Clinical Schizophrenia and Related Psychoses最新文献

Wolff-Parkinson-White syndrome (WPW) is a cardiac conduction abnormality characterized by ventricular contractions that appear sooner than the usual interval regulated by the atrioventricular (AV) node. It is commonly asymptomatic but in rare cases can lead to sudden cardiac death. Little is known about the cardiac effects of antipsychotics on patients with WPW. Here we review all the published information currently available on the use of neuroleptics in patients with this cardiac conduction anomaly. Only a few case reports and one controlled study have been published in this area. The limited existing information suggests patients with WPW may be at higher risk for QTc prolongation when exposed to antipsychotics. It also indicates aripiprazole and droperidol could be potential alternatives but more research on this subject is clearly necessary.

Schizophrenia is a chronic, debilitating and costly illness. The course of illness is often exacerbated by relapses which are associated with negative outcomes including rehospitalisation. The most important risk factor associated with relapse is medication nonadherence. Medication nonadherence is not specific to schizophrenia and is an issue across all of medicine. The objective of this paper is to present a narrative review which synthesizes the rates and predictors of medication nonadherence, as well as associated interventions, across schizophrenia, first episode psychosis and general medicine. Given the breadth of these topics, this paper does not aim to present a complete review of the data but rather a concise synthesis of several lines of research in order to provide a general framework for approaching this important topic. Overall, this paper identifies that rates and risk factors of nonadherence in schizophrenia are similar to those reported in general medicine. Rates of adherence are estimated at 50% for both. Predictors of nonadherence were also quite similar between various illnesses, with lack of insight, poor family support and substance abuse often being highlighted. Well studied approaches of improving adherence include simplifying medication regimens, psychoeducation, engaging family support and use of long-acting injectable antipsychotics. Emerging interventions included text-message reminders, financial incentives and MyCite technology. Additionally, several evidence based interventions were identified in general medicine that may have applicability in schizophrenia and first episode psychosis. Lastly, avenues of future research were identified including the need to further characterize the dichotomy between adherence, partial adherence and nonadherence.

The Cultural Formulation Interview (CFI) is an assessment tool created and intended for provider use to improve culturally appropriate care. We present a case in which portions of the CFI were used to help a care team better understand the diagnosis and culture of a patient with schizophrenia.

Introduction: Aripiprazole is an antipsychotic used in the treatment of different disorders. The most common side effects are dizziness, insomnia, akathisia, activation, nausea and vomiting. Ophthalmologic side effects are rare. We report a case of myopia induced by aripiprazole.

Methods: Case study and literature review on aripiprazole-induced myopia.

Results: a 21-year-old male, with a first psychotic episode, developed myopia two weeks after initiating aripiprazole 20 mg/day. The symptoms of blurred vision were solved eight to ten days after switching to paliperidone. To date, seven cases of aripiprazole-induced myopia were reported in literature, all of them related to the oral formulation.

Discussion: in the present case, as seen in seven previously reported cases, the patient presented with myopia after the initiation of aripiprazol and the problem was solved after discontinuation of the drug. Apparently, this effect is not dose dependent, since the eight patients described were medicated with different dosages, from 3 to 20 mg per day. The onset of the symptoms was within a month, from three to thirty days, and the resolution after discontinuation was reported to be from three to fourteen days. Psychiatrists and ophthalmologists should be alert to the possibility of aripiprazole-induced myopia. When an ophthalmologist detects this problem, the patient should be referred to his psychiatrist to proceed with the prescription changes.

Despite effective pharmacotherapy for positive symptoms of psychosis, cognitive deficits emerge early and are persistent. Efficacy studies have demonstrated cognitive training can produce improvement in cognition, symptoms, and functional outcomes for psychosis. A chart review of seventy-one first episode psychosis patients in a cognitive training program was designed to determine feasibility and effectiveness of the program in a non-research clinic setting. Cognitive testing data, symptom change, and re-hospitalization data were reviewed. The MATRICS Consensus Cognitive Battery (MCCB) was used to measure processing speed, attention, memory, verbal learning, visual learning, problem solving, and social cognition. Improvements in global cognition were found (p < .05), driven by changes in working memory and speed of processing. The expanded Brief Psychiatric Rating Scale (BPRS-E) was used to measure change in mental health symptoms. There were no significant changes in symptoms. Participants without comorbid diagnoses, who underwent cognitive training procedures, had lower re-hospitalization rates when compared to another comprehensive first episode program and routine practice. These findings indicate feasibility and effectiveness for implementing cognitive training for first episode patients in a day treatment setting.

The goal of this 21-year naturalistic study of clozapine-treated patients was to examine the cardiovascular risk factors following clozapine initiation and resultant mortality estimates from cardiovascular disease. Data were collected from January 1992 to February 2012 medical records from clozapine-treated patients with schizophrenia or schizoaffective disorder. Demographics, clozapine dosage and laboratory results were extracted at 12-month intervals. At clozapine initiation, the mean age of the 96 patients was 36.4 years±7.6 years; n=27 (28%) were women. The mean duration of clozapine use was 13 years. The Kaplan-Meier estimate for 21-year cardiovascular events was 29%, while the Kaplan-Meier estimate for 21-year mortality from cardiovascular disease was 10%. The mean cardiovascular risk increased during the first ten years (p<.01), while a slight decrease occurred beyond ten years (p<.01). Patients involved in cardiometabolic research showed a greater decrease in cardiovascular risk factors over 21 years (p=.05). The Kaplan-Meier estimate for 21-year all-cause mortality was 22%. Forty-one patients were diagnosed with diabetes (42.7%), compared to a nationwide prevalence of 13.7% in a similar age group. These results support the hypothesis that clozapine-treated patients are at risk for cardiovascular events and death secondary to an increased risk of medical disorders. Interventions that target weight loss, smoking cessation, and lipid profile improvement may alleviate the increased risk of cardiovascular mortality.