Efficacy and safety of olanzapine for treatment of patients with bipolar depression: Chinese subpopulation analysis of a double-blind, randomized, placebo-controlled study A review of aripiprazole in the treatment of patients with schizophrenia or bipolar I disorder Suicidal ideation and attempts among people with severe mental disorder, Addis Ababa, Ethiopia, comparative cross-sectional study Pimozide Augmentation of Clozapine Inpatients with Schizophrenia and Schizoaffective Disorder Unresponsive to Clozapine Monotherapy Spatial Working Memoryand Planning Ability: Contrasts between Schizophreniaand Bipolar i Disorder Worldwide-Schizophrenia Outpatient Health Outcomes (W-SOHO): baseline characteristics of pan-regional observational data from more than 17,000 patients. An open label follow-up study on amisulpride in the add-on treatment of bipolar I patients The Chinese First-Episode Schizophrenia Trial: background and study design. The European First Episode Schizophrenia Trial (EUFEST): Rationale and design of the trial First do no harm: promoting an evidence-based approach to atypical antipsychotic use in children and adolescents. Intramuscular olanzapine vs. intramuscular short-acting antipsychotics: safety, tolerability and the switch to oral antipsychotic medication in patients with schizophrenia or acute mania. Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST). Bipolar disorder, schizoaffective disorder, and schizophrenia overlap: a new comorbidity index. Prescribing for inpatients with schizophrenia: an international multi-center comparative study. Focus on aripiprazole: a review of its use in child and adolescent psychiatry. Controlled trial of safety and efficacy of bright light therapy vs. negative air ions in patients with bipolar depression An algorithm-based approach to first-episode schizophrenia: response rates over 3 prospective antipsychotic trials with a retrospective data analysis. The epidemiology of bipolar disorder: sociodemographic, disability and service utilization data from the Australian National Study of Low Prevalence (Psychotic) Disorders. Baseline Striatal Functional Connectivity as a Predictor of Response to Antipsychotic Drug Treatment. Effects of a mutual support group for families of Chinese people with schizophrenia: 18-month follow-up. Cognitive effects of adjunctive N-acetyl cysteine in psychosis. Serum levels of brain-derived neurotrophic factor in patients with schizophrenia and bipolar disorder Cannabidiol in Humans—The Quest for Therapeutic Targets
Background Depression in bipolar I disorder responds to the atypical antipsychotic olanzapine . This sub population analysis assessed whether olanzapine is superior to placebo specifically in the treatment of Chinese patients with bipolar I depression . Methods This was a sub population analysis of a 6-week , multicenter , double-blind , parallel , r and omized ,  placebo-controlled  trial among 12 Chinese study centers . Eligible in patients and out patients were r and omized to olanzapine ( 5 to 20 mg/day ) or placebo .  Patients were primarily assessed by the Montgomery-Åsberg Depression Rating Scale total score . Secondary assessment s used a range of other efficacy and safety measures . This sub population analysis was underpowered to show statistically significant differences between treatment groups . Results In total , 210 patients ( mean age 32.9 years at baseline , 54.3 % females ) were r and om-ized . Similar proportions of patients treated with olanzapine ( 75.0 % ) and placebo ( 72.9 % ) completed the double-blind phase . Baseline-to-endpoint least-squares mean ± st and ard error decrease in the Montgomery-Åsberg Depression Rating Scale total score in the olanzapine group ( −13.55±0.80 ) was similar to that noted in the parent trial ( −13.82±0.65 ) . However , the difference between olanzapine and placebo groups was not statistically significant ( P=0.44 ) ; this finding was also true for the secondary efficacy measures . A post hoc analysis showed a greater emergence of mania in the placebo group , which likely reduced the treatment difference between olanzapine and placebo in the primary efficacy measure . Safety data were consistent with the known safety profile of olanzapine , including a higher incidence of weight gain ( ≥7 % ) in the olanzapine group ( 24.1 % vs 1.4 % , P<0.001 ) . Conclusion Olanzapine provides similar improvement in depression among Chinese and non-Chinese bipolar I patients . The lack of a statistically significant difference between the olanzapine and placebo groups in this Chinese sub population analysis may relate to an a priori lack of study power , and underestimation of the effect of olanzapine because of a greater emergence of mania in placebo-treated patients and missing data associated with a high early discontinuation rate Aripiprazole has been approved by regulatory agencies for the treatment of schizophrenia and bipolar I disorder . Although it is a dopamine partial agonist , it also has substantial binding affinity for the serotonin 5HT2A receptor . Several double-blind r and omized clinical trials have established the efficacy and tolerability of aripiprazole within the dose range of 10–30 mg/day for schizophrenia , and 15–30 mg/day for manic or mixed states associated with bipolar I disorder . Relatively few comparative trials with other second-generation antipsychotics have been published for schizophrenia , with none available for bipolar disorder . The evidence so far suggests that in terms of efficacy for schizophrenia , aripiprazole is superior to placebo and haloperidol ( long term ) , similar to perphenazine and risperidone , and inferior to olanzapine .  Its tolerability profile in patients with schizophrenia appears superior to haloperidol , perphenazine , risperidone , and olanzapine .  Efficacy in treating manic or mixed states was established in placebo-controlled trials . Among some patients with bipolar disorder  , akathisia and gastrointestinal ( GI ) complaints can emerge at the start of treatment ; however , the GI symptoms were time-limited in many instances . Appropriate dosing may also be important in individualizing therapy to improve tolerability , with lower starting doses becoming more important when adding to , or switching from , another antipsychotic . Aripiprazole appears to have a low propensity for weight gain , a favorable metabolic profile , and no association with hyperprolactinemia Background People with severe mental disorders are associated with increased risk of suicide and suicide attempts compared to the general population . In low and middle-income countries , research concerning suicide attempts and completed suicide among people living with severe mental disorder is limited . The objective of this study was to assess suicide and attempts in people with severe mental disorder at Amanuel Mental Specialized Hospital , Addis Ababa , Ethiopia . Methods Institution-based cross-sectional study was conducted in August – September 2016 . Patients with schizophrenia and bipolar disorder were selected using systematic r and om-sampling technique . The composite international diagnostic interview was used to assess suicide that was administered by psychiatry professionals . Substance use disorder was assessed through face-to-face interviews using structured clinical interview of DSM-IV . Results A total of 542 ( 272 schizophrenia + 270 bipolar disorder ) patients were included in the study . One hundred nineteen ( 43.75 % ) of schizophrenic participants and 128 ( 47.1 % ) of bipolar participants have suicidal ideation . Fifty-six ( 20.7 % ) of schizophrenic participants and 58 ( 21.3 % ) of bipolar participants have suicidal attempt . Among the schizophrenic and bipolar patients who had suicidal ideation , 31.8 and 32.60 % had co-morbid substance use disorder , respectively . Conclusion In this study , which was performed in Ethiopia , suicidal ideation and attempt were shown to be common problems in people with schizophrenia and bipolar disorder . Co-morbid substance use disorder was a more frequent phenomenon among patients with suicidal ideation and attempt . Attention should be given to screen and assess suicidal ideation and attempt in persons with schizophrenia and bipolar disorder Despite its superior efficacy , clozapine is helpful in only a subset of patients with schizophrenia unresponsive to other antipsychotics . This lack of complete success has prompted the frequent use of various clozapine combination strategies despite a paucity of evidence from r and omized controlled trials supporting their efficacy . Pimozide , a diphenylbutylpiperidine , possesses pharmacological and clinical properties distinct from other typical antipsychotics . An open-label trial of pimozide adjunctive treatment to clozapine provided promising pilot data in support of a larger controlled trial . Therefore , we conducted a double-blind , placebo-controlled , parallel- design ed 12-week trial of pimozide adjunctive treatment added to ongoing optimal clozapine treatment in 53 patients with schizophrenia and schizoaffective disorder partially or completely unresponsive to clozapine monotherapy . An average dose of 6.48 mg/day of pimozide was found to be no better than placebo in combination with clozapine at reducing Positive and Negative Syndrome Scale total , positive , negative , and general psychopathology scores . There is no suggestion from this rigorously conducted trial to suggest that pimozide is an effective augmenting agent if an optimal clozapine trial is ineffective . However , given the lack of evidence to guide clinicians and patients when clozapine does not work well , more controlled trials of innovative strategies are warranted Working memory may be conceptualized as a multi-component system involving the active maintenance and manipulation of stored information in the service of planning/guiding behaviour . Impaired spatial working memory is a robust finding in schizophrenia patients which has been related to an impairment in frontostriatal connectivity . The purpose of this study was to examine the specificity of this impairment by comparing the mnemonic and executive aspects of working memory performance in schizophrenia and bipolar disorder with psychotic features , focusing particularly on the functional dynamics between task components . Twenty-four patients with schizophrenia , 14 patients with bipolar I disorder ( manic phase ) and 33 healthy control subjects were assessed using the Cambridge Neuropsychological Test Automated Battery ( CANTAB ) : including the spatial working memory ( between search errors and strategy scores ) spatial span ( storage capacity ) and spatial planning ( Stockings of Cambridge : accuracy and latency ) tasks . Both patient groups were impaired on the spatial span task , which requires the maintenance and retrieval of stored information . In contrast , only schizophrenia patients showed a significant deficit in between search errors , which requires both maintenance and manipulation of information in working memory . That is , they exhibited both a mnemonic and an executive dysfunction . Spatial span was particularly important to accurate planning ability in bipolar patients . In contrast , in patients with schizophrenia  poor spatial working memory was a significant predictor of planning impairments , consistent with failures in goal selection , evaluation and /or execution . Furthermore , initial planning time was positively correlated with the latency to complete a planning sequence . This pattern of slow cognitive processing in schizophrenia patients only , resembled that reported previously in patients with basal ganglia disorders . These findings are discussed in terms of a possible common disturbance in fronto-parietal circuitry in the two disorders together with a specific disturbance of fronto-striatal circuitry in schizophrenia , that is not present in bipolar disorder OBJECTIVE To describe the Worldwide-Schizophrenia Outpatient Health Outcomes ( W-SOHO ) patient population at study entry , focusing on illness burden and prescribing practice s across regions . METHODS The SOHO study was a 3-year , prospect i ve , observational study design ed to assess costs and outcomes associated with antipsychotic use in out patients initiating or changing antipsychotic ( with an emphasis on olanzapine compared with other antipsychotics ) . SOHO was conducted in 10 European countries and 27 other countries as Intercontinental SOHO ( IC-SOHO ) . Data from all countries have been pooled to produce the W-SOHO data set . MAIN OUTCOMES MEASURES Clinical Global Impression-Schizophrenia ( CGI-SCH ) severity scores , psychotropic medication use , adverse events , social interaction , housing and employment status , self-perceived health state ( EuroQoL EQ-5D scale and Visual Analogue Scale , EQ-VAS ) , and reasons for initiation/change of antipsychotic . RESULTS The W-SOHO data base comprises 17,384 patients from six regions ; East Asia ( n = 1223 ) , Central and Eastern Europe ( n = 2175 ) , Northern Europe ( n = 4291 ) , Southern Europe ( n = 5788 ) , Latin America ( n = 2566 ) , North Africa and the Middle East ( n = 1341 ) . Overall , patients were 38 + /- 13 years old ( mean + /- SD ) , moderately ill ( mean CGI-SCH overall score of 4.4 + /- 1.0 ) with a median duration of illness of 7 years ( interquartile range 1 - 16 years ) ; 43 % were female , 10 % were receiving antipsychotic medication for the first time .  Adverse events were prevalent across all regions ; on average , 50 % ( range 41 - 59 % ) of patients taking antipsychotics exhibited extrapyramidal symptoms at baseline , and 62 % ( 34 - 67 % ) of patients reported sexual dysfunction in the previous month . On average , only 19 % ( 16 - 23 % ) of patients were in paid employment and as many as 69 % were living in dependent housing . CONCLUSIONS Despite inherent diversity in these patients and the health care systems supporting them , there are striking cross-regional similarities in baseline characteristics for most measures . Not all countries are represented ; regional comparisons may not be valid outside of the countries studied Background Atypical antipsychotics are widely used in the treatment of bipolar disorders .  Amisulpride is an atypical antipsychotic that has been proven to be effective in treatment of schizophrenia , major depressive disorder and , more recently , acute mania . At the moment , however , no study has assessed the effectiveness of this compound in maintenance therapy of bipolar disorders . The purpose of this study was to assess the long-term effectiveness of amisulpride in combination with st and ard treatments in patients with bipolar I disorder who have shown inadequate responses to ongoing st and ard therapies .  Methods The study enrolled fourteen bipolar I out patients , not responding to ongoing st and ard therapy .  Three patients discontinued treatment but 11 were followed-up for 11.7 ± 8.2 months before ( range 3–24 months ) and 5.2 ± 2.7 months after the introduction of amisulpride ( range 3–9 months ) . Relapse rates before and during treatment with amisulpride were calculated in accordance to an increase of 1 or more in Clinical Global Impressions Scale-Bipolar Version ( CGI-BP ) score that was accompanied by a change in therapy or to an exacerbation of the symptoms that required hospitalization . Results A statistically significant decrease in overall relapse rate was observed during the period of amisulpride therapy compared with months previous to the introduction of amisulpride . The relative risk of relapse in the absence of amisulpride therapy was 3.1 ( χ2 = 4.2 , P < 0.05 ) . Similarly , the rates of manic/mixed and depressive relapse were decreased but only manic episodes reached statistical significance ( RR = 5.3 , χ2 = 5.2 , P < 0.02 ) . Discussion and conclusion This open-label study suggests that long-term therapy with amisulpride may benefit patients by improving global symptoms of bipolar disorder and reducing the rate of manic/mixed relapses . Large , r and omized , double-blind , placebo-controlled studies are needed to explore the benefits of adding long-term amisulpride to st and ard therapies for bipolar disorder Schizophrenia is a complex illness with unknown aetiology and pathogenesis . Currently , a considerable number of patients with schizophrenia do not receive st and ardised and systematic treatment in China . In the past years , many controlled trials have been conducted in chronic schizophrenia . In contrast , research on first-episode schizophrenia is lacking . This paper describes the background and design of the Chinese First-Episode Schizophrenia Trial project -- a multicentre , r and omised , open-label clinical trial . A total of 600 first-episode schizophrenia patients were r and omly divided into 3 groups and treated with risperidone , aripiprazole , and olanzapine for 1 year . During the study period , only 1 medication change of the 3 antipsychotic medications was allowed BACKGROUND Most studies comparing second generation antipsychotics with classical neuroleptics have been conducted in more or less chronic schizophrenia patients . Such studies were usually conducted in highly selected sample s , and were generally design ed and financed by the manufacturer of the drug tested . These and other facts have stimulated discussion s regarding the effectiveness of the new generation of antipsychotics . AIMS The aim of the European First Episode Schizophrenia Trial ( EUFEST ) is to compare treatment with amisulpride , quetiapine , olanzapine and ziprasidone to a low dose of haloperidol in an unselected sample of first episode schizophrenia patients with minimal prior exposure to antipsychotics . METHODS 500 patients between the ages of 18 - 40 meeting DSM-IV criteria for schizophrenia , schizoaffective disorder or schizophreniform disorder are r and omly allocated to one year of treatment with one of the drugs under study . The primary outcome measure is retention in treatment , defined as time to discontinuation of study drug . Loss of retention can be the result of insufficient clinical effect , or lack of tolerability or acceptance . Secondary measures include changes in different dimensions of psychopathology , side effects , compliance , social needs , quality of life , substance abuse and cognitive functions . CONCLUSIONS At present , more than 400 patients have been recruited and r and omized in the following countries : Austria , Belgium , Bulgaria , Czech Republic , Germany , France , Israel , Italy , the Netherl and s , Pol and , Rumania , Spain , Sweden and Switzerl and : The study should be finished by the end of 2006 and it is expected that results will yield relevant clinical information with regard to the effectiveness of the second generation antipsychotics . This effort represents the first independently design ed trans-European schizophrenia treatment trial OBJECTIVES To review the evidence for efficacy and metabolic effects of atypical antipsychotics ( AAPs ) , and to propose a metabolic monitoring protocol for AAP use in children and adolescents . METHODS A PubMed search was performed to obtain all studies related to efficacy , metabolic side-effects , and monitoring in those less than 18 years of age . RESULTS There are no approved indications for AAP use in children and adolescents in Canada . Based on US Food and Drug Administration approvals and a review of r and omized controlled trials , we identified 7 indications for AAP use that target specific symptoms in youth including schizophrenia , bipolar I disorder , autism , pervasive developmental disorder , disruptive behaviour disorders ( including conduct disorder and ADHD ) , developmental disabilities and Tourette Syndrome . A wide range of metabolic effects including weight gain , increased waist circumference , dysglycemia , dyslipidemia , hypertension , elevated hepatic transaminases and prolactin levels have been reported . We have developed a proposal for metabolic monitoring that includes anthropometric measurements and laboratory testing at baseline and appropriate intervals thereafter . CONCLUSION There is an urgent need for national clinical practice guidelines that provide , not only appropriate treatment algorithms for AAP-use based on evidence , but also address metabolic monitoring and subsequent management of complications in this vulnerable population BACKGROUND This study compared the safety , tolerability and switch to oral medication in patients with bipolar disorder or schizophrenia who received intramuscular ( IM ) olanzapine or other IM antipsychotics for the treatment of acute agitation . METHODS Patients ( N = 2011 ) from 15 countries participated in this prospect i ve , observational , non-interventional study . In patients requiring treatment with at least one IM injection of a short-acting antipsychotic  were assessed at baseline and within 7 days after the first IM injection . Treatment groups comprised : ( i ) patients prescribed IM olanzapine at baseline ; and ( ii ) patients prescribed any other IM antipsychotic medication at baseline . Outcome measures included : treatment-emergent adverse events , concomitant psychotropic medication and the time taken to switch to oral medication . RESULTS Fewer patients in the IM olanzapine group experienced an adverse event than patients in the other IM antipsychotic group ( 34.4 % vs. 46.2 % , p < 0.001 ) . The most frequently reported adverse events in both groups were : sedation , Parkinsonism , disturbance in attention , akathisia , dystonia and orthostatic hypotension . Fewer patients in the IM olanzapine group used anticholinergics ( 13.9 % vs. 42.5 % , p < 0.001 ) or anxiolytics/hypnotics ( 47.6 % vs. 51.6 % , p = 0.023 ) . Patients in the IM olanzapine group switched to oral medication earlier than patients in the other IM antipsychotic group ( median time = 46.5 vs. 48.0 h , p = 0.009 ) . CONCLUSIONS These findings suggest that IM olanzapine may have a favourable impact on individual patients . However , the high rate of oral concomitant medication used throughout the study limits these findings from being associated with IM olanzapine alone OBJECTIVE To compare the effects of haloperidol , amisulpride , olanzapine , quetiapine , and ziprasidone on hostility in first-episode schizophrenia , schizoaffective disorder , or schizophreniform disorder . METHOD We used the data acquired in the European First-Episode Schizophrenia Trial , an open , r and omized trial ( conducted in 14 countries ) comparing 5 antipsychotic drugs in 498 patients aged 18 - 40 years with first-episode schizophrenia , schizoaffective disorder , or schizophreniform disorder . DSM-IV diagnostic criteria were used . Patients were assessed between December 23 , 2002 and January 14 , 2006 . Most subjects joined the study as in patients and then continued with follow-ups in outpatient clinic visits . The Positive and Negative Syndrome Scale ( PANSS ) was administered at baseline and at 1 , 3 , 6 , 9 , and 12 months after r and omization . We analyzed the scores on the PANSS hostility item in a subset of 302 patients showing at least minimal hostility ( a score > 1 ) at baseline . We hypothesized ( 1 ) that the treatments would differ in their efficacy for hostility and ( 2 ) that olanzapine would be superior to haloperidol . Our primary statistical analysis tested the null hypothesis of no difference among the treatment groups in change in hostility over time . Secondary analysis addressed the question of whether the effects on hostility found in the primary analysis were specific to this item . All our analyses were post hoc . RESULTS The primary analysis of hostility indicated an effect of differences between treatments ( F(4,889 ) = 4.02 , P = .0031 ) . Post hoc treatment-group contrasts for hostility change showed that , at months 1 and 3 , olanzapine was significantly superior ( P < .05 ) to haloperidol , quetiapine , and amisulpride in reducing hostility . Secondary analyses demonstrated that these results were at least partly specific to hostility . CONCLUSIONS Both hypotheses were supported . Olanzapine appears to be a superior treatment for hostility in early phases of therapy for first-episode schizophrenia , schizoaffective disorder , and schizophreniform disorder . This efficacy advantage of olanzapine must be weighed against its adverse metabolic effects and propensity to cause weight gain . TRIAL REGISTRATION IS RCT N Register Identifier : IS RCT N68736636 OBJECTIVE Growing evidence of an etiologic overlap between schizophrenia , schizoaffective disorder , and bipolar disorder has become increasingly difficult to disregard . We investigated the magnitude of the overlap between the clinical diagnoses of bipolar affective disorder , schizoaffective disorder , and schizophrenia over a 35-year period based on the entire Danish population . METHOD We established a  register-based prospect i ve cohort study of more than 2.5 million persons born in Denmark after 1954 . Risks for the 3 psychiatric disorders were estimated by survival analysis using the Aalen-Johansen method . Cohort members were followed from 1970 to 2006 . We introduced a new comorbidity index measuring the magnitude of the overlap between the 3 disorders . RESULTS Overall , 12,734 patients were admitted with schizophrenia , 4,205 with bipolar disorder , and 1,881 with schizoaffective disorder . A female bipolar patient 's risk of also being admitted with a schizoaffective disorder by the age of 45 years was approximately 103 times higher than that of a woman at the same age in the general population . Thus , we defined the comorbidity index between schizoaffective disorder and bipolar disorder at age 45 years to be 103 . At age 45 years , the index between schizophrenia and schizoaffective disorder was 80 and between schizophrenia and bipolar disorder was 20 . Similar large comorbidity indexes were found for men . CONCLUSIONS A large comorbidity index between schizophrenia and schizoaffective disorder was found , as well as a large index between bipolar disorder and schizoaffective disorder . But , more surprisingly , it was clear that a substantial comorbidity index between bipolar disorder and schizophrenia was present . This study supports the existence of an overlap between bipolar disorder and schizophrenia and thus challenges the strict categorical approach used in both DSM-IV and ICD-10 classification systems BACKGROUND This study compares prescription practice s for acute in patients with schizophrenia among six academic departments located in China , Japan , Hungary , and the U.S. METHODS Prescription data for a sample of 429 in patients from six academic departments were collected on a r and omly chosen census day . All patients met criteria for schizophrenia according to DSM-IV and had a length of illness of at least two years . RESULTS While patients at the different centers varied in their demographic and clinical characteristics , i. e. , age , sex , and length of illness , a great variation in prescription patterns for antipsychotic and other psychotropic drugs among centers was observed even within the same country for all the variables studied ( i. e. , number and dose antipsychotics , atypical and depot antipsychotics , other psychotropic drugs , multiple antipsychotics , and daily dose ) except antidepressant use . In most cases these differences persisted even after adjusting for demographic and clinical characteristics ( age , sex , and length of illness ) of the subjects . Antipsychotics were usually prescribed in divided daily doses in combination with one or more other psychotropic drugs , including anticholinergics , anticonvulsants , benzodiazepines , and non-benzodiazepine hypnotics .  Anticholinergic use was more common with typical antipsychotics . Rates of atypical antipsychotic drug use were lowest in the Japanese center . The Japanese center had by far the highest mean daily dose of antipsychotics .  CONCLUSIONS The results indicate that prescription patterns in different centers do not follow any specific guidelines for the treatment of schizophrenia . The results also confirm previous findings that prescribing practice s for schizophrenia vary greatly among centers and countries . A common prescribing pattern found was the use of atypical antipsychotic drugs in combination with psychotropic drugs , such as anticholinergics , hypnotics , anticonvulsants , and benzodiazepines , administered in multiple daily doses OBJECTIVE To review published literature regarding aripiprazole in child and adolescent psychiatry . METHOD A literature review was conducted using the medline search term : ' aripiprazole ' with limits : Human trials , English language , All Child ( aged 0 - 18 years ) . Additional articles were identified from reference information and poster presentation data . RESULTS Aripiprazole is an atypical antipsychotic which was recently approved for use in Canada , but has been available for several years in the United States . Pharmacologically , aripiprazole is a partial agonist at D(2 ) and 5-HT(1A ) receptors and an antagonist at 5-HT(2A ) receptors . R and omized controlled trial data is available showing efficacy for aripiprazole in the treatment of children and adolescents with schizophrenia , bipolar disorder and behavioural problems associated with autism . Open-label evidence is also available for use of aripiprazole in other disorders such as tic disorders , aggression and disruptive behavior disorders . Unlike some other available atypical antipsychotics , there does not appear to be any effect on QTc interval on the electrocardiogram . Adverse effects including extrapyramidal symptoms ( EPS ) , akathisia , sedation , headache , nausea were significant in clinical trials in children and adolescents . The possibility of aripiprazole causing tardive dyskinesia can not be excluded . In this population , aripiprazole appears to have minimal impact on the metabolic profile compared to most other atypical antipsychotics , with minimal changes in weight or body mass index , no significant changes in glucose or lipid metabolism , and a decrease in serum prolactin . CONCLUSION Aripiprazole may represent an important alternative for some children and adolescents who have experienced poor efficacy or significant metabolic adverse effects with their current antipsychotic treatment regimen Treatment of bipolar disorder often results in patients taking several drugs in an attempt to alleviate residual depressive symptoms , which can lead to an accumulation of side effects . New treatments for bipolar depression that do not increase the side effect burden are needed . One nonpharmacological treatment with few side effects , bright light therapy , has been shown to be an effective therapy for seasonal affective disorder , yet has not been extensively studied for other forms of depression . Forty-four adults with bipolar disorder , depressed phase were r and omized to treatment with bright light therapy , low-density or high-density negative ion generator for 8 weeks . The primary measure of efficacy was the Structured Interview Guide for the Hamilton Depression Rating Scale with Atypical Depression Supplement ( SIGH-ADS ) . Adverse events were assessed using the Young Mania Rating Scale ( YMRS ) and Systematic Assessment for Treatment Emergent effects ( SAFTEE ) . All outcome variables were statistically analyzed using a mixed model repeated measure analysis of variance ( ANOVA ) . The results showed no statistically significant differences between groups in any outcome measures at study end point ; adverse events , including switches into hypomania , were rare . Further research is needed to determine the efficacy of bright light therapy in this population OBJECTIVE Early , effective treatment in first-episode schizophrenia is advocated , although evidence based on a systematic approach over multiple antipsychotic trials is lacking . Employing a naturalistic design , we examined response rates over 3 circumscribed antipsychotic trials . METHOD Between June 2003 and December 2008 , 244 individuals with first-episode schizophrenia or schizoaffective disorder according to DSM-IV criteria were treated at the Centre for Addiction and Mental Health , Toronto , Ontario , Canada , following an algorithm that moved them through 2 antipsychotic trials , followed by a trial with clozapine . For the first 2 trials , treatment consisted of risperidone followed by olanzapine , or vice versa ; each trial consisted of 3 stages ( low- , full- , or high-dose ) lasting up to 4 weeks at each level and adjusted according to response/tolerability . Clinical response was defined as a Clinical Global Impressions-Improvement score of 2 ( much improved ) or 1 ( very much improved ) and /or a Brief Psychiatric Rating Scale Thought Disorder subscale score ≤ 6 . Data were analyzed retrospectively , and publication of anonymized clinical data was approved by the Research Ethics Board of the Centre for Addiction and Mental Health in May 2003 . RESULTS In trial 1 , 74.5 % of individuals responded , with rates significantly higher for olanzapine ( 82.1 % , 115/140 ) versus risperidone ( 66.3 % , 69/104 ; P = .005 ) . With trial 2 , response rate dropped dramatically to 16.6 % but again was significantly higher for olanzapine ( 25.7 % , 9/35 ) compared to risperidone ( 4.0 % , 1/25 ; P = .04 ) . Response rate climbed above 70 % once more , specifically 75.0 % ( 21/28 ) , in those individuals who agreed to a third trial with clozapine . CONCLUSIONS Results confirm a high response rate ( 75 % ) to initial antipsychotic treatment in first-episode schizophrenia . A considerably lower response rate ( < 20 % ) occurs with a second antipsychotic trial . Results here were specific to olanzapine and risperidone , suggesting clinical differences ( ie , olanzapine more effective than risperidone ) . A subsequent trial with clozapine is clearly warranted , although it remains unclear whether outcome would be further enhanced if it were used earlier in the treatment algorithm OBJECTIVES Data from the Australian National Study of Low Prevalence ( Psychotic ) Disorders were used to describe the clinical and sociodemographic profile of individuals with bipolar disorder , their levels of impairment and disability , and use of medication and treatment services .  METHODS A 1-month census of contacts with mental health services , private psychiatric and general practice s , as well as contact points in marginalized setting s , was conducted in a national catchment of 1.1 million adults . The census yielded 3,800 individuals who screened positive for psychosis , of whom a r and om sample of 980 were administered a comprehensive semi-structured interview schedule . Results are presented on 112 persons with an ICD-10 diagnosis of bipolar disorder . RESULTS Overall , 69.6 % of the 112 persons who met the ICD-10 criteria for bipolar disorder reported a recurrent episodic illness , 25.0 % had a chronic course without clear remissions , and 5.4 % had a single episode of mania . Assessed on a lifetime basis , suicidal ideation was common ( 78.6 % ) and levels of drug and alcohol abuse/dependence were high ( 32.1 % ) . The majority ( 84.8 % ) had had at least one contact with inpatient , outpatient or emergency services in the previous year . Those with serious impairment had levels of service utilization similar to the rest of the sample , but were more likely to report a poorer quality of life and unmet service needs . While the percentage experiencing social and occupational dysfunction was substantial and similar for both sexes , women appeared to be better integrated socially than men . Comparisons with schizophrenia patients within the same survey sample highlighted less chronic impairment but equal or greater utilization of services by bipolar patients . CONCLUSIONS Despite low levels of chronicity , the burden of social disablement associated with bipolar disorder is high . The data suggest a number of important gaps in the provision of services for this predominantly treated population OBJECTIVE Clinical response to antipsychotic drug treatment is highly variable , yet prognostic biomarkers are lacking . The authors recently demonstrated that successful antipsychotic drug treatment alters resting-state functional connectivity of the striatum . The goal of the present study was to test whether intrinsic striatal connectivity patterns provide prognostic information and can serve as a potential biomarker of treatment response to antipsychotic drugs . METHOD The authors used resting-state functional MRI ( fMRI ) to develop a prognostic index in a discovery cohort of 41 first-episode schizophrenia patients , then tested this index in an independent cohort of 40 newly hospitalized chronic patients with acute psychosis . In the discovery cohort , patients underwent  resting-state fMRI scanning at the initiation of r and omized controlled treatment with a second-generation antipsychotic . Whole-brain functional connectivity maps were generated for each subject from striatal seed regions . A stringent measure of clinical response was calculated that required sustained improvement over two consecutive study visits . Clinical response was entered into a survival analysis , and Cox regression was applied to the functional connectivity data . A striatal connectivity index was created , comprising functional connections of the striatum that predicted treatment response . This striatal connectivity index was tested on a generalizability cohort of patients with psychotic disorders who were hospitalized for an acute psychotic episode . RESULTS A total of 91 regions functionally connected with the striatum provided significant prognostic information . Connectivity in these regions was used to create a baseline striatal connectivity index that predicted response to antipsychotic treatment with high sensitivity and specificity in both the discovery and generalizability cohorts . CONCLUSIONS These results provide evidence that individual differences in striatal functional connectivity predict response to antipsychotic drug treatment in acutely psychotic patients . With further development , this has the potential to serve as a prognostic biomarker with clinical utility and to reduce the overall burden associated with psychotic illnesses BACKGROUND Family intervention in schizophrenia can reduce patient relapse and improve medication adherence , but few studies on this have involved a Chinese population . AIMS To examine the effects of a mutual support group for Chinese families of people with schizophrenia , compared with psychoeducation and st and ard care . METHOD R and omised controlled trial in Hong Kong with 96 families of out- patients with schizophrenia , of whom 32 received mutual support , 33 psychoeducation and 31 st and ard care .  The psychoeducation group included patients in all the sessions , the mutual support group did not . Intervention was provided over 6 months , and patient- and family-related psychosocial outcomes were compared over an 18-month follow-up . RESULTS Mutual support consistently produced greater improvement in patient and family functioning and caregiver burden over the intervention and follow-up periods , compared with the other two conditions . The number of readmissions did not decrease significantly , but their duration did . CONCLUSIONS Mutual support for families of Chinese people with schizophrenia can substantially benefit family and patient functioning and caregiver burden BACKGROUND Cognitive deficits are predictors of functional outcome in patients with psychosis . While conventional antipsychotics are relatively effective on positive symptoms , their impact on negative and cognitive symptoms is limited . Recent studies have established a link between oxidative stress and neurocognitive deficits in psychosis . N-acetylcysteine ( NAC ) , a glutathione precursor with glutamatergic properties , has shown efficacy on negative symptoms and functioning in patients with schizophrenia and bipolar disorder , respectively . However , there are few evidence -based approaches for managing cognitive impairment in psychosis . The present study aims to examine the cognitive effects of adjunctive NAC treatment in a pooled subgroup of participants with psychosis who completed neuropsychological assessment in two trials of both schizophrenia and bipolar disorder . METHOD A sample of 58 participants were r and omized in a double fashion to receive 2 g/day of NAC ( n = 27 ) or placebo ( n = 31 ) for 24 weeks . Attention , working memory and executive function domains were assessed . Differences between cognitive performance at baseline and end point were examined using Wilcoxon 's test . The Mann-Whitney test was used to examine the differences between the NAC and placebo groups at the end point . RESULTS Participants treated with NAC had significantly higher working memory performance at week 24 compared with placebo ( U = 98.5 , p = 0.027 ) . CONCLUSIONS NAC may have an impact on cognitive performance in psychosis , as a significant improvement in working memory was observed in the NAC-treated group compared with placebo ; however , these preliminary data require replication . Glutamatergic compounds such as NAC may constitute a step towards the development of useful therapies for cognitive impairment in psychosis There is evidence that major psychiatric discords such as schizophrenia ( SZ ) and bipolar disorder ( BD ) are associated with dysregulation of synaptic plasticity with downstream alterations of neurotrophins . Brain-derived neurotrophic factor ( BDNF ) is the most widely distributed neurotrophin in the central nervous system ( CNS ) , and performs many biological functions such as promoting the survival , differentiation , and plasticity of neurons . Variants in the BDNF gene increase the risk of SZ and bipolar disorder . Chronic administration of drugs used to treat SZ and BD , such as lithium , valproate , quetiapine , clozapine , and olanzapine , increases BDNF expression in rat brain . To examine serum BDNF , three groups of chronically medicated DSM-IV SZ patients , on treatment with clozapine ( n=27 ) , typical ( n=14 ) , and other atypical antipsychotics ( n=19 ) , 30 euthymic BD patients , and 26 healthy control had 5 ml blood sample s collected by venipuncture . Serum BDNF levels were significantly higher in SZ patients ( p<0.001 ) when compared to either controls or euthymic BD patients . Increased BDNF in SZ patients might be related to the course of illness or to treatment variables . Prospect i ve studies are warranted Cannabidiol ( CBD ) , a major phytocannabinoid constituent of cannabis , is attracting growing attention in medicine for its anxiolytic , antipsychotic , antiemetic and anti-inflammatory properties . However , up to this point , a comprehensive literature review of the effects of CBD in humans is lacking . The aim of the present systematic review is to examine the r and omized and crossover studies that administered CBD  to healthy controls and to clinical patients . A systematic search was performed in the electronic data bases PubMed and EMBASE using the key word “ cannabidiol ” . Both monotherapy and combination studies ( e.g. , CBD + ∆9-THC ) were included . A total of 34 studies were identified : 16 of these were experimental studies , conducted in healthy subjects , and 18 were conducted in clinical population s , including multiple sclerosis ( six studies ) , schizophrenia and bipolar mania ( four studies ) , social anxiety disorder ( two studies ) , neuropathic and cancer pain ( two studies ) , cancer anorexia ( one study ) , Huntington ’s disease ( one study ) , insomnia ( one study ) , and epilepsy ( one study ) . Experimental studies indicate that a high-dose of inhaled/intravenous CBD is required to inhibit the effects of a lower dose of ∆9-THC . Moreover , some experimental and clinical studies suggest that oral/oromucosal CBD may prolong and /or intensify ∆9-THC-induced effects , whereas others suggest that it may inhibit ∆9-THC-induced effects . Finally , preliminary clinical trials suggest that high-dose oral CBD ( 150–600 mg/d ) may exert a therapeutic effect for social anxiety disorder , insomnia and epilepsy , but also that it may cause mental sedation . Potential pharmacokinetic and pharmacodynamic explanations for these results are discussed
Findings related to effectiveness ( treatment discontinuation , quality of life , and neurocognitive improvements ) were generally consistent with those observed in non-Chinese population s. No new safety signals specific for Chinese population s were raised for olanzapine .
Chinese and non-Chinese population s with schizophrenia or bipolar disorder treated with olanzapine display broadly similar responses .
BACKGROUND Despite the burden of schizophrenia and bipolar disorder in the Chinese population , country-specific data to guide practitioners regarding antipsychotic therapy are lacking .