Ayako Mikami

The influence of switching from risperidone to paliperidone on the extrapyramidal symptoms and cognitive function in elderly patients with schizophrenia: A preliminary open-label trial

Abstract Objective. This study was to evaluate the effects on clinical symptoms and cognitive function of switching the treatment of elderly patients with schizophrenia from risperidone to paliperidone (PAL). Methods. This study was a 12-weeks, preliminary open-label trial. The subjects were 17 inpatients. Their extrapyramidal symptoms (EPS) were assessed using the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS), Abnormal Involuntary Movement Scale (AIMS), and Barnes Akathisia Scale (BAS), and their cognitive function was assessed using the Brief Assessment Cognition in Schizophrenia: Japanese language version (BACS-J), and their clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression-Severity of illness scale (CGI-S) at the 0 and 12 weeks. Results. The DIEPSS and BAS significantly improved after switching from risperidone to PAL. Furthermore, improvement was found on AIMS. The mean change from baseline in z-score of the digit sequencing task was significantly increased. All items on the PANSS and CGI-S were not significant; however, changes in some cognitive function were correlated with changes in EPS. Conclusions. The results of this study suggest the possibility that switching elderly patients from risperidone to PAL may have improved pre-existing EPS, and may also have helped improve working memory.

Study of the efficacy and safety of switching from risperidone to paliperidone in elderly patients with schizophrenia

We investigated the clinical efficacy and safety of switching to paliperidone (PAL) in elderly schizophrenia patients receiving risperidone.

Relationship between the plasma concentration of paliperidone and the clinical and drug-induced extrapyramidal symptoms in elderly patients with schizophrenia.

We investigated the relationship between the plasma concentration of paliperidone (PAL) and clinical and drug‐induced extrapyramidal symptoms (EPS) in elderly patients with schizophrenia.

Benefit of extending the dosing interval of long-acting antipsychotic injections in elderly schizophrenics with cognitive dysfunction

Dear Editors, In elderly patients, given the various adverse effects of antipsychotic drugs, including extrapyramidal symptoms and cardiovascular diseases, due consideration must be given to minimize their use in the maintenance phase. To minimize their adverse effects while at the same time maintaining efficacy, antipsychotic drugs are given by tapering their dose and extending the dosing interval as part of a treatment strategy. Here, we report an elderly schizophrenia patient whose risperidone long-acting injection (RLAI) dosing interval was extended from 2 to 4 weeks after she became non-psychotic while undergoing RLAI treatment. The interval was increased with the objective of observing cognitive dysfunction. Cognitive function was evaluated using the Wisconsin Card Sorting Test (Keio version) to assess executive function and the St Marianna University School of Medicine’s Computerized Memory Test to assess memory, motor processing function, and attention. The patient was required to be symptomatically stable with no acute exacerbations, as judged by the treating psychiatrist, for at least 3 months during RLAI treatment. Informed consent was obtained, and the patient’s anonymity has been preserved. The inpatient was a 68-year-old woman with paranoid schizophrenia (duration of illness: 20 years) who had cognitive dysfunction under RLAI treatment (25 mg). Six months after the RLAI dosing interval was extended from 2 to 4 weeks, the patient’s immediate and delayed verbal memory, motor processing function, attention, and Positive and Negative Syndrome Scale total score, negative score, and general score increased. There was no change in the Positive and Negative Syndrome Scale positive score, number of categories achieved, Clinical Global ImpressionSeverity (CGI-S), and drug-induced extrapyramidal symptoms total scale (Table 1). Anticholinergics and antipsychotics were not administered. It is known that the excessive interception of dopamine is related to cognitive impairment and extrapyramidal symptoms. In a recent study, it was reported that even if patients with schizophrenia received treatment with an atypical antipsychotic, prescribing a high dosage could still impair their cognitive abilities. Furthermore, although drug absorption decreases in the elderly, the prescribed dose of antipsychotic drugs should be lowered because the prominent decline in drug metabolism and excretory functions of such patients tends to increase the sideeffects. In clinical practice, the dosing interval is generally prescribed on the basis of serum half-life, although its validity has not been investigated

Assessments of plasma concentrations, pathology symptoms, and cognition following paliperidone treatment in schizophrenic patients previously treated with risperidone

In previous study, switching from risperidone to paliperidone suggested cognitive function improvement (Kim et al., 2012, 2013). This study is a secondary analysis of plasma concentration of paliperidone, the relationship between plasma levels, pathology symptoms and cognitive function was investigated in schizophrenic patients treated 12 weeks with paliperidone monotherapy after long-term risperidone monotherapy use. The participants were required to be symptomatically stable no acute exacerbations for at least 3 months prior to swithing, as judged by the treating psychiatrist, and signed release or legal guardian authorizing publication. This study was approved by the ethics committee of Tokai University Hospital. Cognitive function was assessed using the Brief Assessment of Cognition in Schizophrenia, Japanese language version (Kaneda et al., 2007). For statistical analysis, we used Spearman rank-correlation (using Stat View by Abacus Concepts) to examine the relationship between plasma concentration and changes in each rating scale. The significance level was p < 0.05.

Reduced insomnia following short-term administration of suvorexant during aripiprazole once-monthly treatment in a patient with schizophrenia

A patient frequently experienced insomnia because of aripiprazole’s partial dopamine agonism and had been prescribed benzodiazepine hypnotics or lower dose of antipsychotics on these occasions. In recent years, clinical dose-dependency, rebound insomnia, hypomyotonia, and similar problems related to the use of benzodiazepine hypnotics have been pointed out and it is therefore recommended to review their long-term use. Furthermore, due to the possibility that antipsychotic drugs may adversely affect cognitive function, antipsychotic drugs must be used at the minimum dose necessary, especially in patients who already have a decline in cognitive function associated with schizophrenia. The mechanism of the orexin receptor antagonist suvorexant, developed by the American company Merck and introduced into clinical practice in Japan in 2014, differs from former hypnotics (Winrow et al., 2011). Suvorexant has been shown to be effective for both difficulty falling asleep as well as nocturnal awakening, while the incidences of suvorexant withdrawal symptoms and of rebound insomnia found for suvorexant were approximately the same as those for a placebo (Kishi et al., 2015). The suvorexant mechanism does not lead to hypomyotonia. Furthermore, the drug has a low dependence potential, so that it can easily be discontinued. Here, we report on the reduced insomnia following short-term administration of suvorexant during aripiprazole once-monthly (AOM) 300 mg treatment in a patient with schizophrenia.