RESUMEN
BACKGROUND: Management of schizophrenia is sub-optimal in many patients. Targeting negative symptoms, among the most debilitating aspects of schizophrenia, together with positive symptoms, can result in significant functional benefits and dramatically improve quality of life for patients and their carers. Cariprazine, a partial agonist of the dopamine receptors D2/D3 has demonstrated effectiveness across symptom domains in clinical trials, particularly on negative symptoms. OBJECTIVE: To obtain a broader insight from clinicians with specific experience with cariprazine, on how it affects patient populations outside the clinical trial setting. METHODS: The panel addressed a series of psychopharmacologic topics not comprehensively addressed by the evidence-based literature, including characteristics of patients treated, dosing and switching strategies, duration of therapy, role of concomitant medications and tolerability as well as recommendations on how to individualize cariprazine treatment for patients with schizophrenia. RESULTS: Patients recommended for cariprazine treatment are those with first episodes of psychosis, predominant negative symptoms (maintenance/acute phase) and significant side effects (metabolic side effects, hyperprolactinemia, sedation) with other antipsychotics. When the long-term treatment of a lifetime illness is adequately weighted, cariprazine becomes one of the first-line medications, not only for patients with predominant negative symptoms but also for those with relatively severe positive symptoms, especially if they are at the first episodes and if a specific medication is added for symptoms such as agitation or insomnia. For instance, patients with agitation may also benefit from the combination of cariprazine and a benzodiazepine or another sedating agent. Cariprazine may be prescribed as add-on to medications such as clozapine, when that medication alone is ineffective for negative symptoms, and sometimes the first may be discontinued or its dose lowered, after a period of stability, leaving the patient on a better tolerated antipsychotic regimen. CONCLUSIONS: Based on real-world clinical experience, the panel considered that cariprazine, with its distinct advantages including pharmacokinetics/pharmacodynamics, good efficacy and tolerability, represents a drug of choice in the long-term management of schizophrenia not only for patients with predominant negative symptoms but also for those with positive symptoms.
RESUMEN
Negative psychotic symptoms are among the most disabling features of schizophrenia, and are strongly associated with relatively poor clinical and functional outcomes. However, there are no effective treatments for negative symptoms, and this represents a major unmet clinical need. Recent research has shown that negative symptoms are already present in many patients at illness onset. There is evidence that cariprazine may improve negative symptoms in patients with chronic schizophrenia. However, its utility in treating negative symptoms in the early stage of the disorder is unclear. Here, we report six cases of patients with first-episode psychosis who were treated with cariprazine.
RESUMEN
BACKGROUND AND AIMS: This paper describes the context in which the Vron, a six-bedded 24-hour nursed care unit, has developed its role from a fast track rehabilitation unit, to work explicitly within an early intervention service. The study aimed to evaluate the work of the Vron by examining the change in CANSAS, HoNOS and EM scores between admission to and discharge from the unit. RESULTS: Approximately half of the admissions to Vron were from acute psychiatric wards. Most patients were discharged to their own tenancy or supported accommodation. There was a significant reduction in mean HoNOS score and increase in mean EM score during admission. Mean staff and patient-rated unmet needs reduced in the course of admission. In the course of admission, approximately half of the patients developed occupational roles. DISCUSSION AND CONCLUSIONS: The findings of this service evaluation must be interpreted with caution in view of the methodological limitations, in particular the lack of a comparator service intervention. However, it is suggested that units of this type may have a useful role in the rehabilitation of patients with complex severe mental illness, particularly if deployed at an early stage in an individual's illness, to prevent development of disability. The Vron focuses on a number of specific clinical and social areas which align with typical strategies in early intervention.