1,756 results match your criteria clozapine efficacy


Sex differences in the association between serum BDNF and cognitive impairment in schizophrenia patients using various antipsychotics.

J Psychiatr Res 2021 Apr 30;138:492-499. Epub 2021 Apr 30.

CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China. Electronic address:

Background: Cognitive impairment is one of the core symptoms of schizophrenia patients. There are often various differences in the efficacy of different antipsychotics in the treatment of cognitive impairment by sex. The purpose of this study was to explore whether there are gender differences in the association between serum BDNF levels and cognitive performance in patients with schizophrenia taking different antipsychotics. Read More

View Article and Full-Text PDF

Efficacy and safety of antipsychotic treatments for schizophrenia: A systematic review and network meta-analysis of randomized trials in Japan.

J Psychiatr Res 2021 Apr 30;138:444-452. Epub 2021 Apr 30.

Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan.

Background: We examined the efficacy and safety of using antipsychotic medication for schizophrenia using only randomized trials of antipsychotic for schizophrenia conducted in Japan to avoid the biological and environmental heterogeneities caused by pooling data from various races and ethnicities.

Methods: We searched for eligible studies on Embase, PubMed, and CENTRAL. Primary outcomes were improvement in Positive and Negative Syndrome Scale total score (PANSS-T) and all-cause discontinuation. Read More

View Article and Full-Text PDF

A prospective multicenter assessor-blinded randomized controlled study to compare the efficacy of short versus long protocols of electroconvulsive therapy as an augmentation strategy to clozapine in patients with ultra-resistant schizophrenia (SURECT study).

Trials 2021 Apr 15;22(1):284. Epub 2021 Apr 15.

University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France.

Background: Although clozapine is the most effective antipsychotic drug for treatment-resistant schizophrenia, it leads to a poor or partial response in 40 to 70% of patients. Augmentation of clozapine with electroconvulsive therapy (ECT) is a highly effective and relatively safe treatment for these clozapine-resistant patients. However, parameters are not yet well specified, such as the optimal number of sessions, their frequency, and the relevance of maintenance ECT. Read More

View Article and Full-Text PDF

Anticonvulsant and antipsychotic medications in the pharmacotherapy of panic disorder: a structured review.

Ther Adv Psychopharmacol 2021 21;11:20451253211002320. Epub 2021 Mar 21.

Clinical and Experimental Sciences, University of Southampton Faculty of Medicine; University Department of Psychiatry, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton, Hampshire, SO14 3DT, UK.

Background: As the remission rate of panic disorder (PD) achieved with conventional pharmacotherapy ranges between 20% and 50%, alternative psychopharmacological strategies are needed. We aimed to firstly review data regarding use of antipsychotic and non-benzodiazepine anticonvulsant medication in PD patients with or without comorbidities; secondly, to review data concerning reduction of panic symptoms during treatment of another psychiatric disorder with the same medications; and thirdly, to examine reports of anticonvulsant- or antipsychotic-induced new-onset panic symptomatology.

Methods: We performed a PubMed search (last day: 28 April 2020) of English-language studies only, combining psychopathological terms (e. Read More

View Article and Full-Text PDF

Atypical Antipsychotics and Metabolic Syndrome: From Molecular Mechanisms to Clinical Differences.

Pharmaceuticals (Basel) 2021 Mar 8;14(3). Epub 2021 Mar 8.

Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy.

Atypical antipsychotics (AAPs) are commonly prescribed medications to treat schizophrenia, bipolar disorders and other psychotic disorders. However, they might cause metabolic syndrome (MetS) in terms of weight gain, dyslipidemia, type 2 diabetes (T2D), and high blood pressure, which are responsible for reduced life expectancy and poor adherence. Importantly, there is clear evidence that early metabolic disturbances can precede weight gain, even if the latter still remains the hallmark of AAPs use. Read More

View Article and Full-Text PDF

Clozapine treatment: Ensuring ongoing monitoring during the COVID-19 pandemic.

Psychiatriki 2021 Mar 8. Epub 2021 Mar 8.

Department of Psychiatry, Aghioi Anargyroi Hospital, National and Kapodistrian University of Athens, Athens, Greece.

To the Editors, The current coronavirus pandemic (COVID-19) has led mental health systems to uncertainty regarding safe continuation of clozapine monitoring protocols. Clozapine is without doubt the only antipsychotic available with repeatedly proven efficacy in treatment resistant schizophrenia.1 Replacing clozapine with an alternative antipsychotic in patients stabilized with clozapine can potentially lead to higher risk of relapse or exacerbation of severity of illness. Read More

View Article and Full-Text PDF

Clinical and genetic influencing factors on clozapine pharmacokinetics in Tunisian schizophrenic patients.

Pharmacogenomics J 2021 Mar 17. Epub 2021 Mar 17.

Department of Pharmacology, Faculty of Medicine of Monastir, University of Monastir, Avicenna Street, Monastir, 5019, Tunisia.

Clozapine (Clz) is an atypical antipsychotic, which its pharmacokinetics can be influenced by several factors. The CYP1A2 and CYP2C19, major enzymes implicated in Clz metabolism, present an interethnic variation on their activity caused by single nucleotide polymorphisms (SNPs). The present study investigated the influence of genetic and nongenetic factors on Clz pharmacokinetics in a southern Mediterranean population. Read More

View Article and Full-Text PDF

A Focused Review of the Metabolic Side-Effects of Clozapine.

Front Endocrinol (Lausanne) 2021 25;12:609240. Epub 2021 Feb 25.

Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

The second generation antipsychotic drug clozapine represents the most effective pharmacotherapy for treatment-resistant psychosis. It is also associated with low rates of extrapyramidal symptoms and hyperprolactinemia compared to other antipsychotic drugs. However, clozapine tends to be underutilized in clinical practice due to a number of disabling and serious side-effects. Read More

View Article and Full-Text PDF
February 2021

Considering Loxapine Instead of Clozapine: A Case Series and Literature Review.

Cureus 2021 Jan 26;13(1):e12919. Epub 2021 Jan 26.

Psychiatry, Texas Tech University Health Sciences Center, Midland, USA.

This case series highlights the importance of loxapine in psychiatric disorders when clozapine is unable to control agitation and psychotic symptoms due to medication noncompliance, intolerable side effects, or inadequate clinical outcomes. Loxapine is classified as a first-generation typical antipsychotic but displays atypical antipsychotic-like characteristics with structural similarity to clozapine. However, since the inception of second-generation antipsychotic medications, the role of loxapine in modern psychiatric practice has become limited. Read More

View Article and Full-Text PDF
January 2021

Drugs for Parkinson's disease.

Authors:

Med Lett Drugs Ther 2021 02;63(1618):25-32

View Article and Full-Text PDF
February 2021

Safety and related factors of treatment with long-term atypical antipsychotic in Chinese patients with schizophrenia: observational study.

Gen Psychiatr 2021 8;34(1):e100289. Epub 2021 Feb 8.

Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: Atypical antipsychotics as first-line drugs have been used in patients with schizophrenia in China and abroad. However, its safety still needs to be evaluated in a large population, especially in Chinese patients.

Objective: The main objective of this study is to evaluate the safety and related factors of long-term atypical antipsychotic use in patients with schizophrenia in China. Read More

View Article and Full-Text PDF
February 2021

Treatment of catatonia with asenapine in a patient with schizotypal personality disorder, psychotic depression and septic shock from SARS-CoV-2 - A case report.

CNS Neurol Disord Drug Targets 2021 Feb 25. Epub 2021 Feb 25.

Medical director, Faculty of Medicine and Psychology, Sapienza University; Unit of Emergency Medicine and First Aid, Sant'Andrea University Hospital, Rome. Italy.

Introduction: Catatonia is a psychomotor syndrome that presents with severe symptoms which can lead to dangerous and lethal conditions if not diagnosed and treated properly. SARS-CoV-2 is a positive-sense single-stranded RNA virus that can occur in severe cases with acute pneumonia, ARDS, sepsis and septic shock. In these cases, ICU admission is necessary. Read More

View Article and Full-Text PDF
February 2021

A systematic review of clozapine's effectiveness for primary psychotic and bipolar disorders in older adults.

Int Psychogeriatr 2021 Feb 22:1-13. Epub 2021 Feb 22.

Older Persons' Mental Health Service, Concord Centre for Mental Health, Concord, Sydney, New South Wales, Australia.

Objectives: The primary aim was to systematically review the literature regarding the effectiveness of clozapine in reducing symptoms of primary psychotic and bipolar disorders in older adults. The secondary aim was to describe other reported patient and caregiver outcomes of clozapine treatment in older adults.

Design: MEDLINE, Embase, PsychINFO, ProQuest, and PubMed databases were searched according to PRISMA guidelines for original empirical research examining the effectiveness of clozapine in adults aged 65 years or more with primary psychotic and bipolar disorders. Read More

View Article and Full-Text PDF
February 2021

Clozapine Efficacy in a Case of Severe Treatment-Resistant Postpartum Psychosis.

Risk Manag Healthc Policy 2021 12;14:555-559. Epub 2021 Feb 12.

Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania.

Background: The postpartum period is a difficult time for mother and family. Unfortunately, in some cases, two psychiatric complications may occur: postpartum psychoses (PPP) with a prevalence of 0.2% and a very low incidence of 0. Read More

View Article and Full-Text PDF
February 2021

Cariprazine Add-on in Inadequate Clozapine Response: A Report on Two Cases.

Clin Psychopharmacol Neurosci 2021 Feb;19(1):174-178

Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. d'Annunzio," Chieti, Italy.

Cariprazine is a novel antipsychotic drug that exerts partial agonism of dopamine D/D receptors with preferential binding to the D receptor, antagonism of 5HT receptors, and partial agonism of 5HT. Currently, cariprazine has shown clinical efficacy in patients with schizophrenia and with bipolar disorder, as well as adjunctive treatment in patients with Major Depressive Disorder (MDD) and drug-resistant MDD. In the present case series, we report on two patients with treatment-resistant schizophrenia and partial response to clozapine who benefit from combination with cariprazine. Read More

View Article and Full-Text PDF
February 2021

Transcriptome analysis of human induced excitatory neurons supports a strong effect of clozapine on cholesterol biosynthesis.

Schizophr Res 2021 Feb 24;228:324-326. Epub 2021 Jan 24.

Department of Genetic Medicine, Johns Hopkins University School of Medicine, United States of America; Department of Psychiatry, Johns Hopkins University School of Medicine, United States of America. Electronic address:

Antipsychotics are known to modulate dopamine and other neurotransmitters which is often thought to be the mechanism underlying their therapeutic effects. Nevertheless, other less studied consequences of antipsychotics on neuronal function may contribute to their efficacy. Revealing the complete picture behind their action is of paramount importance for precision medicine and accurate drug selection. Read More

View Article and Full-Text PDF
February 2021

Associations between plasma clozapine/N-desmethylclozapine ratio, insulin resistance and cognitive performance in patients with co-morbid obesity and ultra-treatment resistant schizophrenia.

Sci Rep 2021 Jan 21;11(1):2004. Epub 2021 Jan 21.

Institute of Medical Science, University of Toronto, Toronto, Canada.

Clozapine (CLZ), the sole antipsychotic with superior efficacy for ultra-treatment resistant schizophrenia (TRS), is limited by adverse effects, including metabolic dysregulation. Clozapine's main metabolite, N-desmethylclozapine (NDMC), has potent 5-HT2C antagonist properties which may explain this metabolic dysfunction, thus the CLZ:NDMC ratio is of particular interest. High insulin resistance states could be associated with CYP1A2 induction and lower CLZ:NDMC ratios. Read More

View Article and Full-Text PDF
January 2021

The Importance of Conduct Disorder in the Treatment of Violence in Schizophrenia: Efficacy of Clozapine Compared With Olanzapine and Haloperidol.

Am J Psychiatry 2021 03 21;178(3):266-274. Epub 2021 Jan 21.

Department of Psychiatry, Nathan Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Krakowski, Tural); Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest (Czobor).

Objective: Treatment of violence in schizophrenia remains a challenging problem, especially in patients with conduct disorder. Previous clinical studies did not select patients on the basis of violence and did not focus on conduct disorder. This study is a head-to-head comparison of clozapine, olanzapine, and haloperidol in the treatment of violent schizophrenia patients with and without conduct disorder. Read More

View Article and Full-Text PDF

Isolation and neuroprotective prospective of novel bioactive compound "3-(3,4-dimethoxyphenyl)-1-(4-methoxyphenyl) prop-2-en-1-one" against ketamine-induced cognitive deficits in schizophrenia: an experimental study.

Nat Prod Res 2021 Jan 8:1-6. Epub 2021 Jan 8.

Division of Molecular Biology, Department of Zoology, Sri Venkateswara University, Tirupati, India.

For the first time a new flavonoid compound is isolated from the seeds of (CP) using different chromatographic techniques and it's structure is predicted as "3-(3,4-dimethoxyphenyl)-1-(4-methoxyphenyl)prop-2-en-1-one" by employing various spectroscopic studies. The neuroprotective potential of this flavonoid was evaluated against ketamine-induced cognitive deficits with special reference to cholinergic system . The compound has exhibited significant neuroprotective property against ketamine-induced cholinergic alterations in different brain regions of rat which are restored to normal during the treatment with the compound on par with the reference compound, clozapine. Read More

View Article and Full-Text PDF
January 2021

Efficacy of -methyl--aspartate receptor modulator augmentation in schizophrenia: A meta-analysis of randomised, placebo-controlled trials.

J Psychopharmacol 2021 Mar 6;35(3):236-252. Epub 2021 Jan 6.

Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.

Background: Dysfunction of the -methyl--aspartate glutamate receptor is involved in the putative pathology of schizophrenia. There is growing interest in the potential of -methyl--aspartate receptor modulators to improve the symptoms of schizophrenia, but the evidence for the use of glutamatergic agents for augmenting schizophrenia remains inconclusive.

Aims: We conducted a meta-analysis to test the efficacy and safety of -methyl--aspartate receptor modulator supplements in patients with schizophrenia. Read More

View Article and Full-Text PDF

Changes in Brain Glutamate on Switching to Clozapine in Treatment-Resistant Schizophrenia.

Schizophr Bull 2021 04;47(3):662-671

Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.

It has been suggested that the antipsychotic clozapine may modulate brain glutamate, and that this effect could contribute to its efficacy in treatment-resistant schizophrenia (TRS). The aim of this study was to examine the effects of clozapine on brain glutamate in TRS longitudinally. This study examined individuals with TRS before and 12 weeks after switching from a non-clozapine antipsychotic to treatment with clozapine as part of their normal clinical care. Read More

View Article and Full-Text PDF

Antipsychotics and hemodialysis: A systematic review.

Asian J Psychiatr 2021 Jan 3;55:102484. Epub 2020 Dec 3.

Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal, India. Electronic address:

Objective: Antipsychotics play a crucial role in the management of behavioral problems in patients undergoing hemodialysis. Oral and injectable antipsychotics are routinely prescribed to control emergent delirium or exacerbation of previous psychiatric symptoms. However scanty literature is available on the pharmacokinetics of antipsychotics in such patients. Read More

View Article and Full-Text PDF
January 2021

An Open-Label, Head to Head Comparison Study between Prucalopride and Lactulose for Clozapine Induced Constipation in Patients with Treatment Resistant Schizophrenia.

Healthcare (Basel) 2020 Dec 3;8(4). Epub 2020 Dec 3.

Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.

Clozapine remains as the gold standard for the management of treatment resistant schizophrenia. Nevertheless, mortality and morbidity associated with Clozapine is partly contributed by its adverse effect of constipation in view of its prominent anticholinergic properties. Despite the evidence that approximately 60% of patients on Clozapine will experience constipation, there is no proper guideline as to the best laxative in the treatment of Clozapine induced constipation. Read More

View Article and Full-Text PDF
December 2020

Sequential Multiple-Assignment Randomized Trials to Compare Antipsychotic Treatments (SMART-CAT) in first-episode schizophrenia patients: Rationale and trial design.

Schizophr Res 2020 Dec 2. Epub 2020 Dec 2.

First-episode Schizophrenia and Early Psychosis Program, Division of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Shanghai Clinical Research Center for Mental Health, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Institute of Mental Health, Fudan University, Shanghai 200030, China. Electronic address:

Accumulated studies have investigated pharmacological interventions for first-episode schizophrenia (FES) patients. However, studies on subsequent treatment steps, which are essential to guide clinicians, are largely missing. This Sequential Multiple-Assignment Randomized Trials comparing Antipsychotic Treatments (SMART-CAT) program intends to evaluate the effectiveness of commonly used antipsychotic drugs in FES patients. Read More

View Article and Full-Text PDF
December 2020

A Retrospective Review of the Use of Clozapine in Restoration of Competency to Stand Trial.

J Am Acad Psychiatry Law 2021 Mar 27;49(1):42-48. Epub 2020 Nov 27.

Dr. Ghossoub is Assistant Professor of Clinical Psychiatry, Department of Psychiatry, American University of Beirut, Beirut, Lebanon. Dr. Salem is a general psychiatry resident, Department of Psychiatry and Behavioral Neurosciences, Saint Louis University, Saint Louis, MO. Dr. Minchin is Psychiatrist, Metropolitan Saint Louis Psychiatric Center, Saint Louis, MO. Dr. Hayreh is a psychiatrist in private practice, Saint Louis, MO. Dr. Newman is Professor of Psychiatry, Department of Psychiatry and Behavioral Neurosciences, Saint Louis University, Saint Louis, MO.

Most defendants found incompetent to stand trial have psychotic illnesses. Clozapine has been shown to be superior to other antipsychotic medications in treatment-resistant schizophrenia. It is vastly underutilized, however, including in forensic settings. Read More

View Article and Full-Text PDF

Restoring Agonist Function at a Chemogenetically Modified M Muscarinic Acetylcholine Receptor.

ACS Chem Neurosci 2020 12 16;11(24):4270-4279. Epub 2020 Nov 16.

Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia.

Designer receptors exclusively activated by designer drugs (DREADDs) have been successfully employed to activate signaling pathways associated with specific muscarinic acetylcholine receptor (mAChR) subtypes. The M DREADD mAChR displays minimal responsiveness to the endogenous agonist acetylcholine (ACh) but responds to clozapine--oxide (CNO), an otherwise pharmacologically inert ligand. We have previously shown that benzyl quinolone carboxylic acid (BQCA), an M mAChR positive allosteric modulator (PAM), can rescue ACh responsiveness at these receptors. Read More

View Article and Full-Text PDF
December 2020

Contributions of cholinergic receptor muscarinic 1 and CYP1A2 gene variants on the effects of plasma ratio of clozapine/N-desmethylclozapine on working memory in schizophrenia.

J Psychopharmacol 2021 Jan 4;35(1):31-39. Epub 2020 Nov 4.

Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.

Background: Clozapine has heterogenous efficacy in enhancing working memory in schizophrenia. We have previously hypothesized that this is due to opposing effects of clozapine and its metabolite, N-desmethylclozapine, at the muscarinic M1 receptor and demonstrated that a lower clozapine/-desmethylclozapine ratio is associated with better working memory than clozapine or -desmethylclozapine levels alone.

Aims: In this study, we expanded the above hypothesis to explore whether genetic variation in the cholinergic receptor muscarinic 1 gene, encoding the M1 receptor, affects the relationship between clozapine/-desmethylclozapine and working memory. Read More

View Article and Full-Text PDF
January 2021

Olanzapine-induced Concurrent Tardive Dystonia and Tardive Dyskinesia in Schizophrenia with Intellectual Disability: A Case Report.

Clin Psychopharmacol Neurosci 2020 Nov;18(4):627-630

Department of Neuropsychiatry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.

Tardive dystonia and tardive dyskinesia (TDs) are rare extrapyramidal side effects that develop after long-term use of antipsychotics, but they are different syndromes and rarely occur at the same time. Olanzapine is an atypical antipsychotic drug associated with a low risk of extrapyramidal side effects in schizophrenia, but its associations with tardive movements are not clear. We present a case of a 19-year-old Asian female patient with schizophrenia and intellectual disabilities who developed concurrent TDs after long-term use of olanzapine. Read More

View Article and Full-Text PDF
November 2020

Chemogenetic Manipulation of Dopamine Neurons Dictates Cocaine Potency at Distal Dopamine Transporters.

J Neurosci 2020 11 12;40(45):8767-8779. Epub 2020 Oct 12.

Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania 19129

The reinforcing efficacy of cocaine is largely determined by its capacity to inhibit the dopamine transporter (DAT), and emerging evidence suggests that differences in cocaine potency are linked to several symptoms of cocaine use disorder. Despite this evidence, the neural processes that govern cocaine potency remain unclear. In male rats, we used chemogenetics with intra-VTA microinfusions of the agonist clozapine-n-oxide to bidirectionally modulate dopamine neurons. Read More

View Article and Full-Text PDF
November 2020

Antipsychotic Polypharmacy in Treatment of Schizophrenia; Should or Should Not?

Authors:
Chi-Un Pae

Chonnam Med J 2020 Sep 24;56(3):157-165. Epub 2020 Sep 24.

Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Antipsychotics have been utilized as the standard treatment for schizophrenia regardless of illness phase where antipsychotic monotherapy (APM) is routinely recommended as the gold standard rather than antipsychotic polypharmacy (APP). However, approximately 20 to 40% of patients with schizophrenia do not respond to APM based on randomized controlled clinical trials and large practical clinical trials indicating that the subgroup of patients with schizophrenia would need differential treatment approaches beyond traditional treatment strategies such as APM. Numerous studies have supported the use of APP in particular for patients with certain clinical situations including: failure to show efficacy or tolerability from treatment with APM, need for different treatment for targeting specific symptom domains, severe illness, failure to treatment with clozapine, skepticism about following treatment guidelines, or cross titration periods. Read More

View Article and Full-Text PDF
September 2020