divac, Nevena, Milica Prostran, Igor Jakovcevski, and Natasa Cerovac. "Second-Generation Antipsychotics and Extrapyramidal Adverse Effects." BioMed Research International 2014 (2014): 1–6. http://dx.doi.org/10.1155/2014/656370.
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Antipsychotic-induced extrapyramidal adverse effects are well recognized in the context of first-generation antipsychotic drugs. However, the introduction of second-generation antipsychotics, with atypical mechanism of action, especially lower dopamine receptors affinity, was met with great expectations among clinicians regarding their potentially lower propensity to cause extrapyramidal syndrome. This review gives a brief summary of the recent literature relevant to second-generation antipsychotics and extrapyramidal syndrome. Numerous studies have examined the incidence and severity of extrapyramidal syndrome with first- and second-generation antipsychotics. The majority of these studies clearly indicate that extrapyramidal syndrome does occur with second-generation agents, though in lower rates in comparison with first generation. Risk factors are the choice of a particular second-generation agent (with clozapine carrying the lowest risk and risperidone the highest), high doses, history of previous extrapyramidal symptoms, and comorbidity. Also, in comparative studies, the choice of a first-generation comparator significantly influences the results. Extrapyramidal syndrome remains clinically important even in the era of second-generation antipsychotics. The incidence and severity of extrapyramidal syndrome differ amongst these antipsychotics, but the fact is that these drugs have not lived up to the expectation regarding their tolerability.
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McEvoy, Joseph P., Daniel Zigman, and Howard C. Margolese. "First- and Second-Generation Antipsychotics." Canadian Journal of Psychiatry 55, no. 3 (2010): 144–49. http://dx.doi.org/10.1177/070674371005500305.
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Rasool, S., and B. Roy. "Comparison of hospitalization rates in schizophrenic patients on first generation versus second generation antipsychotic depots." European Psychiatry 41, S1 (2017): s830—s831. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1629.
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IntroductionThere is limited data on the efficacy rates between first and second generation antipsychotic depots. One good indicator of efficacy is the rates of hospitalization. Some studies have shown that second generation depot antipsychotics significantly reduce hospitalizations rates as compared to conventional depots.ObjectivesComparison of hospitalization rates for patients with schizophrenia on first and second generation antipsychotic depots.MethodsA retrospective observational study was done by reviewing the records of an antipsychotic depot clinic in Essex, United Kingdom. A list of 47 patients enrolled and receiving depot antipsychotics was obtained. Their records were studied and hospital admission rates calculated.ResultsOf the 47 patients 11 were excluded as they were on depot antipsychotics for non-schizophrenic diagnoses.Of the 36 patients with schizophrenia, 12 were on second generation and 24 were on first generation depots.Amongst the 24 patients on first generation depots, 19 were male, 5 female and mean age was 52 years.Of the 12 patients on second generation depots, 10 were male and 2 female and mean age was 46 years.When comparing hospital admission rates between the 2 groups, the following data was noted (Table 1).ConclusionsThere is no difference in hospitalization rates between patients on first generation antipsychotic depots as compared to second generation antipsychotic depots.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Peluso, Michael J., Shôn W. Lewis, Thomas R. E. Barnes, and Peter B. Jones. "Extrapyramidal motor side-effects of first- and second-generation antipsychotic drugs." British Journal of Psychiatry 200, no. 5 (2012): 387–92. http://dx.doi.org/10.1192/bjp.bp.111.101485.
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BackgroundSecond-generation antipsychotics have been thought to cause fewer extrapyramidal side-effects (EPS) than first-generation antipsychotics, but recent pragmatic trials have indicated equivalence.AimsTo determine whether second-generation antipsychotics had better outcomes in terms of EPS than first-generation drugs.MethodWe conducted an intention-to-treat, secondary analysis of data from an earlier randomised controlled trial (n = 227). A clinically significant difference was defined as double or half the symptoms in groups prescribed first- v. second-generation antipsychotics, represented by odds ratios greater than 2.0 (indicating advantage for first-generation drugs) or less than 0.5 (indicating advantage for the newer drugs). We also examined EPS in terms of symptoms emergent at 12 weeks and 52 weeks, and symptoms that had resolved at these time points.ResultsAt baseline those randomised to the first-generation antipsychotic group (n = 118) had similar EPS to the second-generation group (n = 109). Indications of resolved Parkinsonism (OR = 0.5) and akathisia (OR = 0.4) and increased tardive dyskinesia (OR = 2.2) in the second-generation drug group at 12 weeks were not statistically significant and the effects were not present by 52 weeks. Patients in the second-generation group were dramatically (30-fold) less likely to be prescribed adjunctive anticholinergic medication, despite equivalence in terms of EPS.ConclusionsThe expected improvement in EPS profiles for participants randomised to second-generation drugs was not found; the prognosis over 1 year of those in the first-generation arm was no worse in these terms. The place of careful prescription of first-generation drugs in contemporary practice remains to be defined, potentially improving clinical effectiveness and avoiding life-shortening metabolic disturbances in some patients currently treated with the narrow range of second-generation antipsychotics used in routine practice. This has educational implications because a generation of psychiatrists now has little or no experience with first-generation antipsychotic prescription.
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Dibben, Claire R. M., Golam M. Khandaker, Benjamin R. Underwood, et al. "First-generation antipsychotics: not gone but forgotten." BJPsych Bulletin 40, no. 2 (2016): 93–96. http://dx.doi.org/10.1192/pb.bp.115.050708.
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Aims and methodTo identify training needs of the next generation of psychiatrists and barriers in prescribing first-generation antipsychotics (FGAs). We have surveyed psychiatry trainees in East Anglia with regard to their training experience, knowledge and attitudes to the use of oral FGAs as regular medication.ResultsTwo-thirds of trainees were aware that first- and second-generation antipsychotics (SGAs) have similar efficacy, and a similar proportion perceived the older drugs to have more or ‘stronger’ side-effects. Lack of training experience was noted as the second leading concern for prescribing FGAs. A quarter of trainees received no training exposure to the older drugs and two-thirds had never initiated these drugs themselves. Although nearly 90% of trainees felt confident about initiating an oral SGA as a regular medication, only about 40% felt confident with FGAs (P<0.001).Clinical implicationsThe survey highlights worrying gaps in training. FGAs can be used effectively, minimising side-effects, by careful dose titration, avoiding antipsychotic polypharmacy, high-dose, and high-potency drugs, thus ensuring they are not lost to future generations of psychiatrists.
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Smith, M., D. Hopkins, R. C. Peveler, R. I. G. Holt, M. Woodward, and K. Ismail. "First- v. second-generation antipsychotics and risk for diabetes in schizophrenia: Systematic review and meta-analysis." British Journal of Psychiatry 192, no. 6 (2008): 406–11. http://dx.doi.org/10.1192/bjp.bp.107.037184.
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BackgroundThe increased prevalence of diabetes in schizophrenia is partly attributed to antipsychotic treatment, in particular second-generation antipsychotics, but the evidence has not been systematically reviewed.AimsSystematic review and meta-analysis comparing diabetes risk for different antipsychotics in people with schizophrenia.MethodWe searched MEDLINE, PsycINFO, EMBASE, International Pharmaceutical Abstracts, CINAHL and Web of Knowledge until September 2006. Studies were eligible for inclusion if the design was cross-sectional, case-control, cohort or a controlled trial in individuals with schizophrenia or related psychotic disorders, where second-generation antipsychotics (defined as clozapine, olanzapine, risperidone and quetiapine) were compared with first-generation antipsychotics and diabetes was an outcome. Data were pooled using random effects inverse variance weighted meta-analysis.ResultsOf the studies that met the inclusion criteria (n=14), 11 had sufficient data to include in the meta-analysis. Four of these were retrospective cohort studies. The relative risk of diabetes in patients with schizophrenia prescribed one of the second-generation v. first-generation antipsychotics was 1.32 (95% CI 1.15-1.51). There were insufficient data to include aripiprazole, ziprasidone and amisulpride in this analysis.ConclusionsThere is tentative evidence that the second-generation antipsychotics included in this study are associated with a small increased risk for diabetes compared with firstgeneration antipsychotics in people with schizophrenia. Methodological limitations were found in most studies, leading to heterogeneity and difficulty interpreting data. Regardless of type of antipsychotic, screening for diabetes in all people with schizophrenia should be routine.
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Wolfgang Fleischhacker, W. "Second generation antipsychotics reduce dropout rates compared with first generation antipsychotics." Evidence-Based Mental Health 13, no. 1 (2010): 24. http://dx.doi.org/10.1136/ebmh.13.1.24.
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Kessing, Lars Vedel, Anders Frøkjær Thomsen, Ulla Brasch Mogensen, and Per Kragh Andersen. "Treatment with antipsychotics and the risk of diabetes in clinical practice." British Journal of Psychiatry 197, no. 4 (2010): 266–71. http://dx.doi.org/10.1192/bjp.bp.109.076935.
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BackgroundTreatment with antipsychotics seems to increase the risk of developing diabetes but the association is poorly characterised in clinical practice.AimsTo investigate and characterise the incidence of diabetes for people treated with antipsychotic medication in clinical practice.MethodThe study used the linkage of registers of all prescribed antipsychotics, antidiabetics and diagnoses of diabetes in Denmark during a period from 1996 to 2005 and identified all people treated with antipsychotics in Denmark and a random sample of about 30% of the total Danish population.ResultsIn total, 345 937 patients who purchased antipsychotics and 1 426 488 unexposed individuals were included in the study. Among the total population, 50 379 individuals subsequently developed incident diabetes. Compared with unexposed individuals, treatment with first- (rate ratio, RR = 1.53, 95% CI 1.49–1.56) as well as second-generation (RR = 1.32, 95% CI 1.22–1.42) antipsychotics was associated with increased risk of subsequent incident diabetes. The rate of incident diabetes varied substantially between individual second-generation antipsychotic drugs (olanzapine, risperidone clozapine compared with unexposed individuals: low to moderate rate ratio between 1.17 and 1.57; ziprasidone and sertindol: two or more times increased rate ratio; amisulpride, quetiapine and aripiprazole: no significantly increased rate ratio). For both first- and second-generation antipsychotics, the incidence of diabetes increased with the number of prescriptions. Additionally, the incidence of diabetes increased with the number of combined antipsychotic drugs.ConclusionsIn clinical practice, treatment with first- and second-generation antipsychotics is associated with an increased risk of developing incident diabetes with large differences between individual drugs. The risk increases with the duration of treatment and with polypharmacy of antipsychotic drugs.
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Davies, Linda M., Shôn Lewis, Peter B. Jones, et al. "Cost-effectiveness of first- v. second-generation antipsychotic drugs: results from a randomised controlled trial in schizophrenia responding poorly to previous therapy." British Journal of Psychiatry 191, no. 1 (2007): 14–22. http://dx.doi.org/10.1192/bjp.bp.106.028654.
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BackgroundThere are claims that the extra costs of atypical (second-generation) antipsychotic drugs over conventional (first-generation) drugs are offset by improved health-related quality of life.AimsTo determine the relative costs and value of treatment with conventional or atypical antipsychotics in people with schizophrenia.MethodCost-effectiveness acceptability analysis integrated clinical and economic randomised controlled trial data of conventional and atypical antipsychotics in routine practice.ResultsConventional antipsychotics had lower costs and higher quality-adjusted life-years (QALYs) than atypical antipsychotics and were more than 50% likely to be cost-effective.ConclusionsThe primary and sensitivity analyses indicated that conventional antipsychotics may be cost-saving and associated with a gain in QALYs compared with atypical antipsychotics.
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Citrome, Leslie L., Richard IG Holt, Woodie M. Zachry, et al. "Risk of Treatment-Emergent Diabetes Mellitus in Patients Receiving Antipsychotics." Annals of Pharmacotherapy 41, no. 10 (2007): 1593–603. http://dx.doi.org/10.1345/aph.1k141.
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Background: Type 2 diabetes mellitus has been reported during antipsychotic treatment. Objective: To quantify the potential risk of treatment-emergent diabetes mellitus among patients receiving antipsychotic medications. Methods: The MEDLINE and Psychinfo databases were searched using the key words antipsychotic (including individual drug names), diabetes, risk, and incidence for all English-language articles published between 1966 and 2005. Risk calculations were performed using data obtained from pharmacoepidemiologic studies that met the following criteria: (1) cohort design, (2) determination of preexisting diabetes, (3) inclusion of antipsychotic monotherapy as an exposure variable, and (4) comparison with exposure to first-generation antipsychotics. Studies meeting these criteria were used to calculate incidence, attributable risk between agents, and number needed to harm. Results: A total of 25 observational pharmacoepidemiologic studies were found comparing antipsychotics on the outcome of diabetes mellitus. Sufficient information was provided in 15 of the reports to be able to estimate attributable risk, Attributable risk for individual second-generation antipsychotics relative to first-generation antipsychotics ranged from 53 more to 46 fewer new cases of diabetes per 1000 patients. Little observable difference was noted between the individual second-generation antipsychotics versus first-generation antipsychotics on this outcome. However, few of the studies controlled for body weight, race or ethnicity, or the presence of diabetogenic medications. None adjusted for familial history of diabetes, levels of physical activity, or diet, as this information is not usually available in the databases used in pharmacoepidemiologic studies. Conclusions: Based on the published pharmacoepidemiologic reports reviewed, the avoidance of diabetes as an outcome cannot be predictably achieved with precision by choice of a second- versus a first-generation antipsychotic. Risk management for new-onset diabetes requires the assessment of established risk factors such as family history, advancing age, non-white ethnicity, diet, central obesity, and level of physical activity.
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Caruso, Giuseppe, Margherita Grasso, Annamaria Fidilio, Fabio Tascedda, Filippo Drago, and Filippo Caraci. "Antioxidant Properties of Second-Generation Antipsychotics: Focus on Microglia." Pharmaceuticals 13, no. 12 (2020): 457. http://dx.doi.org/10.3390/ph13120457.
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Recent studies suggest a primary role of oxidative stress in an early phase of the pathogenesis of schizophrenia and a strong neurobiological link has been found between dopaminergic system dysfunction, microglia overactivation, and oxidative stress. Different risk factors for schizophrenia increase oxidative stress phenomena raising the risk of developing psychosis. Oxidative stress induced by first-generation antipsychotics such as haloperidol significantly contributes to the development of extrapyramidal side effects. Haloperidol also exerts neurotoxic effects by decreasing antioxidant enzyme levels then worsening pro-oxidant events. Opposite to haloperidol, second-generation antipsychotics (or atypical antipsychotics) such as risperidone, clozapine, and olanzapine exert a strong antioxidant activity in experimental models of schizophrenia by rescuing the antioxidant system, with an increase in superoxide dismutase and glutathione (GSH) serum levels. Second-generation antipsychotics also improve the antioxidant status and reduce lipid peroxidation in schizophrenic patients. Interestingly, second-generation antipsychotics, such as risperidone, paliperidone, and in particular clozapine, reduce oxidative stress induced by microglia overactivation, decreasing the production of microglia-derived free radicals, finally protecting neurons against microglia-induced oxidative stress. Further, long-term clinical studies are needed to better understand the link between oxidative stress and the clinical response to antipsychotic drugs and the therapeutic potential of antioxidants to increase the response to antipsychotics.
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Ansell, B. R. E., D. B. Dwyer, S. J. Wood, et al. "Divergent effects of first-generation and second-generation antipsychotics on cortical thickness in first-episode psychosis." Psychological Medicine 45, no. 3 (2014): 515–27. http://dx.doi.org/10.1017/s0033291714001652.
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BackgroundWhether there are differential effects of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) on the brain is currently debated. Although some studies report that FGAs reduce grey matter more than SGAs, others do not, and research to date is limited by a focus on schizophrenia spectrum disorders. To address this limitation, this study investigated the effects of medication in patients being treated for first-episode schizophrenia or affective psychoses.MethodCortical thickness was compared between 52 first-episode psychosis patients separated into diagnostic (i.e. schizophrenia or affective psychosis) and medication (i.e. FGA and SGA) subgroups. Patients in each group were also compared to age- and sex-matched healthy controls (n = 28). A whole-brain cortical thickness interaction analysis of medication and diagnosis was then performed. Correlations between cortical thickness with antipsychotic dose and psychotic symptoms were examined.ResultsThe effects of medication and diagnosis did not interact, suggesting independent effects. Compared with controls, diagnostic differences were found in frontal, parietal and temporal regions. Decreased thickness in FGA-treated versus SGA-treated groups was found in a large frontoparietal region (p < 0.001, corrected). Comparisons with healthy controls revealed decreased cortical thickness in the FGA group whereas the SGA group showed increases in addition to decreases. In FGA-treated patients cortical thinning was associated with higher negative symptoms whereas increased cortical thickness in the SGA-treated group was associated with lower positive symptoms.ConclusionsOur results suggest that FGA and SGA treatments have divergent effects on cortical thickness during the first episode of psychosis that are independent from changes due to illness.
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Tarricone, L. "Antipsychotics and lengthening QT / QTc." European Psychiatry 26, S2 (2011): 887. http://dx.doi.org/10.1016/s0924-9338(11)72592-5.
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Serious arrhythmias and / or sudden deaths related to the use of first-generation or typical antipsychotics have been observed for about thirty years. It is considered that the pathophysiological mechanism that causes these events may to be block the potassium and calcium channels with abnormal ventricular repolarization. The assessment of QT, QTc corrected for heart rate, is a predictor of risk for TdP. The introduction of second generation antipsychotics raised the question if these molecules can induce prolongation of the QT interval on the increased risk of arrhythmia and / or TdP. Controlled studies also argue that second-generation antipsychotics may lead to prolongation of QT / QTc. by introducing into the routine ECG and laboratory evaluations The purpose of this study is to analyze any change in ECG QTc observed in patients admitted to the SPDC, and possible correlation with antipsychotic medication.AscoltaThe ECGs of 300 patients admitted during the period January 2009/January 2010 with QTc assessment the first day and fifteen days after the treatment with second generation antipsychotics were examined. Changes were evaluated in relation to gender, age, diagnosis, antipsychotic taken in single or co-therapy QTc value divided into three classes: 440 ≤; 441 ≥ 500 ; 501≥;). There were no significant changes in QTc in relation to medication. It is believed that second-generation antipsychotics are considered safe and effective drugs at the time and that psychiatrists should pay more attention, however, by introducing into the routine ECG and laboratory evaluations.
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Seidlinger, Julie. "Outcomes similar with first- and second-generation antipsychotics." American Journal of Health-System Pharmacy 63, no. 22 (2006): 2172–75. http://dx.doi.org/10.2146/news060022.
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&NA;. "First-generation antipsychotics get second wind in schizophrenia." Inpharma Weekly &NA;, no. 1568 (2006): 3. http://dx.doi.org/10.2165/00128413-200615680-00004.
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&NA;. "EPS similar for first- and second-generation antipsychotics." Reactions Weekly &NA;, no. 1398 (2012): 4. http://dx.doi.org/10.2165/00128415-201213980-00009.
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Pogarell, O., S. Karch, G. Leicht, and C. Mulert. "EEG abnormalities under first and second generation antipsychotics." European Psychiatry 23 (April 2008): S77. http://dx.doi.org/10.1016/j.eurpsy.2008.01.279.
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Wisniewski, A., A. Acewicz, and K. Brewczyk. "P01-365 Safety of second-generation antipsychotics in children-questionnaire evaluation in psychiatrists." European Psychiatry 26, S2 (2011): 367. http://dx.doi.org/10.1016/s0924-9338(11)72076-4.
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Atypical antipsychotics are more safe than first generation drugs. But some researchers suggest that children and adolescents might be more sensitive than adults to developing antipsychotic-related adverse side effects. The standards of safety monitoring strategies do not exist in Poland.ObjectiveThe aim of this study was to estimate physicians awareness to side effects in youth population treated with antipsychotics.Material20 questionnaires filled up by polish child psychiatrists.MethodInformation from author's questionnaire concerns side effects observed in antipsychotics medicated children, psychiatrists own preferences in safety monitoring strategies were analyzed.ResultsAtypical antipsychotics are used in 25% of medicated children. Risperidon is the most popular antipsychotic in psychotic and non-psychotic indications (81%, 66%), afterwards olanzapine (54%, 30%) and quetiapine (34%, 24%). The most common indications for antipsychotics in children are: tics (55%), conduct disorders (53%) and schizophrenia (45%). Before drug initiation doctors check liver enzymes (GOT, GTP) (98%), hematology (98%), glucose level (95%), weight and height (91%), ECG (90%). The most common side effects observed are: weigh gain (63%), somnolence (59%), prolactin elevation (47%), attention deficits (43%).ConclusionIn spite of lack of safety monitoring standards in youth population psychiatrists seem to be aware and careful in atypical neurolpetic treatment in children.
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Leitão-Azevedo, Carmen Lúcia, Lísia Rejane Guimarães, Martha Guerra Belmonte de Abreu, Clarissa Severino Gama, Maria Inês Lobato, and Paulo Silva Belmonte-de-Abreu. "Increased dyslipidemia in schizophrenic outpatients using new generation antipsychotics." Revista Brasileira de Psiquiatria 28, no. 4 (2006): 301–4. http://dx.doi.org/10.1590/s1516-44462006005000016.
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OBJECTIVE: First and second generation antipsychotics are associated with metabolic disturbances. A cross-sectional study was designed to follow outpatients at the Schizophrenia and Dementia Program at a major teaching hospital in Porto Alegre, Brazil (Hospital de Clínicas de Porto Alegre) in order to verify whether second generation antipsychotics were associated with higher glucose and lipid levels regardless of age and gender. METHOD: Four metabolic parameters (cholesterol and fractions, glucose and triglycerides) and anthropometric measures were obtained from 124 consecutive adult outpatients diagnosed with schizophrenia by DSM-IV and ICD-10 with the Operational Criteria Checklist for Psychotic Disorders system using the same antipsychotic drug for at least 9 weeks. RESULTS: Most patients had elevated BMI (76.6%) and dyslipidemia (84.7%). Clozapine users had lower HDL levels compared to first generation antipsychotics users. Both groups had elevated body mass index (p = 0.033; OR = 3.3; 95%CI = 1.1-9.8) and second generation antipsychotics (p = 0.021; OR = 3.5; 95%CI = 1.1-11.2) showed significant effect, adjusted for age and gender in the logistic regression for dyslipidemia, and significant age effect for hyperglycemia (p = 0.030; OR = 1.1; 95%CI = 1.0-1.1). DISCUSSION: There was statistically significant association between the use of second generation antipsychotics and dyslipidemia. It raises the issue of increased vulnerability of second generation antipsychotics-treated patients, regardless of age, as well as the need for assertive treatment for overweight and dyslipidemia in schizophrenia in order to reduce the risk of diabetes and cardiovascular disease.
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Currie, Olivia, Jonathan Williman, Dee Mangin, Bianca McKinnon-Gee, and Paul Bridgford. "Comparative risk of new-onset diabetes following commencement of antipsychotics in New Zealand: a population-based clustered multiple baseline time series design." BMJ Open 9, no. 2 (2019): e022984. http://dx.doi.org/10.1136/bmjopen-2018-022984.
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ObjectiveNewer antipsychotics are increasingly prescribed off-label for non-psychotic ailments both in primary and secondary care settings, despite the purported risk of weight gain and development of type 2 diabetes mellitus. This study aims to determine any relationship between the development of clinically significant new-onset type 2 diabetes mellitus and novel antipsychotic use in New Zealand using hypnotic drugs as control.DesignA population-based clustered multiple baseline time series design.SettingRoutinely collected data from a complete national pharmaceutical database in New Zealand between 2005 and 2011.ParticipantsPatients aged 40–60 years in the year 2006 who were ever dispensed antipsychotics (exposure groups—first-generation antipsychotics, second-generation antipsychotics and antipsychotics with low, medium and high risk for weight gain) or hypnotics (control group) between 2006 and 2011.Main outcome measureFirst ever metformin dispensed to patients in each study group between 2006 and 2011 as proxy for development of clinically significant type 2 diabetes mellitus, no longer amendable by lifestyle modifications.ResultsPatients dispensed a second-generation antipsychotic had 1.49 times increased risk (95% CI 1.10 to 2.03, p=0.011) of subsequently commencing metformin. Patients dispensed an antipsychotic with high risk of weight gain also had a 2.41 times increased risk of commencing on metformin (95% CI 1.42 to 4.09, p=0.001).ConclusionsPatients dispensed a second-generation antipsychotic and antipsychotics with high risk of weight gain appear to be at increased risk of being secondarily dispensed metformin. Caution should be taken with novel antipsychotic use for patients with increased baseline risk of type 2 diabetes mellitus.
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Softic, R., A. Sutovic, and E. Avdibegovic. "Hazardous Lifestyles in Patients with Schizophrenia Treated with Antipsychotics: Results of the Bosnian Clinical Study." European Psychiatry 24, S1 (2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71435-x.
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Background:Individuals with schizophrenia are in greater risk of physical illnesses and their life is shorter comparing with general population. Hazardous lifestyles as tobacco smoking, lack of physical activity, and obesity contributing to this negative trend. Role of antipsychotic therapy, particularly second generation is also possible. This study aimed to establish hazardous lifestyles in clinical sample of patients with schizophrenia treated with first or second generation antipsychotics.Method:Study included 60 patients with schizophrenia (38.3% women) treated with antipsychotics for period of six months or longer. Experimental group included 30 patients treated with second generation antipsychotics, and control group included 30 patients treated with first generation antipsychotics. Physical activity, tobacco smoking, and waist circumference as an increased body weight indicator were analysed. Overweight was defined as a waist circumference above 102 cm for males and 88 cm for females.Results:Mean age was 44.5±12.6. in this sample was 75% tobacco smokers, 30% of subjects taking typical, and 43% of subjects taking atypical antipsychotics declared physical inactivity during most of the day. Increased waist circumpherence was established in 51.6% of subjects. There wasn't statistically significant difference between two group of subjects (p=0.538).Conclusion:Hazardous lifestyles including cigarette smoking, lack of physical activity and increased body weight are common in the individuals with schizophrenia. There wasn't statistically significant difference between subjects taking first or second generation antipsychotics.
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Faber, G., H. G. O. M. Smid, A. R. Van Gool, D. Wiersma, and R. J. Van Den Bosch. "The effects of guided discontinuation of antipsychotics on neurocognition in first onset psychosis." European Psychiatry 27, no. 4 (2012): 275–80. http://dx.doi.org/10.1016/j.eurpsy.2011.02.003.
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AbstractObjectiveTo assess the effects of second generation antipsychotics on neurocognitive function in patients with stable remission of first episode psychosis.MethodsFifty-three patients with first onset psychosis in the schizophrenia spectrum entered a randomised controlled trial of guided discontinuation (GD) versus maintenance treatment (MT) with second generation antipsychotics. A comprehensive neurocognitive test battery was administered at the time of remission and shortly after dose reduction or discontinuation (GD-group) or at the same time in the MT-group.ResultsWith the exception of negative symptoms, PANSS scores decreased over time and neurocognition improved significantly on most tests in both groups. The GD-group, however, improved significantly more than the MT-group on three neurocognitive measures in the domain of speed of processing.ConclusionThese data suggest that, in first episode patients, dose reduction or discontinuation of second generation antipsychotics after stable remission is achieved, might improve neurocognitive function more than continuing second generation antipsychotics, suggesting a negative role for second generation antipsychotics, specifically in the domain of speed of processing.
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Crouse, Ericka L., Jennifer N. Alastanos, Kevin M. Bozymski, and Robert A. Toscano. "Dysphagia with second-generation antipsychotics: A case report and review of the literature." Mental Health Clinician 7, no. 2 (2017): 56–64. http://dx.doi.org/10.9740/mhc.2017.03.056.
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Abstract Background: All antipsychotics are associated with extrapyramidal symptoms (EPS). These can present as dysphagia, esophageal dysmotility, or aspiration, all of which may not be recognized as EPS. Case Report: A 62-year-old with schizophrenia, prescribed olanzapine 5 mg daily, presented agitated and endorsed difficulty swallowing. Speech therapy suggested her complaints were related to either reflux or dysmotility. Esophageal manometry showed her lower esophageal sphincter was not fully relaxing, and identified an esophagogastric junction outflow obstruction. Despite therapeutic dilation, oral intake remained poor. Following an increase in olanzapine, she developed EPS, her dysphagia worsened, and she was choking on food. Following a switch to aripiprazole her EPS and appetite improved, and she ceased complaining of dysphagia. Discussion: Dysphagia has been reported with first- and second-generation antipsychotics. A review of the second-generation antipsychotic literature identified case reports of dysphagia with clozapine (n = 5), risperidone (n = 5), olanzapine (n = 2), quetiapine (n = 2), aripiprazole (n = 1), and paliperidone (n = 1). Postulated mechanisms of antipsychotic-induced dysphagia include that it may be an extrapyramidal adverse reaction or related to anticholinergic effects of antipsychotics. Management of dysphagia includes discontinuing the antipsychotic, reducing the dose, dividing the dose, or switching to another antipsychotic. Complications of dysphagia include airway obstruction (eg, choking, asphyxia), aspiration pneumonia, and weight loss. Additional complications include dehydration, malnutrition, and nonadherence to oral medications. Conclusion: It is important to recognize symptoms of dysphagia and esophageal dysmotility in antipsychotic-treated patients. Intervention is necessary to prevent complications.
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Davis, J. M., N. Chen, and I. D. Glick. "Dose-response analysis of first- and second-generation antipsychotics." Schizophrenia Research 60, no. 1 (2003): 280. http://dx.doi.org/10.1016/s0920-9964(03)80451-6.
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Davis, John M., and Nancy Chen. "Old versus new: weighing the evidence between the first- and second-generation antipsychotics." European Psychiatry 20, no. 1 (2005): 7–14. http://dx.doi.org/10.1016/j.eurpsy.2004.11.002.
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AbstractIn our opinion the best guide to prescribing antipsychotics is the clinician’s experience with his patients and in particular the patient being treated. If treatment works, stick with it. We feel it is also important for the clinician to consider the evidence from well-controlled double-blind random-assignment studies because in “evidence-based medicine,” biases both known and unknown are controlled by blinding and randomization. The purpose of this paper is to summarize and discuss the evidence on efficacy. Choice of antipsychotic, in our opinion, is probably the most important decision that the clinician makes for the psychotic patient. This involves the choice of drug, its dose, balancing efficacy, side-effects and cost.
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Tournier, M., A. Cougnard, B. Bégaud, A. Thiébaut, and H. Verdoux. "The Metabolic Impact of the Antipsychotic Drugs in Patients with Bipolar Disorder." European Psychiatry 24, S1 (2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70490-0.
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Objective:To assess the metabolic impact of adding an antipsychotic to a mood stabilizer or switching a mood stabilizer to an antipsychotic in patients with bipolar disorder.Methods:A retrospective fixed cohort study was conducted through the claims database of the French health care program for the self-employed workers. The study population consisted of 3.172 patients age 18 and over who were exposed to mood stabilizers (i.e. lithium, valproate) a 3 month-period in 2004 without dispensing of non-sedative antipsychotic, antidiabetic or lipid-lowering drugs. The outcome was the occurrence of a metabolic incident over the follow-up period, using the dispensing of an antidiabetic drug as a marker of diabetes and the dispensing of a lipid-lowering drug as a marker of hypercholesterolemia or hypertriglyceridemia. A Cox proportional hazard model was used to assess the metabolic impact of the antipsychotics; using mood stabilizers as a reference. Antipsychotic exposition was stratified in «current» and «recent» (discontinued for less than 6 months) at the time of the metabolic incident.Results:196 patients (6.2%) received a first-generation antipsychotic, 352 (11.1%) a second-generation antipsychotic, 565 (17.8%) a sedative antipsychotic and 367 patients (11.6%) presented with a metabolic incident over the study period. The recent dispensing of a second-generation antipsychotic was associated with the occurrence of a metabolic incident [HR 2.1 (95%CI 1.2-3.7) p=0.006], while current dispensing or dispensing of first-generation antipsychotics were not.Conclusion:Second-generation antipsychotics have a metabolic impact compared to classic mood stabilizers in patients with bipolar disorder.
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&NA;. "Some second-generation antipsychotics appear to be associated with weight gain, compared with first-generation antipsychotics,." Reactions Weekly &NA;, no. 1100 (2006): 5. http://dx.doi.org/10.2165/00128415-200611000-00013.
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&NA;. "Some second-generation antipsychotics appear to be associated with weight gain, compared with first-generation antipsychotics,." Inpharma Weekly &NA;, no. 1536 (2006): 21. http://dx.doi.org/10.2165/00128413-200615360-00052.
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Ellfolk, Maria, Maarit K. Leinonen, Mika Gissler, et al. "Second-generation antipsychotics and pregnancy complications." European Journal of Clinical Pharmacology 76, no. 1 (2019): 107–15. http://dx.doi.org/10.1007/s00228-019-02769-z.
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Abstract Purpose To study if second-generation antipsychotic (S-GA) use during pregnancy is associated with an increased risk of pregnancy and neonatal complications. Methods A population-based birth cohort study using national register data extracted from the “Drugs and Pregnancy” database in Finland, years 1996–2016. The sampling frame included 1,181,090 pregnant women and their singleton births. Women were categorized into three groups: exposed to S-GAs during pregnancy (n = 4225), exposed to first-generation antipsychotics (F-GAs) during pregnancy (n = 1576), and unexposed (no purchases of S-GAs or F-GAs during pregnancy, n = 21,125). Pregnancy outcomes in S-GA users were compared with those in the two comparison groups using multiple logistic regression models. Results Comparing S-GA users with unexposed ones, the risk was increased for gestational diabetes (adjusted odds ratio, OR 1.43; 95% CI 1.25–1.65), cesarean section (OR 1.35; 95% CI 1.18–1.53), being born large for gestational age (LGA) (OR 1.57; 95% CI 1.14–2.16), and preterm birth (OR 1.29; 95% CI 1.03–1.62). The risk for these outcomes increased further with continuous S-GA use. Infants in the S-GA group were also more likely to suffer from neonatal complications. Comparing S-GA users with the F-GA group, the risk of cesarean section and LGA was higher (OR 1.25, 95% CI 1.03–1.51; and OR 1.89, 95% CI 1.20–2.99, respectively). Neonatal complications did not differ between the S-GA and F-GA groups. Conclusions Prenatal exposure to S-GAs is associated with an increased risk of pregnancy complications related to impaired glucose metabolism. Neonatal problems are common and occur similarly in S-GA and F-GA users.
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Přikryl, Radovan, Hana Přikrylová Kučerová, Michaela Vrzalová, and Eva Češková. "Role of Long-Acting Injectable Second-Generation Antipsychotics in the Treatment of First-Episode Schizophrenia: A Clinical Perspective." Schizophrenia Research and Treatment 2012 (2012): 1–7. http://dx.doi.org/10.1155/2012/764769.
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Approximately 80% of patients with the first-episode schizophrenia reach symptomatic remission after antipsychotic therapy. However, within two years most of them relapse, mainly due to low levels of insight into the illness and nonadherence to their oral medication. Therefore, although the formal data available is limited, many experts recommend prescribing long-acting injectable second-generation antipsychotics (mostly risperidone or alternatively paliperidone) in the early stages of schizophrenia, particularly in patients who have benefited from the original oral molecule in the past and agree to receive long-term injectable treatment. Early application of long-acting injectable second-generation antipsychotics can significantly reduce the risk of relapse in the future and thus improve not only the social and working potential of patients with schizophrenia but also their quality of life.
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Doval, Nimisha, Soumitra Das, and Vikas Moun. "Aripiprazole in Tardive Dyskinesia: Is it a Safe Choice?" Journal of Neurosciences in Rural Practice 08, no. 02 (2017): 294–95. http://dx.doi.org/10.4103/jnrp.jnrp_359_16.
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ABSTRACTTardive dyskinesia (TD) is a potentially irreversible drug-induced movement disorder associated with prolonged administration of antipsychotics. Conventionally, first generation antipsychotics were the agents thought to have a higher risk of TD as compared to second and third generation antipsychotics. Aripiprazole is a third generation antipsychotic with a novel mechanism of action, and until recently, cases of drug-induced movement disorders were less well known with it. But off late, several cases of TD with aripiprazole have been reported. We present here a case of middle-aged women with preexisting tardive movements, which exacerbated with aripiprazole use and reduced in frequency and intensity on withdrawal of the drug.
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Mahmoud, Ahmed, Karen P. Hayhurst, Richard J. Drake, and Shôn W. Lewis. "Second Generation Antipsychotics Improve Sexual Dysfunction in Schizophrenia: A Randomised Controlled Trial." Schizophrenia Research and Treatment 2011 (2011): 1–6. http://dx.doi.org/10.1155/2011/596898.
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The impact of antipsychotic drug treatment on sexual function was investigated during a randomised trial comparing first generation antipsychotics (FGAs) to (nonclozapine) second generation antipsychotics (SGAs). Sexual function and quality of life were (rater-blind) assessed in 42 patients with DSM-IV schizophrenia (aged 18–65) using the self-report version of the Derogatis Interview for Sexual Function (DISF-SR) and the Heinrichs Quality of Life Scale (QLS), prior to, and 12 weeks following, a change in medication from an FGA drug to either an FGA or SGA drug. SGAs significantly improved sexual function compared to FGAs. Change in sexual function was associated with change in quality of life. Where impaired sexual functioning is a distressing adverse effect of treatment with an FGA agent, consideration should be given to switching to an SGA.
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Monteiro, F., P. Azevedo, L. Monteiro, et al. "Antipsychotics in first-episode psychosis: Patterns of prescription in an inpatient unit." European Psychiatry 41, S1 (2017): s837—s838. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1650.
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IntroductionThe treatment of first-episode psychosis patients is different from those with multiple-episode schizophrenia: the response to antipsychotics is better, the required doses are lower and the sensitivity to side-effects is higher. As such, current guidelines recommend a “start slow, go slow” strategy and an active avoidance of side-effects.Objectives/aimsTo know the patterns of antipsychotic prescription in first-episode psychosis patients of our inpatient unit.MethodsWe retrospectively reviewed the clinical data of all non-affective first-episode psychosis patients admitted to the Inpatient Unit C of Hospital de Magalhães Lemos during 2015. The antipsychotics prescribed at admission and discharge were recorded, as well as the doses.ResultsA total of 29 patients were identified. The mean age was 36.6 and 65.5% were man. At admission, all patients were medicated with second-generation antipsychotics: 62.1% with risperidone, 27.6% with olanzapine, 6.9% with paliperidone and 3.4% with aripiprazol. The mean dose of risperidone was 3.5 mg/day. By the time of discharge, 34.5% of patients were prescribed a depot antipsychotic, half of them risperidone. Among those with oral medication only, 55.5% were prescribed risperidone, 22.2% paliperidone and the remainder 22.3% other antipsychotics (aripiprazol, olanzapine or quetiapine). The mean dose of risperidone was 3.7 mg/day.ConclusionsSecond-generation antipsychotics are clearly preferred. The mean dose by the time of discharge is similar to that used in clinical trials. However, antipsychotics are initiated at doses above the minimum effective dose. On discharge, an important proportion of patients are prescribed depot antipsychotics, which are known to improve medication adherence.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Haddad, Peter M., Mark Taylor, and Omair S. Niaz. "First-generation antipsychotic long-acting injections v. oral antipsychotics in schizophrenia: Systematic review of randomised controlled trials and observational studies." British Journal of Psychiatry 195, S52 (2009): s20—s28. http://dx.doi.org/10.1192/bjp.195.52.s20.
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BackgroundAntipsychotic long-acting injections (LAIs) are often used in an attempt to improve medication adherence in people with schizophrenia.AimsTo compare first-generation antipsychotic long-acting injections (FGA–LAIs) with first- and second-generation oral antipsychotics in terms of clinical outcome.MethodSystematic literature review.ResultsA meta-analysis of randomised controlled trials (RCTs) showed no difference in relapse or tolerability between oral antipsychotics and FGA–LAIs but global improvement was twice as likely with FGA–LAIs. Four prospective observational studies were identified; two studies reported lower discontinuation rates for FGA–LAIs compared with oral medication and two found that outcome was either no different or better with oral antipsychotics. Mirror-image studies consistently showed reduced in-patient days and admissions following a switch from oral antipsychotics to FGA–LAIs.ConclusionsThe results are variable and inconclusive. Some evidence suggests that FGA–LAIs may improve outcome compared with oral antipsychotics. Methodological issues may partly explain the variable results. Selective recruitment in RCTs and lack of randomisation in observational studies are biases against LAIs, whereas regression to the mean in mirror-image studies favours LAIs. In terms of future research, a long-term pragmatic RCT of an FGA–LAI against an oral antipsychotic, in patients with problematic adherence, would be of value.
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Owens, David Cunningham. "Meet the relatives: a reintroduction to the clinical pharmacology of ‘typical’ antipsychotics (Part 1)." Advances in Psychiatric Treatment 18, no. 5 (2012): 323–36. http://dx.doi.org/10.1192/apt.bp.109.006908.
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SummaryA number of pragmatic trials have cast doubt on the concept of ‘atypicality’ in relation to antipsychotic drugs, and some commentators have argued that the dichotomy between ‘typical’ (‘first-generation’) and ‘atypical’ ('second-generation’) compounds is artificial and should be abandoned, leaving the entire class of antipsychotics available for consideration in more individualised treatment planning. However, younger psychiatrists now gain little or no experience in the use of older antipsychotics. This is the first of two articles addressing practical issues for consideration in prescribing the older antipsychotics available in the UK. It covers background, including the fundamental clinical action of antipsychotics, the nature of drug licensing and identification of pharmacological parameters that may be of value in prescribing decisions, and discusses the phenothiazines: chlorpromazine, promazine, levomepromazine, pericyazine, perphenazine, trifluoperazine and prochlorperazine.
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Verdoux, H., E. Pambrun, S. Cortaredona, M. Tournier, and P. Verger. "Antipsychotic prescribing in youths: A French community-based study from 2006 to 2013." European Psychiatry 30, S2 (2015): S9—S10. http://dx.doi.org/10.1016/j.eurpsy.2015.09.036.
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ObjectivesTo explore in a community-based sample of persons aged 0–25 years:– trends in antipsychotic prescribing;– characteristics of the zone of residence associated with antipsychotic prescribing rates;– the pattern of antipsychotic prescribing.MethodsThe study was performed using reimbursement data from the French Insurance Healthcare system. Prescribing trends were investigated over the period 2006–2013. An ecological design was used to assess the impact of the socio-economical and health resource characteristics of the zone of residence (n = 96 administrative subdivisions of French territory) on antipsychotic prescribing rates. The pattern of antipsychotic prescribing was explored in a cohort of youths newly treated with antipsychotics.ResultsOver the period 2006–2013, antipsychotic dispensing rates were globally stable in persons aged 0–25 years (4.8 per 1000 in 2006 and 4.9 per 1000 in 2013). First-generation antipsychotic dispensing rates decreased from 3.1 to 2.6 per 1000 (OR = 0.96, 95% CI = 0.94–0.98), while second-generation antipsychotic dispensing rates increased from 2.7 to 3.4 per 1000 (OR = 1.03, 95% CI = 1.01–1.05). Antipsychotic prescribing rates were impacted by health resource characteristics of the zone of residence in children aged 10 years and under and by socio-economical characteristics in those aged 16–20 years. In all the age groups, antipsychotics were principally started by hospital practitioners (47%) and general practitioners (34%). The rates of psychostimulants concomitantly prescribed with antipsychotics were lower than 5%.ConclusionRates of youths exposed to second-generation antipsychotics are still rising. The impact of environmental characteristics on antipsychotics prescribing and appropriateness of these prescriptions in youths should be further investigated.
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Wargo, Kurt A., and Rahul Gupta. "Neuroleptic Malignant Syndrome: No Longer Exclusively a “Neuroleptic” Phenomenon." Journal of Pharmacy Technology 21, no. 5 (2005): 262–70. http://dx.doi.org/10.1177/875512250502100505.
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Objective: To review the literature concerning the incidence of neuroleptic malignant syndrome (NMS) associated with the use of atypical antipsychotics. Data Sources: Cases were identified through a search of MEDLINE (1986–March 2004) using the terms neuroleptic malignant syndrome, antipsychotic, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. Study Selection and Data Extraction: Case reports of possible NMS secondary to second-generation antipsychotics were selected for review. Reports meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for NMS were considered. Case reports in which 1 of the 2 major diagnostic criteria was met were also included in the analysis. Furthermore, at least one minor criterion was met. Case reports in which patients received traditional antipsychotics were excluded. Data Synthesis: NMS is a rare and sometimes fatal disease. Several theories exist as to how NMS develops, and an equally large amount of diagnostic criteria are available. However, the majority of available data are based on the first-generation neuroleptics and very few exist with regard to the second-generation antipsychotics. Conclusions: Although there are numerous case reports of NMS occurring secondary to the use of second-generation antipsychotics, the incidence has never been fully elucidated. While the reasons for this remain uncertain, not all cases of second-generation–induced NMS fulfill the diagnostic criteria established for traditional neuroleptics and therefore may not be reported as such.
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Slauer, Ryan, Mina Boazak, Michael Lowley, et al. "185 Second Generation Antipsychotics and Catatonia: A Literature Review." CNS Spectrums 23, no. 1 (2018): 105–6. http://dx.doi.org/10.1017/s1092852918000664.
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AbstractIntroductionCatatonia is an underrecognized neuropsychiatric syndrome affecting approximately 10% of individuals hospitalized on inpatient psychiatric units. First-line treatments for this condition include benzodiazepines (BZD) and/or electroconvulsive therapy (ECT). However, 20-40% of individuals do not respond to BZD alone and ECT is not always accessible. Second generation antipsychotics (SGA) have been used to treat catatonia in these circumstances. Here, we review the literature pertaining to the efficacy and safety of SGA in the treatment of catatonia.MethodsWe conducted a PubMed search for articles linking catatonia to antipsychotics, under the search heading “catatonia” or “kahlbaum” and “risperidone”, “amisulpride”, “iloperidone”, “olanzapine”, “aripiprazole”, “paliperidone”, “clozapine”, “brexpiprazole”, or “cariprazine”. Reports commenting on SGA treatment efficacy and/or their role in the development of catatonia were included in the analysis. Selected articles were reviewed for patient demographics, psychiatric/medical history, symptoms, cause of catatonia and treatment, and co-administered agents. For each SGA, we calculated the number of cases in which catatonia was likely improved with antipsychotic treatment, and the number of cases in which catatonia was precipitated or worsened with antipsychotic treatment (improved/worsened ratio). Case data was assessed using the Naranjo Adverse Drug Reaction Probability Scale. Descriptive statistics were used to analyze the data.ResultsAt the time this abstract was written, we reviewed 480 of the original 507 articles. One hundred and seventeen of the 480 met inclusion criteria. There was one randomized controlled trial (RCT), five prospective studies, four retrospective studies and 107 case reports. Of all reviewed literature quetiapine (34:3, 92%), aripiprazole (16:2, 89%), amisulpride (18:1, 95%), andclozapine (19:1, 95%) had the highest improved/worsened ratio, conversely paliperidone (0:5, 0%) had the lowest improved/worsened ratio.ConclusionOf the available literature quetiapine, amisulpride, aripiprazole, and clozapine were found to be relatively safe andeffective as treatment options in catatonia, while palipderidone was found to have reports pointing to its role in the development/worsening, but none on the improvement, of catatonia. These results need to be interpreted with caution. In the majority of cases where SGA’s were effective, patients were co- treated with other pharmacologic agents (most frequently benzodiazepines), making it difficult to assess the role of the antipsychotic alone. Also, given that the preponderance of studies were case reports, publication bias may be an important limitation. Further studies are needed to examine the safety and efficacy of SGA in treating catatonia.Funding AcknowledgementsNo funding.
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Fleischhacker, W. Wolfgang. "Second-generation antipsychotic long-acting injections: Systematic review." British Journal of Psychiatry 195, S52 (2009): s29—s36. http://dx.doi.org/10.1192/bjp.195.52.s29.
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BackgroundSecond-generation antipsychotics (SGAs) represent an advance in the long-term management of schizophrenia.AimsTo review the available evidence concerning SGA long-acting injections (LAIs).MethodA systematic review of the literature was conducted using PubMed.ResultsRisperidone long-acting injection was the first licensed SGA–LAI compound and is effective in the long-term management of schizophrenia, with a safety profile similar to that of oral risperidone. Olanzapine pamoate has recently been approved in Europe. In terms of efficacy, at injection intervals of up to 4 weeks it appears comparable to oral olanzapine, although the potential for ‘post-injection syndrome’ (delirium) calls for additional safety considerations. Paliperidone palmitate is currently under review with the licensing authorities. It also affords the potential advantage of monthly dosing.ConclusionsMore long-term comparisons of SGA–LAIs with oral SGAs as well as with first-generation antipsychotic LAIs are needed. These studies should include cost-effectiveness data.
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Ellfolk, Maria A., Anna-Maria Lahesmaa-Korpinen, and Heli Malm. "First trimester use of second generation antipsychotics and major malformations." Reproductive Toxicology 57 (November 2015): 212. http://dx.doi.org/10.1016/j.reprotox.2015.06.009.
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Watts, Vabren. "First- and Second-Generation Antipsychotics Compared in Federal Agency Monograph." Psychiatric News 49, no. 20 (2014): 1. http://dx.doi.org/10.1176/appi.pn.2014.10b2.
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Kropp, Stefan, Veronika Kern, Kirsten Lange, et al. "Oxidative Stress During Treatment With First- and Second-Generation Antipsychotics." Journal of Neuropsychiatry and Clinical Neurosciences 17, no. 2 (2005): 227–31. http://dx.doi.org/10.1176/jnp.17.2.227.
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Tandon, Rajiv, William T. Carpenter, and John M. Davis. "First- and Second-Generation Antipsychotics: Learning From CUtLASS and CATIE." Archives of General Psychiatry 64, no. 8 (2007): 977. http://dx.doi.org/10.1001/archpsyc.64.8.977.
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Chen, Hong, and Rajiv Tandon. "First- and Second-Generation Antipsychotics and the Concept of “Atypicality”." Psychopharm Review 44, no. 11 (2009): 81–88. http://dx.doi.org/10.1097/01.idt.0000360999.60168.a4.
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Salgueiro, Monika, and Rafael Segarra. "Long-acting injectable second-generation antipsychotics in first-episode psychosis." International Clinical Psychopharmacology 34, no. 2 (2019): 51–56. http://dx.doi.org/10.1097/yic.0000000000000249.
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Lin, Ching-Hua, Fu-Chiang Wang, Yu-Hui Huang, Shih-Chi Lin, and Chao-Chan Kuo. "Comparison of polypharmacy using low-dose second-generation antipsychotics plus low-dose first-generation antipsychotics with monotherapy using therapeutic-dose second-generation antipsychotics in schizophrenia – a pooled analysis." CNS Spectrums 24, no. 6 (2019): 632–33. http://dx.doi.org/10.1017/s1092852919000877.
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Asmal, Laila. "Tardive dyskinesia on clozapine: A case report." South African Journal of Psychiatry 15, no. 1 (2009): 2. http://dx.doi.org/10.4102/sajpsychiatry.v15i1.169.
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Antipsychotic-induced tardive dyskinesia is a potentially irremediable and debilitating condition with the onset most commonly associated with the use of first-generation antipsychotics. The development of tardive dyskinesia on clozapine, a second-generation antipsychotic, is uncommon, and the drug is therefore a treatment option for those patients who develop the syndrome following treatment with first- generation agents. I report on the case of a 27-year-old man who developed severe tardive dyskinesia following initiation of clozapine treatment. To the best of my knowledge, this is the first case of tardive dyskinesia associated with clozapine use reported in South Africa.
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Morin, Anna K. "Off-label use of atypical antipsychotic agents for treatment of insomnia." Mental Health Clinician 4, no. 2 (2014): 65–72. http://dx.doi.org/10.9740/mhc.n190091.
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Despite limited supporting evidence, off-label uses of atypical or second generation antipsychotics (particularly olanzapine, quetiapine, and risperidone) are not uncommon. The off-label use of these agents for the treatment of insomnia is the focus of this review. While atypical antipsychotics are associated with a lower risk of tardive dyskinesia, extrapyramidal side effects, and more favorable effects on cognitive deficits and negative symptomatology in schizophrenic patients compared to typical or first generation antipsychotic agents, they are not without risks. Metabolic adverse effects are particularly problematic with atypical antipsychotics, even at doses lower than those used to treat FDA-approved indications. The receptor affinity profiles of most atypical antipsychotic agents promote sedation. The level of H1-histamine receptor blockade is believed to be most associated with somnolence and sedation. Several studies evaluating the safety and efficacy of the atypical antipsychotics quetiapine, olanzapine, and risperidone for the treatment of insomnia were identified and are summarized in this article.
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Morrissette, Debbi A., and Stephen M. Stahl. "Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy." CNS Spectrums 19, no. 5 (2014): 439–48. http://dx.doi.org/10.1017/s1092852914000388.
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Insufficient treatment of psychosis often manifests as violent and aggressive behaviors that are dangerous to the patient and others, and that warrant treatment strategies which are not considered first-line, evidence-based practices. Such treatment strategies include both antipsychotic polypharmacy (simultaneous use of 2 antipsychotics) and high-dose antipsychotic monotherapy. Here we discuss the hypothesized neurobiological substrates of various types of violence and aggression, as well as providing arguments for the use of antipsychotic polypharmacy and high-dose monotherapy to target dysfunctional neurocircuitry in the subpopulation of patients that is treatment-resistant, violent, and aggressive. In this review, we focus primarily on the data supporting the use of second-generation, atypical antipsychotics both at high doses and in combination with other antipsychotics.
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Friedrich, Michaela-Elena, Dietmar Winkler, Anastasios Konstantinidis, et al. "Cardiovascular Adverse Reactions During Antipsychotic Treatment: Results of AMSP, A Drug Surveillance Program Between 1993 and 2013." International Journal of Neuropsychopharmacology 23, no. 2 (2019): 67–75. http://dx.doi.org/10.1093/ijnp/pyz046.
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Abstract Background Cardiovascular diseases are still the leading cause of global mortality. Some antipsychotic agents can show severe cardiovascular side effects and are also associated with metabolic syndrome. Methods This observational study was based on data of AMSP (Arzneimittelsicherheit in der Psychiatrie), a multicenter drug surveillance program in Austria, Germany and Switzerland, that recorded severe drug reactions in psychiatric inpatients. Results A total of 404 009 inpatients were monitored between 1993 and 2013, whereas 291 510 were treated with antipsychotics either in combination or alone. There were 376 cases of severe cardiovascular adverse reactions reported in the given timespan, yielding a relative frequency of 0.13%. The study revealed that incidence rates of cardiovascular adverse reactions were highest during treatment with ziprasidone (0.35%), prothipendyl (0.32%), and clozapine (0.23%). The lowest rate of cardiovascular symptoms occurred during treatment with promethazine (0.03%) as well as with aripiprazole (0.06%). The most common clinical symptoms were orthostatic collapse and severe hypotonia, sinustachycardia, QTc prolongation, myocarditis, and different forms of arrhythmia. The dosage at the timepoint when severe cardiovascular events occurred was not higher in any of the given antipsychotics than in everyday clinical practice and was in average therapeutic ranges. In terms of subclasses of antipsychotics, no significant statistical difference was seen in the overall frequencies of adverse reactions cases, when first-generation high potency, first-generation low potency, and second-generation antipsychotics were compared. Thirty percent of adverse events among second-generation antipsychotics were induced by clozapine. Conclusions Our findings on cardiovascular adverse reactions contribute to a better understanding of cardiovascular risk profiles of antipsychotic agents in inpatients.