Simultaneous Comparison of Efficacy and Tolerability of Second-Generation Antipsychotics in Schizophrenia: Mixed-Treatment Comparison Analysis Based on Head-to-Head Trial Data

오규한,유제춘,최경숙,주은정,정성훈 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.1

ObjectiveaaSecond-generation antipsychotics have been repeatedly shown to be superior to placebo. However, the comparative efficacy among these drugs has not been systematically evaluated. In this study, we used Mixed Treatment Comparison (MTC) procedures to elucidate the comparative efficacy and tolerability of second-generation antipsychotics. MethodsaaSeven antipsychotics were selected based on the availability of the relevant data. Data were gathered from a series of review article published by the Cochrane Collaboration. Six outcome measures were analyzed: 1) percentage of no clinically important response as defined by the original authors, 2) PANSS total score change from baseline to endpoint, 3) percentage of akathisia, 4) percentage of antiparkinson medication use, 5) percentage of total body weight increase more than 7%, and 6) percentage of drop-out due to any reasons. ResultsaaAll the second-generation antipsychotics included in this study showed fairly similar efficacy but widely different tolerability. In terms of efficacy, amisulpride, clozapine and olanzapine were ranked higher than aripiprazole, quetiapine and ziprasidone. Clozapine and olanzapine were superior in terms of akathisia and extrapyramidal symptom risk, but, far more prone to induce clinically important weight gain. ConclusionaaUsing MTC methodology, we could line up the second generation antipsychotics according to their hierarchical superiority in terms of efficacy and tolerability. Though the wide overlap among the confidence intervals and the inconsistency between the direct and indirect comparison results may limit the validity of these results, it may still allow the important insights into the relative merits of the available drugs.

Trends in Scientific Literature on Atypical Antipsychotics in South Korea: A Bibliometric Study

Francisco López-Muñoz,Winston W. Shen,Raquel Moreno,Gabriel Rubio,Juan D. Molina,Concha Noriega,Miguel A. Pérez-Nieto,Lorena Huelves,Cecilio Álamo,배치운 대한신경정신의학회 2013 PSYCHIATRY INVESTIGATION Vol.10 No.1

Objective We have carried out a bibliometric study on the scientific publications in relation to atypical or second-generation antipsychotic drugs (SGAs) in South Korea. Methods With the EMBASE and MEDLINE databases, we selected those publications made in South Korea whose title included the descriptors atypic* (atypical*) antipsychotic*, second-generation antipsychotic*, clozapine, risperidone, olanzapine, ziprasidone, quetiapine, sertindole, aripiprazole, paliperidone, amisulpride, zotepine, asenapine, iloperidone, lurasidone, perospirone and blonanserin. We applied some bibliometric indicators of paper production and dispersion with Price's law and Bradford's law, respectively. We also calculated the participation index (PI) of the different countries, and correlated the bibliometric data with some social and health data from Korea (such as total per capita expenditure on health and gross domestic expenditure on research and development). Results We collected 326 original papers published between 1993 and 2011. Our results state fulfilment of fulfilled Price's law, with scientific production on SGAs showing exponential growth (correlation coefficient r=0.8978, as against an r=0.8149 after linear adjustment). The most widely studied drugs were risperidone (91 papers), aripiprazole (77), olanzapine (53), and clozapine (43). Division into Bradford zones yielded a nucleus occupied by the Progress in Neuro-Psychopharmacology and Biological Psychiatry (36 articles). A total of 86 different journals were published, with 4 of the first 10 used journals having an impact factor being greater than 4. Conclusion The publications on SGAs in South Korea have undergone exponential growth over the studied period, without evidence of reaching a saturation point.

Long-Term Evolution of Metabolic Status in Patients with Schizophrenia Stably Maintained on Second-Generation Antipsychotics

Seong Hoon Jeong,Nam Young Lee,Se Hyun Kim,In Won Chung,Tak Youn,Ung Gu Kang,Yong Min Ahn,Han Young You,Yong Sik Kim 대한신경정신의학회 2018 PSYCHIATRY INVESTIGATION Vol.15 No.6

Objective Second-generation antipsychotics (SGAs) increase the risk of metabolic syndrome (MetS). Despite the risk of MetS, SGAs may have to be continued with change in some patients. The aim of this study was to trace the evolution of MetS in these patients. Methods Patients with schizophrenia who had been maintained on a fixed SGA regimen for more than a year were followed-up without changing the regimen. Metabolic indicators were evaluated at baseline and at follow-up. Prevalence, incidence and spontaneous normalization rate of MetS were estimated. Risk factors that might have influenced the evolution were scrutinized. Results A total of 151 subjects were included. During the mean observation period of 389.9±162.4 days, the prevalence of MetS was increased from 35.1 to 45.0%. The incidence rate was 29.6%, while the normalization rate was 26.4%, risk factors affecting incidence were age (OR=1.09, 95% CI: 1.03–1.17), baseline continuous values of metabolic syndrome risk scores (cMetS, OR=1.77, 95% CI:1.29–2.55) and baseline body weight (OR=1.06, 95% CI: 1.01–1.13). Normalization was influenced by age (OR=0.74, 95% CI: 0.57–0.89) and baseline body weight (OR=0.85, 95% CI: 0.72–0.95). Conclusion The prevalence of MetS steadily increased with the continuous use of SGAs. However, individual difference was extensive and about a quarter of the patients were able to recover naturally without specific measurements.

조현병 환자에서 1년간의 2세대 항정신병약물 지속적 투여가 혈소판 활성도에 미치는 영향: 후향적 연구

오윤석,이종욱,오홍석,김승준,이나현,임우영,김지웅 한국정신신체의학회 2022 정신신체의학 Vol.30 No.2

Objectives:This study was conducted to investigate the effect of 1-year administration of second-generation antipsychotics (SGAs) on the platelet activity in patients with schizophrenia through a retrospective review of the medical records. Methods:The mean platelet component (MPC) value was used as an index of the platelet activity. The included subjects (N=24) were the patients who were confirmed to have taken SGAs continuously for one year after the first MPC measurement had been performed. The change of MPC was verified through a paired sample t-test. Results:The result revealed that the mean MPC value was significantly decreased from 26.5±1.4 g/dL to 25.6± 1.8 g/dL after 1-year administration of SGAs from the time of the first MPC measurement. Conclusions:This study suggests that 1-year administration of SGAs may be related with increased platelet activity, and that close monitoring for risks such as cerebrovascular/ or thromboembolic diseases may be necessary during SGAs treatment in clinical practice. 연구목적본 연구는 후향적 의무기록 검토를 통해 조현병 환자에서 1년간의 2세대 항정신병약물 투여가 혈소판 활성에미치는 영향을 알아보기 위해 시행되었다. 방 법혈소판 활성의 지표로는 평균혈소판요소(mean platelet component, MPC) 값을 이용하였다. 첫 평균혈소판요소 측정 이후 1년간 지속적으로 2세대 항정신병약물을 꾸준히 복용한 것으로 확인된 조현병 환자 총 24명을대상으로, 평균혈소판요소의 변화를 대응 표본 t 검정을 통해 검증하였다. 결 과첫 측정 시 및 1년간의 2세대 항정신병약물 투여 후의 평균혈소판요소 값은 각각 26.5±1.4 g/dL와 25.6± 1.8 g/dL로, 1년간의 약물 복용 후 유의하게 평균혈소판요소 값이 감소하였다. 결 론본 연구는 1년간의 2세대 항정신병약물 투여 시 혈소판 활성이 증가될 수 있음을 시사하며, 임상 진료 시 이와 관련될 수 있는 심뇌혈관질환, 혈전색전성 질환 등의 위험성에 대해 면밀한 모니터링이 필요할 수 있음을 시사한다.

Arterial Stiffness in Patients Taking Second-generation Antipsychotics

Ebru Fındıklı,Mustafa Gökçe,Vedat Nacitarhan,Mehmet Akif Camkurt,Hüseyin Avni Fındıklı,Selçuk Kardas,Merve Coşgun Şahin,Mehmet Fatih Karaaslan 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.4

Objective: That treatment with second-generation antipsychotics (SGAs) causes metabolic side effects and atherosclerosis in patients with schizophrenia and bipolar disorder (BD) is well-known. Increased arterial stiffness is an important marker of arteriosclerosis and has been identified as an independent risk factor for cardiovascular diseases. We measured pulse wave velocity (PWV) as a marker of arteriosclerosis in patients with schizophrenia and BD who use SGAs. Methods: Patients and controls were collected from our psychiatry outpatient clinics or family medicine. Mental illness was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Mean age, gender, systolic and diastolic blood pressure, body mass index, Framingham risk score (FRS), etc. were determined. Simultaneous electrocardiography and pulse wave were recorded with an electromyography device. The photo-plethysmographic method was used to record the pulse wave. Inclusion criteria included use of SGAs for at least the last six months. Patients with diseases that are known to cause stiffness and the use of typical antipsychotics were excluded. Results: Ninety-six subject (56 patients, 40 controls) were included in our study. There were 49 females, 47 males. Patients had schizophrenia (n=17) and BD (n=39). Their treatments were quetiapine (n=15), risperidone (n=13), olanzapine (n=15), and aripiprazole (n=13). Although differences in mean age, gender, and FRS in the patient and control groups were not statistically significant (p=1), PWV was greater in patients in the antipsychotic group (p=0.048). Conclusion: This study supported the liability to stiffness in patients with schizophrenia and BD. Using SGAs may contribute to arterial stiffness in these patients.

Comparative Efficacy and Safety of Long-acting Injectable and Oral Second-generation Antipsychotics for the Treatment of Schizophrenia: A Systematic Review and Meta-analysis

Seon-Cheol Park,Miyoung Choi,Jin A Choi,Eunjung Park,Ha Jin Tchoe,Jae Kyung Suh,Young Hoon Kim,Seunghee Won,Young-Chul Chung,Kyung-Yeol Bae,Sang-Kyu Lee,Chan Mi Park,이승환 대한정신약물학회 2018 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.16 No.4

We aimed to compare the efficacy and safety of long-acting injectable (LAI) and oral second-generation antipsychotics (SGAs) in treating schizophrenia by performing a systematic review and meta-analysis. MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library, as well as five Korean databases, were systemically searched to identify studies published from 2000 to 16 April 2015, which compared the efficacy and safety of LAI and oral SGAs. Using data from randomized controlled trials (RCTs), meta-analyses were conducted. In addition, the GRADE (the Grading of Recommendations, Assessment, Development and Evaluation) approach was applied to explicitly assess the quality of the evidence. A total of 30 studies including 17 RCTs and 13 observational studies were selected. The group treated with LAI SGAs was characterized by significantly lower relapse rates, longer times to relapse and fewer hospital days, but also by a higher occurrence of extrapyramidal syndrome and prolactin-related symptoms than that in the group treated with oral SGAs. Our findings demonstrate that there is moderate to high level of evidence suggesting that in the treatment of schizophrenia, LAI SGAs have higher efficacy and are associated with higher rates of extrapyramidal syndrome and prolactin-related symptoms. Additionally, the use of LAI SGAs should be combined with appropriate measures to reduce dopamine D2 antagonism-related symptoms.

항정신병약물 임상의 역사와 미래

이중서 대한신경정신의학회 2019 신경정신의학 Vol.58 No.1

After the discovery of antipsychotic drugs, the nature of clinical practice entered a period of inexorable transition. The advances of psychopharmacotherapy have interacted in complex ways with clinical practice, and the economics and policy of mental health care systems. The study of the mechanisms of action of these drugs has guided the development of hopefully improved treatment, and stimulated biological research on the pathophysiology of severe mental disorders. Despite the considerable effort to modify and change existing antipsychotic drugs, progress has been modest. This review describes the history of antipsychotic drugs and their impact on clinical practice and the study of psychiatric disorders, and offer prospects for future developments. Although finding new knowledge and methodologies to bring innovative discovery is imperative, as of now, it is important to provide comprehensive care, including the optimal use of existing antipsychotic drugs.

비전형적 항정신병 약물 사용중 마비성 장폐색증이 지속된 정신분열병 환자

이서경 ( Seo Kyong Lee ),반건호 ( Geon Ho Bahn ),윤도준 ( Doh Joon Yoon ) 경희대학교 경희의료원 2005 慶熙醫學 Vol.21 No.1

벤라팍신 중독에서 발생한 세로토닌 증후군과 신경이완제 악성증후군 병발 증례 1례

정명현,임태호,강형구,원태영,오재훈,김진수,고벽성,조용일,이준철,배준원,유경헌,이상환,정승교 대한응급의학회 2023 대한응급의학회 학술대회초록집 Vol.2023 No.2