1,721,070 research outputs found
Long-acting antipsychotics: patient’s features and prescribing attitudes in Italy. Findings from the cross-sectional phase of an observational, longitudinal, multicenter study.
Full text linkScientific background. Long-acting injectable antipsychotics (LAIs) are considered one of the most important tools for ensuring medication adherence in people with chronic psychosis. In recent times many authors promoted an earlier and broader use of LAIs, considering not only their efficacy in preventing non-adherence (and therefore relapses), but also their potential role in simplifying the daily medication routine, ultimately ameliorating patient’s quality of life. On this background, this study aims at describing how this new perspective influenced prescribing pattern in Community Psychiatry Services, with a specific interest in comparing first- and second-generation antipsychotics. Methods. The STAR Network “Depot” Study is an observational, longitudinal, multicenter study involving 35 Italian Community Psychiatry Services. Adult patients initiating a new LAI were recruited over a 12-months period and assessed for relevant socio-demographic and clinical features (employing also validated rating scales) at baseline, after 6 and 12 months. Descriptive statistics and a stepped multivariate logistic model accounting for the inter-center variability were employed. Results. Only results from the recruitment (or cross-sectional) phase will be discussed here. Four-hundred-fifty-one patients, mostly males over their 30s, were recruited. Patients were heterogeneously distributed between higher and lower levels of education, social functioning, overall symptom profiles and medication adherence. Beside schizophrenia, also bipolar disorders, personality disorders and mental organic conditions were well represented. Paliperidone and aripiprazole were the most frequently prescribed medications. Analyses showed that, compared to first-generation LAIs, second-generation LAIs were more likely to be prescribed to younger, employed patients, with higher affective symptoms, a diagnosis different from schizophrenia or bipolar disorder, and fewer previous LAI prescriptions. Discussion. LAIs are prescribed to heterogeneous populations of patients, often even off-label. The advocated paradigm shift is under way in clinical practice, although it appears to be largely limited to second-generation LAIs
Comparative effectiveness of long-acting antipsychotics: issues and challenges from a pragmatic randomised study
No full textAlthough long-acting antipsychotics are widely used in individuals with psychotic disorders, it is unclear which long-acting preparation should be considered as first-line treatment in clinical practice. In this commentary, the main strengths and weaknesses of a recently published pragmatic randomised study comparing long-acting paliperidone palmitate v. long-acting haloperidol decanoate are briefly analysed
Autism spectrum disorders: weighing the risk of SSRI exposure in pregnancy
No full textA possible link between prenatal exposure to the selective serotonin reuptake inhibitors (SSRIs) and development of autism spectrum disorders (ASDs), previously suggested by two case-control studies, was not confirmed by a recent cohort study that followed for 5-10 years more than 600,000 births. However, this study failed to demonstrate that SSRI exposure during pregnancy is safe in terms of child development outcomes, as an increased risk of ASDs cannot be completely ruled out. In the present article, the main strengths and weaknesses of this study are briefly analysed, including a possibility of confounding by indication
Expanding access to long-acting antipsychotics in low-income and middle-income countries
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Combining randomised and observational evidence in schizophrenia: how real is the real world?
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Beneficial and harmful consequences of prepartum and postpartum antidepressant exposure
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Calling for policy actions to increase access to long-acting antipsychotics in low-income and middle-income countries
Full text linkSchizophrenia-spectrum disorders are associated with substantial impairment and disability. Lack of treatment adherence is a major issue, especially in low- and middle-income countries (LMICs). Despite growing evidence supporting second-generation long-acting antipsychotics (LAIs) as an effective strategy to ensure continued maintenance treatment in schizophrenia, access to these technologies has been very limited in constrained-resource settings. Including second-generation LAIs in national and international essential medicines lists and evidence-based guidelines, promoting public health-oriented patent pooling and extending their availability to primary health care settings, are key actions that should urgently be implemented to increase access to long-acting technologies. Implementing these policy actions can pragmatically improve treatment adherence, ultimately tackling schizophrenia-related impairment and disability in LMICs, which can be regarded as a global health priority
Ground-breaking change to the mental health section of the WHO Model List of Essential Medicines: implications for low- and middle-income countries
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New EMA report on paliperidone 3-month injections: taking clinical and policy decisions without an adequate evidence base
No full textThree-month long-acting paliperidone is a new, recently marketed, formulation of paliperidone, characterised by the longest available dosing interval among long-acting antipsychotics. The clinical profile of 3-month long-acting paliperidone was recently summarised by the European Medicines Agency (EMA) in a public assessment report, released in April 2016. In this commentary, the main strengths and limitations of the EMA assessment report were appraised and discussed, in order to highlight possible implications for clinical practice, future research and regulatory practices for drug approval
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