Concomitant medication of psychoses in a lifetime perspective

Vares, Maria; Saetre, Peter; Strålin, Pontus; Levander, Sten; Lindström, Eva; Jönsson, Erik G.

doi:10.1002/hup.1209

Cited by 19 publications

(12 citation statements)

References 82 publications

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“…Therefore, the co-prescription of benzodiazepines with antipsychotics for schizophrenia patients should be monitored. Vares et al18) observed that, at some point, almost all patients (95%) in their study had been co-prescribed antipsychotics and benzodiazepines but that these treatment periods were short, at only ~14% of the total duration of antipsychotic medication. Given that in the present study there was a risk of increased mortality and limited information regarding the duration of polypharmacy relative to the total time of antipsychotic use, further studies will be needed to evaluate this point.…”

Section: Discussionmentioning

confidence: 89%

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Prescription Patterns for Patients with Schizophrenia in Korea: A Focus on Antipsychotic Polypharmacy

Kim

Lee

Jung

et al. 2014

Clin Psychopharmacol Neurosci

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ObjectiveThis study investigated the prescription patterns for Korean patients with schizophrenia with a particular focus on antipsychotic polypharmacy. All data were gathered from patients presenting at 41 tertiary university hospitals and 8 secondary hospitals.MethodsData from three multicenter studies conducted in Korea were retrospectively reviewed and integrated to identify patients with schizophrenia who had their antipsychotic medication switched to paliperidone extended-release between 2008 and 2009. The rates for antipsychotic polypharmacy, combined use of different antipsychotic classes with a special focus on atypical antipsychotics, and psychotropic polypharmacy using benzodiazepines, mood stabilizers, and other relevant drugs were identified.ResultsOf the 851 Korean patients analyzed in this study, 20.4% (n=173) had been prescribed antipsychotic polypharmacy. Of the 678 patients receiving antipsychotic monotherapy, 6.9% (n=47) were prescribed a typical antipsychotic and 93.1% (n=631) were prescribed an atypical antipsychotic. Of the 173 patients receiving a combination of antipsychotic drugs, only 6.4% (n=11) had been prescribed polypharmacy with typical antipsychotics, while 46.82% (n=81) were prescribed atypical+atypical antipsychotics or typical+atypical antipsychotics. The highest co-prescription rates for other psychotropic drugs in conjunction with antipsychotics included benzodiazepines (30.3%), anticholinergic drugs (28.8%), antidepressants (13.3%), β-blockers (10.1%), and mood stabilizers (8.7%).ConclusionThe present findings demonstrate that the rate of antipsychotic polypharmacy is relatively low in Korea and that Korean clinicians prefer to prescribe atypical, rather than typical, antipsychotic drugs. This suggests that there is a distinct prescription pattern in Korea that is focused on antipsychotic polypharmacy.

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Section: Discussionmentioning

confidence: 89%

“…According to Vares et al18) most patients with psychosis have been prescribed a combination of medications at some point but the treatment periods were relatively short, corresponding to 14% of the total time of antipsychotics treatment, apart from anti-parkinsonism drugs.…”

Section: Introductionmentioning

confidence: 99%

Prescription Patterns for Patients with Schizophrenia in Korea: A Focus on Antipsychotic Polypharmacy

Kim

Lee

Jung

et al. 2014

Clin Psychopharmacol Neurosci

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“…Consequently, factors such as maternal age, weight, smoking and alcohol consumption cannot be satisfactorily addressed. Additionally, the significance of concomitant medication such as more than one AP, antidepressants, anticonvulsants or anxiolytics, all of which remain common in clinical practice , also remains largely unaccounted for. Publication bias relevant to this MiniReview is likely to be conservative in terms of relative risk estimates; that is, incident cases are more likely to be published than cases or small series with no malformations.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Exposure to Olanzapine, Quetiapine, Risperidone, Aripiprazole and Risk of Congenital Malformations. A Systematic Review

Ennis

Damkier

2015

Basic Clin Pharma Tox

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To review available data on first-trimester exposure to olanzapine, quetiapine, risperidone and aripiprazole and risk of congenital malformations. We performed a systematic literature search in accordance with PRISMA guidelines identifying studies containing original data on first-trimester exposure and pregnancy outcome with respect to congenital malformations. Cumulated data for olanzapine were 1090 first-trimester-exposed pregnancies with 38 malformations resulting in a malformation rate of 3.5%. The corresponding numbers for quetiapine, risperidone and aripiprazole were 443/16 (3.6%), 432/22 (5.1%) and 100/5 (5.0%), respectively. Relative risk estimates and 95% confidence intervals were 1.0 (0.7-1.4) (olanzapine), 1.0 (0.6-1.7) (quetiapine), 1.5 (0.9-2.2) (risperidone) and 1.4 (0.5-3.1) (aripiprazole). First-trimester exposure to olanzapine is not associated with an increased risk of congenital malformation. Data for quetiapine and risperidone do not suggest a substantially increased risk, while the risk estimate for aripiprazole remains imprecise owing to a low amount of data.

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“…FGA are known to cause a variety of extrapyramidal symptoms, whereas SGA have been associated with weight gain and metabolic side effects. Add-on drugs are common 15 and may relieve side effects. Although antipsychotics emerged in the 1950s with FGA and 1980s with SGA, the long-term consequences of these drugs and their respective add-ons on brain structure are still largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Trajectories of brain volume change over 13 years in chronic schizophrenia

Barth

Jørgensen

Wortinger

et al. 2019

Preprint

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Question: Is chronic schizophrenia associated with progressive brain volume loss beyond normal aging?Findings: While brain volume was lower at baseline, patient trajectories of brain volume change over a 13-year follow-up period differed little from healthy individuals. Small effects indicated greater white matter volume loss in patients during the late phase of follow-up. Stable differences in patient brain volumes seem explicable by antipsychotic medication class and respective add-on drugs.Meaning: We found limited evidence of progressive brain volume loss, beyond normal aging, in chronic schizophrenia over 13 years. AbstractImportance: Schizophrenia is a leading cause of disability worldwide, with an illness course that putatively deteriorates over time. Whether the notion of a progressive brain disease holds in its chronic stage is debated.Objective: To investigate brain volume change and the impact of iatrogenic factors in chronic schizophrenia patients (duration of illness at baseline 16.17 ± 8.14 years) and controls over 13 years.Design: Participants were recruited as part of the Human Brain Informatics study. Data acquisition took place between 1999 and 2018, including baseline, 5-and 13-years follow-up.Setting: Naturalistic longitudinal case-control study. Participants:The sample consisted of 143 participants, of whom 64 were patients with chronic schizophrenia (20% female, mean age at baseline 40.5 ± 7.7 years) and 79 healthy controls (37% female, mean age at baseline 42.8 ± 8.4 years). T1-weighted structural imaging and information about medication use were obtained at each time point.Exposure: Antipsychotic medication and other prescribed drugs. Main Outcome(s) and Measure(s):Individual total and tissue-specific brain volumes, as well as two-time point percentage brain and ventricle volume change. Results:Patients had lower total brain volume at baseline. Yet, trajectories in total brain volume and gray matter volume loss as well as ventricular enlargement did not differ relative to controls.White matter volume was similar between groups at baseline and 5-year but diverged between 5year and 13-year follow-up, with accelerated loss in patients. While antipsychotic exposure did not show an association with brain volume loss over time, higher medication load was associated with lower brain volume across time points. Patients on second-generation antipsychotics alone showed lowest total brain volume, only after accounting for add-on drug use. Conclusion and Relevance:We found limited evidence for progressive brain volume loss in chronic schizophrenia, beyond normal aging. Stable differences in patient brain volumes relative

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Concomitant medication of psychoses in a lifetime perspective

Cited by 19 publications

References 82 publications

Prescription Patterns for Patients with Schizophrenia in Korea: A Focus on Antipsychotic Polypharmacy

Prescription Patterns for Patients with Schizophrenia in Korea: A Focus on Antipsychotic Polypharmacy

Pregnancy Exposure to Olanzapine, Quetiapine, Risperidone, Aripiprazole and Risk of Congenital Malformations. A Systematic Review

Trajectories of brain volume change over 13 years in chronic schizophrenia

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