Achieving the Lowest Effective Antipsychotic Dose for Patients with Remitted Psychosis: A Proposed Guided Dose-Reduction Algorithm

AbstractContinuing antipsychotic treatment in patients with schizophrenia under clinical remission remains controversial. Even though the mainstream opinion declares an outweighed balance against medication discontinuation, recent reviews and critiques suggest that some patients may remain symptom free and well functioning after stopping antipsychotics, but few predictors can identify who can try medication discontinuation, whilst no guidelines exist for reducing medication to reach the lowest effective dose safely. Analyzing the findings from studies employing different methodologies, adopting evidence from pharmacodynamic research, and observing dose reduction in stable patients, as well as taking inspiration from the metaphor of the Cantor set in natural philosophy, we introduce an alternative solution and propose a guided dose-reduction algorithm that follows a set of clear precautions and instructions. The algorithm recommends only a fraction (no more than 25%) of the dosage to be reduced at a time, with at least a 6-month stabilization period required before reducing another 25% of the dose. Patients are empowered to actively participate in decision making when they are ready for further dose tapering, or should they retreat to a previous dosage if warning signs of a relapse re-emerge. An intermittent or irregular dosing schedule can be used to adapt this algorithm to real-world practice. Our preliminary findings suggest that patients with remitted psychosis can do well...
Source: CNS Drugs - Category: Neurology Source Type: research

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Publication date: Available online 7 December 2019Source: Saudi Pharmaceutical JournalAuthor(s): Kinga OstrowskaAbstractA number of psychiatric disorders, including anxiety, schizophrenia, Parkinson’s disease, depression and others CNS diseases are known to induce defects in the function of neural pathways sustained by the neurotransmitters, like dopamine and serotonin. N-arylpiperazine moiety is important for CNS-activity, particularly for serotonergic and dopaminergic activity. In the scientific literature there are many examples of coumarin-piperazine derivatives, particularly with arylpiperazines linked to a coum...
Source: Saudi Pharmaceutical Journal - Category: Drugs & Pharmacology Source Type: research
Functional coupling of M1 muscarinic acetylcholine receptor to Gαq/11 in dorsolateral prefrontal cortex from patients with psychiatric disorders: a postmortem study. Eur Arch Psychiatry Clin Neurosci. 2019 Dec 05;: Authors: Odagaki Y, Kinoshita M, Meana JJ, Callado LF, García-Sevilla JA Abstract Accumulating studies have implicated intracellular signaling through muscarinic acetylcholine receptors (mAChRs) in psychiatric illness. In the present study, carbamylcholine chloride (carbachol)-induced Gαi/o and Gαq/11 activation was identified in postmortem human prefrontal cortical ...
Source: European Archives of Psychiatry and Clinical Neuroscience - Category: Psychiatry Tags: Eur Arch Psychiatry Clin Neurosci Source Type: research
ConclusionsRumination is known to be associated with poor prognosis in mental health. This study suggests that rumination is a maladaptive coping style associated not only with worry, distress and illness severity, but also with socioeconomic status. Also, rumination demonstrated a specific association with panic disorder.
Source: Journal of Psychiatric Research - Category: Psychiatry Source Type: research
Publication date: Available online 7 December 2019Source: Progress in NeurobiologyAuthor(s): M.M.J. van den Berg, J. Krauskopf, J.G. Ramaekers, J.C.S. Kleinjans, J. Prickaerts, J.J. BriedéAbstractCirculating microRNAs (cimiRNAs) are a class of non-encoding RNAs found in bodily fluids such as blood, cerebrospinal fluid (CSF) and tears. CimiRNAs have been implicated as promising biomarkers for central nervous system (CNS) disorders because they are actively secreted as messengers and are profoundly involved in fine-tuning of developmental and differentiation processes. Furthermore, they are attractive biomarkers becau...
Source: Progress in Neurobiology - Category: Neuroscience Source Type: research
Contributors : Tae-Yeon Eom ; Seung B Han ; Jieun Kim ; Jay Blundon ; Yong-Dong Wang ; Jing Yu ; Matthew Eicholtz ; Derek C Rose ; Kara Anderson ; Damian B Kaminski ; Stanislav S ZakharenkoSeries Type : Non-coding RNA profiling by arrayOrganism : Mus musculusProgressive ventricular enlargement is one of the most reproducible and recognizable structural abnormalities in schizophrenia, and is associated with more severe symptoms and poorer clinical outcome. The mechanisms of ventricular enlargement in schizophrenia is unknown. We identified that progressive ventricular enlargement is associated with deceleration of motile ci...
Source: GEO: Gene Expression Omnibus - Category: Genetics & Stem Cells Tags: Non-coding RNA profiling by array Mus musculus Source Type: research
AbstractMajor psychiatric traits are genetically inter-correlated with one another, but it not well known which genes play pleiotropic effects across different traits. We curated and compared genes identified from large-scale genome-wide association studies for seven psychiatric traits, including depression, bipolar disorder, schizophrenia, autism spectrum disorder, attention-deficit/hyperactivity disorder, anxiety and neuroticism. We then explored biological functions of the top pleiotropic genes. A total of 243 cross-trait genes were identified for the seven traits. Except for autism spectrum disorder, there was signific...
Source: Human Genetics - Category: Genetics & Stem Cells Source Type: research
This study is among the first to test differences in positive mental health between employed and unemployed persons with schizophrenia living in the community. Participants were 101 unemployed individuals with schizophrenia living in the community and 67 employed ones. Socio-demographic data sheet and Mental Health Continuum-Short Form (MHC-SF) were used to collect the data. Results revealed that emotional and psychological well-being were lower in the unemployed group compared to the employed group, however, there was no significant difference in social well-being between the groups. Emotional and psychological well-being...
Source: Psychiatric Quarterly - Category: Psychiatry Source Type: research
Almost half (48%) of children and adolescents with a psychotic disorder said they recently had suicidal thoughts or had in the past considered death by suicide when interviewed in the emergency department (ED) using a brief screening questionnaire, according to areport published this week inPsychiatric Services. Most of these youth did not report a chief complaint related to suicidal ideation or behavior when arriving at the ED.Notably, half of the children and adolescents who screened positive for suicide using the Ask Suicide-Screening Questions (ASQ) screen were discharged from the ED, including 44% of those who reporte...
Source: Psychiatr News - Category: Psychiatry Tags: Ask Suicide-Screening Questions Jonathan DeVylder Psychiatric Services psychotic disorders youth Source Type: research
CONCLUSION: Our findings suggest a relationship between the risk of cardiovascular disease and the duration and overall severity of schizophrenia and also highlights the role of antipsychotics in this relationship. PMID: 31801314 [PubMed - as supplied by publisher]
Source: Psychiatry Investigation - Category: Psychiatry Tags: Psychiatry Investig Source Type: research
Publication date: Available online 5 December 2019Source: International Review of NeurobiologyAuthor(s): Teresa Vargas, Rachel E. Conley, Vijay A. MittalAbstractChronic stress exposure has been established as a key vulnerability factor for developing psychotic disorders, including schizophrenia. A structural, or systems level perspective, has often been lacking in conceptualizations of chronic stress for psychotic disorders. The current review thus identified three subtypes of structural exposures. Stimulation exposures included urban environments, population density and crime exposure, with intermediary mechanisms of lack...
Source: International Review of Neurobiology - Category: Neuroscience Source Type: research
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