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Current Treatment Options in Oncology Nov 2020Olanzapine has become a major drug in the management of chemotherapy-induced nausea and vomiting as a prophylactic agent. In addition, a recent randomized trial has... (Review)
Review
Olanzapine has become a major drug in the management of chemotherapy-induced nausea and vomiting as a prophylactic agent. In addition, a recent randomized trial has demonstrated its benefits in treating nausea and vomiting associated with advanced cancer. The added benefit to olanzapine is that it also stimulates appetite. As a result, since it treats multiple symptoms associated with advanced cancer, it is likely to become the antiemetic of choice in palliative care at least in the USA. The added benefit of treating insomnia and the avoidance of benzodiazepines should place olanzapine in at the top of the list of drugs to use for patients who do complain of insomnia. There is no good evidence that it potentiates the respiratory depression of opioids unlike benzodiazepines. The evidence is weak that olanzapine in as an adjuvant analgesic. Hopefully, future trials will explore this in greater depth. The benefits of adding olanzapine to potent opioids are that it may reduce craving, drug cues, and opioid misuse. Other symptoms like anxiety and depression may be addressed by the addition of olanzapine to standard antidepressants.
Topics: Antiemetics; Antineoplastic Combined Chemotherapy Protocols; Antipsychotic Agents; Drug Monitoring; Humans; Nausea; Neoplasms; Olanzapine; Palliative Care; Postoperative Complications; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Vomiting
PubMed: 33244634
DOI: 10.1007/s11864-020-00804-1 -
Cancer Letters Feb 2022Psychotropic drugs can penetrate the blood-brain barrier and regulate the levels of neurotransmitters and neuromodulators such as γ-aminobutyric acid, glutamate,... (Review)
Review
Psychotropic drugs can penetrate the blood-brain barrier and regulate the levels of neurotransmitters and neuromodulators such as γ-aminobutyric acid, glutamate, serotonin, dopamine, and norepinephrine in the brain, and thus influence neuronal activity. Neuronal activity in the tumor microenvironment can promote the growth and expansion of glioma. There is increasing evidence that in addition to their use in the treatment of mental disorders, antipsychotic, antidepressant, and mood-stabilizing drugs have clinical potential for cancer therapy. These drugs have been shown to inhibit the malignant progression of glioma by targeting signaling pathways related to cell proliferation, apoptosis, or invasion/migration or by increasing the sensitivity of glioma cells to conventional chemotherapy or radiotherapy. In this review, we summarize findings from preclinical and clinical studies investigating the use of antipsychotics, antidepressants, and mood stabilizers in the treatment of various types of cancer, with a focus on glioma; and discuss their presumed antitumor mechanisms. The existing evidence indicates that psychotropic drugs with established pharmacologic and safety profiles can be repurposed as anticancer agents, thus providing new options for the treatment of glioma.
Topics: Antipsychotic Agents; Drug Repositioning; Glioma; Humans; Psychotropic Drugs
PubMed: 34923043
DOI: 10.1016/j.canlet.2021.12.014 -
Expert Opinion on Pharmacotherapy Aug 2019: Bipolar I disorder (BDI) is amongst the most debilitating psychiatric conditions with a great impact on both patients and their families. A class of drugs commonly... (Review)
Review
: Bipolar I disorder (BDI) is amongst the most debilitating psychiatric conditions with a great impact on both patients and their families. A class of drugs commonly used in this condition is second-generation antipsychotics (SGAs) including asenapine, one of the latest to be introduced into the clinical practice worldwide to treat manic episodes in BDI. : The aim of this paper is to critically review the literature on the pharmacological characteristics, tolerability, and safety data of asenapine, as well as on its short- and long-term clinical trials in manic episodes as both a monotherapy and as an add-on treatment. : The available data indicate that asenapine is an effective antimanic agent in both adult and pediatric patients and that it might also improve depressive symptoms and recurrences in BDI patients. Its tolerability profile is good, and its most common side effects are somnolence, light extrapyramidal symptoms, dizziness, weight gain, and oral (but reversible) hypoesthesia. Taken together, the published studies indicate that asenapine might be an effective therapeutic agent in BDI with a broad spectrum of clinical activities. Further double-blind, short- and long-term studies are, however, necessary to clarify its precise role in the treatment of BD.
Topics: Antipsychotic Agents; Bipolar Disorder; Clinical Trials as Topic; Dibenzocycloheptenes; Dizziness; Half-Life; Heterocyclic Compounds, 4 or More Rings; Humans
PubMed: 31132287
DOI: 10.1080/14656566.2019.1617849 -
Current Diabetes Reports Sep 2019The prevalence of diabetes is 2-3-fold higher in people with severe mental illness than the general population. There are concerns that antipsychotics increase the risk... (Review)
Review
PURPOSE OF REVIEW
The prevalence of diabetes is 2-3-fold higher in people with severe mental illness than the general population. There are concerns that antipsychotics increase the risk of diabetes. This review will examine the latest epidemiological studies linking antipsychotics and diabetes, as well as the mechanisms underlying the association and the clinical implications to minimise the impact of antipsychotics on metabolic health.
RECENT FINDINGS
Although there is an increased risk of diabetes in people with first-episode psychosis, the prevalence increases rapidly after antipsychotics are started. Antipsychotics likely increase the risk of diabetes through weight gain and directly by adversely affecting insulin sensitivity and secretion. It is important to implement measures to prevent diabetes, to screen for diabetes to ensure prompt diagnosis and to provide effective diabetes care. Further research is needed to understand how antipsychotics cause diabetes and to improve the clinical management of diabetes in people with severe mental illness.
Topics: Antipsychotic Agents; Diabetes Mellitus; Humans; Insulin Resistance; Psychotic Disorders; Weight Gain
PubMed: 31478094
DOI: 10.1007/s11892-019-1220-8 -
International Journal of Molecular... Jan 2023Although a number of mood-stabilising atypical antipsychotics and antidepressants modulate serotonin type 7 receptor (5-HT7), the detailed contributions of 5-HT7... (Review)
Review
Although a number of mood-stabilising atypical antipsychotics and antidepressants modulate serotonin type 7 receptor (5-HT7), the detailed contributions of 5-HT7 function to clinical efficacy and pathophysiology have not been fully understood. The mood-stabilising antipsychotic agent, lurasidone, and the serotonin partial agonist reuptake inhibitor, vortioxetine, exhibit higher binding affinity to 5-HT7 than other conventional antipsychotics and antidepressants. To date, the initially expected rapid onset of antidepressant effects-in comparison with conventional antidepressants or mood-stabilising antipsychotics-due to 5-HT7 inhibition has not been observed with lurasidone and vortioxetine; however, several clinical studies suggest that 5-HT7 inhibition likely contributes to quality of life of patients with schizophrenia and mood disorders via the improvement of cognition. Furthermore, recent preclinical studies reported that 5-HT7 inhibition might mitigate antipsychotic-induced weight gain and metabolic complication by blocking other monoamine receptors. Further preclinical studies for the development of 5-HT7 modulation against neurodevelopmental disorders and neurodegenerative diseases have been ongoing. To date, various findings from various preclinical studies indicate the possibility that 5-HT7 modifications can provide two independent strategies. The first is that 5-HT7 inhibition ameliorates the dysfunction of inter-neuronal transmission in mature networks. The other is that activation of 5-HT7 can improve transmission dysfunction due to microstructure abnormality in the neurotransmission network-which could be unaffected by conventional therapeutic agents-via modulating intracellular signalling during the neurodevelopmental stage or via loss of neural networks with aging. This review attempts to describe the current and novel clinical applications of 5-HT7 modulation based on preclinical findings.
Topics: Humans; Lurasidone Hydrochloride; Vortioxetine; Serotonin; Quality of Life; Antipsychotic Agents; Antidepressive Agents; Selective Serotonin Reuptake Inhibitors
PubMed: 36768393
DOI: 10.3390/ijms24032070 -
CNS Spectrums Apr 2020Outpatient diversion programs present an opportunity for severely mentally ill defendants to receive psychiatric treatment and have alleged offenses dismissed by the... (Review)
Review
Outpatient diversion programs present an opportunity for severely mentally ill defendants to receive psychiatric treatment and have alleged offenses dismissed by the court. Moreover, the successful completion of pretrial diversion is associated with fewer post-program arrest and jail days. The target patient population for such programs is typically people with schizophrenia spectrum disorders, but the care of such patients in outpatient settings presents challenges for monitoring treatment fidelity, specifically antipsychotic adherence, as low adherence rates are associated with increased rates of recidivism. Presented here is a review of evidence-based strategies that must be employed to track antipsychotic adherence in outpatient diversion programs, including pill counts, use of long-acting injectable antipsychotics, and determination of plasma antipsychotic levels to assess adherence and the adequacy of antipsychotic treatment. Antipsychotic therapy remains the foundation of schizophrenia treatment, but only through the use of all available modalities can clinicians maximize the odds that schizophrenia patients in pretrial diversion maintain psychiatric stability and successfully complete mental health court mandates.
Topics: Antipsychotic Agents; Forensic Psychiatry; Humans; Medication Adherence; Monitoring, Ambulatory; Outpatients; Psychotic Disorders
PubMed: 31120002
DOI: 10.1017/S1092852919000865 -
Asian Journal of Psychiatry Jul 2022Since the 1950 s, several studies have reported that patients using first generation and/or second-generation antipsychotics had increased risk of venous... (Meta-Analysis)
Meta-Analysis Review
Since the 1950 s, several studies have reported that patients using first generation and/or second-generation antipsychotics had increased risk of venous thromboembolism events. These events include deep vein thrombosis and/or pulmonary embolism (PE). However, data about fatal PE in patients on antipsychotics (APs) remain scarce. Thus, the current study aimed to investigate sociodemographic, clinical and pharmacological characteristics related to psychiatric patients on APs and who died from a fatal PE. We reported a case-series, then conducted a literature review of relevant studies and performed a meta-analysis of studies with usable data. The main outcome of the study suggested a significantly high risk of fatal PE in patients using APs compared to nonusers (Odds Ratio=6.68, with 95% confidence interval 1.43-31.11). Clozapine was the most incriminated drug. Low potency first generation APs were the second most exhibited medication. Studies about the topic remain scarce with a high heterogeneity and a high probability of bias. Further studies are needed to ascertain this risk and to establish target preventive measures in this particularly vulnerable population.
Topics: Antipsychotic Agents; Clozapine; Humans; Odds Ratio; Pulmonary Embolism; Risk Factors; Venous Thromboembolism
PubMed: 35452966
DOI: 10.1016/j.ajp.2022.103105 -
JAMA Jan 2021
Review
Topics: Antipsychotic Agents; Clozapine; Humans; Schizophrenia
PubMed: 33369626
DOI: 10.1001/jama.2020.19048 -
The Medical Letter on Drugs and... Jul 2020
Review
Topics: Antipsychotic Agents; Drug Administration Routes; Drug Administration Schedule; Drug Interactions; Half-Life; Humans; Metabolic Clearance Rate; Randomized Controlled Trials as Topic; Schizophrenia
PubMed: 32728011
DOI: No ID Found -
Revue Neurologique Apr 2024Epileptic seizures have been widely considered as a complication of external or iatrogenic factors in schizophrenia. However, epidemiologic, neurodevelopmental and... (Review)
Review
Epileptic seizures have been widely considered as a complication of external or iatrogenic factors in schizophrenia. However, epidemiologic, neurodevelopmental and genetic data have changed regards on this topic considering the complexity of the bidirectional link between epilepsy and schizophrenia. We will examine these data constituting the pathophysiological aspects of this particular association and detail the particular impact of antipsychotics on the occurence of epileptic seizure in schizophrenia as well as the management strategies.
Topics: Humans; Epilepsy; Schizophrenia; Comorbidity; Antipsychotic Agents
PubMed: 38503587
DOI: 10.1016/j.neurol.2024.03.002