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Need to bleed? Clozapine haematological monitoring approaches a time for change
Regular haematological monitoring during clozapine treatment reduces the risk of complications and death from clozapine-related blood dyscrasias. However, many patients in the course of clozapine treatment develop neutropenia unrelated to drug treatment which leads to treatment discontinuation. The minimum haematological threshold allowed for the continuation of clozapine treatment was recently lowered in the US, but not in the UK. In this case series, we present four cases where lowering the haematological cut-off to that used in the US, allowed treatment continuation. Lowering the current UK threshold for clozapine cessa...
Source: International Clinical Psychopharmacology - August 3, 2019 Category: Psychiatry Tags: Case Reports Source Type: research

Clozapine-associated neutropenia in Latin America: incidence report of 5380 Chilean users
Systematic information about Latino clozapine users is still scarce. Our aim was to evaluate the risk of clozapine-associated neutropenia in a Chilean cohort using the last Food and Drug Administration’s recommendations for clozapine monitoring. Findings should improve clinical practice and promote changes in clozapine guidelines in Latin America. We conducted a retrospective observational study of 5380 Chilean clozapine users that started clozapine treatment between 2003 and 2015. The absolute risk of severe neutropenia was 0.61% (33/5380) with an incidence of 0.086 cases per 100 person-years of follow-up. 87.9% of case...
Source: International Clinical Psychopharmacology - August 3, 2019 Category: Psychiatry Tags: Original Articles Source Type: research

Addressing clozapine under-prescribing and barriers to initiation: a psychiatrist, advanced practice provider, and trainee survey
Clozapine use has declined, despite its superior antipsychotic efficacy in treatment-resistant schizophrenia. Implications for clozapine underutilization include suboptimal treatment outcomes and increased hospitalizations. Many barriers preventing the use of clozapine have been described in the literature, including suboptimal knowledge and poor perceptions. The aim of this study was to assess psychiatry prescribers’ perception and knowledge of clozapine. A survey was distributed to advanced practice providers, psychiatrists, and trainees (i.e. residents and fellows) at 10 medical centers within the US and Canada. The s...
Source: International Clinical Psychopharmacology - August 3, 2019 Category: Psychiatry Tags: Original Articles Source Type: research

Cytochrome P450-mediated inhibition of venlafaxine metabolism by trimipramine
This study is to uncover the potential of pharmacokinetic interactions between venlafaxine and trimipramine in a naturalistic sample. Methods Out of a therapeutic drug monitoring database with plasma concentrations of venlafaxine (VEN) and O-desmethylvenlafaxine (ODV), we considered two groups of patients receiving venlafaxine without known cytochrome P450 confounding medications, taking solely venlafaxine: V0 (n = 905), and a group of patients co-medicated with trimipramine, VTRIM (n = 33). For VEN, ODV and active moiety (sum of VEN + ODV) plasma concentrations and dose-adjusted concentrations as well as ODV/VEN ratios...
Source: International Clinical Psychopharmacology - August 3, 2019 Category: Psychiatry Tags: Original Articles Source Type: research

Comparison of the association of risperidone and quetiapine with deteriorating performance in walking and dressing in subjects with Parkinson’s disease: a retrospective cohort study using administrative claims data
This retrospective cohort study was performed to investigate the association between risperidone and deteriorating performance in walking and dressing in subjects with Parkinson’s disease using the Japanese Diagnosis Procedure Combination data. These data include inpatient claims including information from the time of admission to discharge from 89 acute phase National Hospitals in Japan. The data were evaluated by implementing the inverse probability of treatment weighting, using propensity scores estimated from the clinical characteristics of subjects prescribed risperidone or quetiapine. The generalized estimation equ...
Source: International Clinical Psychopharmacology - August 3, 2019 Category: Psychiatry Tags: Original Articles Source Type: research

Comparing the efficacy of ondansetron and granisetron augmentation in treatment-resistant obsessive-compulsive disorder: a randomized double-blind placebo-controlled study
This study aimed to assess the efficacy and tolerability of ondansetron vs. granisetron in patients with treatment-resistant obsessive-compulsive disorder. A randomized clinical trial conducted on 135 patients with a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis of obsessive-compulsive disorder, who were treatment-resistant and receiving stable treatment with selective serotonin reuptake inhibitors and antipsychotic, received 14 weeks (phase I, intervention period) of placebo (n = 45), ondansetron (n = 45, 4 mg), and granisetron (n = 45, 2 mg) daily augmentations. Patients were rated every 2 w...
Source: International Clinical Psychopharmacology - August 3, 2019 Category: Psychiatry Tags: Original Articles Source Type: research

Effectiveness and safety of long-term benzodiazepine use in anxiety disorders: a systematic review and meta-analysis
Long-term benzodiazepines (BZDs) use is not endorsed in the treatment guidelines for anxiety disorders, but is prevalent in the real-world clinical settings. A systematic literature review was performed by using PubMed (last search: May 2019) to identify randomized controlled trials (RCTs) or maintenance studies following RCT that examined the effectiveness of BZDs in patients with anxiety disorders for a duration of 13 weeks or more. Meta-analyses were then conducted regarding changes in the Hamilton Anxiety Rating Scale (HAM-A) scores from baseline through endpoint, all-cause discontinuation, side effects, and the number...
Source: International Clinical Psychopharmacology - August 3, 2019 Category: Psychiatry Tags: Review Source Type: research

The unmasking of hidden severe hyponatremia after long-term combination therapy in exacerbated bipolar patients: a case series
We presented three clinical cases of patients affected by a long-term psychiatric disorder and under polypharmacotherapy for several months. After excluding other potential factors, we hypothesized that pharmacological treatment with a mood stabilizer (oxcarbazepine) associated with a benzodiazepine (delorazepam), a second-generation antipsychotic (olanzapine) or an antidepressant (fluvoxamine), triggered severe hyponatremia ([Na+] ≤125 mEq/L), serum hypo-osmolarity, and elevated inappropriate urine osmolarity added to more diluted sodium concentration. When we discontinued the treatment, clinical conditions of our pat...
Source: International Clinical Psychopharmacology - May 31, 2019 Category: Psychiatry Tags: Case Report Source Type: research

Personalized and precision medicine as informants for treatment management of bipolar disorder
DSM-5 diagnostic categories, defined by a set of psychopathological symptoms are heterogeneous conditions that may include different biological entities, with distinct etiopathogenesis, different courses and requiring different treatment management. For bipolar disorder the major evidences for this lack of validity are the long paths before a proper diagnosis, the inconsistence of treatment guidelines, the long phases of pharmacological adjustment and the low average of long-term treatment response rates. Personalized medicine for mental disorders aims to couple established clinical–pathological indexes with new molecula...
Source: International Clinical Psychopharmacology - May 31, 2019 Category: Psychiatry Tags: Review Source Type: research

Antipsychotics in the general population and the driver population: comparisons from a population-based registry study
This study is intended for updating the epidemiological knowledge of all involved in the control of use of antipsychotics and other driving-impairing medicines (healthcare providers, patients, authorities, and drug developers) in order to improve prescribing/dispensing and a well tolerated use of all driving-impairing medicines by the population. Awareness is needed to improve safety on driving, and there is a need worldwide to improve interventions in the field of medicines and driving. (Source: International Clinical Psychopharmacology)
Source: International Clinical Psychopharmacology - May 31, 2019 Category: Psychiatry Tags: Short Communication Source Type: research

The effectiveness of high-dose escitalopram in the treatment of patients suffering from schizophrenia with comorbid obsessive-compulsive disorder: an open-label study
Obsessive-compulsive disorder frequently co-occur with schizophrenia causing a significant impairment. There is a paucity of published data on the treatment of such complicated patients. It has been suggested that the combination of antipsychotics and antiobsessive agents is the best treatment for schizophrenia with obsessive-compulsive disorder; however, there is no published data regarding the use of high dose (up to 40 mg/day) escitalopram. This open-label, prospective study was designed to investigate the efficacy, short-term safety and tolerability of escitalopram in doses up to 40 mg in patients with schizophreni...
Source: International Clinical Psychopharmacology - May 31, 2019 Category: Psychiatry Tags: Original Articles Source Type: research

Effects of antidepressant treatments on health service utilization and medical costs among patients with depression: a nationwide population-based retrospective cohort study in Taiwan
This study aimed to assess the associations between the use of different types of antidepressants and health service utilization and costs among depressed patients. Data used in this study were retrieved from the Taiwan National Health Insurance Research Database. We identified 447 411 new antidepressant users during the study period (2011–2015) and they were individually followed for a 1-year period. Two-part generalized estimating equation models were conducted. Results demonstrated that there was a substantial decrease in outpatient service utilized by patients undertaking serotonin antagonists and reuptake inhibito...
Source: International Clinical Psychopharmacology - May 31, 2019 Category: Psychiatry Tags: Original Articles Source Type: research

Attrition in treatment-resistant depression: predictors and clinical impact
The aim of this study was to investigate attrition (dropout) during a second antidepressant trial in treatment-resistant depression. Three hundred forty-two outpatients with major depressive disorder and lack of response to a prior antidepressant were treated with venlafaxine for 6 weeks. Sociodemographic and clinical characteristics were compared between the attrition and non-attrition groups. Attrition was reported in 65 patients (19%), of whom 30 patients (46%) dropped out within week 4. The characteristics of dropout patients included a longer duration of depressive episode (P = 0.011) and lower antidepressant doses (P...
Source: International Clinical Psychopharmacology - May 31, 2019 Category: Psychiatry Tags: Original Articles Source Type: research

Intravenous vortioxetine to accelerate onset of effect in major depressive disorder: a 2-week, randomized, double-blind, placebo-controlled study
This study supported intravenous vortioxetine as a means of rapidly reaching therapeutic vortioxetine blood levels. (Source: International Clinical Psychopharmacology)
Source: International Clinical Psychopharmacology - May 31, 2019 Category: Psychiatry Tags: Original Articles Source Type: research

Lithium and valproate serum level fluctuations within the menstrual cycle: a systematic review
Some women affected by mood disorders experience mood instability during the premenstrual phase. Assuming that fluctuations in drug serum levels may contribute to the worsening of mood symptoms, we carried out a systematic review of available studies that investigated changes in lithium and valproate levels in relation to menstrual phases. We selected five studies; four of which assessed menstrual fluctuations in lithium serum levels and one in valproate levels. Study samples included women in their fertile age affected by bipolar disorder, epilepsy as well as healthy ones. Preliminary results showed a close relationship b...
Source: International Clinical Psychopharmacology - March 30, 2019 Category: Psychiatry Tags: Review Source Type: research