Long-term adverse effects of novel antipsychotics.

The introduction of novel antipsychotics for the treatment of patients with serious psychiatric illness has alleviated the burden of managing some of the side effects of conventional agents. However, the novel agents may also cause adverse events. The long-term adverse events of concern include weight gain, diabetes, tardive dyskinesia (TD), and those associated with hyperprolactinemia.

Clinical effectiveness of atypical antipsychotics in elderly patients with psychosis.

The elderly represent a unique patient group in the sense that they have a high prevalence of psychotic symptoms that are a manifestation of a variety of psychiatric, neurological and organic disorders. Treatment is complicated by several factors including comorbid diagnoses (psychiatric and medical), polypharmacy, age-related changes in pharmacokinetics and pharmacodynamics and high susceptibility to adverse events. Elderly patients require pharmacological interventions that are effective in reducing symptoms but also are well tolerated, improve everyday functioning, subjective well-being and treatment adherence and reduce family/career burden.

Safety considerations in pharmacotherapy of bipolar disorder.

Bipolar disorder is a chronic, frequently relapsing illness with a prevalence of 1.2% to 3.4% in the general population.

Aripiprazole: review of its pharmacology and therapeutic use in psychiatric disorders.

The discovery of antipsychotic medications has revolutionized the treatment of schizophrenia and other psychotic disorders. However, side effects such as extrapyramidal symptoms (EPS) and tardive dyskinesia (TD), electrocardiogram (ECG) changes, weight gain, and metabolic disturbances indicate the continued need to develop new agents. The introduction of atypical drugs such as clozapine, risperidone, olanzapine, quetiapine, and ziprasidone has widened our choices.

Pharmacotherapy of depression in pregnancy.

About 20% of pregnant women experience clinical depression. Inadequate treatment of depression has been associated with adverse outcomes in the mother as well as the newborn. Clinicians are often uncertain about pharmacological interventions to treat depressed pregnant women due to concerns regarding fetal exposure to medications.

Cardiovascular side effects of novel antipsychotics.

Since the introduction of clozapine, several novel antipsychotic agents have been introduced and more are in Phase II/III studies. Because these agents are used clinically as first-line treatment, we need to be more familiar with their side-effect profiles. This manuscript reviews the cardiovascular side effects of currently available novel antipsychotics.

Prescribing conventional antipsychotics at two Veterans Administration hospitals: are there geographical differences?

The medical records of 110 patients receiving conventional antipsychotics at two geographically distinct Veterans Administration hospitals (Syracuse, New York, and Omaha, Nebraska) were reviewed. The most common reasons for continuation of conventional antipsychotics were good response and patient or physician choice. Frequently, physicians did not discuss the reasons for continuing conventional antipsychotics or the availability of alternative therapies with their patients.

Weight decline in patients switching from olanzapine to quetiapine.

This open-label study investigated the strategy of switching patients who had gained excessive weight on olanzapine to quetiapine, with assessments of safety and continued efficacy as well as weight change. Patients who were psychiatrically stable on olanzapine but had gained >20% in weight and had body mass index >25 mg/kg(2) were switched to quetiapine over a 4-week period and followed for 6 weeks, the total study duration being 10 weeks. Assessments included weight change, antipsychotic efficacy using the Positive and Negative Symptom Syndrome Scale (PANSS), extrapyramidal adverse events using the Simpson-Angus Scale (SAS), and laboratory studies for metabolic measures.

Psychotic symptoms in patients with medical disorders.

Psychotic symptoms frequently occur in patients with comorbid medical disorders and present a diagnostic and treatment challenge. They may be a part of an independent psychiatric illness associated with the underlying medical condition or induced by substance use or medications. The presence of psychotic symptoms can contribute to misdiagnosis or complicate the management of the comorbid medical illness.

Paroxetine in Patients With Irritable Bowel Syndrome: A Pilot Open-Label Study.

BACKGROUND: Irritable bowel syndrome (IBS) is a common disorder and is the largest diagnostic cohort seen by gastroenterologists. There is a bidirectional comorbidity of IBS and psychiatric illness. Ours is the first study to examine the effect of any selective serotonin reuptake inhibitor in subjects with IBS.

Treatment of Delirium With Quetiapine.

INTRODUCTION: Delirium, an organic psychiatric syndrome, occurs in 10% of hospitalized patients and is characterized by fluctuating consciousness and impaired cognition, perception, and behavior. METHOD: Charts of 11 consecutive patients with delirium were retrospectively reviewed. These patients were given quetiapine fumarate, a novel antipsychotic, as first-line treatment for their symptoms.

Topiramate in Bipolar and Schizoaffective Disorders: Weight Loss and Efficacy.

BACKGROUND: Although useful in bipolar disorder, mood stabilizers, such as lithium, divalproex sodium, and carbamazepine, can cause significant weight gain. METHOD: We conducted a retrospective chart review of 5 patients with DSM-IV bipolar disorder or schizoaffective disorder who were treated with topiramate as adjunctive therapy or monotherapy. RESULTS: All 5 patients had a good response to treatment at a mean topiramate dose of 195 mg/day (range, 100-375 mg/day).

Novel Antipsychotics in the Treatment of Behavioral Disturbances and Psychoses Associated With Neurodegenerative Disorders.

Behavioral disturbances and psychosis are common features of neurodegenerative disorders and may be drug induced, intrinsic to the underlying pathology, or both. These disturbances, including psychotic and mood symptoms, apathy, aggression and other behavioral symptoms, and superimposed delirium, cause a great amount of disability to the patient and stress on the caregiver. Conventional neuroleptics have been shown to be effective in the treatment of these symptoms, but unacceptable side effects may occur.

Depression Across the Reproductive Life Cycle: Correlations Between Events.

BACKGROUND: This study examines whether women who become depressed at one reproductive cycle event, e.g., postpartum, are likely to become depressed at other such events.