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1.
Psychol Psychother ; 2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33751800

RESUMO

OBJECTIVES: Self-compassion represents a way of interacting with the self involving kindness and a balanced approach to negative self-related stimuli that has shown to contribute to reduced depression, anxiety and stress, and increased psychological well-being. Due to the potential barriers towards self-compassion for people with depressive symptoms, the objective of the present study what to investigate whether the emerging construct of 'nonattachment to self', which reflects a flexible and balanced approach to all self-related stimuli, may be more beneficial for positive psychological outcomes than self-compassion, for individuals with depressive symptoms. METHOD: A sample 388 participants (consisting of 71 men, 317 women) aged from 18 to 77 (M = 35.33, SD = 10.81) completed an online questionnaire measuring levels of self-compassion, nonattachment to self, depressive symptoms, and well-being. RESULTS: Higher levels of both nonattachment to self and self-compassion were related to reduced psychological distress and increased psychological well-being. However, for people with at least mild depressive symptoms, nonattachment to self was found to be a stronger predictor of reduced psychological distress and increased psychological well-being than self-compassion. CONCLUSION: In conclusion, the present study suggests both nonattachment to self and self-compassion are associated with better mental health in non-clinical populations. Further, for individuals experiencing at least mild symptoms of depression, self-compassion may be less beneficial than taking a more nonattached stance towards the self. The findings have implications for the way we conceptualize self-focused attention and suggest assisting individuals to let go of their fixated, self-focused attention may be especially beneficial for individuals with depressive symptoms. PRACTITIONER POINTS: The notion of letting of attachment to the separate static self lies at the core of Buddhist psychological teachings and recent research suggests it can have a positive impact on individuals psychological well-being and ill-being Given the barriers to self-compassion experienced by individuals with depressive symptoms, nonattachment to self may represent a healthy interaction with the self than is met with less resistance than self-compassion. Due to the balanced stance of nonattachment to self towards positive and negative self-related stimuli, it may be prove to be a valuable approach to treating individuals who feel conflict with taking any form of positive or kind stance towards the self.

2.
Psychol Psychother ; 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33215812

RESUMO

OBJECTIVES: Self-compassion and emotional regulation have been identified as constructive attitudes towards the self which can reduce emotional distress. This study is the first to examine the role of a self-compassionate attitude towards the self in reducing symptoms of social anxiety. The study also explored the role of emotional regulation strategies of cognitive reappraisal (CR) and expressive suppression (ES) as mechanisms that mediate the impact of self-compassion on social anxiety. DESIGN: Structural equation modelling (SEM) was conducted on cross-sectional correlational data with MPlus version 6. METHODS: A sample of 750 undergraduate students (378 men and 372 women) completed an online survey comprised of well validated self-report measures of social anxiety, emotional regulation and self-compassion. RESULTS: Structural equation modelling showed that self-compassion predicted lower social anxiety directly and indirectly through lower ES. Higher self-compassion also predicted higher CR. Contrary to expectation, CR did not predict lower social anxiety. Exploratory analyses of self-compassion divided into Compassionate Self-responding (CSR) and Refraining from Non-compassionate Responding (RUSR) identified RUSR as a predictor of lower social anxiety directly and indirectly via ES and CR. CSR had no direct effect on social anxiety but did so indirectly via CR. CONCLUSIONS: The findings provide preliminary evidence that self-compassion can play an important role in alleviating social anxiety and that emotion regulation through ES and CR are important mechanisms of that influence. PRACTITIONER POINTS: Adopting a more compassionate attitude towards the self can reduce the symptoms of social anxiety Emotional regulation through reducing emotional suppression may be a mechanism whereby higher levels of self-compassion reduce symptoms of social anxiety. Although higher levels of self-compassion predict greater use of emotional regulation through cognitive appraisal, cognitive appraisal does not predict levels of symptoms of social anxiety The capacity to refrain from non-compassionate self-responding may reduce symptoms of social anxiety directly and indirectly through lower levels of emotional suppression and greater cognitive reappraisal (CR). However, compassionate self-responding only influences symptoms of social anxiety through CR.

3.
Biophys J ; 117(8): 1387-1392, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31585705

RESUMO

Scaffolding proteins (SPs) are required for the capsid shell assembly of many tailed double-stranded DNA bacteriophages, some archaeal viruses, herpesviruses, and adenoviruses. Despite their importance, only one high-resolution structure is available for SPs within procapsids. Here, we use the inherent size limit of NMR to identify mobile segments of the 303-residue phage P22 SP free in solution and when incorporated into a ∼23 MDa procapsid complex. Free SP gives NMR signals from its acidic N-terminus (residues 1-40) and basic C-terminus (residues 264-303), whereas NMR signals from the middle segment (residues 41-263) are missing because of intermediate conformational exchange on the NMR chemical shift timescale. When SP is incorporated into P22 procapsids, NMR signals from the C-terminal helix-turn-helix domain disappear because of binding to the procapsid interior. Signals from the N-terminal domain persist, indicating that this segment retains flexibility when bound to procapsids. The unstructured character of the N-terminus, coupled with its high content of negative charges, is likely important for dissociation and release of SP during the double-stranded DNA genome packaging step accompanying phage maturation.


Assuntos
Bacteriófago P22/química , Capsídeo/química , Dobramento de Proteína , Proteínas Estruturais Virais/química , Bacteriófago P22/metabolismo , Capsídeo/metabolismo , Proteínas Intrinsicamente Desordenadas/química , Espectroscopia de Ressonância Magnética/métodos , Ligação Proteica , Domínios Proteicos , Proteínas Estruturais Virais/metabolismo
4.
Front Psychol ; 9: 1848, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30319518

RESUMO

There is growing interest in psychological processes that might be targeted in treatments for bipolar disorder (BD). One such process is a vulnerability at the level of self-concept, characterized by presence of, and fluctuations between positive and negative self-concept. The aim of the present study was to advance this literature by investigating the role of two emerging meta-cognitive processes - self-compassion and nonattachment to self - which have potential to therapeutically modulate this unstable self-concept in BD. Using an analog design, it was hypothesized that both variables would mediate the relationship between bipolar tendencies and psychological distress in a general population sample. Participants (N = 372 Australian university students) completed self-report measures of manic and depressive tendencies, self-compassion, nonattachment to self and psychological distress. To investigate the specificity of the two hypothesized mediators, a better-researched psychological variable - rumination - was also included in mediation analyses. Bivariate analyses found tendencies toward mania and depression to be associated with diminished self-compassion and nonattachment to self, while both psychological processes were negatively associated with psychological distress. Mediation analyses showed, as expected, self-compassion and nonattachment to self mediated the relationship between bipolar tendencies and psychological distress after controlling for the effects of rumination. The present findings add incrementally to this literature by demonstrating that two meta-cognitive processes - self-compassion and nonattachment to self - act as mediators, and may be modifiable mechanisms linking bipolar vulnerability to negative mood outcomes. Future research should tackle longstanding conceptual issues in this domain, including the relationship between contents of self-concept (an established focus of BD research) and the person's meta-cognitive approach to their self-concept (the focus here).

5.
Front Psychol ; 9: 2544, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30618965

RESUMO

The Buddhist notion of nonattachment relates to an engagement with experience with flexibility and without fixation on achieving specified outcomes. The present study sought to define, create and validate a new measure of nonattachment as it applies to notions of the self. A new construct of "nonattachment to self" (NTS) was developed, defined the absence of fixation on self-related concepts, thoughts and feelings, and a capacity to flexibly interact with these concepts, thoughts and feelings without trying to control them. Two studies were conducted in the development of the new scale. With expert consultation, study 1 (n = 445) established a single factor, internally consistent 7-item scale via exploratory factor analysis. Study 2 (n = 388, n = 338) confirmed the factor structure of the new 7-item scale using confirmatory factor analyses. Study 2 also found the new scale to be internally consistent, with evidence supporting its test-retest reliability, criterion, and construct validity. Nonattachment to self-emerged as a unique way of relating to the self, distinct from general nonattachment, that aligned with higher levels of well-being and adaptive functioning.

6.
Dermatology ; 232(3): 298-311, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27104356

RESUMO

Optical coherence tomography (OCT) represents a non-invasive imaging technology, which may be applied to the diagnosis of non-melanoma skin cancer and which has recently been shown to improve the diagnostic accuracy of basal cell carcinoma. Technical developments of OCT continue to expand the applicability of OCT for different neoplastic and inflammatory skin diseases. Of these, dynamic OCT (D-OCT) based on speckle variance OCT is of special interest as it allows the in vivo evaluation of blood vessels and their distribution within specific lesions, providing additional functional information and consequently greater density of data. In an effort to assess the potential of D-OCT for future scientific and clinical studies, we have therefore reviewed the literature and preliminary unpublished data on the visualization of the microvasculature using D-OCT. Information on D-OCT in skin cancers including melanoma, as well as in a variety of other skin diseases, is presented in an atlas. Possible diagnostic features are suggested, although these require additional validation.


Assuntos
Dermatologia/métodos , Dermatopatias/diagnóstico , Pele/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Humanos
7.
J Appl Res Intellect Disabil ; 26(1): 14-25, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23255375

RESUMO

BACKGROUND: Creative use of legislation can produce positive change in the lives of people with intellectual disabilities. This may be 'bottom-up' or 'top-down' or at multiple levels and with multiple stakeholders. METHOD: Using a human rights-based approach (HRBA), four initiatives to improve services for people with intellectual disabilities in the UK are described. RESULTS: The first example explains the process of co-producing a DVD and board game to enable people with intellectual disabilities to understand their human rights. The second example considers the impact of organizational culture in the process of embedding a pilot evaluation of practical, human rights-based risk assessment and management tools. A third pilot project examines how the guiding principles of Mental Health Act (MHA) (2007) for England and Wales can be operationalized using an HRBA. Finally, improving equitable access to health care through a 'top-down' process of change involving the Green Light Toolkit is reported. CONCLUSION: The authors consider how to approach the process and where to focus in the system, to realize meaningful change.


Assuntos
Política de Saúde , Direitos Humanos/legislação & jurisprudência , Deficiência Intelectual , Serviços de Saúde Mental/organização & administração , Participação do Paciente , Medicina Estatal/organização & administração , Adulto , Atitude do Pessoal de Saúde , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Inglaterra , Jogos Experimentais , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Humanos , Serviços de Saúde Mental/legislação & jurisprudência , Serviços de Saúde Mental/normas , Cultura Organizacional , Inovação Organizacional , Educação de Pacientes como Assunto/métodos , Projetos Piloto , Gestão de Riscos/organização & administração , Medicina Estatal/legislação & jurisprudência , Medicina Estatal/normas , País de Gales
8.
J Psychiatr Res ; 45(6): 756-62, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20937506

RESUMO

We conducted a secondary analysis of a completed study of the differential efficacy and side effects of aripiprazole versus haloperidol in early-stage schizophrenia (ESS), a subpopulation of patients which does not include first episode or chronic patients. A subpopulation of 360 individuals with ESS were identified from a randomized, multi-center, double-blind study of 1294 individuals with schizophrenia at different stages of illness who were randomized to treatment with aripiprazole (ESS = 237) or haloperidol (ESS = 123) for one year. The primary outcome measure was response rate based on a 50% reduction of Positive and Negative Syndrome Scale (PANSS) total scores. Secondary outcomes included several efficacy and safety measures, as well as treatment discontinuation. More individuals in the aripiprazole group (48%) than in the haloperidol group (28%; p < 0.01) completed the study. Response rates were greater in the aripiprazole group (38% [N = 91]) than in the haloperidol group (22% [N = 27]; p < 0.01). Aripiprazole was associated with fewer extrapyramidal side effects. ESS subjects in the haloperidol group were more likely than those in the aripiprazole group to discontinue the study drug due to an adverse event other than worsening illness (29% and 11%, respectively; p < 0.01), and efficacy differences were reduced by interventions to mitigate side effects (decreasing antipsychotic dose with or without adding antiparkinsonian medication). Aripiprazole has a favorable efficacy/safety profile in ESS and appeared to be superior to haloperidol on a number of efficacy and safety outcomes. However, excessive dosing of the antipsychotic medications, in particular haloperidol, may have played an important role in accounting for the differences between aripiprazole and haloperidol in this study.


Assuntos
Antipsicóticos/administração & dosagem , Haloperidol/administração & dosagem , Piperazinas/administração & dosagem , Quinolonas/administração & dosagem , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Adolescente , Adulto , Idoso , Antipsicóticos/efeitos adversos , Aripiprazol , Relação Dose-Resposta a Droga , Feminino , Haloperidol/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Piperazinas/efeitos adversos , Escalas de Graduação Psiquiátrica , Quinolonas/efeitos adversos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
9.
Manag Care ; 19(8): 40-7, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20822071

RESUMO

PURPOSE: To assess the relationship between patient cost-sharing (e.g., copayments or coinsurance) and adherence and persistence to second-generation (atypical) antipsychotic (SGA) medications. DESIGN AND METHODOLOGY: A retrospective, observational study of adults aged 18-64 years with schizophrenia or bipolar disorder (n = 7,910) who initiated SGA medications with employer-sponsored insurance in the 2003-2006 MarketScan Commercial Claims and Encounters Database. Adherence was defined as percent of days covered in each calendar quarter. Persistence was defined as days from initiation of SGA to the first 90-day gap in medication on-hand. Generalized Estimating Equations were used to determine the effects of cost-sharing on adherence to SGA medications based on patient-quarter data. A Cox proportional hazards model with patient cost-sharing as a time-varying covariate estimated the effects on persistence with SGA medication. PRINCIPAL FINDINGS: Higher cost-sharing was associated with a lower likelihood of adherence. When compared to plans with cost-sharing below $10, adherence rates were approximately 27% lower for patients in plans with SGA cost-sharing of $50 and above and about 10% lower for patients in plans with cost-sharing between $30 and $50. In both cases, the reduction in adherence was significant. Higher cost-sharing was also associated with a shorter time to discontinuation (HR: 1.028; 95% CI [1.006-1.051]). CONCLUSION: High SGA cost-sharing appears to be a financial barrier to SGA medication compliance, especially when cost-sharing levels exceeded $30. Our findings have implications for health plans, employers, and policymakers who have, or are, contemplating establishing cost-sharing tiers for SCA medications for commercially insured patients with serious mental illnesses.


Assuntos
Antipsicóticos/economia , Custo Compartilhado de Seguro , Cobertura do Seguro , Seguro Saúde , Cooperação do Paciente , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
10.
J Med Econ ; 13(2): 185-92, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20235753

RESUMO

OBJECTIVE: Assess the association of schizophrenia patients' perceived copayment burden with medication adherence and outcomes. METHODS: Patients with schizophrenia (aged 18+) completed self-reported questionnaires. Analyses included those currently using a second-generation antipsychotic (SGA) with no exposure to clozapine or depot formulation antipsychotics. Adherence was assessed using the Morisky Medication Adherence Scale (MMAS). Outcomes included emergency room (ER) use, hospitalization, attempted suicide, missed work due to health, and experiencing severe psychological distress. Logistic regression was used to adjust for demographics, health characteristics, psychotropic medication use, and insurance status. RESULTS: Of 351 schizophrenia patients, 39% perceived copayment burden. These patients were less than half as likely to have complete adherence [OR = 0.427; 95% CI:0.257, 0.711; p = 0.001] Copayment burden was associated with greater likelihood of ER use, [OR = 2.157; 95% CI:(1.322, 3.520); p = 0.002], hospitalization [OR = 2.512; 95% CI: (1.475, 4.277); p < 0.001], attempted suicide[OR = 2.385; 95% CI: (1.156, 4.920); p = 0.019], severe psychological distress [OR = 1.833; 95% CI:1.092, 3.075; p = 0.022] and greater likelihood of missing work [OR = 7.193; 95% CI: 2.554, 20.256; p < 0.001]. CONCLUSIONS: Copayment burden is associated with poorer medication adherence and outcomes. Formularies that reduce copayment burden for SGAs may positively affect medication adherence and outcomes among schizophrenia patients. LIMITATIONS: Patient data were self-reported, which may have introduced additional bias in the study measures. Also, the use of a cross-sectional design precludes causal inference and the use of the current sampling methodology (both interview and Internet panel) might impact the ability to generalize the results to the broader population.


Assuntos
Antipsicóticos/economia , Antipsicóticos/uso terapêutico , Dedutíveis e Cosseguros/economia , Adesão à Medicação/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Absenteísmo , Adulto , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Estresse Psicológico , Tentativa de Suicídio/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos
11.
J Child Adolesc Psychopharmacol ; 20(1): 33-8, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20166794

RESUMO

INTRODUCTION: This post hoc analysis evaluated the effects of aripiprazole on Positive and Negative Syndrome Scale (PANSS) Hostility factor scores in adolescents with schizophrenia. METHODS: In total, 302 adolescents (13-17 years) with schizophrenia were enrolled in a 6-week, multicenter, double-blind, randomized, placebo-controlled trial comparing aripiprazole (10 or 30 mg/day) with placebo. The PANSS was the primary outcome measure. To determine the effect of aripiprazole on hostility, a post hoc analysis of the PANSS Hostility factor and individual items was performed. RESULTS: Aripiprazole was superior to placebo in reducing PANSS Hostility factor scores in adolescents with schizophrenia. After 6 weeks, aripiprazole 10 mg/day and aripiprazole 30 mg/day showed a statistically significant improvement versus placebo (-3.0, -3.7, versus -2.1; p < 0.05; last observation carried forward [LOCF]) in the PANSS Hostility factor. For aripiprazole 30 mg/day, statistically significant separation from placebo was evident from week 3 through week 6 and at week 6 for aripiprazole 10 mg/day. Individual PANSS Hostility, Uncooperativeness, and Poor Impulse Control Items showed statistically significant improvement with aripiprazole 30 mg/day over placebo at end point. CONCLUSIONS: This post hoc analysis shows that aripiprazole (10 and 30 mg/day) is an effective treatment for hostility symptoms in adolescents with schizophrenia. Clinical trials information: ClinicalTrials.gov identifier: NCT00102063.


Assuntos
Antipsicóticos/uso terapêutico , Hostilidade , Piperazinas/uso terapêutico , Agitação Psicomotora/tratamento farmacológico , Quinolonas/uso terapêutico , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Administração Oral , Adolescente , Análise de Variância , Antipsicóticos/administração & dosagem , Aripiprazol , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Piperazinas/administração & dosagem , Escalas de Graduação Psiquiátrica , Agitação Psicomotora/psicologia , Quinolonas/administração & dosagem , Esquizofrenia/diagnóstico , Síndrome , Fatores de Tempo , Resultado do Tratamento
12.
Artigo em Inglês | MEDLINE | ID: mdl-21274363

RESUMO

OBJECTIVE: To identify and describe correlates of medication adherence in a large, national sample of outpatients with bipolar disorder. METHOD: Data were collected via a self-report, Web-based survey in January and February of 2008 from US patients aged 18-65 years who reported a diagnosis of bipolar disorder and current use of psychotropic medication. Patients with a Composite International Diagnostic Interview-bipolar disorder (CIDI-bipolar disorder) score ≥ 7, indicating a high risk of bipolar disorder, were included in the analyses. Medication adherence was assessed via the Morisky Medication Adherence Scale, with scores ≥ 2 being considered nonadherent. The primary analysis was a multivariate binomial logistic regression with adherence as the dependent variable. Covariates included patient demographics, physical health measures including Medical Outcomes Study 8-item Short-Form Health Survey physical summary score, number of manic and depressive episodes, 24-item Behavior and Symptom Identification Scale (BASIS-24), Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS), Satisfaction With Antipsychotic Medication scale (SWAM), and current psychiatric medication use. RESULTS: Nearly half (49.5%) of the 1,052 bipolar patients in the analysis were classified as being nonadherent. Adherence was positively associated with college degree, higher SWAM total score, and monotherapy treatment. Adherence was negatively associated with female sex, alcohol use, BASIS-24 total score, and LUNSERS total score. CONCLUSIONS: Nonadherence is common among patients with bipolar disorder. By addressing tolerability issues and treatment satisfaction, which are both significant correlates of adherence, health care providers may be able to improve adherence and, ultimately, treatment outcomes.

13.
Community Pract ; 82(11): 34-7, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19950688

RESUMO

Recent literature and government guidance has highlighted the rights of parents with leaming disabilities and role of services in meeting their needs. In the present study, three focus groups were conducted involving 35 members of community health visiting teams in order to identify estimated incidence and needs of parents with learning disabilities and the needs of services in supporting them. The health visiting teams identified clinically significant numbers of parents with learning disabilities and--through qualitative focus group discussion--suggested a significant need for intervention and support for these parents, greater resources and knowledge within health visiting services, and improved interagency co-ordination and communication.


Assuntos
Enfermagem em Saúde Comunitária , Deficiência Intelectual , Determinação de Necessidades de Cuidados de Saúde , Poder Familiar , Inglaterra , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Relações Interprofissionais , Serviço Social
14.
Clin Med (Lond) ; 9(5): 471-6, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19886111

RESUMO

HIV is now a treatable medical condition and the majority of those living with the virus remain fit and well on treatment. Despite this a significant number of people in the UK are unaware of their HIV infection and remain at risk to their own health and of passing their virus unwittingly on to others. Late diagnosis is the most important factor associated with HIV-related morbidity and mortality in the U.K. Testing for HIV infection is often not performed due to misconceptions held by healthcare workers even when it is clinically indicated and this contributes to missed or late diagnosis. This article summarises the recommendations from the U.K. national guidelines for HIV testing 2008. The guidelines provide the information needed to enable any clinician to perform an HIV test within good clinical practice and encourage 'normalisation' of HIV testing. The full version is available at www.bhiva.org/cmsl 222621.asp.


Assuntos
Sorodiagnóstico da AIDS , Infecções por HIV/diagnóstico , Programas de Rastreamento , Adulto , Criança , Infecções por HIV/complicações , Infecções por HIV/transmissão , Humanos , Fatores de Risco , Reino Unido
15.
Appl Health Econ Health Policy ; 7(2): 109-19, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19731968

RESUMO

BACKGROUND: Since their introduction, second-generation antipsychotics (SGAs) have become the drugs of choice for the treatment of schizophrenia. However, recent findings have questioned the benefits of SGAs over first-generation antipsychotics (FGAs). OBJECTIVE: This post hoc analysis sought to compare the utility of the SGA aripiprazole with the FGA haloperidol in patients with early-phase schizophrenia (ES) or chronic schizophrenia (CS). METHOD: Data were pooled from two identical 52-week, randomized, active comparator trials (31-98-217 and 31-98-304) of aripiprazole 20-30 mg/day versus haloperidol 7-10 mg/day. Patients in the efficacy sample were classified as having ES if they were

Assuntos
Antipsicóticos/uso terapêutico , Haloperidol/uso terapêutico , Piperazinas/uso terapêutico , Quinolonas/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/efeitos adversos , Antipsicóticos/economia , Aripiprazol , Análise Custo-Benefício , Feminino , Haloperidol/efeitos adversos , Haloperidol/economia , Humanos , Masculino , Piperazinas/efeitos adversos , Piperazinas/economia , Quinolonas/efeitos adversos , Quinolonas/economia , Resultado do Tratamento
16.
J Clin Psychiatry ; 70(3): 318-25, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19192469

RESUMO

OBJECTIVE: Race is strongly associated with risk for metabolic dysfunction, but there is limited prospective data concerning the impact of race on antipsychotic metabolic outcomes among patients with schizophrenia. METHOD: This study is a post hoc analysis of data from a 26-week, double-blind, randomized trial of aripiprazole (N = 155) and olanzapine (N = 159) conducted from April 2000 through June 2001 in patients aged >or= 18 years with acute schizophrenia according to DSM-IV criteria. The data were analyzed on the basis of racial breakdown: white and black/Hispanic. Between-drug and within-drug outcomes were analyzed separately for each racial cohort across weight, lipid, and glucose parameters. RESULTS: For white subjects (N = 167), olanzapine significantly worsened all metabolic parameters except high-density lipoprotein (HDL) cholesterol and fasting glucose, and this was significantly different than aripiprazole for every outcome except fasting glucose. In the black/Hispanic cohort (N = 137), olanzapine treatment resulted in adverse metabolic outcomes, and these changes were significantly different from aripiprazole for adiposity, total cholesterol, and non-HDL cholesterol. Aripiprazole decreased the odds of endpoint metabolic syndrome compared with olanzapine for all subjects (OR = 0.33, 95% CI = 0.19 to 0.55), the white cohort (OR = 0.20, 95% CI = 0.10 to 0.41), and black/Hispanic subjects (OR = 0.53, 95% CI = 0.25 to 1.12), but the black/Hispanic result was not statistically significant (p = .096). Within the aripiprazole group, white subjects had significantly lower risk for metabolic syndrome, but there was no significant difference in metabolic syndrome between white and black/Hispanic subjects exposed to olanzapine. CONCLUSIONS: Race may be an important moderator of metabolic risk during atypical antipsychotic therapy. Olanzapine treatment is associated with greater effects on adiposity and lipids than aripiprazole in both white and black/Hispanic subjects, suggesting that antipsychotic choice and intensive monitoring are important in minimizing metabolic risk, especially in nonwhite patients.


Assuntos
Afro-Americanos/psicologia , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Grupo com Ancestrais do Continente Europeu/psicologia , Hispano-Americanos/psicologia , Hipercolesterolemia/induzido quimicamente , Hipercolesterolemia/etnologia , Síndrome Metabólica/induzido quimicamente , Síndrome Metabólica/etnologia , Obesidade/induzido quimicamente , Obesidade/etnologia , Piperazinas/efeitos adversos , Quinolonas/efeitos adversos , Doença Aguda , Adulto , Antipsicóticos/uso terapêutico , Aripiprazol , Benzodiazepinas/uso terapêutico , Glicemia/metabolismo , Peso Corporal/efeitos dos fármacos , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Olanzapina , Piperazinas/uso terapêutico , Quinolonas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
17.
Am J Psychiatry ; 166(3): 345-53, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19147694

RESUMO

OBJECTIVE: The authors sought to quantify plasma lipid and glucose testing rates in patients receiving second-generation antipsychotics before and after guidelines recommending testing were issued in February 2004 by the American Diabetes Association (ADA). METHOD: In this retrospective cohort analysis using data from a large managed care database (PharMetrics, 2000-2006), patients under age 65 on second-generation antipsychotics were identified and followed from 40 days before to 130 days after the antipsychotic prescription was written. Baseline and 12-week (40 days) lipid and glucose testing rates were determined for pre- and postguideline cohorts. Logistic regression analyses determined predictors of baseline and 12-week lipid and glucose testing while controlling for covariates. RESULTS: A total of 5,787 preguideline patients and 17,832 postguideline patients were identified. Baseline lipid testing rates were 8.4% for the preguideline cohort and 10.5% for the postguideline cohort, and the 12-week testing rates were 6.8% and 9.0%, respectively. Baseline glucose testing rates were 17.3% for the preguideline cohort and 21.8% for the postguideline cohort, and the 12-week testing rates were 14.1% and 17.9%, respectively. All four comparisons were statistically significant. Baseline and 12-week testing rates for lipids and glucose in children were the lowest of all age groups. CONCLUSIONS: Despite statistically significant improvements after the ADA guidelines were issued, monitoring for plasma lipids and glucose in this population remains low. Clinicians and administrators responsible for the health of at-risk populations should implement new approaches for effective monitoring of major modifiable risk factors for medical morbidity and mortality in patients taking second-generation antipsychotics.


Assuntos
Antipsicóticos/uso terapêutico , Glicemia/metabolismo , LDL-Colesterol/metabolismo , Sistemas Pré-Pagos de Saúde/estatística & dados numéricos , Hiperglicemia/epidemiologia , Hiperglicemia/metabolismo , Hiperlipidemias/diagnóstico , Hiperlipidemias/epidemiologia , Esquizofrenia/tratamento farmacológico , Esquizofrenia/epidemiologia , Adulto , Estudos de Coortes , Demografia , Feminino , Humanos , Hiperglicemia/diagnóstico , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Estudos Retrospectivos
18.
Schizophr Res ; 107(2-3): 218-22, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19038534

RESUMO

Hyperprolactinemia, an adverse effect associated with the use of typical antipsychotics and the atypical antipsychotic risperidone, has both acute and chronic clinical consequences. One option for clinical management is switching to an agent with a lower liability for inducing hyperprolactinemia. This post-hoc sub-analysis of an 8-week, open-label study in outpatients with schizophrenia (CN138-215) examined short-term effects on prolactin levels during a switch from risperidone or olanzapine to aripiprazole 30 mg/day. Three switch strategies were used: (I) immediate aripiprazole initiation with simultaneous immediate discontinuation of olanzapine/risperidone; (II) immediate aripiprazole initiation while tapering off olanzapine/risperidone over 14 days; (III) titrating aripiprazole upwards while tapering off olanzapine/risperidone over 14 days. Changes in prolactin levels from baseline to each last observation carried forward time point were compared with t-tests using Bonferroni correction for multiple comparisons. This sub-analysis included 269 subjects: 105 previously treated with risperidone; 164 previously treated with olanzapine. Mean baseline prolactin levels (ng/mL) were within normal range for the three olanzapine groups (Group-I, 11.7; Group-II, 13.2; Group-III, 11.2), but above normal for the risperidone groups (Group-I, 39.7; Group-II, 48.5; Group-III, 33.5). Following aripiprazole initiation, mean prolactin levels decreased significantly (p<0.001) at week-1 and were maintained to week-8 in all groups irrespective of prior treatment. Previously elevated prolactin levels in the risperidone groups were reduced to within normal range within 1 week, irrespective of switching strategy. Tolerability was good regardless of prior medication or switching strategy. Overall, rapid decreases of prolactin levels were achieved safely with all three aripiprazole switching strategies. Reversal of hyperprolactinemia during the crossover period indicates the safety and potential utility of aripiprazole addition in patients with elevated prolactin.


Assuntos
Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Hiperprolactinemia/induzido quimicamente , Piperazinas/administração & dosagem , Prolactina/sangue , Transtornos Psicóticos/tratamento farmacológico , Quinolonas/administração & dosagem , Risperidona/efeitos adversos , Esquizofrenia/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Antipsicóticos/administração & dosagem , Aripiprazol , Benzodiazepinas/administração & dosagem , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Hiperprolactinemia/sangue , Masculino , Pessoa de Meia-Idade , Olanzapina , Transtornos Psicóticos/sangue , Risperidona/administração & dosagem , Esquizofrenia/sangue , Fatores Sexuais , Síndrome de Abstinência a Substâncias/etiologia , Adulto Jovem
19.
J Clin Psychiatry ; 69(9): 1393-7, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19012819

RESUMO

OBJECTIVE: Aripiprazole is a second-generation antipsychotic that is increasingly prescribed in a variety of psychiatric disorders. The goal of this study was to investigate patient and treatment factors associated with aripiprazole treatment continuation on hospital discharge in psychiatric inpatients. METHOD: This was a retrospective cohort analysis of patients admitted to a psychiatric hospital between January 1, 2003, and June 30, 2006, and treated with aripiprazole. The goal was to determine factors associated with continuation of aripiprazole throughout the hospital stay and on discharge from the hospital. Covariates assessed included patient demographics, prior psychiatric hospitalizations, diagnoses, prior antipsychotic use, and concomitant psychotropic medications. Aripiprazole-specific covariates were starting and maximum dose and dose titration pattern. Diagnoses were identified using ICD-9-CM codes. RESULTS: There were 1957 aripiprazole-treated patients included in this study, and 1573 (80%) continued aripiprazole treatment at the time of hospital discharge. Median starting doses were lower (5 mg/day) for younger and older patients, and patients with psychotic disorders received higher doses than other patients. Approximately 58% of patients had at least 1 aripiprazole dose titration while hospitalized, and most (73%) of those patients had a dose titration within 3 days of admission. Predictors of treatment continuation in this broad patient population were younger age, a diagnosis of bipolar or major depressive disorder, higher maximum aripiprazole doses, and upward dose titration within 3 days of admission. Patients receiving concomitant anticholinergics or antipsychotics were less likely to continue treatment as were those receiving aripiprazole at the time of hospitalization. CONCLUSION: In this acute inpatient psychiatric setting, continuation of aripiprazole treatment on discharge was achieved in most patients. Demographic, diagnostic, and treatment factors predicting aripiprazole treatment effectiveness were identified.


Assuntos
Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Hospitalização , Piperazinas/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Quinolonas/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Aripiprazol , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Criança , Pré-Escolar , Estudos de Coortes , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Piperazinas/administração & dosagem , Piperazinas/efeitos adversos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Quinolonas/administração & dosagem , Quinolonas/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
20.
Schizophr Res ; 105(1-3): 208-15, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18790605

RESUMO

OBJECTIVE: To examine the efficacy of aripiprazole across symptoms in patients with acute exacerbation of schizophrenia or schizoaffective disorder. METHODS: Data were pooled from five, 4-6-week acute studies. PANSS Total, Positive, Negative, and General Psychopathology Subscale improvements were analyzed, as well as all 30 individual PANSS items. RESULTS: Aripiprazole had statistically significant decreases versus placebo on PANSS subscales at Week 4, similar to those seen with haloperidol. Aripiprazole-treated patients also showed significant decreases versus placebo in 26 of the 30 PANSS items (all p<0.05). CONCLUSION: Aripiprazole demonstrates statistically and clinically significant efficacy across a range of symptoms in schizophrenia.


Assuntos
Antipsicóticos/uso terapêutico , Piperazinas/uso terapêutico , Quinolonas/uso terapêutico , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Doença Aguda , Adulto , Aripiprazol , Transtornos Cognitivos/tratamento farmacológico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Placebos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Esquizofrenia/diagnóstico , Resultado do Tratamento
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