The efficacy of cariprazine in negative symptoms of schizophrenia: Post hoc analyses of PANSS individual items and PANSS-derived factors

Fleischhacker, W. Wolfgang; Galderisi, Silvana; Laszlovszky, István; Szatmári, B.; Born, Christoph; Acsai, K.; Szalai, Erzsébet; Harsányi, J.; Earley, Willie; Patel, Mehul; Németh, György

doi:10.1016/j.eurpsy.2019.01.015

Cited by 94 publications

(98 citation statements)

References 52 publications

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“…The overall severity of schizophrenia was assessed using the Positive and Negative Symptoms Scale (PANSS) [19,20]. The scale for the Assessment of Positive Symptoms (SAPS) was used to measure the severity of AHs and VHs.…”

Section: Assessment Of the Severity Of Psychotic Auditory And Visuamentioning

confidence: 99%

Reciprocal deterioration of visual and auditory hallucinations in schizophrenia presents V-shaped cognition impairment and widespread reduction in brain gray matter-A pilot study

Zhuo

Chen

et al. 2020

Journal of Clinical Neuroscience

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Schizophrenic patients often experience visual hallucinations (VHs) and auditory hallucinations (AHs); however, brain aberrations associated with combined VH and AH in schizophrenic patients remains poorly documented. Changes to the brain and cognition during the first episode of untreated schizophrenic patients (FUSCH) with both VHs and AHs (FUSCHVA) were evaluated. One-hundred and fifty-seven patients were enrolled that had FUSCH (1) with VHs but not AHs (FUSCHV), and (2) with AHs but not VHs (FUSCHA), plus FUSCHVA and healthy controls (n = 30). Gray matter volume (GMV) and MATRICS Consensus Cognitive Battery (MCCB) was measured to reflect impairments to the brain and cognition, respectively. FUSCHVA patients had the severest cognitive impairment for all components of the MCCB, followed by FUSCHV and FUSCHA patients. Compared to healthy patients, FUSCHVA patients had reduced GMV in the occipital, parietal, frontal, and temporal cortex, and increased GMV in the hippocampus and striatum. Compared to FUSCHV patients, FUSCHVA patients had reduced GMV in the occipital cortex and postcentral gyrus, and increased GMV in the posterio-parietal lobe. Compared to patients with FUSCHA, the GMV in patients with FUSCHVV was reduced in the occipital cortex and posterio parietal lobe. In conclusion, visual and auditory hallucinations appear to deteriorate reciprocally in FUSCHVA patients, accompanied with sever cognitive impairments. Compared to AHs, VHs might be accompanied with severe GMV impairment in the brain, especially in the primary visual cortex and higher perception integration cortex (posterio parietal lobe) in patients with FUSCH.

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Section: Assessment Of the Severity Of Psychotic Auditory And Visuamentioning

confidence: 99%

Reciprocal deterioration of visual and auditory hallucinations in schizophrenia presents V-shaped cognition impairment and widespread reduction in brain gray matter-A pilot study

Zhuo

Chen

et al. 2020

Journal of Clinical Neuroscience

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“…Total severity of schizophrenia was assessed by the Positive and Negative Symptoms Scale (PANSS) (Fleischhacker et al 2019). The scale for the Assessment of Positive Symptoms (SAPS) (Kumari et al 2017) was used to measure the severity of AHs and VHs.…”

Section: Psychotic Auditory and Visual Hallucination Symptoms Severimentioning

confidence: 99%

“…Data from these 97 patients were used for analysis. Two independent psychiatrists with no involvement in the current study tested the validity of patient subtype divisions using the Auditory Hallucination Rating Scale (Haddock et al 1999) and the PANSS P3 VHs (Fleischhacker et al 2019) item to distinguish AH and VH severity. The four resulting symptom combination groups and diagnostic assessments of the psychiatrists affirmed our artificial divisions.…”

Section: Demographic and Clinical Characteristics Of Participantsmentioning

confidence: 99%

Abberant inverted U-shaped brain pattern and trait-related retinal impairment in schizophrenia patients with combined auditory and visual hallucinations: a pilot study

Zhuo

Xiao

Chen

et al. 2020

Brain Imaging and Behavior

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Schizophrenic patients often experience auditory hallucinations (AHs) and visual hallucinations (VHs). However, brain and retinal alterations associated with combined AHs and VHs in schizophrenic patients are unknown. This study aimed o investigate brain and retinal alterations in first episode untreated schizophrenic patients with combined AHs and VHs (FUSCHAV). FUSCHAV patients (n = 120), divided into four groups according to severity of AH and VH symptoms, were compared to healthy controls (n = 30). Gray matter volume (GMV) and global functional connectivity density (gFCD) were recorded to reflect brain structure and functional alterations. Total retinal thickness was acquired by optical coherence tomography to assess retinal impairment. The majority of FUSCHAV patients (85.8%) demonstrated both GMV reduction and gFCD increases along with retinal thinning compared to healthy controls. The severity of GMV reduction and gFCD increase differed between patient groups, ranked from highest to lowest severity as follows: severe AHs combined with severe VHs (FUSCHSASV, 20 patients), moderate AHs combined with severe VHs (FUSCHMASV, 23 patients), severe AHs combined with moderate VHs (FUSCHSAMV, 28 patients), and moderate AHs combined with moderate VHs (FUSCHMAMV, 26). Retinal impairment was similar among the four FUSCHAV groups. GMV reduction and gFCD increases in the frontal-parietal lobule show an inverted U-shaped pattern among FUSCHAV patients according to AH and VH severity, while retinal impairment remains stable among FUSCHAV groups. These findings indicate a reciprocal deterioration in auditory and visual disturbances among FUSCHAV patients.

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“…Larger comparative studies with other atypical antipsychotics are missing until now. Based on the findings of previously published studies, an advantage of cariprazine in comparison to other antipsychotics was found, particularly in patients with predominantly "negative symptoms" and prolactin increases or weight gain [7,11]. Akathisia, one of the most common side effects, occasionally led to discontinuation of therapy in some studies [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Efficacy and safety of cariprazine in the treatment of schizophrenia were proven in four phase II/III studies [3][4][5][6]. Cariprazine was shown to be more effective in reducing negative symptoms of schizophrenia compared to risperidone [7]. Regarding safety and tolerability the available clinical trials suggest that the most frequently reported adverse events are extrapyramidal symptoms, insomnia, and akathisia [8].…”

Section: Introductionmentioning

confidence: 99%

Cariprazine

Gahr¹,

Riedesser²

2020

Nervenheilkunde

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Objective Cariprazine is a new antipsychotic drug approved for the treatment of schizophrenia in Europe in 2017. Clinical studies suggest advantages of cariprazine in comparison to other antipsychotic agents regarding therapeutic effects on “negative symptoms”, antipsychotic-induced weight gain and increased serum prolactin levels. Akathisia was reported to be one of the most common side effects. Currently, however, data from naturalistic treatment settings regarding the efficacy, safety and tolerability of cariprazine are missing. Thus, we report and discuss our clinical experiences with cariprazine regarding efficacy, safety and tolerability in order to provide first treatment data from a naturalistic treatment setting. Material and methods The course of treatment of a series of 3 patients with schizophrenia spectrum disorders and treatment with cariprazine (mono- or combined therapy) is presented and discussed. Results Cariprazine demonstrated sufficient antipsychotic effects in 2 out of 3 cases; however, in 2 out of 3 cases treatment had to be discontinued due to akathisia/agitation; in 1 case, cariprazine monotherapy facilitated successful normalization of elevated prolactin serum levels (due to combined treatment with risperidone and olanzapine). Conclusion(s): In general, experience with cariprazine within a naturalistic treatment setting is in accordance with data from clinical studies, particularly concerning effects on “negative symptoms”, antipsychotic-associated elevation of prolactin serum levels and risk of akathisia. The comparatively high incidence of discontinuation of cariprazine due to akathisia/agitation in our case series may be an effect of polypharmacy which was very common among our three cases. Clinical relevance This case series provides some evidence that safety, tolerability and antipsychotic efficacy of cariprazine in naturalistic treatment settings may be similar to findings from the available clinical studies.

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The efficacy of cariprazine in negative symptoms of schizophrenia: Post hoc analyses of PANSS individual items and PANSS-derived factors

Cited by 94 publications

References 52 publications

Reciprocal deterioration of visual and auditory hallucinations in schizophrenia presents V-shaped cognition impairment and widespread reduction in brain gray matter-A pilot study

Reciprocal deterioration of visual and auditory hallucinations in schizophrenia presents V-shaped cognition impairment and widespread reduction in brain gray matter-A pilot study

Abberant inverted U-shaped brain pattern and trait-related retinal impairment in schizophrenia patients with combined auditory and visual hallucinations: a pilot study

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