Clinical Schizophrenia and Related Psychoses最新文献

Nonadherence to antipsychotic medications for the treatment of schizophrenia is a widely recognized concern, leading to poorer clinical outcomes and higher treatment costs. Long-acting injectable (LAI) antipsychotics offer an extended dosing interval option for patients, although the current options may require an oral overlap at initiation. Aripiprazole lauroxil is an LAI that offers multiple dosing options but requires oral treatment overlap during initiation for the first 21 consecutive days. As an alternative to oral overlap, a novel nano-crystalline milled dispersion delivery system of aripiprazole lauroxil was recently approved as a one-day regimen to be added to aripiprazole lauroxil treatment.

Bipolar I disorder is a serious and disabling psychiatric illness. It is associated with a significant reduction in quality of life and an increased risk for suicide. Pharmacotherapy is essential for both the acute and maintenance treatment of bi-polar I disorder. While multiple oral medications are recommended for the maintenance treatment, there are not many long-acting injectable medications approved for this indication. New treatments that would improve patient adherence have the potential for decreasing relapses and improving patients' ability to remain functional members of society. In this paper we discuss the available data for safety and efficacy of aripiprazole long-acting injectable in bipolar disorder.

Tardive dyskinesia remains a significant, potentially stigmatizing or crippling adverse effect for any patient treated with an antipsychotic medication. While second- and third-generation antipsychotics have exhibited lower annual incidence rates for tardive dyskinesia than classic or first-generation agents, 3.9% versus 5.5%, the estimated incidence rate is only modestly lower. When coupled with the fact that second- and third-generation antipsychotic medications have come to be employed in treating a wider range of disorders (e.g., autism spectrum disorders, mood disorders, personality disorders, etc.), it is clear that the population of patients exposed to the risk of tardive dyskinesia has expanded. On April 3, 2017, the U.S. Food and Drug Administration (FDA) approved a deuterated version of tetrabenazine (Xenozine®) for the treatment of the involuntary choreic movements associated with Huntington's disease. More recent data, however, have indicated that deuterium tetrabenazine or deutetrabenazine (Austedo®) is effective in treating tardive dyskinesia. Moreover, like the other derivative of tetrabenazine, valbenazine (Ingrezza®), deutetrabenazine offers less frequent dosing and a better short-term adverse effect profile than that of tetrabenazine. Longer use in a broader range of patients, however, will be required to identify risks and benefits not found in short-term trials, as well as optimal use parameters for treatment of tardive dyskinesia.

Background: Research suggests that while patients wish to talk about positive psychotic symptoms, psychiatrists may be reluctant to do so in routine outpatient consultations.

Aims: To explore the content, context and impact of discussion of positive symptoms within psychiatric consultations.

Methods: Thematic analysis was applied to first discussions of positive symptoms, and overall impact assessed on the length of the consultation and the therapeutic relationship.

Results: Sixty-five of 143 consultations contained discussion of a positive psychotic symptom. Symptom discussion neither harmed the therapeutic relationship nor lengthened the consultation. Patients' disclosures strongly corresponded with psychological models of psychosis, emphasizing personal meaning and emotional impact. In contrast, psychiatrists focused on topographical characteristics, such as frequency and location. Strengths in psychiatric practice included using open questions, positive reinforcement and offering explanations tentatively.

Conclusions: Findings support discussion of positive symptoms within outpatient consultations, to include necessary assessment of topography and risk alongside exploration of patients' subjective experience.

Almost fifty percent of patients with schizophrenia experience some type of dermatitis. The standard treatment for dermatitis is a topical corticosteroid. Despite their demonstrated effectiveness, topical corticosteroids are associated with various side effects that may limit their use. These include generalized adverse effects from systemic absorption, such as suppression of the hypothalamic-pituitary-adrenal axis. While dose-related, oral corticosteroid-induced psychiatric symptoms, such as psychosis, are well documented, the literature is devoid of cases of topical corticosteroids precipitating psychosis. We present a case of a patient with schizophrenia who developed morphea. She was liberally treated with the potent topical corticosteroid clobetasol, possibly resulting in a "supraphysiologic exposure." Subsequently, our patient developed an exacerbation of activephase symptoms of schizophrenia. After clobetasol administration was reduced, these active phase symptoms dissipated.

In 2013 more than 150,000 Americans died from all types of lung cancer. Small cell lung cancer (SCLC) represents about 13% of all lung cancers and is notoriously associated with paraneoplastic syndromes (PNS). Here we present an interesting case of psychosis associated with one such PNS-- ectopic Cushing syndrome of SCLC. A 56 year old African-American male with no prior psychiatric history who was diagnosed with SCLC two months prior, presented to the ER for treatment of a right arm laceration he sustained while fighting off attackers, with high concern these individuals may have been part of hallucinatory experiences and well-systematized persecutory delusions regarding his wife. Physical assessment was notable for Cushingoid symptoms. Initial results of serum ACTH and cortisol were 221pg/ml (10-50pg/ml) and 37.1 mcg/dl (10-20mcg/dl) respectively. For psychosis, patient was started on Olanzapine which was titrated from 5 to final dose of 10mg nightly. Since patient was not a surgical candidate, he was treated with metyrapone 250 mg BID and radiation therapy was continued throughout hospitalization. Serum Cortisol level decreased steadily after initiation of metyrapone and psychotic symptoms dramatically reduced on olanzapine, metyrapone, and radiation therapy with apparently resolved persecutory delusions at discharge. This case broadens the available literature and provides data on successful symptomatic treatment with olanzapine while biological treatments of the underlying condition were beginning to take effect. As SCLC remains an important cause of morbidity and mortality in the US, it is imperative that physicians be aware of paraneoplastic syndromes and their psychiatric sequelae.

Clinical staging for schizophrenia and related disorders might provide an ideal means to overcome some limitations of the current diagnostic system and to facilitate early intervention. This study aims to retrospectively explore 1) the validity of a staging model 2) the stability of staging over time, and 3) the clinical factors associated with transition to more chronic stages. Data were derived from the Genetic Risk and Outcome of Psychosis study, a large cohort study of patients with a schizophrenia spectrum disorder. We assigned patients to a clinical stage, according to methods described by McGorry in 2010, using PANSS and GAF measures at baseline and three-year follow-up. Distinction between the stages was best explained by worse symptomatic, social and neurocognitive functioning in the first ('First Episode of Psychosis'), and last stage ('Severe/Persisting illness') as compared to the intermediate stages. Approximately half of the participants changed stages over time. Transition to more chronic stages was associated with worse premorbid functioning, higher levels of hostility and depressive symptoms and lower quality of life at baseline. We conclude that the clinical staging model was applicable in our sample. However, distinction between the intermediate stages and their prognostic validity could be improved.