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Biomedical subjects

Peter F Buckley

Publications and source records attributed to Peter F Buckley.

At least 19 recordsLinked to original sources
PubMed2006

Pharmacotherapy of delusional disorders in the context of offending and the potential for compulsory treatment.

Delusional disorder is an uncommon mental illness with an estimated prevalence of 0.03%. Its low prevalence has likely contributed to the paucity of research interest in this area, leading to substantial gaps in knowledge concerning its treatment and management. In the absence of a robust literature, most clinicians rely on their experience and guidelines for treating schizophrenia when treating patients with delusional disorder. This article reviews the available literature that is specific to the treatment of delusional disorder. In addition, it focuses on specific forensic and medicolegal aspects of managing patients with delusional disorder.

Delusions↗
PubMed2006

Prevalence and consequences of dual diagnosis.

The co-occurrence of a severe mental illness and a substance abuse or dependence disorder is common enough to be considered the expectation more than the exception. Substance use disorders can occur at any phase of mental illness. Causes of this comorbidity may include self-medication, genetic vulnerability, environment or lifestyle, underlying shared origins, and/or a common neural substrate. The consequences of dual diagnosis include poor medication compliance, physical comorbidities, poor health, poor self-care, increased risk of suicide or risky behavior, and even possible incarceration. All of these factors contribute to increased burden and reduced capacity of the health care system to adequately treat patients. Screening, assessment, and integrated treatment plans for dual diagnosis to address both the substance use disorder and the mental illness are strongly recommended.

Cost of Illness↗
PubMed2006

The art and science of switching of antipsychotic medications, part 1.

In the presentation "Prevalence of and Factors Influencing the Switching of Antipsychotic Medications," Weiden defines the recovery approach for the treatment of schizophrenia, focuses on reasons for switching antipsychotic medications, and offers recommendations for evaluating switch studies. In "Combining and Switching Medications in Bipolar Disorder," Young discusses the similarities and differences between schizophrenia and bipolar disorder, offers recommendations for switching medications in bipolar disorder, and evaluates studies of atypical antipsychotics in the treatment of bipolar disorder. Buckley's presentation, "Differential Pharmacology of Atypical Antipsychotics: Clinical Implications," examines response rates in patients with schizophrenia after switching antipsychotic medications, outlines receptor-binding profiles of atypical antipsychotics, highlights adverse events that may occur when switching antipsychotic medications, and offers recommendations for treating those adverse events.

Antipsychotic Agents↗
PubMed2006

Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness.

The co-occurrence of a severe mental illness and a substance use or abuse disorder is common in the United States as well as internationally and could be considered as more the expectation than the exception when assessing patients with serious mental illness. Substance use disorders can occur at any phase of the mental illness, perhaps even inducing psychosis. Causes of this comorbidity may include self-medication, genetic vulnerability, environment or lifestyle, underlying shared origins, and/or a common neural substrate. The consequences of dual diagnosis include poor medication compliance, physical comorbidities and poor health, poor self-care, increased suicide risk or aggression, increased sexual behavior, and possible incarceration. All of these factors contribute to a greater health burden, which reduces the health care system's capacity to adequately treat patients. Therefore, screening, assessment, and integrated treatment plans for dual diagnosis that can address both the addiction disorder and the mental illness are recommended in order to provide accurate treatment, after-care, and other health care to accommodate patients' social and vocational needs.

Comorbidity↗
PubMed2005

Clinicians' recognition of the metabolic adverse effects of antipsychotic medications.

There is a growing concern regarding the propensity of second generation antipsychotics (SGAs) to induce weight gain and metabolic adverse effects. Recent consensus guidelines have recommended assessment and monitoring procedures to appropriately detect and manage these adverse effects. This study addresses the appreciation and readiness of clinicians to implement management guidelines for these adverse effects. Respondents indicated awareness of the risks of treatment with SGAs. The extent of monitoring for metabolic adverse effects was low and inconsistent across measures and in frequency of evaluation. Ongoing efforts are needed to support and encourage change in clinician practice.

Antipsychotic Agents↗
PubMed2005

Clozapine-induced weight gain associated with the 5HT2C receptor -759C/T polymorphism.

Weight gain has been documented as a significant adverse effect associated with many of the atypical antipsychotic medications. Several recent reports have linked a -759C/T polymorphism of the 5HT2C receptor gene and obesity as well as chlorpromazine, risperidone, and clozapine induced to weight gain. This aim was to determine the association between changes in body mass index (BMI) during clozapine treatment and the -759C/T polymorphism of the 5HT2C receptor gene. This study included 41 patients with treatment-refractory schizophrenia (DSM-IV) who were followed prospectively during treatment with clozapine. Weight and height measurements were obtained prior to starting clozapine and after 6-months of treatment. Genomic DNA was isolated from a whole blood sample and analyzed for the -759C/T polymorphism of the 5HT2C receptor gene. A chi(2) analysis comparing whether or not the subjects carried a -759T allele in subjects grouped as having an increase of more or less than 7% of their baseline BMI during treatment with clozapine found that the presence of the -759T allele was significantly higher in subjects with less than or equal to a 7% increase in baseline BMI compared to those with a greater than 7% increase in BMI. A multiple linear regression analysis showed that both baseline BMI and the presence or absence of the -759T allele had significant effects on 6-month BMI. The T allele may have a protective function in preventing significant weight gain from clozapine. Subjects without the -759T variant allele were at a greater risk for weight gain from clozapine over 6-months compared to those with the -759T allele.

Adult↗
PubMed2005

Stimulus sequence affects schizophrenia-normal differences in event processing during an auditory oddball task.

Schizophrenia patients have difficulty distinguishing relevant from irrelevant auditory information. Auditory oddball paradigms are commonly used to investigate the processing of stimulus relevance. The present study used dense-array EEG and distributed source reconstructions to examine schizophrenia-normal differences in the processing of targets and standards as a function of the temporal sequence of stimuli. Brain responses were evaluated separately for early and late standards (standards 1-3 and 4-6 following a target, respectively) and early and late targets (those following 2-3 standards and 4-6 standards, respectively). The latencies of peaks (N1, P2, P3) in the event-related potential (ERP) waveforms did not differ between schizophrenia and normal subjects. However, schizophrenia-normal differences in neural activity, derived from minimum norm estimation, occurred at specific times during stimulus processing as a function of stimulus sequence. Schizophrenia patients displayed smaller activity than normals in early ERPs (left hemispheric N1, right frontal P2) to late targets, and they produced P3-like responses to late standards. Furthermore, during the P2/N2 time interval, opposite patterns of brain activity were elicited in schizophrenia and normal subjects in response to standards, indicating different neural responses to the same stimulus events. These results suggest attention allocation to task-irrelevant stimuli in schizophrenia, consequent upon insufficient representation of stimulus significance and context. Thus, schizophrenia compromises the ability to properly use context to solve even simple cognitive problems.

Acoustic Stimulation↗
PubMed2005

Optimizing treatment of schizophrenia. Enhancing affective/cognitive and depressive functioning.

Recognition and treatment of schizophrenia has largely focused on positive symptoms of the disorder, such as delusions, hallucinations, and disorganization. However, other important symptoms, such as depression, cognition, and social functioning, have not received comparable attention. Fifty percent of schizophrenic patients suffer from comorbid depression, which is a major risk factor for suicide in this population, while 10% to 25% suffer from comorbid obsessive-compulsive disorder. Cognitive deficits commonly observed in patients with schizophrenia include problems with concentration, attention, and memory, as well as problem-solving and verbal skills. These deficits are observed at early stages of the illness and can predict deficits in functional capabilities, such as occupational and social skills, educational attainment, and the ability to live independently. The severity of such impairments affects all patient in this population, including up to 10% of patients working full time and up to one third of those working part time. In light of the debilitating effects of depression, cognitive impairment, and other aspects of affective functioning on the quality of life of patients with schizophrenia, physicians need to partner with their patients to address these concerns and determine an appropriate treatment regimen. This can be done with simple functional-based cognitive questioning, the use of evidence-based psychosocial practices, and psychoeducation on the many pharmacotherapeutic options. It is recommended that depressive or suicidal symptoms of schizophrenia be treated with an antidepressant or mood stabilizer only if the symptoms have not subsided after treatment of the psychosis with an atypical antipsychotic. Additionally, relative to older medications, atypicals have demonstrated benefit in improving some of the cognitive impairments.

Affective Symptoms↗
PubMed2005

Treatment-refractory schizophrenia.

PURPOSE OF REVIEW: The aim of this article is to critically review the current literature on treatment-refractory schizophrenia with an emphasis on emergent themes and key findings. RECENT FINDINGS: New information continues to emerge on the impact of each second-generation antipsychotic on the treatment-refractory patient population and on the traditionally more difficult-to-treat components (e.g. cognition, suicidality, violence) of the illness. There are continued efforts with pharmacogenetics to predict response and side-effect risk with antipsychotic medications. Polypharmacy continues to be a major and poorly understood treatment practice. SUMMARY: Our field is advancing the therapeutic nuances of therapy with second-generation antipsychotics in treatment-refractory schizophrenia. Additionally, there is a growing appreciation of the emergent adverse-effect profile of antipsychotic medications and these risk-benefit considerations are more pronounced in severely ill patients.

Journal Article↗
PubMed2005

A three-dimensional morphometric study of craniofacial shape in schizophrenia.

BACKGROUND: Subtle dysmorphogenesis of the craniofacial region constitutes important corroborating evidence of the neurodevelopmental origins of schizophrenia. Advances in facial visualization now allow for three-dimensional anthropometric evaluations of potentially greater discriminatory power in examining the complex geometric relationships of facial topography. METHOD: Sixty-five anthropometrically derived landmarks were identified from three-dimensional facial images collected from 14 patients with schizophrenia and 11 comparison subjects, imaged with a high-resolution, portable laser scanner. RESULTS: Using the Procrustes morphometric approach for shape analysis, the difference in mean shapes was highly significant, with patients exhibiting superoinferior elongation of the face. CONCLUSIONS: The topography of craniofacial anomalies in schizophrenia is not random and points to midline deformation.

Adult↗
PubMed2005

Second-generation antipsychotic medications in the treatment of mood disorders: focus on aripiprazole.

Second-generation antipsychotic medications offer a broader range of therapeutic efficacies than first-generation agents. Consequently, our field has witnessed a rapid expansion of the use of second-generation antipsychotic drugs for several conditions beyond psychosis. The use of second-generation antipsychotic medications has been most pronounced in mood disorders, especially in bipolar disorders. Information about the agents clozapine, risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole in terms of their efficacy and tolerability in bipolar disorder is now available. Aripiprazole, a new agent whose proposed mechanism(s) of action differs from that of other agents, has been shown in placebo-controlled comparative trials in bipolar patients to be an effective and well tolerated treatment option for this patient group. The role of second-generation antipsychotic medications in the therapeutic armamentarium for bipolar disorders will be determined by clinical experience, by additional phase IV studies and by trials that compare second-generation antipsychotics with each other and also with mood-stabilizing medications. There is also a pressing need for additional information on the long-term efficacy and safety of each second-generation antipsychotic agent during maintenance therapy for bipolar disorders.

Antipsychotic Agents↗
PubMed2005

Olanzapine: a critical review of recent literature.

The purpose of this review is to critically review the current literature on olanzapine with an emphasis on emergent themes and key findings in the use of this agent for the treatment of mood disorders and schizophrenia. New information continues to emerge on the impact of olanzapine on schizophrenia and on aspects of the course of mood disorders. There are also continued efforts to understand, predict and manage the side-effect risk with olanzapine.

Antipsychotic Agents↗
PubMed2004

Rate of stimulation affects schizophrenia-normal differences on the N1 auditory-evoked potential.

The present study examined how increasing the rate of steady-state stimulation affects schizophrenia-normal differences on the N1 auditory-evoked potential, an index of auditory integration. Dense-array EEG was recorded while schizophrenia and normal subjects heard 1 kHz tones amplitude modulated at 10, 20, 40, or 80 Hz. Spectral power across frequency and time was calculated. The typically lower N1 amplitude in schizophrenia, observed at the 10 Hz burst rate, increased to nearly equal that of normal individuals at 20 Hz. Unlike normal subjects, schizophrenia subjects' power at N1 failed to increase at the 40 and 80 Hz burst rates. These results suggest steady-state stimuli, up to a point, provide the extra information needed for schizophrenia patients to more efficiently integrate auditory information.

Acoustic Stimulation↗
PubMed2004

Efficacy and tolerability of quetiapine in poorly responsive, chronic schizophrenia.

With the notable exception of clozapine, there is at present insufficient information on the efficacy of atypical antipsychotic medications in patients with poorly responsive schizophrenia. The present study reports on the efficacy and tolerability of quetiapine and haloperidol in patients with schizophrenia who showed no response to treatment with fluphenazine. This study is a post hoc subanalysis of an 8-week, double-blind study of patients receiving quetiapine 600 mg/day or haloperidol 20 mg/day. The proportion of patients classified as "Clinical Global Impression responders" (defined as Clinical Global Impression Severity of Illness score of < or = 3 at study end) was greater in the quetiapine group compared with the haloperidol group (51% vs. 25%; P = 0.023). Overall, quetiapine was well tolerated with less extrapyramidal side-effects and reduction in prolactin when compared to haloperidol. Weight gain was modest but more apparent in quetiapine-treated patients. Quetiapine is an appropriate treatment choice in patients who do not respond to prior antipsychotic treatment.

Adult↗
PubMed2004

Maintenance treatment for schizophrenia with quetiapine.

With the majority of current information being derived from short-term clinical trials, the impact of atypical antipsychotics during maintenance treatment of schizophrenia is of considerable interest, although only limited data are available at present. The present report is an analysis of data that are available up to 156 weeks after the start of an open-label extension (OLE) phase of three, double-blind randomized trials in quetiapine-treated patients who responded to an initial 6-week treatment period. The mean daily quetiapine dose (range 150-750 mg) was 439.5 mg for patients included in the brief psychiatric rating scale (BPRS) and 438.5 mg for patients included in the clinical global impression (CGI) analyses. The initial mean acute phase BPRS total score (40.67; n=258) and CGI severity of illness score (4.81; n=259) were reduced at the start of the OLE to 13.94 and 3.00, respectively. After 156 weeks, endpoint scores were 9.04 for BPRS and 2.43 for CGI severity of illness. Although limited by patient attrition, these OLE data suggest that an initial beneficial response with quetiapine treatment can be maintained over a long-term period.

Brief Psychiatric Rating Scale↗
PubMed2004

Effective dosing and dose equivalency of second-generation antipsychotic medications.

Dosing patterns with second-generation antipsychotic medications (SGAs) are dynamic, with some SGAs surpassing current recommendations while others are declining in dose since their initial regulatory guidelines. Pertinent recent studies and available pharmacoepidemiologic reports, information, and expert consenses are reviewed herein to illuminate current thinking on the topic of dosing with SGAs. There is a need for fixed-dose studies of each SGA. Additionally, dosing should be a primary consideration when designing and subsequently interpreting comparative studies between SGAs.

Antipsychotic Agents↗
PubMed2004

Insight and its relationship to violent behavior in patients with schizophrenia.

OBJECTIVE: Lack of insight affects the management of schizophrenia. The interrelationship between lack of insight and illness attributes in patients with schizophrenia who commit violent acts is important and underresearched. METHOD: One hundred fifteen violent patients with schizophrenia in a jail or court psychiatric clinic were evaluated on measures of symptoms, illness severity, insight into illness, and the legal consequences of their illness ("forensic insight"). A sample of nonviolent patients served as a comparison group. RESULTS: Compared with the nonviolent cohort, violent patients were more symptomatic, had poorer functioning, and had a more prominent lack of insight. Deficits of insight into illness coexisted with a lack of forensic insight, which was also associated with psychosis. CONCLUSIONS: Patients with schizophrenia who commit violent acts have insight deficits, including lack of awareness of the legal implications of their behavior. Targeted interventions to improve insight and treatment compliance in this population are warranted.

Adult↗