The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia

Keepers, George A.; Fochtmann, Laura J.; Anzia, Joan M.; Benjamin, Sheldon; Lyness, Jeffrey M.; Mojtabai, Ramin; Servis, Mark E; Walaszek, Art; Buckley, Peter F.; Lenzenweger, Mark F.; Young, Alexander S.; Degenhardt, Amanda; Hong, Seung-Hee

doi:10.1176/appi.ajp.2020.177901

Cited by 454 publications

(418 citation statements)

References 43 publications

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“…In 2017, however, the US Food and Drug Administration (FDA) approved valbenazine, a novel and highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor, for the treatment of TD in adults; FDA approval of a second VMAT2 inhibitor, deutetrabenazine, followed later that year. More recently, the American Psychiatric Association (APA) released its evidence-based practice guideline for treatment of patients with schizophrenia, that includes the recommendation (based on results from randomized clinical trials) that patients with moderate to severe TD be treated with a VMAT2 [17].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of valbenazine compared with deutetrabenazine for the treatment of tardive dyskinesia

Ganz¹,

Chavan²,

Dhanda

et al. 2021

Journal of Medical Economics

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Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of valbenazine compared with deutetrabenazine for the treatment of tardive dyskinesia

Ganz¹,

Chavan²,

Dhanda

et al. 2021

Journal of Medical Economics

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“…3 In the most recent iteration of the guidelines for the treatment of patients with schizophrenia published by the American Psychiatric Association, the authors advocate that patients receive treatment with a LAI antipsychotic medication if they prefer such treatment or if they have a history of poor or uncertain adherence. 4 Regarding the latter, nonadherence to oral antipsychotic medication treatment (defined by some investigators as a failure to take at least 80% of prescribed medication) is common and has been observed in approximately half of all patients with schizophrenia, schizoaffective disorder, and bipolar disorder. [5][6][7] Lack of adherence extends out to treatments targeting comorbidities, especially when the underlying psychiatric disorder remains poorly managed.…”

Section: Introductionmentioning

confidence: 99%

Long-acting injectable antipsychotics: what, when, and how

Citrome

2021

CNS Spectr.

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Current guidelines for the treatment of patients with schizophrenia advocate that patients receive treatment with a long-acting injectable (LAI) antipsychotic medication if they prefer such treatment or if they have a history of poor or uncertain adherence. Available LAI formulations in the United States include first-generation antipsychotics (fluphenazine decanoate and haloperidol decanoate), risperidone/paliperidone containing products (risperidone microspheres, paliperidone palmitate, and risperidone subcutaneous), aripiprazole containing products (aripiprazole monohydrate and aripiprazole lauroxil), and olanzapine pamoate. LAI antipsychotics can address the guesswork about adherence status and patients may prefer them if they are offered this as a choice, including individuals early in their disease course. Additional approved indications in the United States for LAI antipsychotics include bipolar I disorder maintenance treatment for risperidone microspheres and aripiprazole monohydrate, and schizoaffective disorder for paliperidone palmitate once monthly. Differences and similarities among the different products are discussed, including guidance regarding optimal treatment selection. Tips are provided to enhance effective patient communication to maximize the likelihood of acceptance of this treatment modality.

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“…The frequency of the CYP2D6 gene duplication is highly dependent on the population 12,13,14,15,16 . The effects of genetic variants on drug metabolism are large enough to cause the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to add pharmacogenetic information on drug labels 17,18,19 and the American Psychiatric Association to inform clinicians on pharmacogenetics in recently updated schizophrenia guidelines 20 . Whether the difference in allele frequency explains why different ethnicities respond to certain drugs differently is difficult to estimate, as there are other cultural and socio-economic factors at play as well 21 .…”

Section: Introductionmentioning

confidence: 99%

Implementation of CYP2D6 copy-number imputation panel and frequency of key pharmacogenetic variants in Finnish individuals with a psychotic disorder

Häkkinen

Kiiski

Lähteenvuo

et al. 2020

Preprint

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PurposeWe constructed a CYP2D6 copy-number imputation panel by combining copy-number information to GWAS chip data. In addition, we report frequencies of key pharmacogenetic variants in individuals with a psychotic disorder from the genetically bottle-necked population of Finland.MethodsWe combined GWAS chip and CYP2D6 copy-number variation (CNV) data from the Breast Cancer Pain Genetics study (BrePainGen) to construct an imputation panel (N=902) for CYP2D6 CNV. The resulting data set was used as a CYP2D6 CNV imputation panel in 9,262 non-related individuals passing genotype data quality control procedures. The panel performance was evaluated by genotyping the CNV from a subset (N=297) of SUPER-Finland participants.ResultsCYP2D6 CNV was imputed correctly in 272 (92%) individuals. Sensitivity and specificity for detecting a duplication were 0.986 and 0.946, respectively. Sensitivity and specificity for detecting a deletion using imputation were 0.886 and 0.966, respectively. Based on imputation, the frequency of a CYP2D6 duplication and deletion in the whole SUPER-Finland sample with 9,262 non-related individuals passing quality control were 8.5% and 2.7%, respectively. We confirm the higher frequency of CYP2D6 ultrarapid metabolizers in Finland compared with non-Finnish Europeans. Additionally, we confirm a 21-fold enrichment of the UGT1A1 decreased function variant rs4148323 (also known as 211G>A, G71R or UGT1A1*6) in Finland compared with non-Finnish Europeans. Similarly, the NUDT15 variant rs116855232 was highly enriched in Finland.ConclusionOur results demonstrate that imputation of CYP2D6 CNV is possible. The methodology is not accurate enough to be used in clinical decision making, but it enables studying CYP2D6 in large biobanks with genome-wide data. In addition, it allows for researchers to recontact patients with certain pharmacogenetic variations through biobanks. We show that bottle-necked populations may have pharmacogenetically important variants with allele frequencies very different from the main ancestral group. Future studies should assess whether these differences are large enough to cause clinically significant changes in trial results across different ancestral groups.

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The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia

Abstract: At its December 2019 meeting, the American Psychiatric Association (APA) Board of Trustees approved "The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia." The full guideline is available at APA's Practice Guidelines website.

Cited by 454 publications

References 43 publications

Cost-effectiveness of valbenazine compared with deutetrabenazine for the treatment of tardive dyskinesia

Cost-effectiveness of valbenazine compared with deutetrabenazine for the treatment of tardive dyskinesia

Long-acting injectable antipsychotics: what, when, and how

Implementation of CYP2D6 copy-number imputation panel and frequency of key pharmacogenetic variants in Finnish individuals with a psychotic disorder

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