Management of psychosis and schizophrenia in adults: summary of updated NICE guidance

This Section of Epidemiology and Psychiatric Sciences appears in each issue of the Journal to stress the role of the epidemiological approach to promote advances in the field of clinical psychopharmacology, with a particular attention to controversial findings. The ultimate aims are to help develop a more critical attitude towards the results of research studies published in the international literature, to promote original research projects with higher methodological standards, and to implement the most relevant results of research in every-day clinical practice. These contributions are written in house by the journal's editorial team or commissioned by the Section Editor (no more than 1000 words, short unstructured abstract, 4 key-words, one Table or Patients experiencing psychoses and in need of antipsychotic agents may be exposed to a higher risk of myocardial infarction (MI) than the general population. As there have been no randomised studies investigating this association, a recent systematic review and meta-analysis included all observational studies that compared the incidence of MI among patients receiving antipsychotics v. no treatment. It found nine studies and calculated that the odds (risk) for developing MI were 1.88-fold higher in antipsychotic users compared with individuals who had not taken antipsychotic drugs. In this commentary, the results of this systematic review are discussed in view of their clinical implications for everyday clinical practice. Key words: Antipsychotics, myocardial infarction, observational studies, psychosis, systematic reviews.While it is widely recognised that systematic reviews of randomised controlled trials (RCTs) represent the most reliable and appropriate reference standard to summarise the efficacy of interventions, for safety outcomes individual RCTs and systematic reviews may not provide satisfactory information. This is especially the case when safety outcomes are rare, as RCTs usually enrol too few participants to establish associations, when adverse effects are unexpected, as RCTs may systematically collect information only on pre-defined adverse outcomes, and when adverse effects do not occur immediately after the intervention is provided, as RTCs are usually short in duration.For these reasons, observational studies and systematic reviews of these studies are usually considered at the pinnacle of the evidence hierarchy for safety outcomes, to be used to inform future research, clinical practice and policy decisions (Vandenbroucke, 2008). A practical example of synthesis of observational studies for investigating the occurrence of a safety outcome has recently been provided by Yu et al. (2016), who carried out a systematic review investigating whether exposure to antipsychotic drugs (AP) increases the risk of myocardial infarction (MI). This association has been investigated by several epidemiological studies, but findings are controversial and therefore difficult to translate into practical recommendations. While an association between cardiovascular ev...

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“…This is in line with most recent guidelines and recommendations for people using AP drugs (Kuipers et al 2014). …”

supporting

confidence: 70%

Antipsychotic drug exposure and risk of myocardial infarction

Barbui

Gastaldon

Papola

et al. 2016

Epidemiol Psychiatr Sci

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“…Both antipsychotic treatment and psychosocial interventions still have limited benefit on negative symptoms and cognitive impairment. 9,10 Beneficial effects of aerobic exercise on cognition and negative symptoms as well as brain volumes have been shown also in schizophrenia although the available data differ between studies. [11][12][13][14][15] However, the exercise interventions in these studies were diverse and ranged from, eg, yoga or circuit training to the use of ergometers, and duration and frequency of the training stimulus differed.…”

Section: Introductionmentioning

confidence: 99%

Effects of Endurance Training Combined With Cognitive Remediation on Everyday Functioning, Symptoms, and Cognition in Multiepisode Schizophrenia Patients

Malchow

Keller

Hasan

et al. 2015

SCHBUL

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Aerobic exercise has been shown to improve symptoms in multiepisode schizophrenia, including cognitive impairments, but results are inconsistent. Therefore, we evaluated the effects of an enriched environment paradigm consisting of bicycle ergometer training and add-on computer-assisted cognitive remediation (CACR) training. To our knowledge, this is the first study to evaluate such an enriched environment paradigm in multiepisode schizophrenia. Twenty-two multiepisode schizophrenia patients and 22 age-and gender-matched healthy controls underwent 3 months of endurance training (30 min, 3 times/ wk); CACR training (30 min, 2 times/wk) was added from week 6. Twenty-one additionally recruited schizophrenia patients played table soccer (known as "foosball" in the United States) over the same period and also received the same CACR training. At baseline and after 6 weeks and 3 months, we measured the Global Assessment of Functioning (GAF), Social Adjustment Scale-II (SAS-II), schizophrenia symptoms (Positive and Negative Syndrome Scale), and cognitive domains (Verbal Learning Memory Test [VLMT], Wisconsin Card Sorting Test [WCST], and Trail Making Test). After 3 months, we observed a significant improvement in GAF and in SAS-II social/ leisure activities and household functioning adaptation in the endurance training augmented with cognitive remediation, but not in the table soccer augmented with cognitive remediation group. The severity of negative symptoms and performance in the VLMT and WCST improved significantly in the schizophrenia endurance training augmented with cognitive remediation group from week 6 to the end of the 3-month training period. Future studies should investigate longer intervention periods to show whether endurance training induces stable improvements in everyday functioning.

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“…Antipsychotic drugs (APDs) have been the mainstay for the management of 89 schizophrenia for more than 60 years [1]. In recent decades they have also become 90 established in the treatment of bipolar disorder, for episodes of both mania and 91 depression [2], and were also recommended as combination treatment with 92 antidepressants for major depressive disorder (MDD) [3].…”

mentioning

confidence: 99%