Clinical factors related to schizophrenia relapse

Porcelli, Stefano; Bianchini, O.; Girolamo, Giovanni de; Aguglia, Eugenio; Crea, Luciana; Serretti, Alessandro

doi:10.3109/13651501.2016.1149195

Cited by 34 publications

(28 citation statements)

References 129 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As to our findings that a diagnosis of a co-morbid affective disorder, a co-morbid substance misuse disorder, or a diagnosis of a cardiovascular disease was associated with an increased risk of relapse, substance misuse has previously been linked to an increased risk of relapse (Porcelli et al, 2016). In RCTs, co-morbid psychiatric disorders are often an exclusion criterion, and in observational studies affective disorders co-morbid to schizophrenia have not been linked with relapse as an outcome previously (Bowtell et al, 2017;Porcelli et al, 2016). The finding of an association between relapse and cardiovascular disease is novel, and to further elucidate this, studies with other designs could be conducted.…”

Section: Discussionmentioning

confidence: 47%

Second-generation LAI are associated to favorable outcome in a cohort of incident patients diagnosed with schizophrenia

Nielsen

Hessellund

Valentin

et al. 2018

Schizophrenia Research

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 47%

Second-generation LAI are associated to favorable outcome in a cohort of incident patients diagnosed with schizophrenia

Nielsen

Hessellund

Valentin

et al. 2018

Schizophrenia Research

View full text Add to dashboard Cite

show abstract

“…Breakthrough psychosis and/or symptom worsening may occur for a variety of reasons, including psychotic relapse, concurrent medical illness, substance abuse or misuse, other psychiatric comorbidity, psychosocial stressors, suboptimal drug administration, incorrect dosage, ineffective medication, use of other drugs leading to pharmacodynamic (PD) or PK interactions, poor adherence, and AEs leading to refusal or discontinuation of treatment. 1,2,16 Low plasma therapeutic levels may also contribute to breakthrough psychosis. Therapeutic plasma reference ranges are now available in the new AGNP guidelines, 15 and while these are preliminary, together with therapeutic dose monitoring they may be of some use toward medication and dosing decision making, as exemplified in Table 2.…”

Section: General Factors That Contribute To Breakthrough Psychosis Anmentioning

confidence: 99%

Practical considerations for managing breakthrough psychosis and symptomatic worsening in patients with schizophrenia on long-acting injectable antipsychotics

et al. 2018

View full text Add to dashboard Cite

With more long-acting injectable (LAI) antipsychotics available for treating schizophrenia, each with variable durations of action (2 weeks to 3 months), it is important to have clear management strategies for patients developing breakthrough psychotic symptoms or experiencing symptomatic worsening on LAIs. However, no treatment guidelines or clinical practice pathways exist; health-care providers must rely on their own clinical judgment to manage these patients. This article provides practical recommendations—based on a framework of clinical, pharmacokinetic, and dosing considerations—to guide clinicians’ decisions regarding management of breakthrough psychotic symptoms. Management options include ruling out/addressing medical illness or substance abuse/misuse as a contributing factor, addressing stressors, optimizing nonpharmacologic treatments, treating medical/psychiatric comorbidities, ensuring proper LAI administration technique, addressing missed LAI doses or lack of steady-state attainment, and increasing LAI dose directly or indirectly by shortening the injection interval (off-label). If these strategies do not work sufficiently with frequent monitoring, the LAI could be supplemented with a low dose of the corresponding oral formulation for fast symptom control (off-label). However, caution should be exercised with this strategy, because data on the safety of concomitant use of LAI and oral antipsychotics (OAPs) are limited, especially over extended periods. If symptoms abate, therapy optimization could be continued and slow discontinuation of the OAP could be considered. For persistent/worsening symptoms, the OAP should be increased to optimum effective dose while intensifying the initial steps used before it was added. If this fails, switching the OAP or LAI could be considered. We believe that these strategies will help clinicians manage breakthrough psychotic symptoms during LAI treatment and improve overall outcomes among those who can benefit from LAIs.

show abstract

“…Relapses occur frequently in the course of severe mental illnesses, such as Bipolar Disorder (BD), Schizophrenia (SCH) or Schizoaffective Disorder (SAD) 1,2 . In both clinical trials and naturalistic studies on individuals with SCH, one‐year relapse rates result to be around 30%, 1,3 while lifetime rates reach up to 70% 4 . Despite the lack of a global consensus on the definition of what represents a ‘relapse’ in SCH, ‘hospitalization’ is the most frequently used hallmark among studies 5 .…”

Section: Introductionmentioning

confidence: 99%

Comparing re‐hospitalisation rates in a real‐world naturalistic 24‐month follow‐up of psychotic patients with different treatment strategies: Oral versus LAI antipsychotics

Carmassi

Milani²,

Bertelloni

et al. 2020

Int J Clin Pract

View full text Add to dashboard Cite

Aim & Background Non‐adherence to antipsychotic treatment is a major issue in the management of severe psychiatric disorders, because it is usually related to future relapses and re‐hospitalisations. Long‐Acting‐Injection (LAI) antipsychotics can be useful to increase treatment adherence in these patients. The aim of the present study was to compare the re‐hospitalisation rates of psychotic patients discharged from a psychiatric ward and then, divided into three groups upon the treatment received: LAI antipsychotic, oral antipsychotic at home or oral antipsychotic administered daily by psychiatric nurse staff as patients lived in a long‐term care facility. Methods Data on all inpatients consecutively admitted to the Psychiatric Unit of the Nuovo Ospedale Apuano (Massa, Italy), between January 2017 and December 2018, were obtained by the registration record system. Information about eventual re‐hospitalisations of these patients, occurred within a 24‐month timeframe since discharge, were collected from the same database. Results In a Kaplan‐Meyer analysis, patients treated with LAI antipsychotics showed significantly lower re‐hospitalisation rates in the first 24 months after discharge than those treated with oral ones. Conclusions This study highlights the impact of LAI antipsychotics in preventing re‐hospitalisation in severe psychotic patients at high risk in a naturalistic setting. The benefits appear relevant also with respect to a controlled long‐term oral antipsychotic treatment, however, further studies are needed to develop more tailored intervention strategies in such complex psychiatric population.

show abstract

Clinical factors related to schizophrenia relapse

Cited by 34 publications

References 129 publications

Second-generation LAI are associated to favorable outcome in a cohort of incident patients diagnosed with schizophrenia

Second-generation LAI are associated to favorable outcome in a cohort of incident patients diagnosed with schizophrenia

Practical considerations for managing breakthrough psychosis and symptomatic worsening in patients with schizophrenia on long-acting injectable antipsychotics

Comparing re‐hospitalisation rates in a real‐world naturalistic 24‐month follow‐up of psychotic patients with different treatment strategies: Oral versus LAI antipsychotics

Contact Info

Product

Resources

About