Biomedical subjects

Nick C Patel

Publications and source records attributed to Nick C Patel.

At least 19 recordsLinked to original sources

PubMed2006

Treatment effects of antidepressants in patients with post-stroke depression: a meta-analysis.

BACKGROUND: Appropriate treatment of post-stroke depression (PSD) is critically important, considering the negative impact of PSD. Data regarding the treatment efficacy of antidepressants in patients with PSD are conflicting, and the time-dependent effects of antidepressant treatment in this population are unknown. OBJECTIVE: To systematically assess treatment effects of antidepressants in patients with PSD, incorporating data from recent studies. METHODS: A meta-analysis of randomized placebo-controlled trials (RCTs) of antidepressants in patients with PSD was conducted, using published studies from 1984 to 2006. Outcome measures of antidepressant treatment included response rate, depression rating scale scores, recovery of neurologic impairments, and improvements in activities of daily living (ADLs) after stroke. The effect size was presented as rate difference (RD) and weighted mean difference for dichotomous outcomes and continuous outcomes, respectively. Pooled effect sizes were calculated by both fixed-effects and random-effects models. RESULTS: A total of 1320 patients who met inclusion criteria were identified from 16 RCTs. The pooled response rates in the active and placebo groups were 65.18% (234/359) and 44.37% (138/311), respectively. The pooled RD was 0.23 (95% CI 0.03 to 0.43), indicating a significantly higher response rate in the active group compared with the placebo group. From baseline to endpoint, patients in the active group had significantly greater improvement in depressive symptoms compared with patients in the placebo group. Longer duration of treatment was positively correlated with the degree of improvement in depressive symptoms (Spearman's correlation, [rho] = -0.93, p = 0.001). No consistent evidence was found for positive antidepressant effects on the recovery of neurologic impairments and improvements in ADLs. CONCLUSIONS: The results of this meta-analysis suggest that use of antidepressants among patients with a diagnosis of PSD is associated with improvement in depressive symptoms. Longer durations of antidepressant treatment may be associated with greater reductions in depressive symptoms.

Aged↗

PubMed2006

Lithium treatment effects on Myo-inositol in adolescents with bipolar depression.

BACKGROUND: The neurochemical effects of lithium in adolescents with bipolar disorder largely are unknown. This study used proton magnetic resonance spectroscopy (1H MRS) to identify the in vivo effects of lithium on myo-inositol (mI) concentrations in adolescent bipolar depression. METHODS: Twenty-eight adolescents (12-18 years old) with bipolar I disorder, current episode depressed, received open-label lithium 30 mg/kg, adjusted to achieve serum levels of 1.0-1.2 mEq/L. The mI concentrations in the medial as well as the left and right lateral prefrontal cortices were measured at baseline, day 7, and day 42 of treatment. Changes in mI concentrations over time were analyzed. RESULTS: Significant main effects of time were observed for mI concentrations in the medial (p = .03) and right lateral (p = .05) prefrontal cortices. Baseline concentrations of mI were not significantly different from day 7 or day 42 concentrations. However, mI concentrations on day 42 were significantly higher than those on day 7 (p = .02) in both regions. CONCLUSIONS: This study demonstrates that prefrontal mI concentrations do not significantly change from baseline after acute and chronic lithium treatment in adolescents with bipolar depression. Further investigation of the effect of lithium on mI is warranted to better understand possible mechanisms by which lithium exerts antidepressant activity.

Adolescent↗

PubMed2006

Atomoxetine versus stimulants for treatment of attention deficit/hyperactivity disorder.

OBJECTIVE: To identify, review, and analyze studies comparing atomoxetine with psychostimulants with the intent of determining the role of atomoxetine in the pharmacologic management of attention deficit/hyperactivity disorder (ADHD). DATA SOURCES: Primary, review, and meta-analysis articles were identified by a MEDLINE search (1966-December 2005). MeSH headings used in the search include: attention deficit/hyperactivity disorder, ADHD, atomoxetine, stimulants, psychostimulants, methylphenidate, and amphetamine salts. Relevant data presented at professional meetings that we attended were also identified. STUDY SELECTION AND EXTRACTION: All clinical studies comparing atomoxetine with psychostimulants, regardless of study design, were evaluated. Relevant efficacy and safety data from these studies were included in the discussion. DATA SYNTHESIS: At time of writing, 5 head-to-head trials had compared psychostimulants and atomoxetine in the treatment of ADHD. No significant difference between atomoxetine and methylphenidate immediate-release were found on the ADHD Rating Scale total score. Osmotic oral release system (OROS) methylphenidate showed significantly greater improvement at weeks 1 and 2, and significantly more patients treated with OROS methylphenidate were classified as responders. Patients on both atomoxetine and mixed amphetamine salts extended-release (MAS XR) showed significant improvements at endpoint over baseline; however, Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) scores were significantly better with MAS XR. Tolerability was similar between atomoxetine and stimulant medications. CONCLUSIONS: Based on available evidence, psychostimulants are regarded as first-line pharmacologic treatment for children and adolescents with ADHD, as the efficacy and safety of these agents have been well established based on clinical trials and extensive naturalistic use. Adverse effects in some patients and abuse potential have led to the search for new treatments. Atomoxetine represents an alternative treatment for ADHD and is unlikely to be associated with abuse; however, long-term safety data are needed to further establish its place in therapy.

Adrenergic Uptake Inhibitors↗

PubMed2006

Ethnic variation in symptoms and response to risperidone in youths with schizophrenia-spectrum disorders.

BACKGROUND: Evaluation of symptom presentation and antipsychotic response based on ethnicity in children and adolescents with schizophrenia is limited. The purpose of this naturalistic, retrospective database study was to compare symptom presentation of children and adolescents of different ethnicities with schizophrenia-spectrum disorders, and response to risperidone. METHOD: African-American (n = 38), Caucasian (n = 30), or Hispanic (n = 37) youths started on risperidone were eligible. Child Behavior Checklist (CBCL) total, internalizing, and externalizing scores were evaluated at baseline, 90 days, 1 year, and 2 year intervals. RESULTS: At baseline, Hispanic patients had lower CBCL externalizing scores than African-Americans or Caucasians. African-Americans showed significant differences in CBCL total, internalizing, and externalizing scores at 90 days compared to baseline. Hispanics showed improvement in CBCL internalizing scores over the 2 year period. No significant improvements were observed in Caucasians. African-American patients had significantly lower CBCL total at 90 days compared to Hispanic patients. No significant difference existed in 2 year hospitalization rates between groups. CONCLUSIONS: These findings suggest that ethnicity may play a role in symptom presentation and treatment response to risperidone for children and adolescents with schizophrenia-spectrum disorders. Future studies in children and adolescents are necessary to examine ethnospecific differences in antipsychotic use and treatment response.

Adolescent↗

PubMed2006

Diagnoses and antipsychotic treatment among youths in a public mental health system.

BACKGROUND: The use of antipsychotics, namely newer atypical agents, has increased significantly in children and adolescents. It is important to examine diagnoses associated with antipsychotic treatment in youths. OBJECTIVE: To evaluate trends in psychiatric diagnoses of children and adolescents in a public mental health system who were prescribed antipsychotics. METHODS: Children and adolescents, up to the age of 19 years, who were prescribed an antipsychotic between January 1998 and December 2001 were identified using the Texas Medicaid Vendor Drug database. Patient identification numbers were then cross-linked to the Client Assignment and Registration database of the Texas Department of Mental Health and Mental Retardation to extract diagnostic data. RESULTS: Disruptive behavioral disorders accounted for the highest percentage (35%) of diagnoses associated with children and adolescents receiving antipsychotic treatment and mental healthcare services. Depressive disorders were the second most common diagnosis (18%), and bipolar disorders accounted for roughly 12% of all diagnoses. Approximately 3% of children and adolescents did not have a psychiatric diagnosis. The percentage of youths with comorbid psychiatric diagnoses decreased over time. CONCLUSIONS: Although disruptive behavioral disorders accounted for a large percentage of antipsychotic use in this population, these findings suggest that antipsychotics are being used to treat other psychiatric diagnoses, for which limited supporting data exist. Future research in children and adolescents should aim to provide needed efficacy and safety data of antipsychotics across the spectrum of neuropsychiatric disorders.

Adolescent↗

PubMed2006

Preliminary study of relationships among measures of depressive symptoms in adolescents with bipolar disorder.

PURPOSE: The aim of this study was to explore relationships between the Children's Depression Rating Scale-Revised (CDRS-R) and Hamilton Rating Scale for Depression (HAM-D) in adolescent bipolar disorder. We hypothesized that CDRS-R and HAM-D scores would be significantly correlated and both scales would be sensitive to change resulting from treatment. METHODS: Data from a randomized, double-blind, placebo-controlled study of quetiapine with divalproex versus divalproex alone (n = 30) and an open-label study of lithium (n = 27) were used. Assessments using the CDRS-R and HAM-D were completed separately without any dependence on ratings from the alternate rating scale or specific order. All raters for symptom rating scales were blinded to the study for which they were completing a patient assessment and the intent to conduct these post hoc analyses and were different from those who performed diagnostic interviews. Relationships between these measures were assessed using the Pearson correlation coefficient, and receiver operator characteristic curves evaluated the ability of CDRS-R and HAM-D scores to predict the level of global improvement. RESULTS: The mean (+/- standard deviation) age of subjects was 15.0 +/- 1.6 years. Baseline CDRS-R and HAM-D scores were moderately correlated (r = 0.63; p < 0.001), while week 6 scores showed stronger correlation (r = 0.88; p < 0.001). Both measures showed significant main effects for time on treatment (CDRS-R: F(3.4,191.2) = 39.4, p < 0.001; HAM-D: F(3.9,217.9) = 38.5, p < 0.001). A CDRS-R score of 30.5 and HAM-D score of 7.5 represent the highest sensitivity and specificity in classifying responders and nonresponders. A 42.2% and 60.6% reduction in baseline CDRS-R and HAM-D scores, respectively, provided the highest sensitivity and specificity. CONCLUSIONS: Our preliminary results demonstrated that CDRS-R and HAM-D scores were significantly correlated, suggesting that either measure may be used to assess depressive symptoms in studies of adolescent bipolar disorder. Limitations to this study included a relatively small pooled sample, variation in clinician judgment, and study design not specific for the comparison of rating scales. Studies with methods specific to evaluate and compare these rating scales and larger patient samples from multiple treatment sites are needed to confirm these findings.

Adolescent↗

PubMed2006

Open-label lithium for the treatment of adolescents with bipolar depression.

OBJECTIVES: To investigate the effectiveness and tolerability of lithium for the treatment of acute depression in adolescents with bipolar disorder. We hypothesized that patients receiving open-label treatment with lithium during a 6-week period would experience a statistically and clinically significant decrease in depressive symptoms and tolerate lithium treatment fairly well. METHOD: Twenty-seven adolescents (12-18 years old) with an episode of depression associated with bipolar disorder type I received open-label lithium 30 mg/kg (twice-daily dosing), which was adjusted to achieve a therapeutic serum level (1.0-1.2 mEq/L). Effectiveness measures included the Children's Depression Rating Scale-Revised (CDRS-R) and Clinical Global Impressions Scale for Bipolar Disorder (CGI-BP). Adverse events were assessed weekly. RESULTS: Mean CDRS-R scores significantly decreased from baseline to endpoint (mean [SD] change = -25.5 (20.4); p < .001), resulting in a large effect size of 1.7. Response and remission rates (defined by a > or = 50% reduction in CDRS-R score from baseline to endpoint, and a CDRS-R score < or = 28 and a CGI-BP Improvement score of 1 or 2, respectively) were 48% and 30%. Side effects, which were generally mild to moderate in severity, included headache (74%), nausea/vomiting (67%), stomachache (30%), and abdominal cramps (19%). CONCLUSIONS: The findings of this study indicate that lithium may be effective and is relatively well tolerated for the treatment of an acute episode of depression in adolescents with bipolar disorder. Controlled studies of lithium in adolescent bipolar depression are needed.

Adolescent↗

PubMed2006

Single-dose pharmacokinetics and safety of ziprasidone in children and adolescents.

OBJECTIVE: The purpose of this study was to provide single-dose pharmacokinetic, safety, and tolerability data for ziprasidone in youths with tic disorder, for comparison to adult studies to discern whether ziprasidone pediatric dosing could be modeled from adult data. METHOD: A single-dose, open-label study of ziprasidone was conducted in youths (ages 7-16 years) with Tourette's disorder or chronic tic disorder. Dosing of ziprasidone oral suspension (40 mg/mL) was weight adjusted: >60 kg, 20 mg (group 1, n = 8); 31 to 60 kg, 10 mg (group 2, n = 8); and 16 to 30 kg, 5 mg (group 3, n = 8). Patients were assessed for serum ziprasidone concentration, safety, tolerability, and electrocardiogram pre- and postdose. RESULTS: Twenty-four patients were evaluated for safety and tolerability, and 23 were evaluated for pharmacokinetics. Regression analysis of AUC(0-infinity) and Cmax values versus weight-normalized dose showed linear, dose-related changes in ziprasidone exposure. Ziprasidone was well tolerated with frequent, although transient, somnolence. No clinically significant change from baseline was observed in Bazett's or Fridericia's corrected QT(c) interval, and change in QT(c) interval was not related to serum ziprasidone concentration. CONCLUSIONS: Oral ziprasidone exhibited linear pharmacokinetics and dose-related exposure in youths with Tourette's disorder or chronic tic disorder, which are comparable to adult data. A single dose of ziprasidone was well tolerated without clinically significant effects on electrocardiograms collected around the time of maximum serum concentration.

Adolescent↗

PubMed2006

Physician specialty associated with antipsychotic prescribing for youths in the Texas Medicaid program.

BACKGROUND/OBJECTIVE: The use of antipsychotics in children and adolescents in the Texas Medicaid program has increased with the introduction of newer atypical antipsychotics. The purpose of this study was to examine physician specialty associated with antipsychotic prescribing from 1996 to 2001. METHODS: All antipsychotic prescription claims records for children and adolescents younger than the age of 20 years from 1996 to 2001 were extracted from the Texas Medicaid Drug Vendor prescription database. Physician specialty associated with youths receiving all, atypical, and conventional antipsychotic prescriptions was examined for time trends. Physician specialty categories included psychiatry, primary care, neurology, other, and unspecified. RESULTS: Psychiatrists accounted for more than 80% of youths receiving antipsychotic prescriptions from 1996 to 2001. The proportion of youths receiving antipsychotic prescriptions from primary care physicians remained fairly steady over the course of time (1996: 19%; 2001: 16%). The number of youths prescribed conventional antipsychotics decreased in all specialty groups, whereas the number prescribed atypical antipsychotic prescriptions increased dramatically. CONCLUSIONS: Although the majority of children and adolescents in the Texas Medicaid program were prescribed antipsychotics by psychiatrists and child and adolescent psychiatrists, youths may often receive treatment within the primary care setting. Future research is necessary to evaluate patient outcomes associated with antipsychotic treatment across different treatment settings.

Adolescent↗

PubMed2006

Phenomenology associated with age at onset in patients with bipolar disorder at their first psychiatric hospitalization.

OBJECTIVE: To compare the clinical presentation of patients with early-onset (age <18 years) and typical-onset (age 20-30 years) bipolar disorder at the time of first hospitalization. METHODS: Patients, aged 12-45 years at their first psychiatric hospitalization, with a DSM-IV diagnosis of bipolar disorder, manic or mixed, were evaluated on measures of manic, depressive, and positive psychotic symptoms. Differences in symptom profiles between early- and typical-onset groups were examined. RESULTS: One hundred three early-onset and 58 typical-onset patients were compared. Mixed episodes were more common in the early-onset group, while psychotic features and current substance use were more common in the typical-onset group. There was no significant difference in manic symptom severity ratings between early- and typical-onset groups (F = 1.8, df = 11, 144, p = 0.06). However, these groups differed in depressive (F = 4.2, df = 16, 139, p < 0.001) and positive psychotic (F = 2.8, df = 16, 139, p = 0.001) symptom profiles. Typical-onset bipolar patients reported more severe weight loss and formal thought disorder compared with early-onset patients. CONCLUSIONS: Depressive and positive psychotic symptoms may differ in association with age at onset among patients with bipolar disorder. Additional studies are necessary to determine whether homogeneous phenotypes of bipolar disorder can be delineated based upon age at onset.

Adolescent↗

PubMed2006

Ethnic differences in symptom presentation of youths with bipolar disorder.

OBJECTIVE: To compare symptom profiles of African-American and white adolescents with a diagnosis of bipolar disorder. METHOD: Adolescents, aged 12-18 years at their first psychiatric hospitalization, with a DSM-IV diagnosis of bipolar disorder, manic or mixed, were evaluated on measures of manic, depressive, and positive symptoms of psychosis. Ethnic differences in symptom profiles were examined using multivariate analysis of covariance, and specific symptoms contributing to the difference were analyzed. RESULTS: Ethnic differences existed in manic and positive symptom profiles, but not depressive symptoms. Compared with the white cohort, African-American youths were diagnosed more frequently as having psychotic features, and had higher ratings for auditory hallucinations. CONCLUSIONS: Similar to adults, symptom expression in adolescent bipolar disorder may differ between ethnic groups. Future studies are needed to replicate these findings and explore possible explanations.

Adolescent↗

PubMed2006

Ziprasidone: efficacy and safety in patients with bipolar disorder.

Atypical antipsychotics have been increasingly shown to have efficacy in the treatment of various phases of bipolar disorder. Ziprasidone acts primarily through serotonergic and dopaminergic receptor antagonism, and exerts effects as an inhibitor of serotonin and norepinephrine reuptake. Ziprasidone exhibits dose proportional, linear changes in exposure and is hepatically metabolized primarily by aldehyde oxidase. In studies of patients with acute manic or mixed episodes, treatment with ziprasidone monotherapy or in combination with lithium, resulted in rapid symptom improvement and was generally well tolerated. Results from open-label extension studies of ziprasidone indicate continued improvement in manic symptoms. Preliminary data in pediatric patients with bipolar disorder also suggest it may be efficacious in this population. Ziprasidone is considered as a first-line treatment option in patients with bipolar manic or mixed episodes, with or without psychosis and displays a favorable side-effect profile.

Bipolar Disorder↗

PubMed2005

Unanswered questions regarding atypical antipsychotic use in aggressive children and adolescents.

The aim of this paper was to discuss the arguments for and against the use of atypical antipsychotics in children and adolescents with aggression, and provide recommendations for future research. A MEDLINE search (1985-2004) was performed to identify key literature. Search terms included, but were not limited to, clozapine, olanzapine, quetiapine, risperidone, ziprasidone, children, and adolescents. The search was limited to English-language literature and randomized controlled trials. The use of atypical antipsychotics in children and adolescents has increased significantly over the past few years. Atypical antipsychotics are associated with a more favorable side-effect profile, and growing evidence supports their efficacy for aggression in this population. However, the long-term effects of these agents are unknown. No head-to-head evidence exists to suggest whether pharmacological or nonpharmacological treatments are superior for managing aggression associated with childhood and adolescent psychiatric and behavioral conditions. Future research of atypical antipsychotics in children and adolescents needs to evaluate not only the efficacy but also the effectiveness. Examination of treatment mediators and moderators may help to optimize treatment regimens and improve patient outcomes. Finally, effective interventions require the development and implementation of evidence-based treatment strategies using a multidisciplinary approach.

Adolescent↗

PubMed2005

Ethnic differences in maintenance antipsychotic prescription among adolescents with bipolar disorder.

PURPOSE: The aim of this study was to compare the longitudinal use of psychotropic medications in African-American and Caucasian adolescents with a diagnosis of bipolar disorder following their first psychiatric hospitalization. METHODS: Age- and gender-matched African-American (n=16) and Caucasian (n=16) adolescents, between the ages of 12 and 18 years and meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for bipolar I disorder, manic or mixed, were evaluated over a period of 1 year following their first psychiatric hospitalization for a mood episode. Medication prescription and adherence during follow-up were compared between ethnic groups. RESULTS: African-American adolescents received antipsychotic prescription for a significantly greater percentage of time during follow-up than Caucasian adolescents, after adjusting for rate of psychotic features (79% versus 40%; p=0.05). African-American and Caucasian patients received mood stabilizer/anticonvulsant prescription for similar percentages of time during follow-up. African-American and Caucasian adolescents exhibited similar rates of full adherence to antipsychotics, mood stabilizers/anticonvulsants, and all psychotropic medications. CONCLUSIONS: African-American adolescents were prescribed atypical antipsychotic medications for longer periods of time than Caucasian adolescents, but reasons for this finding were unclear. Additional research efforts in adolescent bipolar disorder are needed to explore factors associated with ethnic disparity in pharmacological treatment interventions.

Adolescent↗

PubMed2005

Trends in the use of typical and atypical antipsychotics in children and adolescents.

OBJECTIVE: To estimate prevalence rates of antipsychotic use in children and adolescents from 1996 to 2001 in three state Medicaid programs (midwestern [MM], southern [SM], and western [WM]) and one private managed care organization (MCO). METHOD: Prescription claims were used to evaluate antipsychotic prevalence, defined as the number of children and adolescents up to the age of 19 years with at least one prescription claim for an antipsychotic per 1,000 enrolled youths. RESULTS: From 1996 to 2001, the prevalence of total antipsychotic use increased in each program (MM: 4.7 to 14.3 per 1,000; SM: 6.3 to 15.5; WM: 4.5 to 6.9; and MCO: 1.5 to 3.4). Typical antipsychotic use decreased (MM: 3.7 to 2.0 per 1,000; SM: 4.6 to 1.5; WM: 4.4 to 1.3; and MCO: 1.2 to 0.9), while atypical antipsychotic use dramatically increased (MM: 1.4 to 13.1 per 1,000; SM: 2.5 to 14.9; WM: 0.3 to 6.2; and MCO: 0.4 to 2.7). CONCLUSIONS: The increased prevalence of antipsychotic use in children and adolescents from 1996 to 2001 was attributed to increased use of atypical antipsychotics. Given the limited data with atypical antipsychotics in youths, this emphasizes the need for additional studies of these agents and other treatment modalities in this population.

Adolescent↗

PubMed2005

Drug adherence: effects of decreased visit frequency on adherence to clozapine therapy.

OBJECTIVE: To study the effects of visit frequency on drug-adherence parameters subsequent to the change in the United States Food and Drug Administration (FDA)-mandated monitoring of white blood cell counts from weekly to every 2 weeks (biweekly) after 6 months of clozapine therapy. METHODS: Paid prescription claims records for clozapine from September 1, 1995-August 31, 2001, were extracted from the Texas Medicaid Vendor Drug Program database. Two groups of subjects were identified: subjects treated before and those treated after the FDA labeling change in monitoring frequency, which occurred on April 1, 1998. Prescription claims records for each subject were assessed for 365 days after the initial 6 months of therapy. Adherence measures included persistence, medication possession ratio (MPR), and time taking clozapine. RESULTS: Subjects receiving weekly hematologic monitoring had significantly higher rates of persistence (0.79 +/- 0.35 vs 0.70 +/- 0.38, p < 0.001) and MPRs (0.75 +/- 0.36 vs 0.66 +/- 0.38, p < 0.001) and continued to take clozapine longer (p < 0.002) compared with subjects receiving biweekly monitoring. Fewer subjects in the weekly monitoring group discontinued clozapine therapy during the 1-year study period (49.4% vs 57.9%, p = 0.008). Similar results were observed when cohorts were matched according to age, sex, and index clozapine dosage. CONCLUSION: Significant effects of visit frequency on adherence to clozapine therapy were noted. For patients inadequately adherent to therapy, an increase in visit frequency may improve adherence, and based on these results, the extra visits do not need to be with a physician or have any specific purpose other than contact with a provider.

Adolescent↗

PubMed2004

Aripiprazole: a comprehensive review of its pharmacology, clinical efficacy, and tolerability.

BACKGROUND: Recently approved for the treatment of schizophrenia, aripiprazole represents the sixth second-generation antipsychotic (SGA) introduced to the US market. Aripiprazole is considered a partial dopaminergic agonist, acting on both postsynaptic dopamine(2) receptors and presynaptic autoreceptors, in addition to displaying partial agonism at serotonin(1A) receptors and antagonism at serotonin(2A) receptors. OBJECTIVE: The aim of this study was to comprehensively review all available literature regarding the mechanism of action, pharmacokinetics, clinical efficacy, and adverse effects of aripiprazole. METHODS: Relevant data were collected using MEDLINE and International Pharmaceutical Abstracts searches with the terms aripiprazole and OPC-14597 and with no limitations on year. Abstracts and posters presented at national and international scientific meetings were also reviewed. RESULTS: Aripiprazole exhibits linear pharmacokinetics and is administered once daily. In multiple clinical trials, aripiprazole was effective in significantly reducing symptomatology associated with schizophrenia-related disorders compared with placebo (P < 0.05). Dosages > or =15 mg/d more consistently produced significant reductions from baseline of Positive and Negative Syndrome Scale total scores (P < 0.05) and were more likely to elicit a response than smaller dosages. Effects observed were comparable to those seen with risperidone and haloperidol, which were also significantly more effective than placebo (P < or = 0.05). Aripiprazole exhibited a favorable safety and tolerability profile, with a low propensity to cause extrapyramidal symptoms, weight gain, cardiovascular abnormalities, hyperprolactinemia, hypercholesterolemia, or glucose dysregulation. CONCLUSIONS: Aripiprazole represents a well-tolerated and effective addition to the antipsychotic armamentarium. However, definitive advantages associated with dopamine partial agonism have yet to be determined. Long-term, head-to-head comparisons with other SGAs are needed to establish the effects of chronic administration and the relative safety and efficacy of aripiprazole.

Antipsychotic Agents↗

PubMed2004

A retrospective analysis of the short-term effects of olanzapine and quetiapine on weight and body mass index in children and adolescents.

STUDY OBJECTIVE: To evaluate changes in short-term weight and body mass index (BMI) in children and adolescents receiving olanzapine or quetiapine. DESIGN: Retrospective study Setting. Austin State Hospital, Austin, Texas. PATIENTS: One hundred three patients younger than 18 years who were admitted to the hospital and treated with olanzapine (50 patients) or quetiapine (53) for at least 2 weeks between October 1, 1997, and October 31, 2001. INTERVENTION: Treatment with at least 2 weeks of olanzapine or quetiapine. MEASUREMENTS AND MAIN RESULTS: Mean+/-SD daily doses of olandzapine and quetiapine were 13.9+/-7.3 and 510.9+/-250.3 mg, respectively Weight and height were measured at baseline and 14 or more days after baseline. Body mass index (in kg/m2) was calculated using serial measurements of weight and height, and change in BMI was determined. The olanzapine group gained an average of 3.8 kg, the quetiapine group 0.03 kg. In the olanzapine group, BMI increased by an average of 1.3 kg/m2; in the quetiapine group, BMI decreased by 0.2 kg/m2. After controlling for baseline differences, significant between-group differences in weight and BMI change were noted. Change in BMI correlated significantly with baseline BMI in quetiapine-treated girls. CONCLUSION: Patients taking olanzapine had greater increases in weight and BMI than those taking quetiapine. Further studies are necessary to determine the relative risk, magnitude, and time course of antipsychotic-induced weight gain in this patient population.

Adolescent↗