Purpose: The objective of this retrospective chart review study was to evaluate the long-term efficacy and tolerability of blonanserin treatment in individuals with schizophrenia. Patients and methods: We collected data from 28 (56%) antipsychotic-naïve subjects with firstepisode (FE) schizophrenia and 22 subjects with relapsed schizophrenia treated with blonanserin. We investigated psychiatric hospitalization and medication discontinuation rates, Positive and Negative Syndrome Scale (PANSS) scores, Clinical Global Impression-Severity (CGI-S) scale scores, body mass index (BMI) at baseline to endpoint and laboratory tests including serum prolactin, total cholesterol (TC), low-density lipoproteins (LDL), highdensity lipoproteins (HDL), triglycerides (TG), and glucose. Additionally, we measured the differences between the two groups and overall changes in levels. Results: Thirty-one subjects received blonanserin for 3 years. Significant improvements in psychiatric symptoms from baseline to endpoint were observed individuals with schizophrenia who received blonanserin treatment. There were remarkable changes in PANSS and CGI-S scores between baseline and those measured after 3 years (p < .01) in both groups; the FE schizophrenia group demonstrated better improvement as reflected by clinical changes assessments. Compared to baseline values, the endpoint measurements showed no statistical differences in terms of serum prolactin, glucose, or LDL and HDL cholesterol (p > .05) in both groups. After 3 years of treatment, there was a statistically significant increase in TC and TG with only a minimal increase in BMI (p < .05). However, there were no statistical differences between the two groups. Conclusion: Blonanserin is useful for the maintenance treatment of schizophrenia due to its therapeutic efficacy; moreover, it does not induce hyperprolactinaemia, significant weight gain, or cause problematic endocrine effects. Its strength might be attributed to its unique pharmacological properties.
Background Long-acting antipsychotic therapy (LAT) may help effectively manage individuals with schizophrenia by optimizing adherence, improving treatment response, reducing the risk of relapse, and improving long-term outcomes. LAT has an established role in the maintenance treatment of chronic, poorly adherent, and/or severely ill patients in later stages of schizophrenia. It is not yet known whether the positive effects of these LATs are merely on the control of symptoms and preventing relapse or on changes in insights and attitudes to medications, resulting in changes in disease course. Methods This retrospective, single-center study was conducted within the Department of Psychiatry at Inje University Haeundae Paik Hospital. To investigate the efficacy of LAT on the disease course, we compared re-hospitalization rate, drug attitude inventory (DAI), and The Positive and Negative Syndrome Scale (PANSS) in individuals with schizophrenia who had treated with once-monthly paliperidone palmitate and then switched to oral antipsychotics. Results A total of 105 patients changed from oral drugs to LAI. Of these, 31 patients were later changed to oral medication. Of the total LAI patients, 32 patients received less than 5 months a week. Thirteen patients were hospitalized for 6 months before LAI change and 3 patients were re-hospitalized during the maintenance period after LAI change. Three patients who did not have hospitalized for 6 months after the change of oral medication but did not have hospitalized during LAI maintenance period were re-hospitalized after changing to oral medication. Of the 72 patients who maintained the LAI for more than 5 months, 28 patients experienced re-hospitalization during oral medication before LAI, 9 of whom were re-hospitalized during the LAI. All of them kept on LAI. Seven patients who changed to oral medication during maintenance were not hospitalized during the maintenance period, but three patients were hospitalized after changing to oral medication. Of the 92 patients who had never been hospitalized within 6 months before the change of LAI, 14 had re-hospitalized after changing to LAI. However, none of the 92 patients who had never been hospitalized changed to oral medication. Regardless of the length of time, 5 (about 16%) were re-hospitalized in 31 patients who changed from LAI to the oral medication again. Interestingly, the patients were not hospitalized during the LAI period. There were 27 dropouts. Twenty patients (19%) after LAI change and 7 patients (6%) after oral change. There was no statistical difference in DAI and PANSS scores after the change from LAI to oral medication. Discussion As previously known, the inhibition effect of relapse was evident during the LAI period. There was no change in adherence to medication, attitudes toward treatment, and degree of illness within 6 months. There were 27 dropouts. Twenty patients (19%) after LAI change and seven patients (6%) after oral change. It has been a long time since the onset, and 7 patients have moved to the hospital. Most of these seven patients were considered to be the case of compliance problems. Immediately after the change of oral medication, dropout occurred in 4 patients, and the duration of LAI in these patients was 2–5 months. The lack of statistical difference between DAI and PANSS after changing to oral drug in LAI can be attributed to the short interval of 6 months.
ÖZETTardif distoni (TDt) uzun süreli antipsikotik tedavinin sakatlayıcı bir yan etkisidir. Tardif distoninin psikiyatrik morbidite ve mortaliteyi arttırması, yaşam kalitesini düşürmesine rağmen kesin bir tedavi yöntemi yoktur. Tardif distonisi olan şizofreni hastaları için bir tedavi seçeneği klozapindir. Fakat, ilginçtir ki yakın zamanda yayınlanan bir çok olgu sunumu klozapinin de TDt'ye yol açabildiğini ya da arttırabildiğini ortaya koymaktadır. Bu yazıda, klozapinle ilişkili olarak ortaya çıkan tardif distoninin tedavisinde düşük doz aripiprazol (günlük 0.5 mg) kullanı-mıyla ilgili bir olgu örneği bildirmekteyiz. Sunduğumuz olgudaki hastamız açık psikotik belirtileri nedeniyle psikiyatri servisine yatırılan 51 yaşında şizofreni hastası Koreli bir kadındır. Tardif distoni belirtileri bir yıl klozapin (günlük 200 mg) kullandıktan sonra ortaya çıkmıştır. Gün-lük klozapin (175 mg/gün) kullanımına düşük doz aripiprazol (günlük 0.5 mg) eklenmesiyle birlikte hastanın motor belirtilerinde belirgin bir şekilde düzelme sağlanmıştır. Aripiprazol, serotonin 1A (5-HT1A) reseptörlerinde kısmi agonistik ve 5HT2A reseptörlerinde tam antagonist etkinlik sergileyen bir dopamin D2 reseptörü kısmi agonistidir. Aripiprazolün etkinliği açısından ortamın dopaminerjik niteliği önemlidir. Ek olarak, aripiprazolün antioksidatif etkileri de klozapinin nörotoksik etkileriyle baş etmek için değerli olabilir. Bildiğimiz kadarıyla, klozapine bağlı gelişen tardif distoni tedavisinde orta düzeydeki dozlarda aripiprazol (10-15 mg) kullanıldığına ilişkin tek bir olgu sunumu yayınlan-mıştır. Burada sunduğumuz olgu klozapine bağlı olarak ortaya çıkan tardif distoni tedavisinde düşük doz aripiprazol kullanımının ilk örneği olabilir.Anahtar Sözcükler: Aripiprazol, Klozapin, Tardif distoni, Şizofreni SUMMARY Efficacy of low-Dose Aripiprazole to Treat Clozapine-Associated Tardive Dystonia in a Patient with SchizophreniaTardive dystonia (TDt) is a debilitating side effect of long-term antipsychotic treatment. Even though TDt is associated with increased psychiatric morbidity, mortality, and severely decreased quality of life, there are no treatment modalities for TDt. Clozapine has been used as a treatment option for TDt in patients with schizophrenia. Interestingly, several recent case reports have indicated that it can enhance or induce TDt. We report a case of clozapine-associated TDt that was treated with low-dose aripiprazole (0.5 mg/day). The patient was a 51-yearold Korean woman with schizophrenia that had been admitted to the psychiatric ward for her florid psychotic symptoms. The patient's TDt symptoms began to develop after 1 year of clozapine (200 mg/day) treatment. Her motor symptoms improved markedly after adding lowdose aripiprazole (0.5 mg/day) to clozapine (175 mg/day). Aripiprazole is a dopamine D2 receptor partial agonist that exhibits partial agonistic activity against serotonin-1A (5-HT1A) receptors and full antagonistic activity against 5-HT2A receptors. The dopaminergic tone in the surrounding milieu is important for aripiprazo...
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