Search

Thomas Aubel Kliniken Essen-Mitte, Klinik für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin, Essen, GermanyCorrespondence: Thomas AubelKliniken Essen-Mitte, Klinik für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin, Henricistraße 92, Essen, 45136, GermanyTel +4920117430005Email T.Aubel@kem-med.comAbstract: Schizophrenia is a chronic relapsing and remitting disorder associated with significant impairments in social and vocational functioning and a shortened lifespan, and it is a disabling psychiatric brain syndrome whose phenotype is characterized by three core symptom domains: positive symptoms, such as delusions and hallucinations, negative symptoms, which include lack of motivation and social withdrawal, and cognitive impairment. Moreover, patients with schizophrenia have severe problems with personal and social relations which affect their quality of life. Antipsychotic medications in conjunction with psychosocial interventions can help patients achieve recovery. Here are described three clinical cases of schizophrenic patients treated with cariprazine for inadequate response to a previous treatment. The purpose of this clinical series is to give useful information for the use of cariprazine in clinical practice.Keywords: cariprazine, schizophrenia, paranoid schizophrenia, negative symptoms, resistant schizophrenia, antipsychotics

Abstract Objectives Several studies have shown persistent neurocognitive impairment in patients with a bipolar affective disorder (BD) even in euthymia as well as in patients with a schizoaffective disorder (SAD). The aim of our study was to compare the neuropsychological performance between these two groups. Confounding variables were controlled to enhance our understanding of cognitive dysfunction in both BD and SAD. Methods Several domains of neurocognitive function, executive function, memory, attention, concentration and perceptuomotor function were examined in 28 euthymic SAD patients and 32 BD patients by using a neuropsychological test battery. The Hamilton Depression Rating Scale (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) were used to evaluate the patients' clinical status. Data analysis was performed by using a multivariate analysis of covariance (ANCOVA/MANCOVA). Results Euthymic SAD patients showed greater cognitive impairment than euthymic BD patients in the tested domains including declarative memory and attention. Putative significant group differences concerning cognitive flexibility vanished when controlled for demographic and clinical variables. Age and medication were robust predictors to cognitive performance of both SAD and BD patients. Conclusions Our results point out the worse cognitive outcome of SAD compared to BD patients in remission. Remarkably, the variance is higher for some of the test results between the groups than within each group, this being discussed in light of the contradictive concept of SAD.

Background: Management of schizophrenia is sub-optimal in many patients. Targeting negative symptoms, among the most debilitating aspects of schizophrenia, together with positive symptoms, can result in significant functional benefits and dramatically improve quality of life for patients and their carers. Cariprazine, a partial agonist of the dopamine receptors D2/D3 has demonstrated effectiveness across symptom domains in clinical trials, particularly on negative symptoms., Objective: To obtain a broader insight from clinicians with specific experience with cariprazine, on how it affects patient populations outside the clinical trial setting., Methods: The panel addressed a series of psychopharmacologic topics not comprehensively addressed by the evidence-based literature, including characteristics of patients treated, dosing and switching strategies, duration of therapy, role of concomitant medications and tolerability as well as recommendations on how to individualize cariprazine treatment for patients with schizophrenia., Results: Patients recommended for cariprazine treatment are those with first episodes of psychosis, predominant negative symptoms (maintenance/acute phase) and significant side effects (metabolic side effects, hyperprolactinemia, sedation) with other antipsychotics. When the long-term treatment of a lifetime illness is adequately weighted, cariprazine becomes one of the first-line medications, not only for patients with predominant negative symptoms but also for those with relatively severe positive symptoms, especially if they are at the first episodes and if a specific medication is added for symptoms such as agitation or insomnia. For instance, patients with agitation may also benefit from the combination of cariprazine and a benzodiazepine or another sedating agent. Cariprazine may be prescribed as add-on to medications such as clozapine, when that medication alone is ineffective for negative symptoms, and sometimes the first may be discontinued or its dose lowered, after a period of stability, leaving the patient on a better tolerated antipsychotic regimen., Conclusions: Based on real-world clinical experience, the panel considered that cariprazine, with its distinct advantages including pharmacokinetics/pharmacodynamics, good efficacy and tolerability, represents a drug of choice in the long-term management of schizophrenia not only for patients with predominant negative symptoms but also for those with positive symptoms., Competing Interests: Competing interestsAF is/has been a consultant and/or a speaker and/or has received research grants from Allergan, Angelini, Apsen, Boheringer Ingelheim, Daiichi Sankyo Brasil Farmacêutica, Doc Generici, FB-Health, Italfarmaco, Janssen, Lundbeck, Mylan, Otsuka, Pfizer, Recordati, Sanofi Aventis, Sunovion, Vifor; JAA has been a speaker for Adamed, Angelini, Casen Recordati, Lundbeck, Janssen-Cilag, Pfizer and Servier and an advisor to Lundbeck, Janssen-Cilag and Servier; TA has given lectures and participated in Advisory Boards for Janssen-Cilag, Otsuka, Recordati, Servier, Lilly; WB has reported no conflicts of interest; MNKB has been a consultant and speaker for Lundbeck, Otsuka and Recordati; JG has been an occasional speaker for Lundbeck, Janssen, Jaba-Recordati, Angelini; GC has been a speaker for Recordati, Janssen Cilag, Lundbeck, Doc Generici; MC TBA; FCS has received honoraria from the following companies for presentations fees and travel grants from Casen Recordati, Lundbeck-Otsuka, Janssen; AC is/has been a consultant and/or a speaker for Angelini, Apsen, Lundbeck, Otsuka, Pfizer; HF has received speaker and consultant honoraria (last 3 years) from Recordati, Servier, Janssen-Cilag; EI has acted as a consultant for Recordati; P-A K has given lectures for Eli Lilly, Janssen, Recordati, Lundbeck, Astra Zeneca, was involved in conducting safety studies for Janssen, Eli Lilly and took part in Advisory boards for Recordati and Eli Lilly; PP has been a speaker and/or consultant and/or received grants from Astra Zeneca, Janssen, Lundbeck, Recordati, Sunovion, Servier; MP has reported no conflicts of interest; HJRP has reported no conflicts of interest; JSS has given talks for Recordati and his employer Sahlgrenska University Hospital Gothenburg; IBV has given lectures for Recordati, Janssen, Neuraxpharm and Otsuka., (© The Author(s) 2020.)

Introduction: There is a lack of data about post-traumatic stress disorder (PTSD) in European bipolar patients compared to the US-population. This study was conducted to ascertain the rates and types of traumatic events and PTSD in bipolar-I disorder., Methods: Euthymic bipolar patients were screened for lifetime diagnosis of PTSD using the Post-Traumatic Stress Diagnostic Scale and the Clinician Administered Post-traumatic Stress Disorder Scale., Results: A total of 74 patients (m = 30, f = 44) with diagnosis of bipolar-I disorder were assessed. 37 patients (50%) reported no trauma, 22 patients (29.7%) experienced traumatic events without diagnosis of PTSD and 15 patients (20.3%) had comorbid PTSD. Bipolar PTSD patients were at higher risk to be exposed to physical violence, parental disregard, alcohol dependence of parents, sexual assault by a family member or acquaintance. The number of siblings was higher and they had higher scores on the Hamilton Depression Rating Scale and the Global Assessment of Functioning Scale., Conclusions: Bipolar patients are more likely to experience traumatic events and PTSD is a relevant comorbid disorder. PTSD is associated with an increased illness severity of bipolar disorder.