Atypical antipsychotics in bipolar disorders
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Evidence base for the use of atypical antipsychotics in bipolar disorders, psychopharmacological principles thereof
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Treatment resistant schizophrenia is defined as lack of satisfactory improvement despite trials of two antipsychotics for adequate duration and dose. Around 20-30% of schizophrenia patients are considered treatment resistant. Clozapine is currently the treatment of choice for such patients, though combination and augmentation strategies with other agents have limited evidence. Definitive treatment guidelines recommend establishing treatment resistance before trials of clozapine or other strategies for treatment resistant schizophrenia.
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This document discusses the pharmacological treatment of schizophrenia. It covers the classification and clinical use of antipsychotics, the development of typical and atypical antipsychotics, their mechanisms of action and side effect profiles. It summarizes key studies on the effectiveness of typical versus atypical antipsychotics and provides recommendations from the 2009 PORT treatment guidelines for using antipsychotics to treat acute episodes and as maintenance therapy for multi-episode and first-episode schizophrenia. Alternatives to antipsychotic medication like the Soteria paradigm are also discussed.
quetiapine in BPD canmat 2018
1) Quetiapine was initially approved to treat schizophrenia but is now also approved to treat manic and depressive episodes associated with bipolar I and II disorder.
2) Quetiapine's mechanism of action involves antagonism of dopamine D2 and serotonin 5-HT2 receptors. It also has partial agonist effects on 5-HT1A receptors.
3) Studies have shown quetiapine to be effective in reducing manic and depressive symptoms in bipolar disorder as monotherapy or adjunctive therapy, and as maintenance therapy to delay relapse of mood episodes.
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Clozapine is a second-generation antipsychotic drug known as an atypical antipsychotic. It was the first discovered to be effective for treatment-resistant schizophrenia without causing extrapyramidal symptoms. However, it was withdrawn from the market briefly in the 1970s due to cases of agranulocytosis. Three studies summarized found clozapine to be superior to typical antipsychotics like risperidone and haloperidol in improving positive symptoms. While it improved positive symptoms, clozapine did not significantly impact negative symptoms. The mechanism of action is believed to involve antagonizing dopamine D1, D4, and serotonin 5-HT2 receptors.
Lecture 09 autism
Autism spectrum disorder (ASD) is a developmental disorder characterized by impaired social communication and repetitive behaviors. Reported prevalence is approximately 1% of children. Children with ASD often experience psychiatric issues like aggression, anxiety, and mood symptoms. While medications are often prescribed, children with ASD generally respond less favorably than peers. Current evidence shows risperidone and aripiprazole can effectively treat irritability, and methylphenidate can treat ADHD symptoms, but side effects are common. More treatment options are still needed to address the core symptoms of ASD.
N:\ceutical2[1]
This document provides information about various antipsychotic drugs used to treat schizophrenia. It discusses first and second generation antipsychotics including chlorpromazine, haloperidol, clozapine, and olanzapine. It describes their mode of action, synthesis, structure activity relationships, and side effects. Newer atypical antipsychotics like risperidone, quetiapine, aripiprazole, and ziprasidone are also mentioned along with their usual dosages and side effect profiles. The development of antipsychotics is an ongoing area of research to determine the most appropriate treatment for individual patients.
Asenapine & agomelatine
1) Asenapine and agomelatine are drugs used to treat schizophrenia, bipolar disorder, and major depressive disorder. Asenapine is an antipsychotic while agomelatine is an antidepressant with a novel mechanism of action targeting melatonin receptors.
2) Both drugs have advantages like rapid onset of action and promising safety profiles. However, they also have limitations and warnings. Asenapine is associated with increased mortality in elderly patients with dementia. Agomelatine requires dose adjustment in patients with hepatic impairment.
3) The document provides details on the pharmacology, pharmacokinetics, clinical trials, dosing, precautions and drug interactions of asenap
Role of atypical antipsychotics in the treatement of generalized anxiety diso...
This review article examines the evidence for using atypical antipsychotics as adjunctive therapy or monotherapy to treat generalized anxiety disorder (GAD). The most evidence has been collected for quetiapine, which approximately 50% of participants tolerated, most commonly experiencing sedation and fatigue. Among those who continued treatment, significant reductions in anxiety were demonstrated when used as adjunctive therapy or monotherapy. While atypical antipsychotics show promise based on evidence from other disorders, their use for GAD remains off-label and careful consideration of risks and benefits is needed, especially regarding long-term use.
journal reading
This study investigated the effectiveness of different antipsychotic treatment strategies in 1011 acutely hospitalized patients with schizophrenia over 1 year. The results showed that treatment with long-acting injectable antipsychotics (LAIs) or antipsychotic polytherapy (APEC) was associated with a lower risk of treatment failure compared to antipsychotic monotherapy. Specifically, treatment with LAIs was associated with a 19% lower risk of failure, while APEC was associated with a 17% lower risk. The only antipsychotic combination found to be significantly associated with lower failure risk than monotherapy was olanzapine and paliperidone.
Demenza
This document discusses the treatment of behavioral symptoms related to dementia. It notes that behavioral symptoms are extremely common in Alzheimer's disease and other forms of dementia. It reviews the causes and treatment of behavioral disturbances, including the use of antipsychotic drugs. Both typical and atypical antipsychotics have been used but come with risks like increased mortality or extrapyramidal side effects. Overall, the document examines the evidence around different drug options for treating behavioral issues in dementia patients and their potential risks and benefits.
Antipsychotic induced diabetes 6.23
The document discusses a case study of a 67-year-old male patient (AM) who presented with altered mental status and was diagnosed with non-ketonic hyperglycemic hyperosmolar state (HHS) secondary to clozapine therapy. AM was treated with IV fluids and insulin and discharged after his blood glucose levels stabilized. The document then reviews the metabolic side effects of antipsychotic medications like clozapine and their association with new-onset diabetes. Studies show clozapine is linked to hyperglycemia within 6 months of starting treatment and discontinuing it can sometimes reverse glucose dysregulation. Patients on clozapine also have a higher risk of developing very high blood glucose levels over 600 mg/dL
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- 1. Atypical Antipsychotics In Bipolar Disorder Seminar Dr Ramkumar G S 10/3/2010 Chair person Dr Jagadisha
- 4. 2 Asenapine 2 Ziprasidone 2 6 Aripirazole 2 5 11 40 Total 2 2 3 8 Quetiapine 1 2 9 Risperidone 6 13 Olanzapine Rapid cycling maintenance depression Mania
- 6. 2 Asenapine 2 Ziprasidone 2 6 Aripirazole 2 5 11 40 Total 2 2 3 8 Quetiapine 1 2 9 Risperidone 6 13 Olanzapine Rapid cycling maintenance depression Mania
- 8. Olanzapine- Mania QOL, working status haloperidol olan 234 +mixed, 6wks CBZ Olan+ CBZ 58 +mixed, 6wks olnz> plac in HDRS score Dival+Placebo Olan + dival 100 No difference in effect. RSPN Olanz 165 3wks, paediatric placebo Olanz 107 4wks lithium olan features control study n Maintenance, time to ist mood episode placebo Olanz 225 placebo olanz 55 RCT+open label ext.Qol placebo Olan placebo olan 70 Val & olan >placebo at 3ks: olan> val ar 12wks Olan vs dival vs placebo ~200 Response, remission val Olan 125 +mixed,response Placbo+ ms Olan+ MS 3wks val olan 63 47wks,Relapse rate was same dival olan Maintrnance,Clinical improv, QOL, Olanz alone Olanz+ MS 224 decreased disphoria,suicidality Val or Li olanz 85 12 months maintenance Lithium olanz CGI Lithium Olanz 69
- 9. Olanzapine- depression features control study n FLU VS PLACEBO VS Flu+ olenz ~370 LOW SWITCH FOR OLANZ FLU VS OLANZ VS (FLU+OLAN) 32 8WKS SAME effect, SIDE EFFECT NOT MORE FOR OLAN + FLUX OLAN VS placebo vs OLAN+ FLUOX ~370 OPEN LAB RAND SHIFTING TO OLANZ ALONE CAUSED WORSENING OLANZ Fluo+ OLAN cgi lamotrigine Olan+ lamotrig 205 CGI, 6 month lamotrigine Olan +fluoxetine
- 10. Systematic review and meta analysis
- 22. Spectrum of Efficacy in Mania , Depression , anxiety