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Psychosis: Goals of Pharmacotherapy01:26

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Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
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The term "psychosis" refers to a spectrum of mental disorders characterized by abnormal thoughts, perceptions, and behaviors. It can manifest as mood disorders, dementia, delirium with psychotic features, substance-induced psychosis with psychotic features, brief psychotic disorder, delusional disorder, schizoaffective disorder, and schizophrenia. Among all these disorders, schizophrenia is the most common psychotic disorder, affecting 1% of the worldwide population. Psychotic...
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The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
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The elimination half-life and drug clearance of drugs following nonlinear kinetics can vary with dosage. The Michaelis-Menten parameters and drug concentration influence these factors. As the dose increases, the elimination half-life tends to lengthen, resulting in a reduction in clearance and a disproportionately larger area under the curve. The total clearance can be derived from the Michaelis-Menten equation for drugs following a one-compartment model.
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2001-2021 Comparative Persistence of Oral Antipsychotics in Patients Initiating Treatment: Superiority of Clozapine

Alberto Parabiaghi1, Alessia A Galbussera2, Barbara D'Avanzo3

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This summary is machine-generated.

Second-generation antipsychotics (SGAs) show better treatment persistence than first-generation antipsychotics (FGAs). Clozapine demonstrated superior persistence among SGAs, outperforming olanzapine and risperidone in real-world data.

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Area of Science:

  • Psychiatry
  • Pharmacoepidemiology
  • Pharmacology

Background:

  • Continuous antipsychotic (AP) therapy is vital for managing psychotic disorders.
  • Early interruption of AP treatment often signifies therapeutic failure.
  • Real-world epidemiological research is crucial for validating experimental findings and guiding new hypotheses.

Purpose of the Study:

  • To analyze the persistence of oral antipsychotic (AP) treatments in a large Italian population.
  • To compare the real-world effectiveness of different antipsychotic classes and specific agents.

Main Methods:

  • Utilized dispensing data from 2000-2021 across four Italian provinces.
  • Linked regional healthcare utilization databases for a comprehensive patient sample.
  • Assessed treatment discontinuation over 3 months using Kaplan-Meier curves and Cox regression.

Main Results:

  • Second-generation antipsychotics (SGAs) exhibited superior persistence compared to first-generation antipsychotics (FGAs) (HR: 0.76).
  • Clozapine demonstrated the highest persistence among all SGAs, outperforming olanzapine and risperidone.
  • Olanzapine and aripiprazole showed better persistence than risperidone and quetiapine; quetiapine had inferior 3-month persistence.

Conclusions:

  • Clozapine, though less frequently dispensed, is a significant choice for antipsychotic therapy due to its superior persistence.
  • Pharmacoepidemiological studies provide valuable real-world insights complementing experimental data on antipsychotic efficacy.