Efficacy for Psychopathology and Body Weight and Safety of Topiramate-Antipsychotic Cotreatment in Patients With Schizophrenia Spectrum Disorders: Results From a Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: To meta-analyze the efficacy and tolerability of topiramate-antipsychotic cotreatment in schizophrenia. DATA SOURCES: PubMed/MEDLINE database were searched until September 5, 2015, using the keywords topiramate AND antipsych* OR neurolept* OR specific antipsychotic names. STUDY SELECTION: Randomized controlled trials (RCTs) of topiramate-antipsychotic cotreatment versus placebo and ongoing antipsychotic treatment in patients with schizophrenia spectrum disorders were included. DATA EXTRACTION: Two evaluators extracted data. Standardized mean difference (SMD), weighted mean difference (WMD), and risk ratio (RR) ± 95% CIs were calculated. RESULTS: In 8 RCTs, lasting a mean ± SD of 13.6 ± 4.9 weeks, 439 patients were randomized to topiramate (100-400 mg/d) versus placebo (trials = 7) or ongoing antipsychotic treatment (trial = 1). Topiramate outperformed the comparator regarding total psychopathology (trials = 6, n = 269, SMD = -0.57 [95% CI, -1.01 to -0.14], P = .01), positive symptoms (trials = 4, n = 190, SMD = -0.56 [95% CI, -1.0 to -0.11], P = .01), negative symptoms (trials = 4, n = 190, SMD = -0.62 [95% CI, -1.13 to -0.10], P = .02) general psychopathology (trials = 3, n = 179, SMD = -0.69 [95% CI, -1.27 to -0.11], P = .02), body weight (trials = 7, n = 327, WMD = -3.14 kg [95% CI, -5.55 to -0.73], P = .01), and body mass index (BMI) (trials = 4, n = 198, WMD = -1.80 [95% CI, -2.77 to -0.84], P = .0003). Topiramate's efficacy for total psychopathology and weight reduction effects were not mediated/moderated by trial duration, topiramate dose, sex, age, inpatient status, baseline Positive and Negative Syndrome Scale, or baseline BMI. Conversely, clozapine-topiramate cotreatment moderated greater efficacy, but less weight loss, compared to topiramate-nonclozapine antipsychotic combinations. All-cause discontinuation was similar between topiramate and control groups (trials = 7, RR = 1.24 [95% CI, 0.76 to 2.02], P = .39). Topiramate trended only toward more paresthesia than placebo (trials = 4, RR = 2.03 [95 % CI, 0.99 to 4.18], P = .05). CONCLUSIONS: Topiramate-antipsychotic cotreatment significantly reduced total, positive, negative, and general psychopathology and weight/BMI in patients with schizophrenia spectrum disorder while being well tolerated. However, larger studies are needed to confirm and extend these findings.

La capacidad de marcha está asociada a la calidad de vida (relacionada con la salud) y nivel de actividad física en pacientes con esquizofrenia: estudio preliminar / Walking capacity is associated with health related quality of life and physical activity level in patients with schizophrenia: a preliminary report

Objetivos. Examinar la capacidad de marcha (caminar) en pacientes con esquizofrenia y la relación con calidad de vida y nivel de actividad física. Métodos. La capacidad de ejercicio funcional fue medida con el test de los 6 minutos caminando (6 Minute Walk Test (6MWT)). Para evaluar la calidad de vida y los niveles de actividad física, usamos respectivamente el cuestionario SF 36 y el cuestionario Baecke de Actividad Física habitual. Resultados. La capacidad de marcha está fuertemente relacionada con el índice de masa corporal (IMC) y la calidad de vida. La actividad física está positivamente relacionada con la capacidad de caminar. Conclusión. Los resultados confirman que la capacidad de marcha podría ser un buen indicador de la calidad de vida y nivel de actividad física en pacientes con esquizofrenia (AU)

Objectives. To examine walking capacity in patients with schizophrenia and the relation with quality of life and physical activity level. Methods. Functional exercise capacity was measured with the 6 Minute Walk Test (6MWT). To assess quality of life and physical activity levels, we used respectively the SF-36 Questionnaire and the Baecke Physical Activity Questionnaire. Results. Walking capacity was strongly related to BMI and quality of life. Physical Activity (PA) was positively related to walking capacity .Conclusion: Present findings confirm that walking capacity could be a good indicator of quality of life and PA level in patients with schizophrenia (AU)

Ventajas y desventajas del tratamiento de combinación con antipsicóticos. Reunión ECNP Consensus, marzo de 2008, Niza / Advantages and disadvantages of combination treatment with antipsychotics. ECNP Consensus Meeting, March 2008, Nice

El término «combinación» incluye prácticamente todas las modalidades en las que una medicación puede añadirse a otra. Los otros términos de uso frecuente son «aumento», que implica un efecto aditivo de la adición de un segundo fármaco al obtenido de la prescripción de un primero, y «adyuvante», que implica la adición a un tratamiento existente, posiblemente eficaz que, por una razón u otra, no puede o no debe interrumpirse. Las cuestiones que se derivan en todas las indicaciones potenciales son: a) ¿Cuánto tiempo es razonable esperar para poder demostrar la insuficiencia de la respuesta a la monoterapia?; b) ¿Mediante qué criterios debe definirse dicha respuesta?; c) ¿Cuán óptima es la dosis de la primera monoterapia y, por consiguiente, con qué certeza sabemos que su falta de efecto se debe a una respuesta realmente insuficiente?. Antes de considerar un tratamiento de combinación, es preciso que se cumplan uno o más de los criterios siguientes: a) la monoterapia solo ha sido parcialmente eficaz en los síntomas básicos; b) la monoterapia ha sido eficaz en algunos síntomas concurrentes pero no en otros, por lo que se considera que se requiere una medicación adicional; c) en algunas circunstancias podría estar indicada una combinación particular de novo; d) la combinación podría mejorar la tolerabilidad porque ambos fármacos pueden administrarse por debajo del umbral de la dosis individual asociada a efectos adversos. Los responsables de las políticas sanitarias han suscitado preocupación principalmente con el criterio a, y en principio como mínimo, con el c. En la práctica clínica la utilización de un tratamiento de combinación refleja el desenlace, con frecuencia insatisfactorio, del tratamiento con un fármaco individual (AU)

The term "combination" includes virtually all the ways in which one medication may be added to another. The other commonly used terms are "augmentation", which implies an additive effect from adding a second medicine to that obtained from prescribing a first, an "add on", which implies adding on to existing, possibly effective treatment which, for one reason or another, cannot or should not be stopped. The issues that arise in all potential indications are: a) how long it is reasonable to wait to prove insufficiency of response to monotherapy; b) by what criteria that response should be defined; c) how optimal is the dose of the first monotherapy and, therefore, how confident can one be that its lack of effect is due to a truly inadequate response? Before one considers combination treatment, one or more of the following criteria should be met; a) monotherapy has been only partially effective on core symptoms; b) monotherapy has been effective on some concurrent symptoms but not others, for which a further medicine is believed to be required; c) a particular combination might be indicated de novo in some indications; d) the combination could improve tolerability because two compounds may be employed below their individual dose thresholds for side effects. Regulators have been concerned primarily with a and, in principle at least, c above. In clinical practice, the use of combination treatment reflects the often unsatisfactory outcome of treatment with single agents (AU)

Cardiovascular disease and diabetes in people with severe mental illness.

Position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). People with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess cardiovascular mortality associated with schizophrenia and bipolar disorder is attributed to an increased risk of the modifiable coronary heart disease risk factors, obesity, smoking, diabetes, hypertension, and dyslipidaemia. Antipsychotic medication and possibly other psychotropic medication like antidepressants can induce weight gain and further increase the risk of adverse metabolic effects which may result in further increased incidence of cardiovascular disease. Patients have limited access to general healthcare with less opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population. The European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) published this statement aiming to improve the care of patients suffering from severe mental illness. The intention is to initiate co-operation and shared care between the different health care professionals and to increase the awareness of psychiatrists caring for patients suffering from severe mental illness to screen and treat increased cardiovascular risk factors and diabetes.

Validation study of PECC (Psychosis Evaluation tool for Common use by Caregivers): Interscale validity and inter-rater reliability.

INTRODUCTION: PECC (Psychosis Evaluation tool for Common use by Caregivers) is a recently developed tool for the longitudinal evaluation and follow-up of psychotic patients. This integrated evaluation tool covers different functional and symptomatic outcome measures, which are relevant for both the patient and the planning of interventions. PECC was especially designed to be easily implementable in the daily practice of nursing work. In this study we aimed to evaluate the inter-rater and interscale validity of PECC. RESULTS: The results indicate that both the inter-rater validity and the interscale validity of PECC are satisfactory. CONCLUSION: PECC can now be implemented on a large scale. (Int J Psych Clin Pract 2002; 6: 135-140).