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Converging evidence has suggested that treatment augmentation with a second-generation atypical antipsychotic (SGA) may improve treatment outcomes in major depressive disorder (MDD) patients after an incomplete response to a first-line antidepressant. Cariprazine is a recently approved SGA for MDD augmentation. Herein, we evaluate both continuous (ie, change in depressive symptom severity scores over time) and categorical (ie, remission and response rates) outcomes. Following a full-text review, four randomized controlled trials (RCTs) were included in our meta-analysis, while five studies were included for a qualitative review. Risk ratios (RRs) were calculated for all included randomized controlled studies to determine the relative response and remission rates of cariprazine compared to placebo augmentation. The RR for all-cause dropout was also determined as a proxy for overall acceptability. Two studies found a statistically significant treatment response using cariprazine augmentation. One study observed depressive symptom remission for cariprazine compared to placebo. Our random-effects model revealed moderate antidepressant effects of cariprazine, with a standardized mean difference (SMD) in Montgomery–Åsberg Depression Rating Scale (MADRS) scores of −1.79 (95% CI): −2.89, −0.69). Our pooled response RR and remission RR were calculated as 1.21 (95% CI: 1.05, 1.39, P =0.008) and 0.99 (95% CI: 0.84, 1.17, P =0.91), respectively. The RR for response was statistically significant (P <0.05). However, the RR for remission was not statistically significant. The findings from our meta-analysis include a variable magnitude of effects. Evidence suggests cariprazine may be an effective treatment for MDD; however, further results are needed to clarify this relation. [ABSTRACT FROM AUTHOR]

Second-generation antipsychotics (SGAs) are commonly used to treat schizophrenia (SCZ), but SGAs may differ in the severity of side effects. Long-term studies are lacking, and previous observational studies have limitations, such as failure to account for confounding factors and short follow-up durations. To compare the long-term anthropometric and metabolic side effects of seven SGAs in a Chinese population, using a within-subject approach to reduce the risk of confounding. We collected longitudinal data of SGA prescriptions, concomitant medications, fasting blood glucose (BG), lipid profiles, and BMI in a cohort of 767 patients with SCZ, with follow-up lasting up to 18.7 years (median ∼6.2 years). A total of 192,152 prescription records were retrieved, with 27,723 metabolic measures analysed. Linear mixed models were used to estimate the effects of SGA on BG, lipid profiles and BMI. Besides studying the effects of SGA medications (as binary predictors), we also investigated the effects of SGA dosage on metabolic profiles. Considering SGA medications as binary predictors, clozapine and olanzapine were associated with the most substantial worsening of lipid profiles and BMI. A significant increase in BG was observed with clozapine only. Amisulpride, paliperidone and quetiapine were associated with worsened lipid profiles and increased BMI. Conversely, aripiprazole was associated with significant improvement in lipid profiles but a small increase in BMI. When SGA dosage was considered, the model showed consistent results overall. At the minimum effective dose, clozapine was associated with the most severe metabolic side effects, followed by olanzapine. Risperidone and aripiprazole showed the least metabolic side effects, with aripiprazole being significantly associated with lower lipids. This study clarified the long-term and dose-dependent effects of different SGAs on anthropometric and metabolic parameters in Chinese SCZ patients. Our findings may inform clinicians and SCZ patients of SGA choices. • Long-term effects of second-generation antipsychotics (SGAs) on metabolic profiles and BMI in schizophrenia patients. • Within-subject approach to reduce confounding factors in observational study of SGA side effects. • Dose-dependent effects of SGAs on blood glucose, lipid profiles, and BMI in Chinese schizophrenia cohort. • Clozapine and olanzapine associated with most substantial worsening of lipid profiles and BMI. • Aripiprazole associated with improved lipid profiles but small increase in BMI. [ABSTRACT FROM AUTHOR]

Objective: Second-generation antipsychotics (SGAs) have a negative impact on metabolic syndrome (MetS) risk factors for their effects on body weight and on metabolic parameters. Statins are widely used in the treatment of dyslipidemia; less is known on the ability of statins to treat SGAs-induced dyslipidemia, and nutraceutical approaches may represent promising strategies in SGAs-treated patients. Red Yeast Rice (RYR), the fermented product of the Aspergillaceae mold Monascus purpureus (red yeast) grown on white rice, has been shown to have a cholesterol-lowering effect which can be ascribed to monacolin K, although other active compounds may play a role management of hyperlipidemia. The present study was aimed to explore the efficacy and safety of RYR treatment on clinical and metabolic parameters in a sample of subjects receiving SGAs.Methods: Fifteen outpatients treated with SGAs assumed RYR at the oral daily dose of 200 mg/day (total monacolin K = 11.88 mg) for 30 days. Fasting levels of triglycerides, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol and glucose were determined.Results: RYR administration resulted in a statistically significant reduction of LDL (p = 0.029), corresponding to 11.0% decrease from baseline mean value. No significant differences in clinical and in other and metabolic parameters were observed.Conclusions: Our findings suggest that RYR, at the daily dose of 200 mg for 30 days, could be a promising agent to prevent and/or treat SGAs-induced hyperlipidemia. However, future adequately-powered and well-designed studies with long-term follow-up should evaluate RYR effectiveness, as an alternative option to statins, on the SGAs-induced metabolic side effects. [ABSTRACT FROM AUTHOR]

Psychosis is an umbrella term used in the description of various conditions involving delusions and hallucinations. This article focuses mainly on the management of schizophrenia. Schizophrenia is a complex disorder, which provides many pharmacotherapy-related challenges. Advances have been made in the treatment of the condition; however, this requires a team approach, with the pharmacist having to monitor treatment both for safety and efficacy. The involvement of medicines that might modulate the N-methyl-D-aspartate (NMDA) receptors is an exciting development that should be monitored. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) is a disabling psychiatric condition. Although antidepressant medications are the mainstay of treatment, many patients fail to achieve remission with their use. Consequently, a range of augmentation and combination strategies has been used to improve treatment outcomes. Recent evidence has shown that adjunctive therapy with atypical or second-generation antipsychotics (SGAs) could improve and potentiate the beneficial antidepressant effects even in the absence of psychotic symptoms. This review summarizes the SGAs used as augmenting agents for the treatment of resistant MDD and the pharmacologic mechanisms involved in this combined treatment approach. Primary care providers using SGAs to treat MDD must monitor patients for certain adverse effects such as weight gain and hyperglycemia. [ABSTRACT FROM AUTHOR]

This study was undertaken to determine adherence rates to side effect monitoring guidelines of second-generation antipsychotics (SGAs) approximately 10 years after their publication to assess the quality of care being provided to patients with mental illness at an urban community mental health center located in the Southeast United States. Results indicated an initial combined collection of fasting blood glucose (FBG) and fasting lipid profile (FLP) of 30%. At the 3-month time point, 20% of FBG and FLP were checked and at 1 year 14%. Study results suggest there is a need for practice improvements to increase quality of care. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To assess the association of second-generation antipsychotics (SGAs) with changes in body mass index (BMI) among adolescents compared with a matched untreated comparison group. Methods: A retrospective cohort study was conducted using an electronic medical record database between January 2004 and July 2009. Adolescents (12–19 years old), newly initiated on SGAs formed the exposure group and untreated adolescents formed the comparison group matched (3:1) to the antipsychotic group based on age, gender, and month of index SGA. Both the exposure and comparison groups were followed for slightly more than a year (395 days). Baseline and follow-up BMI were evaluated for both groups and percentage change from baseline BMI to follow-up BMI was calculated. Multivariate linear regression was conducted to assess the impact of SGAs on percent change in follow-up BMI from baseline controlling for demographic characteristics, baseline medications, comorbidities, and other covariates. Results: The mean percentage increase in follow-up BMI from baseline for antipsychotic group was significantly higher than the comparison group (p < .01). After adjusting for covariates, adolescents on olanzapine had the highest percentage increase in follow-up BMI from baseline (5.84%, 95% confidence interval [CI], 4.07–7.61) followed by aripiprazole (4.36%; 95% CI, 3.08–5.64), risperidone (3.65%; 95% CI, 2.61–4.68), and quetiapine (1.53%; 95% CI, .53–2.52) compared with the comparison group. Conclusion: This study further validates a growing concern of increased BMI in adolescents on SGA therapy. [Copyright &y& Elsevier]

Abstract: Treatment options for patients with schizophrenia are more plentiful than ever before. Despite their established efficacy in treating schizophrenia symptoms, typical or first-generation compounds are associated with high rates of troubling extrapyramidal side effects. Moreover, there is still an unmet therapeutic need for the management of negative, cognitive and affective symptoms of schizophrenia. Second-generation antipsychotics were developed with the promise of enhanced efficacy and improved tolerability relative to their first-generation predecessors. The existing clinical trials, however, have not conclusively answered the questions about the clinical advantages and the cost-effectiveness of second-generation antipsychotics, especially from the perspective of clinical practice and public health. To address these issues, clinical trials of effectiveness have been conducted in the USA and the UK. Effectiveness trials are designed to answer the question ‘Will a treatment work in real-world conditions?’, whereas the existing industry-funded trials, often called efficacy trials, answer the question ‘Will a treatment work under ideal conditions?’. Overall, effectiveness trials have shown that second-generation antipsychotics are as effective and cause fewer extrapyramidal side effects relative to first-generation drugs, but come with new metabolic side effects. A clinical advantage over all other antipsy chotics was demonstrated for clozapine, the prototype of atypical antipsychotics. The goal for the next decade will be to use the current agents more intelligently, to match patients to drugs individually, and to continue the search for more efficacious antipsychotics and new add-on drugs for cognitive and negative symptoms. [Copyright &y& Elsevier]

Individuals with psychiatric disorders tend to have excessive morbidity. They typically have high rates of respiratory illnesses, infectious diseases, substance abuse (including smoking), obesity, diabetes mellitus, and cardiovascular disease (CVD). Persons with schizophrenia and affective disorders also have a high prevalence of risk factors for CVD, such as diabetes and obesity, which are on the order of 1.5 to 2.0 times higher than in the general population; this translates into increased mortality rates due to CVD. The use of certain psychotropics results in metabolic sequelae, such as obesity, dyslipidemia, glucose dysregulation, and the metabolic syndrome. These sequelae exacerbate the already elevated risk of CVD and diabetes in this group of people. Therefore, the use of psychotropic agents that result in, for example, excessive weight gain not only add another complication for physicians managing a patient with schizophrenia but also may have serious prognostic and cost implications with respect to treatment-related diabetes and coronary disease incidence. The recent American Diabetes Association (ADA) Consensus Panel concluded that some agents are associated with greater diabetes risk than others. The current review describes the prevalence of the metabolic syndrome in people with affective disorders and schizophrenic populations, its prognostic relevance, and its exacerbation among patients treated with particular psychotropic agents, including certain atypical antipsychotics, selective serotonin reuptake inhibitors, and mood stabilizers. The costs associated with the treatment of the metabolic syndrome, diabetes, and coronary heart disease in populations with schizophrenia are also described. [Copyright &y& Elsevier]

Second-generation antipsychotics are an important component in the management of psychiatric conditions but their use can also lead to weight gain, diabetes, and dyslipidemia. Thus, this study aimed to assess the magnitude of metabolic syndrome and its predictors among patients who were on second-generation antipsychotic drugs at six psychiatry Hospitals, in Addis Ababa, Ethiopia, 2019. This study was conducted using a Multicenter cross-sectional study design. Medical charts of 510 patients on second-generation antipsychotic drugs who were selected by convenience sampling method and complete patients' charts were included in this study. Data was gathered using a checklist from patients' medical charts. To identify the determinants of metabolic syndrome, a logistic regression model was used. From a total of 510 patients' Medical charts on the second-generation antipsychotic drugs, 270 (52.9%) of them were females and 240 (47.1%) were males. The magnitude of metabolic syndrome among patients receiving second-generation antipsychotic drugs was found to be 88 (17.8%). Age, education, family history of cardiovascular disease, and type of second-generation antipsychotic drugs are found to be significantly associated factors with metabolic syndrome. Considerable proportion of patients receiving second-generation antipsychotic medications have metabolic syndrome. • Metabolic syndrome is common with psychiatric patients taking second generation antipsychotics. • Metabolic syndrome is more sever in bipolar disorder psychiatric patients than the other types of psychiatric patients. • Risperidone and olanzapine drugs are associated with metabolic syndrome than other types of antipsychotic drugs. • Drug types, type of psychiatric disorders, age, and level of education are determinant factors of metabolic syndromes. [ABSTRACT FROM AUTHOR]

Over the 2004 through 2008 period, total second-generation antipsychotic prescriptions grew 33 percent from 6.9 million to 9.2 million; second-generation antipsychotic prescriptions for patients under age 18 also increased, but at a slightly slower rate: 24-percent increase from 1.0 million to 1.2 million prescriptions. One-third of patients under age 18 who are prescribed secondgeneration antipsychotics use them for the treatment of affective psychoses, primarily bipolar disorder (34%). Other common uses for second-generation antipsychotics include hyperkinetic syndrome (12%), pervasive developmental disorders (10%), emotional disorders of children/adolescents (10%), and conduct disturbance (7%). A discussion of the data is provided. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study compared all-cause and schizophrenia-related health care utilization and costs among patients with schizophrenia using second-generation oral antipsychotics (SGOAs) and experiencing ≥2 psychiatric-related relapses with those experiencing <2 relapses. Study Design: Patients with schizophrenia who initiated SGOA therapy were identified in the MarketScan® Medicaid Multi-State database between July 1, 2004 and December 31, 2007. Patients were stratified by <2 psychiatric-related relapse events and ≥2 psychiatric-related relapse events during the 12-month period following SGOA initiation. All-cause and schizophrenia-related health care utilization and costs were estimated for each cohort in various care settings. Univariate and multivariate regression analyses were conducted to assess the differences in all-cause and schizophrenia-related health care utilization and costs between the 2 cohorts. No adjustments were made for multiple inferential statistical tests. Results: The cohort consisted of 19,813 patients, of whom 3714 (18.75%) had ≥2 psychiatric-related relapse events during the follow-up period. On average, patients with ≥2 psychiatric-related relapse events were younger than patients with <2 psychiatric-related relapse events (42.62 years vs. 44.21 years; P < 0.001), and the all-cause and schizophrenia-related inpatient costs were approximately 12 and 23 times higher, respectively. The mean covariate-adjusted predicted schizophrenia-related total medical costs per patient were significantly higher among patients with ≥2 psychiatric-related relapse events than among patients with <2 psychiatric-related relapse events ($17,910 vs. $10,346; P < 0.001). Conclusion: Patients who received an SGOA and experienced ≥2 psychiatric-related relapse events within the first year of treatment incurred significantly greater all-cause and schizophrenia-related total medical costs than those with <2. [Copyright &y& Elsevier]