bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can Quetiapine Induced Hypothyroidism be Reversible?
Authors: Kontaxakis V. , Karaiskos D. , Havaki-Kontaxaki B. , Skourides D. , Ferentinos P. , Pappa D. , Papadimitriou G. 
Published: March 2009

Objective:Quetiapine induced hypothyroidism is a rare side effect requiring either drug discontinuation or initiation of thyroid replacement therapy. We highlight the potential reversibility of quetiapine induced hypothyroidism in two such cases.Methods:Two case reports.Results:Case 1.Quetiapine (200mg/day) was initiated to a psychotic female patient due to exaggeration of positive symptomatology. Although her thyroid function tests (TFTs) upon admission were normal after a month significant decreases in T3 and T4 level and an elevation in TSH was observed. 45 days later the TFT returned to normal, although she remained on quetiapine. Case 2. Quetiapine (300mg/daily) was prescribed to a bipolar male patient due to a mixed affective episode with a very good response. Despite his normal admission TFTs, three weeks later a decrease in total T4 and a marked increase in TSH was observed .45 days later, although no measures were taken, TFTs returned within reference range.Conclusions:These are the first cases reporting reversibility of quetiapine induced hypothyroidism. TFTs alterations are dose related, relatively slight and linked to a positive history of thyroid abnormality. Our patients did not fulfil any of these criteria. Besides, hypothyroidism resolved although the antipsychotic therapy was continued and no thyroid replacement therapy was given. We suggest a careful thyroid monitoring for patients initiating quetiapine. However, physicians should wait in cases of thyroid dysfunction, since thyroid dysregulation may soon be resolved.
Clozapine as an Antiagressive Agent in an Adolescent with Autism
Authors: Lambrey S. , Quilici G. , Bonnefoy C. , Rosier A. , Guillin O. 
Published: March 2009

Violent behaviours such as aggression or self-harming are commonly observed in persons with autistic disorders. They constitute the main reason for emergency admissions of these patients to the hospital and can sometimes result in substantial physical injuries toward the patients themselves or towards others. Atypical antipsychotics have been emerging for some years as the first-line pharmacologic treatment for violence in children with autism or other pervasive development disorders. in particular, the anti aggressive effect of risperidone and olanzapine has been found significant in double-blind, placebo-controlled trials and North American and European agencies recently approved the use of risperidone for the treatment of aggressiveness in children with autism. by contrast, clozapine has received very little attention so far.Here we report the case of a 15-years old adolescent with autism whose severe tantrums and violent behaviours were not improved by risperidone or haloperidol but were drastically improved with clozapine (more than 40% reduction of violent events). the anti aggressive effect of clozapine has been sustained for one year of follow-up. No significant side effects were reported in this patient and co prescription was reduced by 50%. This case report suggests the importance to conduct controlled trials assessing the efficiency of clozapine for the treatment of aggressiveness in patients with autism. More generally, specific anti aggressive properties of clozapine are discussed in the light of the relevant literature.
Clozapine Treatment for Resistant Schizophrenia May Reveal UN Unusual Hematological Disease: Polycythemia Vera. Case Report
Authors: Marian G. , Ionescu B. , Ghinea D. , Alina N. 
Published: March 2009

Background:Clozapine remains the gold standard of treatment for schizophrenic patients with treatment-resistant symptoms. Sometimes patients develop unusual hematological reactions with increased mostly red blood cells, which rises differential diagnostic issues: is it a side effect of clozapine treatment or is it a primary medical condition?Aim:To elucidate the etiology of the hematological disturbances in order both to control psychotic symptoms as well as to maintain an optimal somatic profile of the patient.Method:41 years female with a long history of schizophrenia became refractory of treatment, so clozapine was instituted as treatment of first choice. by monitoring paraclinical parameters we found progressive increased of the blood cells, mainly red blood cells, which has un unpredictable risk for somatic complications. We approached this case by interdisciplinary management-psychiatric and hematological to find the etiology of this peculiar comorbid condition.Results:The evaluations performed led us to the conclusion that there are two different nosologic entities, treatment of the psychiatric condition revealing polycythemia vera. This conclusion required reducing clozapine dose and adding another atypical antipsychotic. All subsequent evaluations demonstrated the efficiency in managing the psychiatric disorder and even an improvement in hematological condition.Conclusion:Treatment-resistant schizophrenia remains a challenge for psychiatrists, clozapine treatment requiring for an active monitoring because it can be a trigger for an unusual somatic disease-polycythemia vera.
Development of a Tool to Improve Screening Rates for Cardiometabolic Risk Factors Associated with Mental Illness
Authors: Newcomer J. , Haupt D. 
Published: March 2009

Major mental illness is associated with premature mortality, primarily from cardiovascular disease. Modifiable risk factors include obesity, smoking, hyperglycemia, dyslipidemia and hypertension, all prevalent in this population, and commonly underrecognized and undertreated. Public health guidelines for screening and interventions to lower risk have reduced cardiovascular mortality in the general population, but these improvements have not extended to mentally ill populations. Recent recommendations to screen in this population have come from psychiatric professional groups, and in relation to regulatory warnings on potential adverse drug effects. However, recent studies suggest low levels of monitoring, both pre- and post-guidelines and warnings.Public health interest is now directed at improving screening in this population. One of the barriers to increasing screening is limited awareness among mental health professionals of the details of existing public health guidelines that define specific risk thresholds, diagnostic values and treatment targets for adiposity, blood pressure, plasma glucose and plasma lipids levels. Quality assurance/quality improvement (QA/QI) tools to facilitate screening include data collection forms that educate about risk parameters and organize patient data in a manner that helps to track risk over time.This presentation will describe a specific QA/QI tool for screening and monitoring cardiometabolic risk in the mentally ill, based on published guidelines from the European Association for the Study of Diabetes (EASD) and the European Society for Cardiology (ESC). Cardiometabolic screening, along with treatment approaches and interventions to reduce risk, offers an established public health approach to lower morbidity and mortality in vulnerable populations.
A Review of Metabolic Parameters in Quetiapine Studies Across Diagnoses
Authors: Newcomer J. , Ratner R. , Åström M. , Eriksson H. 
Published: March 2009

Background:Data pertaining to changes in weight during long-term treatment with quetiapine (QTP) have been published previously (1).Methods:Pooled data are presented from 26 short-term clinical studies (up to 12 weeks) of QTP or quetiapine extended-release (QTP XR)-as monotherapy or adjunct therapy-conducted by AstraZeneca up to November 2007. Studies were conducted in adult patients (18-65 years) across a number of psychiatric diagnoses. Variables were analyzed irrespective of fasting status with similar analyses planned in the fasting subset. LSM changes from baseline for the difference between QTP and placebo are presented.Results:Approximately 10000 patients were included in the analyses, 70% of whom were treated with QTP or QTP XR. Across the entire short-term dataset, the difference in LSM change in weight for QTP vs. placebo was 1.07 kg. Corresponding differences in glucose regulation parameters were 1.39 mg/dL for glucose and 0.04% units for HbA1C. the overall difference in total cholesterol was 5.48 mg/dL, with differences in HDL and LDL cholesterol of -0.62 mg/dL and 1.69 mg/dL. the difference in LSM change in triglycerides was 22.62 mg/dL.Discussion:Within the context of balancing potential risks against the acknowledged benefits of atypical antipsychotics, the degree and significance of variations in metabolic parameters is an area of continued interest. This analysis helps clinicians to better understand changes in important metabolic parameters across trials with QTP and QTP XR, and the size and uniqueness of the dataset permits further analyses within this important area.Supported by funding from AstraZeneca Pharmaceuticals LP.
Evaluation of Dyslipidaemia Risk among Patients Treated with Aripiprazole: Meta Analysis of Placebo- and Olanzapine-controlled Studies
Authors: Peyro-Saint-Paul H. , Loze J.-Y. , Kaplita S. , Han J. , Baker R.A. , Cahn R. , Owen R. 
Published: March 2009

Aims:To evaluate dyslipidaemia risk among patients with schizophrenia treated with aripiprazole or olanzapine.Methods:Pooled analysis of the aripiprazole clinical database, including studies of ≥7 days with at least an oral aripiprazole monotherapy arm. Mean changes from baseline to endpoint and shifts from normal to abnormal lipid levels were calculated.Results:Seventeen placebo- and five olanzapine-controlled studies (3 weeks->3 years) of adult patients (≥18 years) were included. Mean changes (LOCF) in lipids were similar between aripiprazole and placebo for all lipid parameters; aripiprazole showed significant improvements versus olanzapine (p≤0.01). the incidence (OC) of switching to abnormal lipid levels from baseline normal was similar between placebo and aripiprazole, and significantly lower with aripiprazole than olanzapine for most measures.Conclusion:Despite limitations inherent to pooled analyses, these findings lend further support to the differential profile of atypicals, with aripiprazole showing effects on lipids comparable with placebo.
Clozapine Induced Rash: Case Report of Successful Desensitization
Authors: Singh R. , Raju K. , Southern J. , Darroch J. 
Published: March 2009

Aim:Clozapine is the drug of choice for patients with treatment-resistant schizophrenia. However a minority of them have been unable to continue with Clozapine due to side-effects, for example rash. This report looks at the use of graded desensitization in a patient who developed cutaneous reactions to Clozapine.Method:This report describes the management of a patient with treatment resistant-schizophrenia, mild learning disabilities and epilepsy, following a cutaneous reaction to Clozapine. Having been maintained on Clopixol depot until 4 years ago, he required a change in antipsychotics following a relapse of psychotic symptoms. He was then treated unsuccessfully with various anti-psychotics, before starting Clozapine, to which he showed a good response. Unfortunately he developed an eczematous rash on two separate occasions when the drug was introduced. Again he was tried on other anti-psychotics, to which he also developed a rash. He was then put on a graded desensitization regimen of liquid Clozapine.Results:Graded desensitization, using incremental increases in drug dose, allowed maintenance treatment with therapeutic doses of Clozapine to be achieved in the absence of cutaneous hypersensitivity reactions. the patient's previously treatment-resistant psychotic symptoms were improved by this method.Conclusion:We should be aware of possibilities for the management of both the common and uncommon side-effects associated with Clozapine, as the result might vastly improve the patients’ quality of life. Desensitisation regimens can be an effective means of overcoming drug hypersensitivity but should be used with great caution, especially when patients exhibit delayed-type hypersensitivity reactions.
Functional Recovery in Schizophrenia and Schizoaffective Disorder: Results from the Risperidone Long-acting Injectable Versus Quetiapine Relapse Prevention Trial (constatre)
Authors: Rouillon F. , Eriksson L. , Burba B. , Raboch J. , Kaprinis G. , Schreiner A. 
Published: March 2009

Objective:To report the functional recovery results from an open-label, randomized-controlled, relapse prevention trial (ConstaTRE) in stable patients with schizophrenia or schizoaffective disorder treated with risperidone long-acting injectable (RLAI) or the oral atypical antipsychotic quetiapine.Methods:Clinically stable adults with schizophrenia or schizoaffective disorder previously treated with oral risperidone, olanzapine, or oral conventional antipsychotics were randomized to treatment with either RLAI (25 mg every-two-weeks) or quetiapine (300-400 mg/day) for 24 months. Functional recovery was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS) and two quality-of-life (QoL) measures (Short -Form 12 [SF-12] and Schizophrenia Quality-of-Life Scale Revision 4 [SQLS-R4]).Results:710 subjects were randomized to treatment with RLAI or quetiapine (n=355 patients/group). Baseline demographics were similar between treatment groups. Relapse occurred in 16.5% RLAI and 31.3% quetiapine patients. A total of 105 RLAI and 107 quetiapine patients dropped out of the study for other reasons than relapse, most commonly due to withdrawal of consent. A significant improvement in SOFAS, SF-12, and SQLS-R4 scores was observed from baseline to month-24 with both RLAI and quetiapine. at months 6, 12, and endpoint, SOFAS had significantly increased more for RLAI than quetiapine (p< 0.05).Conclusions:Among stable patients with schizophrenia or schizoaffective disorder, the likelihood of functional recovery appears to be higher in those switching to RLAI. Improvement in functional status and QoL from baseline was observed with both RLAI and quetiapine.
Survey of Safety and Efficacy of Long-acting Injectable Risperidone in Daily Practice: An Open-label, Non-interventional Prospective Study
Authors: Parellada E. , Kouniakis F. , Siurkute A. , Schreiner A. , Don L. 
Published: March 2009

Objective:This post-authorization safety survey evaluated the long-term safety, tolerability, and efficacy of risperidone long-acting injectable (RLAI) in routine clinical practice.Methods:In this 6-month, multicenter, European, naturalistic survey, patients were included if, during routine clinical practice, long-term antipsychotic therapy with RLAI was deemed necessary by the treating physician. Efficacy measures (at baseline and after 1, 3, 6 months) included Clinical Global Impression-Severity (CGI-S) and Global Assessment of Functioning (GAF). Safety was evaluated by recording treatment-emergent adverse events (TEAEs) at every visit.Results:RLAI was initiated in 5,134 predominantly male (58.6%) patients (aged 14-94 years) with a diagnosis of paranoid schizophrenia (69.8%). RLAI initial doses were 25 mg every-two-weeks in 37.0%, or 50 mg in 44.4% of patients. at endpoint, RLAI dosages were 50 mg in 49.3% of patients, 25 mg in 27.0%, and 37.5 mg in 22.1%. Six-month treatment with RLAI was completed by 4,314 patients (84.0%). RLAI was discontinued due to loss to follow-up (n=346;6.7%), insufficient response (n=116;2.3%), and AEs (n=106;2.1%). CGI-S significantly improved from baseline to endpoint (p< 0.001). Patient functioning in the GAF scale also significantly improved from baseline to endpoint (45.4±16.0 versus 62.4±17.7, respectively, p< 0.001). TEAEs were recorded by 20% of patients. AEs occurring in ≥5% of patients were akathisia, extrapyramidal disorders, depression, psychotic disorder, anxiety, and weight gain. Serious AEs were reported by 384 (8%) patients.Conclusions:This large prospective survey confirms the good safety, tolerability, and efficacy of RLAI as reported in previous controlled clinical trials when used in routine clinical practice.
Effects of Topiramate in Prevention of Obesity in Schizophrenic Patients Treated by Olanzapine
Authors: Talaei A. 
Published: March 2009

Aims:Schizophrenic patients treated with atypical antipsychotics commonly suffer weight gain. Additive flow of using these drugs lead to more researches to solve this problem. Weight gain is associated not only with several medical conditions (such as hypertension, diabetes, cardiovascular disease, etc) but also may be related to treatment noncompliance. Topiramate is an anticonvulsant drug that has been used in psychiatric disorders and also leads to weight reduce. Many researches have been studied this effect of topiramate and positive outcomes of weight reduce without creation or development of psychotic signs have already been reported. as there is no approved therapeutic dose of topiramate for appropriate weight loss and also no study referred to its prophylactic effect of weight gain in these patients, in this study we proceed to check forenamed subjects.Method:Forty - eight schizophrenic patients treated with olanzapine in beginning of hospitalization in Ibn-e-Sina Hospital were selected and randomly placed in four groups: placebo, 50, 100, 200 mg topiramate daily was added to their treatment regimen. Patients were followed for 12 weeks for body weight changes, BMI, waist and wrist diameters. Data were analyzed by SPSS software.Results:Only BMI and waist diameter had significant difference in patients treated with 200 mg topiramate daily in compare with placebo group in 12th week. other data had no significant difference in handling.Conclusion:Prophylactic treatment of obesity in schizophrenic patients with topiramate is effective in 200 mg daily dosage and no significant adverse effects were found.
Antipsychotic Combinations in an Acute Psychiatric Unit
Authors: Manteiga A. Tatay , Magán T. Merino , Diez-Canseco M. Lloret , Sopena L. Laguna , Díez S. Cepeda , Boada P. Cervera , Garibo M. Medina , Crespo R. Calabiug 
Published: March 2009

Introduction:Available data does not recommend antipsychotic drug combinations in treatment of psychotic symptoms and monotherapy is nowadays considered the option with the highest scientific evidence. Nevertheless, antipsychotics combination is a common practice in countries such as USA (40-60%), Japan (90%) and Spain (50-70%).Aims:To determine antipsychotic combinations frequency in patients with a diagnosis into the psychotic spectrum admitted in an acute psychiatric unit. to determine the differences among these combinations according to diagnosis. to analyze which are the associations more commonly prescribed as well as the theoretical basis that supports them according to receptorial profiles.Methods:Demographic and clinical data of patients with a psychotic-spectrum diagnosis admitted to the Doctor Peset University Hospital acute unit during 2004-2007 were retrospectively analyzed. We observed the percentage of patients treated with more than one antipsychotic drug, as well as the combinations more frequently prescribed.Results:Out of 677 analyzed patients, 302 were treated with an antipsychotic combination therapy (45%). the associaton most commonly prescribed was an oral atypical antipsychotic + an intramuscular atypical antipsychotic (121 patients). According to diagnosis, 50% from each diagnostic group was treated with a combination antipsychotic therapy.Conclusions:There is a high percentage of inpatients treated with more than one antipsychotic. We found no significant differences by diagnosis nor any clearly-defined key according to receptorial profiles.
Anger Expression in Obsessive-compulsive Spectrum Disorders (SOGS): Common and Differential Traits
Authors: Krug I. , Julia-Capmany I. Bueno , Aymami-Sanroma N. , Jimenez-Murcia S. , Jaurrieta N. , Forcano L. , Aguera Z. , Villarejo C. , Castejon V. , Menchon-Magrina J.M. , Fernandez-Aranda F. 
Published: March 2009

Objective:The objective of this study was to examine the experience and expression of anger in eating disorders (EDs) including bulimia nervosa purging (BN-P) and anorexia nervosa restrictive (AN-R) subtypes, impulsive disorders such as pathological gambling (PG), obsessive-compulsive disorder (OCD) and a non psychiatric healthy control group.Method:The sample comprised 80 female SODs individuals (20 BN-P, 21 AN-R, 19 PG, 21 TOC) consecutively admitted to our Department and 21 healthy controls. Patients were diagnosed according to DSM-IV-R criteria. We administered the State-Trait Anger Expression Inventory-2 (STAXI-2). in the control group, the GHQ-28 was also employed.Results:Compared to the healthy control group, elevated Trait Anger scores were revealed for the BN-P (p< .011) and OCD (p< .003) groups. in addition, the OCD group scored higher on this scale than the PG patients (p< .039). as regards to State Anger, higher scores were uncovered for the OCD patients than for the control group (p< .017). Finally, when Anger Expression was assessed, higher scores were found for the OCD (p< .001) and BN (p< .001) individuals when compared to healthy controls. in addition, compared to AN-R, the BN-P and OCD exhibited higher scores on this scale (p< .001 and p< .037, respectively).Conclusions:Our results indicate that, OCD and BN-P patients may have inadequate anger expressions and deficits in coping with anger and frustration when compared to a healthy control group. Conversely, no significant differences were revealed between AN-R, PG and controls. Finally, some differences across diagnoses were also obtained.
Benefit of Clomipramine-quetiapine Combination in Obsessive-compulsive Disorder with Non Response to Serotonin Selective Reuptake Inhibitors. Case Report
Authors: Marian G. , Ionescu B. , Ghinea D. , Alina N. 
Published: March 2009

Background:Patients who suffer of obsessive-compulsive disorder (OCD) experience obsessive thoughts and/or urges to engage in compulsive behaviours. the condition causes severe discomfort and, in many cases, leads to serious impairment in social and work-related functioning.Although antipsychotic monotherapy has been associated with ineffectiveness and even increase of psychotic symptoms (especially in psychotic patients), antipsychotics as adjuvant to antidepressant medication have proven to be effective in several case series and pilot clinical trials.The objective of this case was to evaluate the effectiveness of clomipramine-quetiapine combination in OCD refractory to serotonin selective reuptake inhibitors treatment patient.Method:23 years unemployed male was diagnosed with OCD after 1 year from onset and received 3 trials with serotonin selective reuptake inhibitors at therapeutical doses, without any improvement and even more with worsening of affective associated symptoms. We managed this case by using a tricyclic antidepressant (clomipramine up to 100 mg/day) with an atypical antipsychotic (quetiapine up to 200 mg/day). We employed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive-Compulsive Checklist (OCC) and Hamilton Depression rating Scale (HDRS) at baseline, weekly for the first 2 months and monthly after (follow up 2 years).Results:Patient achieved a very fast and sustained improvement both in obsessive-compulsive and affective symptoms, which provided a very good social and work rehabilitation.Conclusion:Clomipramine-quetiapine combination may be a benefit for OCD refractory to serotonin selective reuptake inhibitors and a safe strategy.