Therapeutic Advances in Psychopharmacology

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Editorial
Free accessEditorialFirst published August, 2013pp. 185-185
Editorial
David Taylor
Research article
Free accessResearch articleFirst published August, 2013pp. 186-190
Clinical trial in the treatment of 80 Iranian patients with major depression disorder by the combination of omega 3 fatty acid and a selective serotonin reuptake inhibitor
Mitra SafaSaeed Fallah TaftiFatemeh Ghassem Boroujerdi
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Abstract
Objectives:
Bipolar disorder type I is a disturbing psychiatric syndrome, which is treated by mood-stabilizing medications, psychosocial intervention and electroconvulsive therapy. As supplementation with omega 3 has been considered effective in the treatment of many diseases especially mental disorders, this study aimed at evaluating the effect of omega 3 with fluvoxamine compared with fluvoxamine alone in the treatment of the deep depression phase in bipolar patients type I.
Methods:
A total of 80 patients in this clinical trial study were selected using a randomized controlled trial in two case and control groups by a psychiatrist. The case group took fluvoxamine and omega 3 tablets and the control group took only fluvoxamine. Patients completed the Hamilton Depression Rating Scale and demographic questionnaire at the beginning of the study and after 2, 4, 8 and 12 weeks.
Results:
The mean scores in the Hamilton Depression Rating Scale in both groups under study after 2, 4, 8, 12 weeks decreased. Statistics showed a significant difference in scores in both groups before the treatment and after mentioned weeks.
Conclusions:
Since research findings showed the effectiveness of omega 3 and its harmlessness, it is suggested that omega 3 can be prescribed with other antidepressant medications.
Research article
Free accessResearch articleFirst published August, 2013pp. 191-199
Long-term remission in schizophrenia and schizoaffective disorder: results from the risperidone long-acting injectable versus quetiapine relapse prevention trial (ConstaTRE)
Enrico SmeraldiRoberto CavallaroVera Folnegović-Šmalc
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Abstract
Objective:
The objective of this study was to report the long-term remission results from the ConstaTRE relapse prevention trial, in which clinically stable adults with schizophrenia or schizoaffective disorder treated with oral risperidone, olanzapine, or oral conventional antipsychotics were randomized to risperidone long-acting injectable (RLAI) or oral quetiapine, dosed according to package-insert recommendations.
Methods:
In the ConstaTRE trial, efficacy and tolerability were recorded for up to 24 months. This post hoc analysis presents remission data, defined, according to the Schizophrenia Working Group criteria, as achieving and maintaining eight core symptoms of schizophrenia that are mild or less over 6 months. Additional secondary outcome measures are also presented.
Results:
A total of 710 patients were randomized to RLAI (n = 355) or quetiapine (n = 355). Mean mode ± standard deviation (SD) drug doses were RLAI 33 ± 10 mg every 2 weeks and quetiapine 413 ± 159 mg daily. Full remission was achieved by 51.1% of patients with RLAI and 39.3% with quetiapine (p = 0.003). Mean ± SD of full remission durations were not significantly different with RLAI (540 ± 181 days) and quetiapine (508 ± 188 days). Overall tolerability was similar between treatment groups.
Conclusions:
Among stable patients with schizophrenia or schizoaffective disorder, remission was more likely after switching to RLAI than quetiapine.
Research article
Free accessResearch articleFirst published August, 2013pp. 200-218
Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence,a systematic literature review
Kyoko HigashiGoran MedicKavi J. Littlewood
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Abstract
Background:
Nonadherence to medication is a recognized problem and may be the most challenging aspect of treatment.
Methods:
We performed a systematic review of factors that influence adherence and the consequences of nonadherence to the patient, healthcare system and society, in patients with schizophrenia. Particular attention was given to the effect of nonadherence on hospitalization rates, as a key driver of increased costs of care. A qualitative systematic literature review was conducted using a broad search strategy using disease and adherence terms. Due to the large number of abstracts identified, article selection was based on studies with larger sample sizes published after 2001. Thirty-seven full papers were included: 15 studies on drivers and 22 on consequences, of which 12 assessed the link between nonadherence and hospitalization.
Results:
Key drivers of nonadherence included lack of insight, medication beliefs and substance abuse. Key consequences of nonadherence included greater risk of relapse, hospitalization and suicide. Factors positively related to adherence were a good therapeutic relationship with physician and perception of benefits of medication. The most frequently reported driver and consequence were lack of insight and greater risk of hospitalization respectively.
Conclusions:
Improving adherence in schizophrenia may have a considerable positive impact on patients and society. This can be achieved by focusing on the identified multitude of factors driving nonadherence.
Research article
Free accessResearch articleFirst published August, 2013pp. 219-232
Methadone,QTc interval prolongation and torsade de pointes : Case reports offer the best understanding of this problem
W. Victor R. ViewegMehrul HasnainRobert H. Howland
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Abstract
We reviewed the literature and found 31 adult cases and 1 newborn case of methadone-associated QTc interval prolongation and/or torsade de pointes (TdP). Parametric statistics may not be useful in studying this issue because methadone-associated TdP is a very rare event and, hence, “an extreme outlier” consistent with scalable randomness. We may have to rely upon narrative medicine in the form of case reports with all its limitations and hazards to provide our best understanding. We report risk factors for methadone-associated QTc interval prolongation and TdP based on review of published case reports. We believe both drug manufacturers and the FDA would better serve our patients and inform clinicians if they more readily reported drug-induced outliers such as methadone-associated TdP using a case report format.
Research article
Free accessResearch articleFirst published August, 2013pp. 233-243
Off-licence prescribing and regulation in psychiatry: current challenges require a new model of governance
Philip SugarmanAmy MitchellCatherine Frogley
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Abstract
The growing worldwide use of pharmaceuticals is managed in some countries by a regulatory system which sharply divides legal use into licensed and unlicensed categories. We examine how for the range of psychotropics this simultaneously restricts the possible benefits to patients, prescribers and producers in some domains, while failing to manage the risks in others. A more flexible system, which shares at an earlier stage experience and evidence on benefits and risks in patients, previously marginalized on the grounds of age, diagnosis or comorbidity, would aid the development of safer, more effective ‘real-world prescribing’. Practical recommendations are made for a new model of research and prescribing governance, to enable more effective repurposing of these treatments.
Letter
Free accessLetterFirst published August, 2013pp. 244-245
Psychosis during treatment with isotretinoin
Felix Maximilian SegmillerTobias RütherAndrea Linhardt
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Letter
Free accessLetterFirst published August, 2013pp. 246-250
The emergence of obsessive compulsive and compulsive buying symptomatology after acute stress and short-term use of ribavirin: case reports
Görkem Karakaş UğurluMustafa UğurluAli Çayköylü
Letter
Free accessLetterFirst published August, 2013pp. 251-254
Contribution of methotrexate in precipitation of manic episode in bipolar affective disorder explored: a case report
Jayaraman HariramYogaratnam Jegan
Abstract
Bipolar affective disorder is characterized by recurring episodes of mania with or without, but commonly with, episodes of depression. It usually begins in adolescence and can cause enduring and substantial impairment if left untreated. It needs a long-term treatment with mood stabilizers to prevent relapses. Elevated or depressed mood relapses can be either primary or secondary. However, primary mood relapses can occur without a significant precipitating factor, more often tending to occur following stressful life events or discontinuation of mood stabilizer medications. Secondary mood relapses can be caused by many conditions, such as physical illnesses, substance misuse and medications. When a mental illness coexists with another physical illness and the treatment of one complicates the other, it adds complexity to the selection of appropriate pharmacological regime for either condition. In this paper, the authors present a case of bipolar affective disorder who had two episodes of mania likely precipitated by methotrexate, which were reversed by the withdrawal of the offending drug (methotrexate). To the best of the authors’ knowledge, to date there have been no published reports in the literature in which methotrexate, an immunosuppressive and a cytotoxic drug, precipitated a manic episode in a patient with bipolar affective disorder.

January-December 2013