Add-on mirtazapine enhances antipsychotic effect

Add-on mirtazapine enhances antipsychotic effect of first generation antipsychotics in schizophrenia: A double-blind, randomized, placebo-controlled trial
Schizophrenia Research, 03/25/09

Joffe G et al. - Mirtazapine-FGAs combination appears to be a safe, well-tolerated and efficacious treatment option in this challenging population. These findings are important due to the current re-emerging attention to FGAs. Methods

• Schizophrenia-diagnosed patients with a prolonged disease and a history of a poor response to numerous antipsychotics, who were at least moderately ill despite their FGAs treatment, received add-on mirtazapine (n = 20) or placebo (n = 19) in a 6-week double-blind randomized controlled trial (RCT).
• The analysis was made on a Modified Intent-to-Treat (MITT) basis with Last Observations Carried Forward (LOCF).

Results

• Mirtazapine outranged placebo on almost all measures.
• The clear-cut clinical relevance of this finding was demonstrated by a large effect size of 1.00 (95% CI 0.23–1.67, p = 0.003) on the total Positive and Negative Syndrome Scale (PANSS) scores (the primary outcome).
• The PANSS positive subscale scores decreased by 17.2% with mirtazapine vs. 1.6% with placebo (p < 0.001), and the PANSS negative subscale scores by 12% and 3% (p < 0.001), correspondingly.second bullet.

 

 

 

 

 

The Prognostic Impact of Psychotropic Drugs in Intentional Drug Overdose
Pharmacopsychiatry, 03/25/09

Tournier M et al. - Some drugs may be dangerous because of low toxic doses; hence, prescriptions of short duration may be recommended. Moreover, for safety reasons, prescribers may prefer SSRIs to tricyclics and benzodiazepines to carbamates or phenothiazines. Methods

• In order to assess which types of psychotropic drugs ingested during IDOs were associated with an increased morbidity, a cohort study included 1 974 patients consecutively hospitalised for IDO.
• IDOs were categorised as serious if associated with one of the following criteria: death, hospitalisation longer than 48 h, respiratory support, vasopressive drugs, cardiac massage or dialysis.

Results

• Nearly all the patients ingested psychotropic medications during the IDO (88.4%), most often benzodiazepines (71.6%).
• Serious IDO was associated with tricyclics (OR 5.7; 95% CI 3.3-9.8), lithium (OR 4.3; 95% CI 1.6-11.6), carbamates (OR 2.7; 95% CI 1.8-4), anticonvulsants (OR 2.4: 95% CI 1.4-4.3), first-generation antipsychotics (OR 2.4; 95% CI 1.7-3.5) or selective serotonin reuptake inhibitors (SSRIs) (OR 1.6; 95% CI 1.1-2.3).

 

 

 

 

Cross-sectional and Longitudinal Relationships Between Insight and Attitudes Toward Medication and Clinical Outcomes in Chronic Schizophrenia
Schizophrenia Bulletin, 03/24/09

Mohamed S et al. - Greater patient understanding of their illness and more positive attitudes toward medication may improve outcomes. Educational interventions that affect these attitudes may be an important part of psychosocial rehabilitation and/or recovery-oriented services.

 

 

 

 

 

Antipsychotic Combinations vs Monotherapy in Schizophrenia: A Meta-analysis of Randomized Controlled Trials
Schizophrenia Bulletin, 03/24/09

Correll CU et al, - In certain clinical situations, antipsychotic cotreatment may be superior to monotherapy. However, the database is subject to possible publication bias and too heterogeneous to derive firm clinical recommendations, underscoring the need for future research. Methods

• Randomized controlled trials comparing antipsychotic monotherapy to cotreatment with a second antipsychotic.
• Two authors independently extracted data.
• For homogenous dichotomous data, we calculated random effects, relative risk (RR), 95% confidence intervals (CIs), and numbers needed to treat (NNT).
• For continuous data, weighted mean differences were calculated.

Results

• In 19 studies (1229 patients) with 28 monotherapy and 19 cotreatment arms, antipsychotic cotreatment was superior to monotherapy regarding 2 a priori defined coprimary outcomes: less study-specific defined inefficacy (N = 22, n = 1202, RR = 0.76, CI = 0.63?0.90, P = .002, NNT = 7, CI = 4?17, P = .0008, I2 = 78.9%) and all-cause discontinuation (N = 20, n = 1052, RR = 0.65, CI = 0.54?0.78, P < .00001).
• Results were consistent using Clinical Global Impressions thresholds of less than much (P = .006) and less than minimally (P = .01) improved.
• Specific psychopathology and adverse event data were insufficient to yield meaningful results.
• In sensitivity analyses, 5 efficacy moderators emerged: concurrent polypharmacy initiation, clozapine combinations, trial duration >10 weeks, Chinese trials, and second-generation + first-generation antipsychotics.
• In a meta-regression, similar dose combinations, second-generation + first-generation antipsychotics and concurrent polypharmacy initiation remained significant.

 

 

 

 

 

Loneliness, social support networks, mood and wellbeing in community-dwelling elderly
International Journal of Geriatric Psychiatry, 03/24/09

Golden J et al. - Loneliness and social networks both independently affect mood and wellbeing in the elderly, underlying a very significant proportion of depressed mood. Methods

• One thousand two hundred and ninety-nine people aged 65 and over, recruited through primary care practices, were interviewed in their own homes using the GMS-AGECAT
• Social network was assessed using Wenger's typology

Results

• 35% of participants were lonely, with 9% describing it as painful and 6% as intrusive.
• 34% had a non-integrated social network.
• 32% of participants with an integrated social network reported being lonely. Loneliness was higher in women, the widowed and those with physical disability and increased with age.
• When age-related variables were controlled for this association was non-significant. Wellbeing, depressed mood and hopelessness were all independently associated with both loneliness and non-integrated social network.
• Loneliness explained the excess risk of depression in the widowed.
• The population attributable risk (PAR) associated with loneliness was 61%, compared with 19% for non-integrated social network. Taken together they had a PAR of 70%.