Suicidal Behavior and Medication Adherence in Schizophrenic Patients

Warriach, Zain I; Sanchez-Gonzalez, Marcos A.; Ferrer, Gerardo F

doi:10.7759/cureus.12473

Cited by 9 publications

(10 citation statements)

References 41 publications

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“…This is especially important for schizophrenia treatment, as it has been reported that up to 75% of patients discontinue the treatment within the first year and a half [ 44 ]. Non-adherence to treatment has an enormous impact for this patient as it increases the risk of relapse, hospitalization, and even suicide rates [ 45 , 46 , 47 , 48 , 49 ]. Moreover, there is an obvious economic impact for healthcare systems.…”

Section: Resultsmentioning

confidence: 99%

Radiolabeled Risperidone microSPECT/CT Imaging for Intranasal Implant Studies Development

et al. 2023

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The use of intranasal implantable drug delivery systems has many potential advantages for the treatment of different diseases, as they can provide sustained drug delivery, improving patient compliance. We describe a novel proof-of-concept methodological study using intranasal implants with radiolabeled risperidone (RISP) as a model molecule. This novel approach could provide very valuable data for the design and optimization of intranasal implants for sustained drug delivery. RISP was radiolabeled with 125I by solid supported direct halogen electrophilic substitution and added to a poly(lactide-co-glycolide) (PLGA; 75/25 D,L-Lactide/glycolide ratio) solution that was casted on top of 3D-printed silicone molds adapted for intranasal administration to laboratory animals. Implants were intranasally administered to rats, and radiolabeled RISP release followed for 4 weeks by in vivo non-invasive quantitative microSPECT/CT imaging. Percentage release data were compared with in vitro ones using radiolabeled implants containing either 125I-RISP or [125I]INa and also by HPLC measurement of drug release. Implants remained in the nasal cavity for up to a month and were slowly and steadily dissolved. All methods showed a fast release of the lipophilic drug in the first days with a steadier increase to reach a plateau after approximately 5 days. The release of [125I]I− took place at a much slower rate. We herein demonstrate the feasibility of this experimental approach to obtain high-resolution, non-invasive quantitative images of the release of the radiolabeled drug, providing valuable information for improved pharmaceutical development of intranasal implants.

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Section: Resultsmentioning

confidence: 99%

Radiolabeled Risperidone microSPECT/CT Imaging for Intranasal Implant Studies Development

et al. 2023

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“…Specifically, the ABILIFY MYCITE System is a drug-device combination product (aripiprazole tablets with a sensor) that comprises 4 separate components that enable the monitoring of treatment adherence by a patient and the patient's provider (Table 1). The four components include (1) the ABILIFY MYCITE tablet (DMS tablet), an aripiprazole tablet embedded with an ingestible event marker sensor; (2) MYCITE System patch (DMS patch); (3) MYCITE System smartphone app (DMS app); and (4) MYCITE System dashboard (DMS dashboard).…”

Section: The Abilify Mycite Systemmentioning

confidence: 99%

“…Suboptimal medication adherence is a significant problem for patients with serious mental illness (SMI), including those with schizophrenia, bipolar disorder, posttraumatic stress disorder, and major depressive disorder. Suboptimal adherence among these individuals may lead to symptom exacerbation, relapse, and hospital readmissions [1]. Moreover, suboptimal adherence to prescribed psychotropic medication is associated with increased mortality [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Suboptimal adherence among these individuals may lead to symptom exacerbation, relapse, and hospital readmissions [1]. Moreover, suboptimal adherence to prescribed psychotropic medication is associated with increased mortality [1,2]. However, measuring medication adherence in the clinical setting is challenging and primarily subjective (ie, patient self-report) [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Digital Medicine System in Veterans With Severe Mental Illness: Feasibility and Acceptability Study

Gonzales¹,

Okusaga²,

Reuteman-Fowler³

et al. 2022

JMIR Form Res

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Background Suboptimal medication adherence is a significant problem for patients with serious mental illness. Measuring medication adherence through subjective and objective measures can be challenging, time-consuming, and inaccurate. Objective The primary purpose of this feasibility and acceptability study was to evaluate the impact of a digital medicine system (DMS) among Veterans (patients) with serious mental illness as compared with treatment as usual (TAU) on medication adherence. Methods This open-label, 2-site, provider-randomized trial assessed aripiprazole refill adherence in Veterans with schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder. We randomized 26 providers such that their patients either received TAU or DMS for a period of 90 days. Semistructured interviews with patients and providers were used to examine the feasibility and acceptability of using the DMS. Results We enrolled 46 patients across 2 Veterans Health Administration sites: 21 (46%) in DMS and 25 (54%) in TAU. There was no difference in the proportion of days covered by medication refill over 3 and 6 months (0.82, SD 0.24 and 0.75, SD 0.26 in DMS vs 0.86, SD 0.19 and 0.82, SD 0.21 in TAU, respectively). The DMS arm had 0.85 (SD 0.20) proportion of days covered during the period they were engaged with the DMS (mean 144, SD 100 days). Interviews with patients (n=14) and providers (n=5) elicited themes salient to using the DMS. Patient findings described the positive impact of the DMS on medication adherence, challenges with the DMS patch connectivity and skin irritation, and challenges with the DMS app that affected overall use. Providers described an overall interest in using a DMS as an objective measure to support medication adherence in their patients. However, providers described challenges with the DMS dashboard and integrating DMS data into their workflow, which decreased the usability of the DMS for providers. Conclusions There was no observed difference in refill rates. Among those who engaged in the DMS arm, the proportion of days covered by refills were relatively high (mean 0.85, SD 0.20). The qualitative analyses highlighted areas for further refinement of the DMS. Trial Registration ClinicalTrials.gov NCT03881449; https://clinicaltrials.gov/ct2/show/NCT03881449

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“…A major advantage of clozapine in treatment refractory schizophrenia is that it reduces suicidality. 6,7 Sadly, the corollary is that if patients become nonadherent to clozapine, the impulse to self-harm may return. If clozapine has been stockpiled there is a ready source of drug, even moderate overdosage with which will often prove fatal especially in a nontolerant patient.…”

mentioning

confidence: 99%

Assessing Adherence to Clozapine

Flanagan

Hunter

Obee

2023

J Clin Psychopharmacol

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Background The clinical assessment of adherence to clozapine may prove difficult. Method We studied the incidence of nonadherence (plasma clozapine <0.01 mg L−1) in samples submitted to a clozapine therapeutic drug monitoring (TDM) service, 1993–2017. Results Clozapine was not detected in 2865 samples from men (2214 patients, 1.1% of all samples from men) and 1068 samples from women (822 patients, 1.0% of all samples from women). Information on the prescribed dose was supplied for 1623 of these samples from men and 492 of these samples from women. Prescribed doses ranged up to 1200 mg d−1, although most were in the range 100 to 600 mg d−1. Norclozapine was detected in 260 (9.1%) and 67 (6.3%) of the samples from men and from women, respectively, that did not contain clozapine. While an assay was requested to confirm either a patient history of nonadherence, or to establish that clozapine had been cleared from the circulation after overdosage, for example, in at least 38 instances, in the vast majority of cases the absence of clozapine from the sample was unexpected. Implications While adherence to clozapine may be good in general, tolerance to its potentially fatal cardiovascular effects is easily lost. Moreover, in treatment-resistant schizophrenia, the risk of self-harm increases if the drug is not taken regularly. In addition to presently available TDM services, the advent of a clozapine immunoassay for laboratory use should make it easy to institute at least monthly clozapine TDM at minimal extra cost.

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Suicidal Behavior and Medication Adherence in Schizophrenic Patients

Cited by 9 publications

References 41 publications

Radiolabeled Risperidone microSPECT/CT Imaging for Intranasal Implant Studies Development

Radiolabeled Risperidone microSPECT/CT Imaging for Intranasal Implant Studies Development

Digital Medicine System in Veterans With Severe Mental Illness: Feasibility and Acceptability Study

Assessing Adherence to Clozapine

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