The impact on functioning of second-generation antipsychotic medication side effects for patients with schizophrenia: a worldwide, cross-sectional, web-based survey

Tandon, Rajiv; Lenderking, William R.; Weiss, Catherine; Shalhoub, Huda; Barbosa, Carla Dias; Greene, Mallik; Meehan, Stine R; Duvold, Laëtitia Bouérat; Arango, Celso; Agid, Ofer; Castle, David

doi:10.1186/s12991-020-00292-5

Cited by 36 publications

(33 citation statements)

References 22 publications

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“…The more minor side effects of AP-induced hyperprolactinemia (acne, hirsutism, infertility, menstrual, and sexual difficulties) while, to clinicians, may appear insignificant when compared to the symptoms of psychosis, can, nevertheless, exert major influence on the quality of life in patients with schizophrenia (56).…”

Section: Hyperprolactinemiamentioning

confidence: 99%

The Pharmacodynamics of Antipsychotic Drugs in Women and Men

Seeman

2021

Front. Psychiatry

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Background: Animal and human experiments have confirmed sex differences in the expression of hepatic enzymes that metabolize antipsychotic drugs and that may, in this way, be partly responsible for the clinical sex/gender differences observed in the efficacy and tolerability of antipsychotic treatment.Aim: The aim of this mini review is to synthesize the literature on the pharmacodynamics of male/female differential response to antipsychotic drugs.Method: Relevant search terms were used to search for pre-clinical and human trials and analysis of antipsychotic differential drug response and occurrence/severity of adverse effects in women and men.Results: The search found that sex influences drug response via the amount of a given drug that enters the brain and the number of neurotransmitter receptors to which it can bind. Consequently, sex partly determines the efficacy of a specific drug and its liability to induce unwanted effects. There are other factors that can overshadow or enhance the dimorphic effect of sex, for instance, the host's age, hormonal status, diet and life style as well as the molecular structure of the drug and its dose, and the method of its administration. Most of all, the host's individual genetics affects each step of a drug's pharmacodynamics.Conclusion: On average, women's psychotic symptoms respond to antipsychotic drugs at doses lower than men's. This means that many women may be de facto overdosed and, thus, experience unnecessary adverse effects. That being said, factors such as genetics and age probably determine drug response and tolerability to a greater degree than do biological sex or gender social roles.

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Section: Hyperprolactinemiamentioning

confidence: 99%

The Pharmacodynamics of Antipsychotic Drugs in Women and Men

Seeman

2021

Front. Psychiatry

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“…Perhaps this indicates that women were even less willing to tolerate potential weight gain during the later timeframe. This may not be without reason as women may be more susceptible to psychotropic drug-induced weight gain (Seeman 2009 , 2020 ; Tandon et al 2020 ) and have a harder time subsequently losing gained weight (Seeman 2009 ).…”

Section: Discussionmentioning

confidence: 99%

Sex differences in pharmacological treatment of major depressive disorder: results from the AMSP pharmacovigilance program from 2001 to 2017

Seifert

Führmann²,

Reinhard

et al. 2021

J Neural Transm

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Data on drug prescription for outpatients with major depressive disorder (MDD) suggest women are more likely to be treated with psychotropic drugs, while data on sex differences regarding pharmacological treatment of psychiatric inpatients are currently not available. Drug utilization data from the program “Drug Safety in Psychiatry” (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) of 44,418 psychiatric inpatients with MDD were analyzed for sex differences between 2001 and 2017. Sex differences were analyzed using relative risks (RR) and 95% confidence intervals (95% CI). Time trends were analyzed by comparing the first (2001–2003) with the last time period (2015–2017). In general, men and women were equally likely to use psychotropic drugs. Monotherapy was more common in men. Women were more likely to utilize ≥ 4 psychotropic drugs. Antidepressant drugs (ADDs) were the most prescribed drug class. Men had a higher utilization of noradrenergic and specific serotonergic antidepressants (RR 1.15; 95% CI 1.12–1.19), especially mirtazapine (RR 1.16; 95% CI 1.12–1.19), but also of other ADDs such as bupropion (RR 1.50; 95% CI 1.35–1.68). Males had a slightly higher utilization of second-generation antipsychotic drugs (RR 1.06; 95% CI 1.03–1.09) and were less often treated with low-potency first-generation antipsychotic drugs (RR 0.86; 95% CI 0.83–0.90). Tranquilizing (e.g., benzodiazepines; RR 0.89; 95% CI 0.86–0.92) and hypnotic drugs (e.g., Z-drugs; RR 0.85; 95% CI 0.81–0.89) were less utilized in the treatment of male patients. Not all sex differences were stable over time. More sex differences were detectable in 2015–2017 than in 2001–2003. Findings suggest that certain psychotropic drugs are preferred in the treatment of men vs. women, however, sex differences found in this study are not as large as in ambulatory settings. To make evidence-based sex-specific recommendations in the treatment of MDD, differences in drug response and tolerability need to be further researched.

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“…In conclusion, this is the first study to investigate the character and correlates of excessive sleepiness in psychosis. This in itself is surprising given the frequency with which sedation, sleepiness, and oversleeping are identified as issues by patients and clinicians [ 3 , 24 , 25 ]. One particular focus might be to develop interventions (for example, behavioural activity interventions as described in [ 30 ]) to test their effect on excessive sleepiness in this patient group, as these results suggest improvement may be possible despite the presence of sedating medications.…”

Section: Discussionmentioning

confidence: 99%

“…A clear and well-known factor in excessive sleepiness in psychosis is antipsychotic medication. Feeling ‘sleepy during the day’ was the most commonly reported side effect of antipsychotic medication in a recent worldwide study [ 24 ]—and was associated with significant levels of distress and reduced functioning. Randomised controlled trials of medication nearly universally identify sedation as a side-effect, although the rates vary widely (5.1%-49.1%) across different patient groups, different antipsychotic types, and different dosages [ 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Excessive sleepiness in patients with psychosis: An initial investigation

2021

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Clinical experience indicates that excessive sleepiness and hypersomnia may be a common issue for patients with psychosis. Excessive sleepiness is typically ascribed to the sedating effects of antipsychotic medications but there may be other potential contributors such as sleep disorders and depression. Furthermore, the impact of excessive sleepiness itself on patients’ symptoms and general wellbeing is yet to be examined. The current study reports an exploratory cross-sectional between-groups comparison of patients with early psychosis fulfilling criteria assessed in a diagnostic interview for problematic excessive sleepiness (n = 14), compared with those not reporting excessive sleepiness (n = 46). There were no differences between the groups in diagnosis, medication type, or antipsychotic medication dosage. There were no significant group differences in sleep duration. Significantly lower activity levels were found in the excessive sleepiness group. Insomnia and nightmares were common in those reporting excessive sleepiness. No significant differences were found in psychiatric symptoms, although data did indicate more severe cognitive disorganisation and grandiosity, but less severe paranoia and hallucinations, in the excessive sleepiness group. Wide confidence intervals and small sample size mean that care should be taken interpreting these results. Overall, this study indicates that excessive sleepiness may not be solely related to medication but also to low levels of activity and other sleep disorders. This is a novel finding that, if replicated, could indicate routes of intervention for this clinical issue. Future research should aim to disentangle directions of effect amongst sleepiness, mood, activity, and psychotic symptoms and investigate possible interventions for excessive sleepiness in psychosis.

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The impact on functioning of second-generation antipsychotic medication side effects for patients with schizophrenia: a worldwide, cross-sectional, web-based survey

Cited by 36 publications

References 22 publications

The Pharmacodynamics of Antipsychotic Drugs in Women and Men

The Pharmacodynamics of Antipsychotic Drugs in Women and Men

Sex differences in pharmacological treatment of major depressive disorder: results from the AMSP pharmacovigilance program from 2001 to 2017

Excessive sleepiness in patients with psychosis: An initial investigation

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