Marnina Swartz

Vitamin E (α-Tocopherol) in the Treatment of Tardive Dyskinesia: A Statistical Meta-Analysis

AbstractTardive dyskinesia is an involuntary movement disorder developing following treatment with neuroleptics. As many as 50% of chronic psychotic patients develop this disabling condition. No treatment has been found effective for tardive dyskinesia. This study was undertaken to meta-analyze the effects of vitamin E (α-tocopherol) reported in the last decade. All studies published since 1987, focusing on vitamin E and tardive dyskinesia are reviewed. Double-blind studies are analyzed using measures of effect and variance as described by secondary analysis of magnitude of effects in pooled data. A total of 223 patients received vitamin E treatment (400-1600 IU/day) for tardive dyskinesia, in 12 studies. A significant subgroup (28.3%) showed a modest improvement. Vitamin E was well tolerated, and only rarely did side effects occur-of no clinical significance. Vitamin E is a safe, well-tolerated compound that may provide some beneficial effects in patients suffering from neuroleptic-induced tardive dyskin...

Venlafaxine or a second SSRI: Switching after treatment failure with an SSRI among depressed inpatients: A retrospective analysis ☆

BACKGROUND Approximately 50% of patients with major depressive disorder (MDD) do not respond after adequate first-line treatment with a selective serotonin reuptake inhibitor (SSRI). Special interest is paid to whether specialist level inpatient psychiatric care results differ from community studies. AIM To compare switching alternatives after treatment failure with an SSRI; switching to venlafaxine (Dexcel Pharma Israel) versus switching to another SSRI in depressed inpatients. METHOD A retrospective register study of inpatients was undertaken in a psychiatric tertiary care university center serving an urban catchment area in Israel with a population of more than 900,000. RESULTS A total of 401 MDD inpatients were assigned to antidepressant treatment. Of these, 232 records (47 venlafaxine, 185 SSRI) were included in the analysis. Patients assigned to venlafaxine treatment were older (mean age 64.3 ± 15 years versus 53.6 ± 17; p<0.01) and had more comorbid physical disorders (80% versus 57%; p<0.001). In the primary analysis, there was no statistical difference between groups in reduction in CGI-S total scores. The secondary end point of achieving a CGI-S score of 2 or less (1 = normal, not at all ill or 2 = borderline mentally ill) was statistically significantly better for the venlafaxine treated inpatients (P=0.02). AEs were reported less than 10% of patients in both groups. CONCLUSION Patients who remain severely depressed following treatment with an SSRI may gain benefit from the dual-action drug venlafaxine, rather than switching to another SSRI. These findings need to be further supported by prospective studies.

Tetrabenazine for tardive tremor in elderly adults: a prospective follow-up study.

AbstractTardive tremor (TT) is a rare neuroleptic-induced tardive syndrome. It is mainly postural and action associated rather than resting tremor without other parkinsonian features and resistant to most therapeutic interventions. Tetrabenazine (TBZ) is a possible option for treating TT.This study aimed to evaluate the efficacy and tolerability of TBZ in elderly patients with TT. Patients (N = 10) received TBZ (25–150 mg/d) for 6 weeks. Five subjects completed the study. Mean TBZ dose at study end was 57.5 ± 37.3 mg/d. Mean Abnormal Involuntary Movement score was 13.3 ± 6.6, mean Tremor Scale score was 2.3 ± 0.9, mean Clinical Global Impression-Change was 3.6 ± 2.2, and mean Geriatric Depression Score was 5.2 ± 4.9; all not significantly changed from baseline. Five patients suffered side effects, including depression (n = 3), parkinsonism (n = 2), akathisia (n = 1), and mild stroke (n = 1).This prospective study does not support TBZ treatment for TT in elderly psychiatric patients.

Treating depression in Alzheimer's disease: integration of differing guidelines.

BACKGROUND The developments in the understanding of Alzheimers disease (AD) have led to genetic testing, expansion of research centers, and emergence of novel treatment modalities. However, behavioral symptoms and disturbances remain the leading cause of distress to families and patients. The management of these disturbances is not fully elucidated and not without controversies. AIM To review and integrate the two important approaches to management and treatment of depression in AD as published in the American Psychiatric Associations guidelines for the treatment of patients with AD versus the American Academy of Neurologys official publication on managing AD. METHOD Both publications are analyzed focusing on the pharmacological treatment of depression. The analysis includes sources of data, generalization, and common and conflicting recommendations. CONCLUSION Selective serotonin reuptake inhibitors are the drugs of choice for the treatment of depression in AD patients.

Assessing cardiovascular risks of olanzapine treatment: a 6-month study versus haloperidol in schizophrenia patients.

The introduction of second generation antipsychotics (SGA) represents a major advance in the treatment of schizophrenia. Concerns about the metabolic and cardiovascular adverse effects of the SGA have been widely disseminated. The benefits and risks of these drugs have been studied with a focus on particular organ systems. A basic principle of prevention is that the intensity of risk-reduction therapy should be adjusted to a individuals absolute risk. Hence, the first step is to assess an individuals risk status. The present study was designed to evaluate whether there is an added cardiovascular disease (CVD) risk in switching schizophrenia patients from typical antipsychotics to the SGA olanzapine. Risk status was determined by a 10-year risk assessment as recommended by the USA National Heart, Lung, and Blood Institute. This was carried out with Framingham scoring to identify individuals whose short-term (10-year) risk warrants consideration of intensive treatment. This risk was calculated for schizophrenia patients who were treated by haloperidol for a minimum period of 6 months and again following 6 months of exposure to olanzapine. Forty-three patients fulfilled inclusion criteria. There were 25 male and 18 female patients (mean age 40.7±2.4 years). The mean 10-year percentage risk of CVD for the group while on haloperidol treatment was 4.58±0.9 and, after 6 months of exposure to olanzapine, this was reduced to 4.12±0.9. Changes in the total risk and each evaluated risk variable were not statistically significant, except for a decrease in resting systolic blood pressure. Switching schizophrenia patients from typical antipsychotic treatment to olanzapine is safe and does not increase the long-term risk of cardiovascular disease.

Amisulpride for older patients with long-standing schizophrenia.

Abstract A large and growing number of older people across the world experience schizophrenia. Recommendations for their treatment are largely based on data extrapolated from studies of the use of antipsychotic medications in younger populations. The present study was designed to evaluate the efficacy and safety of amisulpride monotherapy in a diagnostically homogeneous group of elderly patients without cognitive impairment experiencing schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for schizophrenia). Mortality and rehospitalization for a 5-year period were the predefined outcome measures. We conducted a retrospective chart review of all elderly (60 years and older) schizophrenia patients treated in a large tertiary care center. Of the 527 elderly schizophrenia patients for a 5-year period (2007–2013), 30 patients, mean (SD) age of 67.5 (5.8) years, were treated with amisulpride monotherapy. There were 19 women and 11 men in the analyzed group. Mean duration of disease was 34.4 years. All had been exposed to at least 3 first- and second-generation antipsychotics before amisulpride treatment. Amisulpride was very well tolerated by the patients, and mortality rate (10% vs 19%) was significantly lower than that of other first- and second-generation antipsychotics (P < 0.02). Rehospitalization rates with amisulpride were significantly lower than those with other second-generation antipsychotics (P < 0.001). We tentatively conclude that our preliminary results demonstrate that amisulpride is an efficacious and safe atypical antipsychotic for the treatment for elderly schizophrenia patients.