Selection of Atypical Antipsychotics for the Management of Schizophrenia

Sprague, Denise A; Loewen, Peter; Raymond, Colette B

doi:10.1345/aph.1c461

Cited by 26 publications

(18 citation statements)

References 17 publications

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“…The most potent atypical antipsychotic drugs were olanzapine, risperidone, and clozapine with ziprasidone and quetiapine being an order of magnitude less potent. This potency profile is similar to that observed in the treatment of humans with psychosis (Leo and Regno, 2000;Miyamoto et al, 2005;Sprague et al, 2004). This animal data must be considered with caution since only a few atypical antipsychotics were tested, a variety of drugs block injury produced by MK-801, and both oral and i.p.…”

Section: Discussionsupporting

confidence: 76%

“…Although doses vary, the average doses of the atypicals used to treat psychosis in humans are as follows: risperidone, 4-8 mg/day; olanzapine 5-20 mg/day; clozapine 6.25-400 mg/ day; ziprasidone 40-160 mg/day; and quetiapine 130-800 mg/day (Leo and Regno, 2000;Miyamoto et al, 2005;Sprague et al, 2004). This potency profile compares roughly to the potency in the present study of olanzapine4risper-idone4clozapine4ziprasidone4quetiapine.…”

Section: Discussionsupporting

confidence: 64%

“…The actions on non-D2 receptors are thought to account for their effects on the negative symptoms of schizophrenia (Leo and Regno, 2000;Miyamoto et al, 2005;Sprague et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

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Atypical Antipsychotics and a Src Kinase Inhibitor (PP1) Prevent Cortical Injury Produced by the Psychomimetic, Noncompetitive NMDA Receptor Antagonist MK-801

Dickerson

Sharp

2005

Neuropsychopharmacol

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Noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonists such as phencyclidine, ketamine, and MK-801 produce schizophrenia-like psychosis in humans. The same NMDA antagonists injure retrosplenial cortical neurons in adult rats. We examined the effects of atypical antipsychotics and an inhibitor of nonreceptor tyrosine kinase pp60 (Src) on the cortical injury produced by MK-801. An atypical antipsychotic (either clozapine, ziprasidone, olanzapine, quetiapine, or risperidone) or vehicle was administered to adult female Sprague-Dawley rats. PP1 (Src inhibitor), PP3 (nonfunctional analog of PP1) or vehicle (DMSO) was administered to another group of animals. After pretreatment, animals were injected with MK-801, killed 24 h after the MK-801, and injury to retrosplenial cortex assessed by neuronal Hsp70 protein expression. All atypical antipsychotics examined significantly attenuated MK-801-induced cortical damage. PP1 protected compared to vehicle, whereas PP3 did not protect. The ED50s (decrease injury by 50%) were as follows: PP1 o0.1 mg/kg; olanzapine 0.8 mg/kg; risperdal 1 mg/kg; clozapine 3 mg/kg; ziprasidone 32 mg/kg; and quetiapine 45 mg/kg. The data show that the atypical antipsychotics tested as well as a Src kinase inhibitor prevent the injury produced by the psychomimetic MK-801, and the potency of the atypical antipsychotics for preventing cortical injury was roughly similar to the potency of these drugs for treating psychosis in patients.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 64%

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Atypical Antipsychotics and a Src Kinase Inhibitor (PP1) Prevent Cortical Injury Produced by the Psychomimetic, Noncompetitive NMDA Receptor Antagonist MK-801

Dickerson

Sharp

2005

Neuropsychopharmacol

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“…The ability of olanzapine, to cause weight gain is well documented. 2,8,10,11 Medications that antagonize serotonergic transmission, such as olanzapine, may cause an increase in food consumption. The amount of weight gain correlates with the agents' affinity for H 1 receptors.…”

Section: Discussionmentioning

confidence: 99%

“…4 The first reported case of olanzapine-induced hyperglycemia dates back to 1998. 6 Since that time, olanzapine' s potential to cause hyperglycemia as well as weight gain has been established [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] ; however, the frequency or severity of these reactions is still undetermined.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Lack of Control of Diabetes and Weight Gain in a Patient on Initiation and Rechallenge of Therapy With Olanzapine

Schwetschenau¹

2006

JMCP

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SummaryThe following is a case report analysis intended to draw attention to the need for better care coordination by describing the observed relationship of olanzapine to metabolic changes manifested as uncontrolled diabetes mellitus and weight gain. A 47-year-old male with bipolar I disorder/hallucinations presented to the Veterans Affairs Medical Center (VAMC) with suicidal ideations. He was referred to the psychiatry service where he was treated with olanzapine. He was followed exclusively by the psychiatry service for more than a year. During that time, weight issues and diabetes status were not addressed. Upon presenting to the primary care service a year and a half later, the patient was taking 40 mg per day of olanzapine and had gained 62 pounds, a 30% increase in body weight; glycosylated hemoglobin (A1c) was 11.1%. The patient was enrolled in a weight-loss clinic, and his diabetes medications were adjusted. Subsequently, olanzapine was discontinued because of weight gain and uncontrolled diabetes. Blood sugar and A1c were finally stabilized one month after discontinuation of olanzapine (A1c, 6.9%). The patient experienced a relapse in his bipolar disorder, and olanzapine was restarted at 20 to 40 mg per day. His blood sugar became uncontrolled, he gained 13 pounds, and his A1c increased to 9.4%.

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Late-life schizophrenia: Optimizing treatment

Schultz

Ellingrod²,

Pharm³

2005

Current Psychosis & Therapeutics Reports

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Selection of Atypical Antipsychotics for the Management of Schizophrenia

Abstract: Additional randomized, blinded clinical trials directly comparing efficacy, tolerability, and cost-effectiveness are needed to confirm the proposed differences among atypical antipsychotic agents before recommendations can be made with confidence.

Cited by 26 publications

References 17 publications

Atypical Antipsychotics and a Src Kinase Inhibitor (PP1) Prevent Cortical Injury Produced by the Psychomimetic, Noncompetitive NMDA Receptor Antagonist MK-801

Atypical Antipsychotics and a Src Kinase Inhibitor (PP1) Prevent Cortical Injury Produced by the Psychomimetic, Noncompetitive NMDA Receptor Antagonist MK-801

Case Report: Lack of Control of Diabetes and Weight Gain in a Patient on Initiation and Rechallenge of Therapy With Olanzapine

Late-life schizophrenia: Optimizing treatment

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