Subjective tolerability of antipsychotic medications and the emerging science of subjective tolerability disorders

Awad, A. George

doi:10.1586/erp.10.2

Cited by 13 publications

(10 citation statements)

References 37 publications

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“…Although there are very few such categorizations in the literature regarding AEDs, there are emerging data that subjective experiences of an AE play a major role in the patient's decision to either continue or discontinue their treatment, especially regarding antipsychotics. [212223] In a study conducted by Uijl et al ., most of the subjective complaints turned out to be cognitive of nature followed by general CNS problems. [22] This may explain the absence of some CNS-related AEs as the etiology of DAE in the current study contrary to literature.…”

Section: Discussionmentioning

confidence: 99%

Newer antiepileptic drugs discontinuation due to adverse effects: An observational study

Golpayegani¹,

Salari²,

Gharagozli³

2019

Ann Indian Acad Neurol

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Aims:Antiepileptic drugs are the main therapy for epilepsy. However, the incidence of adverse effects (AEs) results in treatment discontinuation. The aim of this study is evaluating the factors involved in discontinuation of antiepileptic drugs.Settings and Design:We studied 2797 epileptic patients who consumed levetiracetam (LEV), oxcarbazepine (OXC), topiramate (TPM), zonisamide (ZNS), rufinamide, and lacosamide to evaluate the discontinuation because of AEs.Statistical Analysis Used:Data were analyzed using descriptive statistics and Chi-square test.Results:This study showed the rate of discontinuation due to adverse reactions as follows: TPM (7.10%), OXC (4.5%), ZNS (1.8%), and LEV (1.6%) (Chi-square analysis, P < 0.0001). Our study also showed that 1.35% of the patients did not continue the therapy because of subjective experiences of the AEs. Furthermore, neurologic complications in TPM, skin rashes in OXC, and patients' subjective experiences in LEV prescription were the main reasons for nonadherence due to a AEs.Conclusions:AEs in newer antiepileptic drugs are extremely prevalent. Our observation revealed that skin rashes and paresthesia were the most probable causes of treatment discontinuation because of AEs.

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Section: Discussionmentioning

confidence: 99%

Newer antiepileptic drugs discontinuation due to adverse effects: An observational study

Golpayegani¹,

Salari²,

Gharagozli³

2019

Ann Indian Acad Neurol

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“…It was observed that, D3 dopamine receptor mRNA expression of peripheral lymphocytes in drug-medicated schizophrenics significantly reduced when compared to that of drug-free schizophrenics [43]. In fact, antipsychotic drugs as DA antagonists are more likely to over-occupancy D2 receptor, to diminish receptor expression and cause manifest as secondary negative symptoms, in particular, akinesia or bradykinesia [44,45,46]. This suggests that the characteristics of peripheral lymphocytes in schizophrenic might reflect the clinical manifestion.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio exhibits the different correlation with psychiatric symptoms in the different status of antipsychotic therapy in schizophrenia: a large-scale retrospective cross-sectional study.

Shen¹,

Zhou²,

Wang³

et al. 2020

Preprint

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Background There are some conflicting results regarding the neutrophil-to-lymphocyte ratio (NLR) and the severity of disease in patients with schizophrenia. Inconsistent findings among the studies might be caused by several limitations, such as, heterogeneous patient populations lacking stratification by antipsychotic therapy, small sample sizes lacking statistical power, ignoring multicollinearity between NLR and other related factors, and lack of controlling for potential confounding factors. In this study, we evaluated the possible correlation between NLR and disease severity as manifested in clinical scores in patients with schizophrenia. In particular, NLR is correlated with discrepant psychiatric symptoms in the different status of antipsychotic medication administration. Methods This was a cross-sectional study conducted in our hospital. We identified inpatients with schizophrenia between July 12, 2018 and March 27, 2019 and who had NLR, Clinical Global Impression Severity scale (CGIS) and Brief Psychiatric Rating Scale (BPRS) scores. Results The records of 1144 identified patients (32.4% male, 76.6% with NLR ≤ 1.98, and 10.8% drug-free patients) were analyzed. Multivariate logistic regression showed that NLR was positively associated with worse psychiatric symptoms, both the CGIS score (moderately ill: OR: 63.578, p = 0.011; severely ill: OR: 53.617, p = 0.015) and the BPRS total score (moderately ill: OR: 4.049, p = 0.055; severely ill: OR: 4.312, p = 0.045). In the drug-therapy subgroup, there was a negative correlation between NLR and severe negative symptoms (severely ill: OR: 0.850, p = 0.018) after controlling for potential confounding factors. Conclusions The study is the first to confirm the hypothesis that NLR is independently associated with severe psychopathology in schizophrenia. There is the different correlation between NLR and psychiatric symptoms in the different status of antipsychotic therapy. Therefore, NLR is not appropriate to be an inflammatory biomarker for assessment of disease severity, but provide potential mechanistic insights on specific pathological cellular processes, as well be a potential target to improve the course of the psychotic disorder.

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“…Specifically, antipsychotic drug treatment is reported to provoke (1) neuroleptic dysphoria, 142,143 primarily via high D2 blocking agents, (2) sedation/drowsiness that impairs judgment, thinking, or motor skills, 125,144 (3) altered reward functions, 145,146 and (4) misbalanced dietary preferences. 81 We propose that using AL indices could provide insights into PAL.…”

Section: Pharmacotherapy Iatrogenic Effects and Pharmacological Allmentioning

confidence: 99%

“…150 Furthermore, negative effects on subjective experience may appear even before the threshold for other side effects has been reached, 145,147 and likely reflect excessive inhibition of dopamine neurotransmission in the striatal, temporal, and insular regions 145 involved in reward and motivation (ventral striatum) and in affective regulation and awareness of internal feelings (temporal and insular structures). Interestingly, neuroleptic dysphoria has been proposed to be one of the missing links between schizophrenia and substance abuse, 142 as these patients are more likely than nondysphoric patients to develop comorbid drug abuse. 151 The differential capacities of FGAs and SGAs to induce dopamine deficits seem to be clinically important.…”

Section: Pharmacotherapy Iatrogenic Effects and Pharmacological Allmentioning

confidence: 99%

Allostatic Load as a Tool for Monitoring Physiological Dysregulations and Comorbidities in Patients with Severe Mental Illnesses

Bízik

Picard

Nijjar

et al. 2013

Harvard Review of Psychiatry

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Severe mental illnesses like schizophrenia and bipolar disorder are disabling, chronic conditions that are often accompanied by medical comorbidities. In this theoretical article, we review the allostatic load model representing the "wear and tear" that chronic stress exacts on the brain and body. We propose an innovative way of monitoring physical and psychiatric comorbidities by integrating the allostatic load model into clinical practice. By interpreting peripheral biomarkers differently, medical professionals can calculate a simple, count-based, allostatic load index known to predict diverse stress-related pathologies. In addition to screening for comorbidities, allostatic load indices can be used to monitor the effects of pharmacological and psychosocial interventions. This framework can also be used to generate a dialogue between patient and practitioner to promote preventive and proactive approaches to health care.

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Subjective tolerability of antipsychotic medications and the emerging science of subjective tolerability disorders

Cited by 13 publications

References 37 publications

Newer antiepileptic drugs discontinuation due to adverse effects: An observational study

Newer antiepileptic drugs discontinuation due to adverse effects: An observational study

Neutrophil-to-lymphocyte ratio exhibits the different correlation with psychiatric symptoms in the different status of antipsychotic therapy in schizophrenia: a large-scale retrospective cross-sectional study.

Allostatic Load as a Tool for Monitoring Physiological Dysregulations and Comorbidities in Patients with Severe Mental Illnesses

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