Guidelines for the Pharmacotherapy of Schizophrenia in Adults.

Guidelines for the Pharmacotherapy of Schizophrenia in Adults.
Can J Psychiatry. 2017 Jan 01;:706743717720448
Authors: Remington G, Addington D, Honer W, Ismail Z, Raedler T, Teehan M
Abstract
OBJEC…

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A systematic review and combined analysis of therapeutic drug monitoring studies for long-acting risperidone.

A systematic review and combined analysis of therapeutic drug monitoring studies for long-acting risperidone.

Expert Rev Clin Pharmacol. 2017 Jul 12;:1-17

Authors: Schoretsanitis G, Spina E, Hiemke C, de Leon J

Abstract
INTRODUCTION: This systematic review of therapeutic drug monitoring (TDM) identifies three long-acting injectable (LAI) risperidone formulations. Areas covered: Limited data is available on two formulations (RBP-7000 and in Situ Microparticle), but 20 TDM articles on the microsphere formulation were found. Risperidone TDM includes the serum concentrations of risperidone and its active metabolite, 9-hydroxyrisperidone, used for calculating: 1) the risperidone/9-hydroxyrisperidone (R/9-OH-R) ratio (a measure of CYP2D6; values >1 are indicative of a CYP2D6 poor metabolizer) and 2) the total risperidone concentration-to-dose (C/D) ratio (a measure of risperidone clearance with a normal value around 7 in oral risperidone). The weighted mean R/9-OH-R ratio was 0.48 (approximately twice that of oral risperidone TDM) in a combined analysis from 329 patients in 6 risperidone LAI studies without major confounders. The total C/D ratios from 297 patients in 6 risperidone LAI studies ranged from 7.4 to 9.7 ng/ml/mg/day with a weighted mean of 8.8 ng/ml/mg/day. Expert commentary: Clinicians using TDM for risperidone LAI microsphere formulation need to: 1) consider steady state to be reached ≥ 6 weeks after the first injection, 2) pay attention to a) co-medications with inducers/inhibitors, b) severe inflammations/infections, and c) hepatic/renal impairment, and 3) use Castberg’s recommendation to calculate risperidone dosing.

PMID: 28699847 [PubMed – as supplied by publisher]

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[A step-by-step recovery].

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[A step-by-step recovery].

Soins Psychiatr. 2017 Jan – Feb;38(308):35-39

Authors: Perrin-Niquet A

Abstract
A patient retraces her care pathway with authenticity and emotion. While her memories of her time in hospital are still raw, her path towards recovery was built on constructive stages and encounters, from one structure to another, towards refound freedom. An interview with Marie-Paule Chanel.

PMID: 28065290 [PubMed – indexed for MEDLINE]

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Pharmacogenetic evaluation to assess breakthrough psychosis with aripiprazole long-acting injection: a case report.

Pharmacogenetic evaluation to assess breakthrough psychosis with aripiprazole long-acting injection: a case report.

BMC Psychiatry. 2017 Jul 03;17(1):238

Authors: Eum S, Schneiderhan ME, Brown JT, Lee AM, Bishop JR

Abstract
BACKGROUND: Given the complex nature of symptom presentation and medication regimens, psychiatric clinics may benefit from additional tools to personalize treatments. Utilizing pharmacogenetic information may be helpful in assessing unique responses to therapy. We report herein a case of wearing-off phenomena during treatment with aripiprazole long-acting injectable (LAI) and a proof of concept strategy of how pharmacogenetic information may be used to assess possible genetic factors and also hypothesize potential mechanisms for further study.
CASE PRESENTATION: A 51-year-old African American male with schizoaffective disorder was referred to a psychiatric clinic for medication management. After unsuccessful trials of multiple antipsychotics, oral aripiprazole was initiated (up to 30 mg/day) and transitioned to aripiprazole LAI with symptom improvement. At a high dose of aripiprazole LAI (400 mg Q3wks), the patient experienced breakthrough symptoms approximately 3 days prior to his next injection. Various considerations were examined to explain his atypical dose requirements, including but not limited to pharmacogenetic influences. Pharmacogenetic testing ruled out genetic influences on drug metabolism but noted a -141C Del variant in the dopamine-D2 receptor (DRD2) gene associated in prior studies of poor-response to antipsychotics. At this time, a new formulation, aripiprazole lauroxil, was explored due to its availability in higher dose options. Transition to the new formulation (882 mg Q4wks) greatly improved and stabilized the patient’s symptoms with no breakthrough psychosis. Comparable daily dose equivalents were achieved with two different formulations due to the Q3wks vs Q4wks dosing strategies, although the two agents have some differences in pharmacokinetic profiles.
CONCLUSIONS: We report a case of a patient experiencing wearing-off symptoms with aripiprazole LAI who benefited from switching to aripiprazole lauroxil. Pharmacogenetic testing revealed normal activity for relevant metabolism pathways but a DRD2 -141C variant that may influence brain D2 expression and antipsychotic responsiveness. The clinical utility of DRD2 information and what to do with genotyping results has not been previously addressed, despite availability on clinical test panels. Our case report suggests further investigations of altered dosing strategies and receptor genotype sensitivities to pharmacokinetic factors may be helpful in understanding symptom re-emergence observed in some patients taking LAI antipsychotics.

PMID: 28673279 [PubMed – in process]

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Pharmacokinetic Drug Evaluation of Paliperidone in the Treatment of Schizoaffective Disorder.

Pharmacokinetic Drug Evaluation of Paliperidone in the Treatment of Schizoaffective Disorder.
Expert Opin Drug Metab Toxicol. 2017 Jul 04;:
Authors: Macaluso M, Oliver H, Sohail Z
Abstract
INTRODUCT…

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Patients’ Knowledge about Prescribed Antipsychotics and Medication Adherence in Schizophrenia: A Cross-Sectional Survey.

Patients’ Knowledge about Prescribed Antipsychotics and Medication Adherence in Schizophrenia: A Cross-Sectional Survey.
Pharmacopsychiatry. 2017 Jul 04;:
Authors: Nagai N, Tani H, Suzuki T, Ikai S, Gerretsen P, M…

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Neural Correlates of Belief and Emotion Attribution in Schizophrenia.

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Neural Correlates of Belief and Emotion Attribution in Schizophrenia.
PLoS One. 2016;11(11):e0165546
Authors: Lee J, Horan WP, Wynn JK, Green MF
Abstract
Impaired mental state attr…

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Ecological Momentary Assessment and Intervention in the Treatment of Psychotic Disorders: A Systematic Review.

Ecological Momentary Assessment and Intervention in the Treatment of Psychotic Disorders: A Systematic Review.
Psychiatr Serv. 2017 Jul 03;:appips201600523
Authors: Bell IH, Lim MH, Rossell SL, Thomas N
Abs…

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Relapse and hospitalization in patients with schizophrenia and bipolar disorder at the St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: a comparative quantitative cross-sectional study.

Relapse and hospitalization in patients with schizophrenia and bipolar disorder at the St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: a comparative quantitative cross-sectional study.
Neuropsychiatr Dis Trea…

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A meta-analysis of adjuvant group-interventions in psychiatric care for patients with bipolar disorders.

A meta-analysis of adjuvant group-interventions in psychiatric care for patients with bipolar disorders.
J Affect Disord. 2017 Jun 27;222:28-31
Authors: Macheiner T, Skavantzos A, Pilz R, Reininghaus EZ
Abs…

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