Assessment of strategies for switching patients from olanzapine to risperidone: A randomized, open-label, rater-blinded study

<p>Abstract</p> <p>Background</p> <p>In clinical practice, physicians often need to change the antipsychotic medications they give to patients because of an inadequate response or the presence of unacceptable or unsafe side effects. However, there is a lack of consensus in the field as to the optimal switching strategy for antipsychotics, especially with regards to the speed at which the dose of the previous antipsychotic should be reduced. This paper assesses the short-term results of strategies for the discontinuation of olanzapine when initiating risperidone.</p> <p>Methods</p> <p>In a 6-week, randomized, open-label, rater-blinded study, patients with schizophrenia or schizoaffective disorder, on a stable drug dose for more than 30 days at entry, who were intolerant of or exhibiting a suboptimal symptom response to more than 30 days of olanzapine treatment, were randomly assigned to the following switch strategies (common risperidone initiation scheme; varying olanzapine discontinuation): (i) abrupt strategy, where olanzapine was discontinued at risperidone initiation; (ii) gradual 1 strategy, where olanzapine was given at 50% entry dose for 1 week after risperidone initiation and then discontinued; or (iii) gradual 2 strategy, where olanzapine was given at 100% entry dose for 1 week, then at 50% in the second week, and then discontinued.</p> <p>Results</p> <p>The study enrolled 123 patients on stable doses of olanzapine. Their mean age was 40.3 years and mean (± standard deviation (SD)) baseline Positive and Negative Syndrome Scale (PANSS) total score of 75.6 ± 11.5. All-cause treatment discontinuation was lowest (12%) in the group with the slowest olanzapine dose reduction (gradual 2) and occurred at half the discontinuation rate in the other two groups (25% in abrupt and 28% in gradual 1). The relative risk of early discontinuation was 0.77 (confidence interval 0.61–0.99) for the slowest dose reduction compared with the other two strategies. After the medication was changed, improvements at endpoint were seen in PANSS total score (-7.3; <it>p </it>< 0.0001) and in PANSS positive (-3.0; <it>p </it>< 0.0001), negative (-0.9; <it>p </it>= 0.171) and anxiety/depression (-1.4; <it>p </it>= 0.0005) subscale scores. Severity of movement disorders and weight changes were minimal.</p> <p>Conclusion</p> <p>When switching patients from olanzapine to risperidone, a gradual reduction in the dose of olanzapine over 2 weeks was associated with higher rates of retention compared with abrupt or less gradual discontinuation. Switching via any strategy was associated with significant improvements in positive and anxiety symptoms and was generally well tolerated.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00378183</p

Increased caffeine and nicotine consumption in community-dwelling patients with schizophrenia

It is known that people with schizophrenia make poor dietary choices and smoke at alarmingly high rates. There is also anecdotal evidence that they may ingest large amounts of caffeine. However, while smoking habits in this population have been examined, no recent study has quantified caffeine consumption taking into account various dietary caffeine sources unrelated to coffee including convenience foods such as candy bars, chocolate or soft drinks, and compared results to US population data. We employed 24-h diet recalls to assess dietary habits in a sample of outpatients suffering from schizophrenia or schizoaffective disorder. Caloric intake and caffeine consumption were quantified and the relationship to various sociodemographic variables including body mass index (BMI) and dietary quality was examined. 146 patients were recruited. Mean BMI in the sample was 32.7+/-7.9. Patients ingested 3,057+/-1,132 cal on average. Patients smoked at higher rates (59.6% vs. 23.4%, p< or =0.001), higher numbers of cigarettes/day (24+/-14.4 vs. 13.5+/-11.3, t=8.549, p<0.001) and ingested more caffeine (471.6+/-584.6 mg vs. 254.2+/-384.9 mg, t=6.664, p<0.001) than US population comparisons. Caffeine consumption was correlated to the number of cigarettes smoked daily (r=0.299, p< or =0.001), but not to BMI (r=0.134, p=0.107) or dietary parameters such as caloric intake (r=0.105, p=0.207). Community-dwelling schizophrenia patients consume significantly more caffeine and nicotine than US population comparisons. Clinicians should be aware that while a significant proportion of patients are overweight and have poor dietary quality - which merits lifestyle counseling on its own - there is a lack of correlation between those factors and smoking and caffeine intake. Thus, lifestyle modification counseling in all patients should address smoking and caffeine intake concurrently

Low cardiorespiratory fitness and physical functional capacity in obese patients with schizophrenia

BACKGROUND: Low cardiorespiratory fitness is a prominent behavioral risk factor for cardiovascular disease (CVD) morbidity and mortality, as cardiorespiratory fitness is strongly associated with CVD outcomes. High rates of CVD have been observed in the schizophrenia population, translating into a markedly reduced life expectancy as compared to healthy controls. Surprisingly however, while cardiorespiratory fitness is an eminent indicator for overall cardiovascular health as well as eminently modifiable risk factor for CVD, no studies have systematically assessed cardiorespiratory fitness in schizophrenia. METHODS: Community-dwelling schizophrenia patients underwent graded-exercise tests, to ascertain maximal oxygen uptake (MaxVo2), considered to be the gold standard for the evaluation of cardiorespiratory fitness and physical functional capacity. The modified Bruce-protocol was used to ascertain cardiorespiratory fitness and physical functional capacity; data was normalized and compared to population standards derived from the ACLS (Aerobics Center Longitudinal Study) and the National Health and Nutrition Examination Surveys (NHANES), Cycle III and IV. RESULTS: Data for n=117 participants (41 % male, 46 % white) was analyzed. Mean age (y) was 43.2±9.9, and mean BMI was 37.2±7.3. Peak HR attained during exercise was 145.6±19.6, after 8.05±3.6 min, achieving 111.2±44.2 watts. MaxVo2 was 1.72±6.6 l/min, MaxVCo2 1.85±7.2 l/min, and minute ventilation (VE) was 55.6 ±21.9 ml/sec. PANSS Positive subscores (13.3±4.4; r=−0.21, p=0.024) were inversely correlated with Max Vo2 ml(−1)min(−1)kg(−1). Neither PANSS Total (56.3±12.3; r=−0.105, p=0.72) PANSS Negative (14±5.1; r=−0.52, p=0.57) nor PANSS General Psychopathology (28.4±7.4; r=−0.28, p=0.76) scores were correlated with Max Vo2 ml(−1)min(−1)kg(−1). Peak heart rate and duration of exercise were not correlated with PANSS scores. Compared to healthy controls derived from the ACLS and NHANES, respectively, 115 participants achieved ‘low levels‘ of fitness only, as well as highly significantly reduced MaxVo2, across all age-groups. CONCLUSION: The test was generally well received and tolerated by those who elected to participate; and adherence to the protocol was good. Among participants with schizophrenia, most of whom were obese, and across all age groups, cardiorespiratory fitness was exceedingly poor. Only two participants in our entire sample fit the categorization of ‘moderate fitness level‘; that is, a fitness level at or above the 20(th)p ercentile of ACLS-derived population comparisons. Conversely, this left 98.3 % of participants with schizophrenia below population standards. Low cardiorespiratory fitness emerges as an eminent modifiable risk factor for CVD mortality and morbidity in schizophrenia complicated by obesity

Physical activity and depressive symptoms in older adults.

ObjectivesDepressive symptoms are prevalent in older adults, and physical activity (PA) may have beneficial effects on depression. The purpose of this study was to explore the association between physical activity and depressive symptoms, taking into account demographic factors, and the associations between selected demographic factors and physical activity levels in community-dwelling older adults (age ≥ 60 years).MethodsData were drawn from the National Health and Nutrition Examination Survey 2005-2006. Descriptive statistics and logistic models were used in data analysis.ResultsFour percent of participants reported moderate depressive symptoms, and 24% of subjects exhibited sedentary PA. Factors associated with increased risk of moderate depression included age, sedentary PA, and chronic medical conditions (ps &lt; 0.05). Sedentary PA was significantly associated with age, race, education, BMI, smoking status, alcohol use, and taking psychotropics (ps &lt; 0.05).DiscussionPA is a protective factor for depression in older adults, and clinical implications to encourage PA are discussed