Pharmacotherapy Update: Risperidone in the Treatment of Schizophrenia

2009 ◽  
Vol 1 ◽  
pp. CMT.S1123
Author(s):  
Michele Raja
Keyword(s):  
Side Effects ◽  
Psychotic Disorders ◽  
Lower Cost ◽  
Clinical Effectiveness ◽  
Psychotic Symptoms ◽  
Number Of Patients ◽  
Wide Range ◽  
Favorable Safety ◽  
Extensive Clinical Experience

The paper is a review of the clinical use of risperidone, an antipsychotic introduced in the treatment of schizophrenia in 1994. Randomized controlled trials, naturalistic studies and extensive clinical experience have definitively shown strong efficacy and effectiveness of risperidone in the treatment of schizophrenia and other psychotic disorders. On the basis of available evidence, no other antipsychotic drug has shown superior clinical effectiveness in the treatment of psychotic disorders, with the significant exception of clozapine. The wide use of risperidone in the last 15 years has confirmed a favorable safety index. Some features of risperidone render it uniquely useful in the management of psychotic disorders, including a very wide range of dosage, availability in liquid and long-term injectable forms. Finally, the drug is currently available in generic form, at lower cost. However, risperidone presents major limitations. A substantial number of patients with psychotic symptoms do not respond to risperidone, whatever its dose. Most of these patients will need clozapine. For some risperidone treated patients, extrapyramidal side effects remain a serious concern. Weight gain, metabolic syndrome, and hyperprolactinemia related side effects are frequent and may be severe, unacceptable, and even dangerous in some patients.

scholarly journals Out-patients' perceptions of the clinical and psychosocial effects of neuroleptic medication

1990 ◽  
Vol 14 (6) ◽  
pp. 331-332 ◽  
Author(s):  
Tom Chapman ◽  
Eric Mulvihill
Keyword(s):  
Side Effects ◽  
Clinical Effectiveness ◽  
Psychotic Symptoms ◽  
Psychosocial Effects ◽  
Neuroleptic Medication ◽  
Wide Range ◽  
Prevention Of Relapse

While research into the effectiveness of neuroleptic medication consistently demonstrates its value in improving psychotic symptoms, and in the prevention of relapse, the treatment continues to generate controversy. Indeed, McClelland (1989) has recently asserted that this treatment of choice is “an indispensable evil”; “indispensable” by virtue of its clinical effectiveness, and “evil” because of the wide range of adverse and distressing side effects experienced by patients.

Deinstitutionalisation for Long-Term Mental Illness: A 2-Year Clinical Evaluation

2000 ◽  
Vol 34 (3) ◽  
pp. 476-483 ◽  
Author(s):  
Coletta Hobbs ◽  
Christopher Tennant ◽  
Alan Rosen ◽  
Lesley Newton ◽  
Helen M. Lapsley ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Social Behaviour ◽  
Rating Scale ◽  
Longitudinal Design ◽  
Psychiatric Service ◽  
Clinical Effectiveness ◽  
Psychotic Symptoms ◽  
Service Support ◽  
Community Psychiatric Service

Objective: The closure of a long-stay psychiatric hospital in Sydney caused the transfer of an initial 40 very long-term patients to four community residences, each with 10 beds, for a continuing process of deinstitutionalisation. Community psychiatric service support and 24-h supervision were provided. This paper describes the residents' clinical progress which was assessed over a 2-year period. Method: This study employed a quasi-experimental longitudinal design. Evaluation commenced prior to discharge and continued for 2 years following community relocation using the Brief Psychiatric Rating Scale, Life Skills Profile, Social Behaviour Scale, Montgomery Asberg Depression Rating Scale and Quality Of Life measures. Readmission, demographic, case history and medication data were also collected. Results: Of the 40 patients initially transferred to the community, seven required long-term readmission to hospital (either prior to or after amalgamation) and one patient died of medical causes. Additional patients transferred from the hospital to the community following the readmissions. Three of these additional patients had achieved a 2-year community tenure during the study period and were included in the clinical evaluation. The 35 residents in total who remained in the community for 2 years, demonstrated a significant improvement in psychotic symptoms, without significant change in the level of neuroleptic medication. Importantly, the 2 years of community living resulted in a significant increase in the residents' life satisfaction. There were no statistically significant changes in residents' living skills, depressive symptoms or social behaviour problems over the 2 years, indicative of the need for supervision and community service support following deinstitutionalisation. Over the 2-year period, some 37% of the residents required temporary readmission. Conclusion: This study demonstrates the clinical effectiveness of deinstitutionalisation, when planned within a mental health system with adequate community resources.

scholarly journals A comparative study of effectiveness, safety and cost effectiveness of olanzapine, risperidone and aripiprazole therapy in schizophrenia

2020 ◽  
Vol 9 (5) ◽  
pp. 786
Author(s):  
Pooja R. Kanani ◽  
Ajita Pillai
Keyword(s):  
Cost Effectiveness ◽  
Antipsychotic Drugs ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Psychotic Symptoms ◽  
Average Dose ◽  
Psychiatric Hospitalizations ◽  
Score Analysis ◽  
Risperidone Group

Background: Schizophrenia is the most common psychotic disorder and responsible for approximately half of long-term psychiatric hospitalizations. Antipsychotic medications reduce the psychotic symptoms and prevent relapses. The choice of drug for treatment of schizophrenia depends on many issues, including effectiveness, cost, side-effect burden, availability, and tolerability. Many studies have compared antipsychotic drugs with one another, but no broad consensus has been reached. Our study compares the clinical effectiveness, safety and cost effectiveness of atypical antipsychotics in our setting.Methods: This was an observational, prospective study in which schizophrenia patients receiving either olanzapine, risperidone or aripiprazole were enrolled. Patients were followed up for 3 months. Evaluation of effectiveness was done by analysing mean reduction in PANSS score. Analysis of ADRs was done using WHO causality scale and Hartwig and Siegel severity scale. Cost analysis was done by comparing all three groups in term of cost range of antipsychotic drugs per improvement in PANSS score during the study period.Results: In the present study, the average dose of antipsychotic drugs received by a patient per day was 8.83±2.98 mg in olanzapine group, 4.76±1.12 mg in risperidone group and 20.43±8.5 mg in aripiprazole group. Mean reduction in PANSS score from baseline to 12 weeks was 23.79% in olanzapine group, 25.41% in risperidone group and 24.65% in aripiprazole group. Conclusions: All the groups were equally effective in reduction in PANSS score while risperidone was the most cost effective.

Choice of Antenatal Steroids for Prevention of Complications of Prematurity: Betamethasone Versus Dexamethasone

2021 ◽  
pp. 097321792110483
Author(s):  
Tanushree Sahoo ◽  
Abhishek Somasekhara Aradhya ◽  
Kanya Mukhopadhyay
Keyword(s):  
Side Effects ◽  
Early Onset ◽  
Lower Cost ◽  
Antenatal Steroids ◽  
Term Adverse Effect ◽  
Early Onset Sepsis ◽  
Poor Neurological Outcome ◽  
Long Term Follow Up

Antenatal steroids (ANS) are proven strategies to maximize outcomes of premature neonates without any major maternal side effects. Their use results in decreased incidence of neonatal mortality and major morbidities (respiratory distress syndrome, early onset sepsis, necrotizing enterocolitis, and intraventricular hemorrhage). However, due to concerns of long-term adverse effect (early onset hypertension and poor neurological outcome), a close follow-up is required. Similarly, due to lack of long-term follow-up data and potential risk of hypoglycemia, a cautious use is recommended in late preterms and elective cesareans. There is currently no consensus regarding preferential use of one ANS over the other. The current review therefore tried to address these issues for use of ANS in Indian prospective in light of recent emerging evidence. Due to better safety profile, lesser side effects, lower cost, and easy storage, we recommend dexamethasone as a steroid of choice for antenatal prophylaxis.

scholarly journals EP20 Long term safety and efficacy of denosumab and zoledronate

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Ziad Alkutobi ◽  
Deena Laila ◽  
Mohammad Tariq
Keyword(s):  
Side Effects ◽  
Neck Of Femur ◽  
Dxa Scan ◽  
Safety And Efficacy ◽  
Oral Bisphosphonate ◽  
Retrospective Audit ◽  
Number Of Patients ◽  
Gastrointestinal Side Effects ◽  
To Receive

Abstract Background Denosumab and zoledronate are increasingly prescribed for primary and secondary osteoporosis long-term management. Methods A retrospective audit was conducted at Basildon Hospital during 2012-2019 using the NICE guidelines standards to evaluate the long term safety and efficacy of denosumab and zoledronate. Number of patients was 84, diagnosed with osteoporosis or osteopenia, 34 of them received 10 or more denosumab injections and 50 patients planned to receive 5 zoledronate infusions (9 patients received 5 and 38 patients received 4). Results Forty percent of the patients were at their 8th decade followed by 28.57% and 21.42 % at their 9th and 7th decades respectively. More than 90% were Caucasian females. Primary prevention was in 39.28% and secondary prevention in 60.71%. The commonest sites of fracture were the wrist and vertebrae at 34.37% for each; followed by the neck of femur and humerous at 12.5% for each. Denosumab was the 1st, 2nd, 3rd or 4th line of treatment in 9.52%, 13.09%, 16.66% and 1.19% respectively; whereas zoledronate was the 1st, 2nd or 3rd line of treatment in 13.09%, 40.47% and 5.95% respectively. The commonest reason for choosing denosumab as the first line was chronic kidney disease, whereas the reason for choosing it as the 2nd or 3rd line was inefficacy of bisphosphonate in 69% or gastrointestinal side effects in 14%. Zoledronate was chosen in all cases because of intolerability to oral bisphosphonate or gastrointestinal side effects. Repeat DXA scan was performed after the 5th, 10th denosumab injections and the 3rd zoledronate infusions. After the 5th Denosumab, DXA scan showed improvement or stability in 100% and 85.29% at the spine and hip respectively whilst deterioration was seen in 14.7% at the hip. After the 10th denosumab, the rate of improvement or stability at the spine was reduced to 88.23% and decline was seen in 2.94%. At the hip area, 73.52% continued to show improvement or stability, whilst 17.66 % showed deterioration. After the 3rd zoledronate, 98% and 88% showed improvement or stability at the spine and hip respectively whilst deterioration seen in 2% and 12% at the spine and hip respectively. One patient on zoledronate experienced dental issues after the 4th injection and stopped treatment. There were no jaw osteonecrosis, no new fractures and no significant side effects with either denosumab or zoledronate. Ninety percent of patients who completed 10 denosumab injections were planned to continue for another 5 injections. Conclusion After the period of 3-5 years, denosumab and zoledronate were well tolerated and BMD was either stable or improved at both spinal and hip sites. There were few cases of deterioration mainly at the hip area with both zoledronate and denosumab. Future researches are needed to stratify guidelines on discontinuation of denosumab. Disclosures Z. Alkutobi None. D. Laila None. M. Tariq None. A. Nandagudi None.

What Diagnoses Are Associated with Psychosis?

2021 ◽  
pp. 35-48
Author(s):  
Beth Broussard ◽  
Michael T. Compton
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Healthcare Provider ◽  
Psychotic Disorders ◽  
Definitive Diagnosis ◽  
Psychotic Symptoms ◽  
Specific Diagnosis ◽  
Substance Related Disorders

In this chapter we discuss the different diagnoses associated with psychosis. Schizophrenia is one of several primary psychotic disorders, a group of psychiatric disorders that primarily cause psychosis. Other disorders can cause psychotic symptoms—or symptoms similar to these—but are not considered psychotic disorders. A few examples of such disorders are major depressive disorder, bipolar disorder, and some substance-related disorders. It is often difficult to make a specific diagnosis when long-term information is not available at first. In instances in which a definitive diagnosis is uncertain, a working diagnosis allows the healthcare provider to begin effective treatments for psychosis even before a more certain diagnosis is made.

scholarly journals Prospective evaluation of multitarget treatment of pediatric patients with helical intensity-modulated radiotherapy

2020 ◽  
Vol 196 (12) ◽  
pp. 1103-1115
Author(s):  
Maria-Elena A. Salfelder ◽  
Kerstin A. Kessel ◽  
Uwe Thiel ◽  
Stefan Burdach ◽  
Severin Kampfer ◽  
...  
Keyword(s):  
Survival Rate ◽  
Side Effects ◽  
Survival Rates ◽  
Young Patients ◽  
Intensity Modulated Radiotherapy ◽  
High Survival ◽  
Single Target ◽  
Number Of Patients ◽  
Grade 3

Abstract Background and purpose Radiotherapy (RT) is persistently gaining significance in the treatment of pediatric tumors. However, individual features of a growing body and multifocal stages complicate this approach. Tomotherapy offers advantages in the treatment of anatomically complex tumors with low risks of side effects. Here we report on toxicity incidence and outcome of tomotherapy with a focus on multitarget RT (mtRT). Materials and methods From 2008 to 2017, 38 children diagnosed with sarcoma were treated with tomotherapy. The median age was 15 years (6–19 years). Toxicity was graded according to the Common Terminology Criteria for Adverse Events v.4.03 and classified into symptoms during RT, acutely (0–6 months) and late (>6 months) after RT, and long-term sideeffects (>24 months). Results The main histologies were Ewing sarcoma (n = 23 [61%]) and alveolar rhabdomyosarcoma (n = 5 [13%]). RT was performed with a median total dose of 54 Gy (40.5–66.0 Gy) and a single dose of 2 Gy (1.80–2.27 Gy). Twenty patients (53%) received mtRT. Median follow-up was 29.7 months (95% confidence interval 15.3–48.2 months) with a 5-year survival of 55.2% (±9.5%). The 5‑year survival rate of patients with mtRT (n = 20) was 37.1 ± 13.2%, while patients who received single-target RT (n = 18) had a 5-year survival rate of 75 ± 10.8%. Severe toxicities (grade 3 and 4) emerged in 14 patients (70%) with mtRT and 7 patients (39%) with single-target RT. Two non-hematological grade 4 toxicities occurred during RT: one mucositis and one radiodermatitis. After mtRT 5 patients had grade 3 toxicities acute and after single-target RT 4 patients. One patient had acute non-hematological grade 4 toxicities (gastritis, pericarditis, and pericardial effusion) after mtRT. Severe late effects of RT occurred in 2 patients after mtRT and in none of the single-target RT patients. No severe long-term side effects appeared. Conclusion Our results showed acceptable levels of acute and late toxicities, considering the highly advanced diseases and multimodal treatment. Hence, tomotherapy is a feasible treatment method for young patients with anatomically complex tumors or multiple targets. Especially mtRT is a promising and innovative treatment approach for pediatric sarcomas, delivering unexpectedly high survival rates for patients with multifocal Ewing sarcomas in this study, whereby the limited number of patients should invariably be considered in the interpretation.

scholarly journals Kezdeti tapasztalataink spinalis muscularis atrophiában szenvedő gyermekek intravénás génterápiájával

2020 ◽  
Vol 161 (42) ◽  
pp. 1806-1816
Author(s):  
Borbála Mikos ◽  
Anita Gergely ◽  
Réka Balázsfi ◽  
Edina Bányász ◽  
Beáta Gyömörei ◽  
...  
Keyword(s):  
Side Effects ◽  
Troponin I ◽  
Muscular Atrophy ◽  
Safety Data ◽  
Clinical Results ◽  
Genetic Diagnostics ◽  
Number Of Patients ◽  
Movement Performance ◽  
Term Basis

Összefoglaló. A veleszületett gerincvelői izomsorvadás ritka, progresszív neurodegeneratív betegség, a gyermekkori halál egyik legjelentősebb genetikai oka. Az orvostudomány lehetőségei a XXI. század előtt a progresszió megfékezésére, a szövődmények késleltetésére és ellátására korlátozódtak. A legsúlyosabb génhibában szenvedő gyermekeket általában kétéves kor előtt elveszítettük. A genetikai diagnosztika fejlődése lehetővé teszi a korai diagnózist, a súlyosság és a progresszió előrejelzését. A 2018-ban hazánkban engedélyezett intrathecalis nuszinerszennel a nagy betegszámon alapuló klinikai eredmények meggyőzőek. A 2019-től elérhető új, intravénás génpótló terápiával (onaszemnogén abeparvovek) kapcsolatos tapasztalatok még kisebb betegszámon alapulnak. Hazánkban öt betegnél került sor az alkalmazására a Bethesda Gyermekkórházban, szigorú szakmai kritériumok és előkészületek alapján. Közülük annak a három gyermeknek a kezeléséről számolunk be dolgozatunkban, akiknél már rendelkezünk utánkövetési tapasztalatokkal. Vizsgálatunk szerint a készítmény elősegíti a mozgásteljesítmény javulását. A mellékhatások elsősorban reverzibilis májenzim-emelkedésben, thrombocytopeniában, granulocytopeniában és a szívizom-nekroenzim emelkedésében nyilvánultak meg. Ezért fontosnak tartjuk a betegek szoros és tartós követését, a mellékhatások korai észlelése és elhárítása érdekében. Orv Hetil. 2020; 161(42): 1806–1816. Summary. Congenital spinal muscular atrophy is a rare, progressive neurodegenerative disease, one of the major genetic causes of childhood death. The possibilities of medicine to curb its progression and to delay and treat the disease’s complications were limited before the 21st century. Therefore, children with the most severe genetic defects were usually lost before their second birthday. Advances in genetic diagnostics allow for early diagnosis, prediction of severity and expected progression. Using intrathecal nusinersen (available in Hungary since 2018), clinical results based on a large number of patients are convincing. Experience with the new intravenous gene therapy (onasemnogene abeparvovec) available from 2019 is still based on a less number of patients. It was used in Hungary in Bethesda Hospital in five children based on strict professional criteria and preparations. Our paper summarizes the most important efficacy and safety data of the first three consecutive patients. According to our experiences, the product helps to improve movement performance. Side effects are mainly reversible elevations of liver enzymes and serum troponin-I levels, thrombocytopenia and granulocytopenia. Therefore, we found that it is important to monitor patients closely on a long-term basis in order to detect and eliminate side effects early. Orv Hetil. 2020; 161(42): 1806–1816.

A Ten-Year Assessment of Methicillin-Associated Side Effects

PEDIATRICS ◽  
1976 ◽  
Vol 58 (3) ◽  
pp. 329-334
Author(s):  
Martha D. Yow ◽  
Larry H. Taber ◽  
Fred F. Barrett ◽  
A. Aaron Mintz ◽  
G. Richard Blankinship ◽  
...  
Keyword(s):  
Side Effects ◽  
Great Majority ◽  
Incidence Rates ◽  
Term Therapy ◽  
Average Dose ◽  
True Incidence ◽  
Number Of Patients ◽  
Chemical Irritation ◽  
Long Term Therapy

The exact incidence and importance of side effects associated with methicillin therapy in children is unknown. During the ten-year period from 1964 to 1974 approximately 3,000 Houston children who received methicillin were observed for side effects. The great majority of these patients received the drug for less than ten days; however, side effects were more common in patients receiving long-term therapy. In order to assess these side effects, experiences with 124 children who received methicillin for ten days or longer were reviewed in depth. The average dose of methicillin was 200 mg/kg/day and the average duration was 22 days. In this highly selected group there were no adverse side effects in 54.8% and only eosinophilia in an additional 13%. Leukopenia occurred in 16%, microscopic hematuria in 8%, gross hematuria in 4%, skin rash in 6%, and "drug fever" in 6%. In many instances several of these side effects occurred within a single patient so that the total number of patients with definite side effects was 39 of 124 (31.5%). The true incidence figure of overall side effects is much lower than 31.5%. Corrected incidence rates based on a conservative figure of 3,000 methicillin-treated children are less than 1.5% for all side effects. In some patients the mechanism producing the adverse reactions seemed to be chemical irritation or toxicity and in others hypersensitivity. In nine of the 39 patients follow-up studies were not optimal. In the other 30 patients all side effects were reversible.

Bioregulatory opportunities of Viburkol and Limphomiozot medicines in obstetries and gynecology

2016 ◽  
pp. 41-44
Author(s):  
O. Ostapenko ◽  
Keyword(s):  
Side Effects ◽  
Reproductive System ◽  
Labor Pain ◽  
Therapeutic Effects ◽  
Female Reproductive System ◽  
Pregnancy And Childbirth ◽  
Wide Range ◽  
Nursing Mothers ◽  
Pregnancy And Lactation ◽  
Favorable Safety

Modern obstetrics and gynecology use a wide range of medicines (drugs) when accompanied by pregnancy and childbirth (miscarriage, discoordination labor, labor pain relief), diseases of the female reproductive system (inflammation, dishormonal disorders, etc.). Among the traditional drugs most widely used antibiotics, NSAIDs, analgesics, antispasmodics, hormones. These drugs, along with the achievement of rapid and pronounced therapeutic effects cause different side effects, and have a number of contra-indications (diseases of the liver, the pancreas, the risk of thrombosis, the development of immunodeficiency, etc.) [12]. In this regard, special attention and care requires the use of drugs in pregnant women and nursing mothers. Also relevant is the increase of efficiency of treatment of many gynecological diseases. All these and many other factors encourage to search for new – more effective and safer treatment approaches and drugs, including pathogenesis [12,22]. The review presents brief characteristics and clinical researches on the use and integrated bioregulatory approach through the use of complex combination bioregulatory medicines (CBM) Viburkol, Limphomiozot, Limphomiozot N in obstetrics and in various diseases and disorders of the female reproductive system [1–3]. The research results show that the inclusion of one or more of the CBM in the traditional treatment help reduce the duration of therapy, a decrease in some side effects, and in some cases rejection of it. In addition, they do not burden for opportunistic diseases, tolerated well and have a favorable safety profile, can be used during pregnancy and lactation [4–22]. Key words: Viburkol, Limphomiozot, Limphomiozot N, bioregulatory approach, combination bioregulatory medicines, obstetrics, gynecology, diseases of the female reproductive system.

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