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5 - What Is an Adequate Antipsychotic Trial? Using Plasma Levels to Optimize Psychiatric Response and Tolerability

Published online by Cambridge University Press:  19 October 2021

Jonathan M. Meyer
Affiliation:
University of California, San Diego
Stephen M. Stahl
Affiliation:
University of California, Riverside and San Diego
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Summary

Psychiatry is the youngest medical specialty, with continually evolving methods of disease classification, models of pathogenesis, and concepts about evidence-based management. One of the greatest advances in the treatment of schizophrenia comes from sophisticated analyses of clinical trials data, with a view to identifying patients who appear unlikely to respond to the current treatment condition (i.e. the current dose of the psychotropic) regardless of how much time they are given [1]. These analyses are not a trivial exercise, but a concerted effort to minimize unnecessary patient suffering when clinicians delay changes in dose (or medication), waiting for delayed response.

Type
Chapter
Information
The Clinical Use of Antipsychotic Plasma Levels
Stahl's Handbooks
, pp. 114 - 146
Publisher: Cambridge University Press
Print publication year: 2021

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References

Gorwood, P., Bayle, F., Vaiva, G., et al. (2013). Is it worth assessing progress as early as week 2 to adapt antidepressive treatment strategy? Results from a study on agomelatine and a global meta-analysis. Eur Psychiatry, 28, 362371.Google Scholar
Leucht, S., Busch, R., Hamann, J., et al. (2005). Early-onset hypothesis of antipsychotic drug action: A hypothesis tested, confirmed and extended. Biol Psychiatry, 57, 15431549.Google Scholar
Agid, O., Kapur, S., Arenovich, T., et al. (2003). Delayed-onset hypothesis of antipsychotic action: A hypothesis tested and rejected. Arch Gen Psychiatry, 60, 12281235.Google Scholar
Younis, I. R., Gopalakrishnan, M., Mathis, M., et al. (2020). Association of end point definition and randomized clinical trial duration in clinical trials of schizophrenia medications. JAMA Psychiatry, 77, 10641071.Google Scholar
Vyas, P., Hwang, B. J., and Brasic, J. R. (2019). An evaluation of lumateperone tosylate for the treatment of schizophrenia. Expert Opin Pharmacother, 30, 17.Google Scholar
Meyer, J. M. (2020). Lumateperone for schizophrenia. Curr Psychiatr, 19, 3339.Google Scholar
Samara, M. T., Leucht, C., Leeflang, M. M., et al. (2015). Early improvement as a predictor of later response to antipsychotics in schizophrenia: A diagnostic test review. Am J Psychiatry, 172, 617629.Google Scholar
McCutcheon, R., Beck, K., D’Ambrosio, E., et al. (2018). Antipsychotic plasma levels in the assessment of poor treatment response in schizophrenia. Acta Psychiatr Scand, 137, 3946.Google Scholar
Kylleso, L., Smith, R. L., Karlstad, O., et al. (2020). Undetectable or subtherapeutic serum levels of antipsychotic drugs preceding switch to clozapine. NPJ Schizophr, 6, 17.Google Scholar
Meyer, J. M. (2014). A rational approach to employing high plasma levels of antipsychotics for violence associated with schizophrenia: Case vignettes. CNS Spectr, 19, 432438.Google Scholar
Meyer, J. M. and Stahl, S. M. (2019). The Clozapine Handbook. Cambridge: Cambridge University Press.Google Scholar
Conley, R. R., Carpenter, W. T., Jr., and Tamminga, C. A. (1997). Time to clozapine response in a standardized trial. Am J Psychiatry, 154, 12431247.Google Scholar
Haddad, P. M. and Correll, C. U. (2018). The acute efficacy of antipsychotics in schizophrenia: A review of recent meta-analyses. Ther Adv Psychopharmacol, 8, 303318.Google Scholar
Loebel, A., Silva, R., Goldman, R., et al. (2016). Lurasidone dose escalation in early nonresponding patients with schizophrenia: A randomized, double-blind, placebo-controlled study. J Clin Psychiatry, 77, 16721680.Google Scholar
Giegling, I., Drago, A., Schafer, M., et al. (2010). Interaction of haloperidol plasma level and antipsychotic effect in early phases of acute psychosis treatment. J Psychiatr Res, 44, 487492.Google Scholar
Schennach, R., Riesbeck, M., Mayr, A., et al. (2013). Should early improvement be re-defined to better predict the maintenance of response in first-episode schizophrenia patients? Acta Psychiatr Scand, 127, 474481.Google Scholar
Siwek, M., Dudek, D., Rybakowski, J., et al. (2009). Mood Disorder Questionnaire – characteristic and indications. Psychiatr Pol, 43, 287299.Google Scholar
Overall, J. E. and Gorham, D. R. (1962). The Brief Psychiatric Rating Scale. Psychol Rep, 10, 799812.Google Scholar
Kay, S. R., Fiszbein, A., and Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull, 13, 261276.Google Scholar
American Psychiatric Association (2013). Diagnostic & Statistical Manual of Mental Disorders: Fifth Edition. Washington, DC: American Psychiatric Press, Inc.Google Scholar
Ritsner, M. S., Mar, M., Arbitman, M., et al. (2013). Symptom severity scale of the DSM5 for schizophrenia, and other psychotic disorders: Diagnostic validity and clinical feasibility. Psychiatry Res, 208, 18.Google Scholar
Park, S. C., Lee, K. U., and Choi, J. (2016). Factor structure of the clinician-rated Dimensions of Psychosis Symptom Severity in patients with schizophrenia. Psychiatry Investig, 13, 253254.Google Scholar
Berendsen, S., van der Veen, N. M., van Tricht, M. J., et al. (2020). Psychometric properties of the DSM-5 Clinician-Rated Dimensions of Psychosis Symptom Severity. Schizophr Res, 216, 416421.Google Scholar
Guy, W. (1976). Clinical Global Impressions (028-CGI). In ECDEU Assessment Manual for Psychopharmacology – Revised (DHEW Publication ADM76-338). Rockville, MD: US Department of Health, Education, and Welfare: Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs, pp. 218222.Google Scholar
Leucht, S., Kane, J. M., Etschel, E., et al. (2006). Linking the PANSS, BPRS, and CGI: Clinical implications. Neuropsychopharmacology, 31, 23182325.Google Scholar
Mortimer, A. M. (2007). Symptom rating scales and outcome in schizophrenia. Br J Psychiatry Suppl, 50, s714.Google Scholar
Busner, J. and Targum, S. D. (2007). The clinical global impressions scale: Applying a research tool in clinical practice. Psychiatry (Edgmont), 4, 2837.Google Scholar
Targum, S. D., Busner, J., and Young, A. H. (2008). Targeted scoring criteria reduce variance in global impressions. Hum Psychopharmacol, 23, 629633.Google Scholar
Spearing, M. K., Post, R. M., Leverich, G. S., et al. (1997). Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): The CGI-BP. Psychiatry Res, 73, 159171.Google Scholar
Haro, J. M., Kamath, S. A., Ochoa, S., et al. (2003). The Clinical Global Impression-Schizophrenia scale: A simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatr Scand Suppl, 1623.Google Scholar
Leucht, S., Kane, J. M., Kissling, W., et al. (2005). What does the PANSS mean? Schizophr Res, 79, 231238.Google Scholar
Leucht, S., Kane, J. M., Kissling, W., et al. (2005). Clinical implications of Brief Psychiatric Rating Scale scores. Br J Psychiatry, 187, 366371.Google Scholar
Leucht, S. and Engel, R. R. (2006). The relative sensitivity of the Clinical Global Impressions Scale and the Brief Psychiatric Rating Scale in antipsychotic drug trials. Neuropsychopharmacology, 31, 406412.Google Scholar
Marder, S. R., Aravagiri, M., Wirshing, W. C., et al. (2002). Fluphenazine plasma level monitoring for patients receiving fluphenazine decanoate. Schizophr Res, 53, 2530.Google Scholar
Hough, D., Gopal, S., Vijapurkar, U., et al. (2010). Paliperidone palmitate maintenance treatment in delaying the time-to-relapse in patients with schizophrenia: A randomized, double-blind, placebo-controlled study. Schizophr Res, 116, 107117.Google Scholar
Samtani, M. N., Vermeulen, A., and Stuyckens, K. (2009). Population pharmacokinetics of intramuscular paliperidone palmitate in patients with schizophrenia: A novel once-monthly, long-acting formulation of an atypical antipsychotic. Clin Pharmacokinet, 48, 585600.Google Scholar
Helland, A. and Spigset, O. (2017). Serum concentrations of paliperidone after administration of the long-acting injectable formulation. Ther Drug Monit, 39, 659662.Google Scholar
Jann, M. W., Ereshefsky, L., and Saklad, S. R. (1985). Clinical pharmacokinetics of the depot antipsychotics. Clin Pharmacokinet, 10, 315333.Google Scholar
Wei, F. C., Jann, M. W., Lin, H. N., et al. (1996). A practical loading dose method for converting schizophrenic patients from oral to depot haloperidol therapy. J Clin Psychiatry, 57, 298302.Google Scholar
Altamura, A. C., Sassella, F., Santini, A., et al. (2003). Intramuscular preparations of antipsychotics: Uses and relevance in clinical practice. Drugs, 63, 493512.Google Scholar
Pandina, G. J., Lindenmayer, J.-P., Lull, J., et al. (2010). A randomized, placebo-controlled study to assess the efficacy and safety of 3 doses of paliperidone palmitate in adults with acutely exacerbated schizophrenia [Erratum appears in J Clin Psychopharmacol 2010 Aug, 30(4), 364]. J Clin Psychopharmacol, 30, 235244.Google Scholar
Kurland, A. A. and Richardson, J. H. (1966). A comparative study of two long acting phenothiazine preparations, fluphenazine-enanthate and fluphenazine-decanoate. Psychopharmacologia, 9, 320327.Google Scholar
Meyer, J. M. (2017). Converting oral to long acting injectable antipsychotics: A guide for the perplexed. CNS Spectr, 22, 1428.Google Scholar
Takeuchi, H. and Remington, G. (2013). A systematic review of reported cases involving psychotic symptoms worsened by aripiprazole in schizophrenia or schizoaffective disorder. Psychopharmacology (Berl), 228, 175185.Google Scholar
Jain, R., Meyer, J. M., Wehr, A. Y., et al. (2020). Size matters: The importance of particle size in a newly developed injectable formulation for the treatment of schizophrenia. CNS Spectr, 25, 323330.Google Scholar
Meyer, J. M. (2020). Monitoring and improving antipsychotic adherence in outpatient forensic diversion programs. CNS Spectr, 25, 136144.Google Scholar
Barnes, T. R., Drake, R., Paton, C., et al. (2020). Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol, 34, 378.Google Scholar
Simpson, G. M. and Kunz-Bartholini, E. (1968). Relationship of individual tolerance, behavior and phenothiazine produced extrapyramidal system disturbance. Dis Nerv System, 29, 269274.Google Scholar
Midha, K. K., Hubbard, J. W., Marder, S. R., et al. (1994). Impact of clinical pharmacokinetics on neuroleptic therapy in patients with schizophrenia. J Psychiatry Neurosci, 19, 254264.Google Scholar
Coppens, H. J., Slooff, C. J., Paans, A. M., et al. (1991). High central D2-dopamine receptor occupancy as assessed with positron emission tomography in medicated but therapy-resistant schizophrenic patients. Biological Psychiatry, 29, 629634.Google Scholar
Nyberg, S., Dencker, S. J., Malm, U., et al. (1998). D(2)- and 5-HT(2) receptor occupancy in high-dose neuroleptic-treated patients. Int J Neuropsychopharmacol, 1, 95101.Google Scholar
Du, J., Quiroz, J., Yuan, P., et al. (2004). Bipolar disorder: Involvement of signaling cascades and AMPA receptor trafficking at synapses. Neuron Glia Biol, 1, 231243.Google Scholar
Meyer, J. M. (2018). Pharmacotherapy of psychosis and mania. In Brunton, L. L., Hilal-Dandan, R., and Knollmann, B. C., eds., Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 13th edn. Chicago, IL: McGraw-Hill, pp. 279302.Google Scholar
Schou, M. (2004). Lithium Treatment of Mood Disorders, 6th edn. Basel: S. Karger AG.Google Scholar
Leucht, S., Helfer, B., Dold, M., et al. (2015). Lithium for schizophrenia. Cochrane Database Syst Rev, 10, CD003834.Google Scholar
Wang, Y., Xia, J., Helfer, B., et al. (2016). Valproate for schizophrenia. Cochrane Database Syst Rev, 11, CD004028.Google Scholar
Weibell, M. A., Hegelstad, W. T. V., Auestad, B., et al. (2017). The effect of substance use on 10-year outcome in first-episode psychosis. Schizophr Bull, 43, 843851.Google Scholar
Mizrahi, R., Addington, J., Rusjan, P. M., et al. (2012). Increased stress-induced dopamine release in psychosis. Biol Psychiatry, 71, 561567.Google Scholar
Lieberman, J. A., Alvir, J., Geisler, S., et al. (1994). Methylphenidate response, psychopathology and tardive dyskinesia as predictors of relapse in schizophrenia. Neuropsychopharmacology, 11, 107118.Google Scholar
Vaughn, C. E., Snyder, K. S., Jones, S., et al. (1984). Family factors in schizophrenic relapse: Replication in California of British research on expressed emotion. Arch Gen Psychiatry, 41, 11691177.Google Scholar
Nuechterlein, K. H., Snyder, K. S., Dawson, M. E., et al. (1986). Expressed emotion, fixed-dose fluphenazine decanoate maintenance, and relapse in recent-onset schizophrenia. Psychopharmacol Bull, 22, 633639.Google Scholar
Hogarty, G. E., McEvoy, J. P., Munetz, M., et al. (1988). Dose of fluphenazine, familial expressed emotion, and outcome in schizophrenia: Results of a two-year controlled study. Arch Gen Psychiatry, 45, 797805.Google Scholar
Howes, O. D., McCutcheon, R., Agid, O., et al. (2017). Treatment-resistant schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology. Am J Psychiatry, 174, 216229.Google Scholar
Siskind, D. J., Lee, M., Ravindran, A., et al. (2018). Augmentation strategies for clozapine refractory schizophrenia: A systematic review and meta-analysis. Aust N Z J Psychiatry, 52, 751767.Google Scholar
Sinclair, D. J. M., Zhao, S., Qi, F., et al. (2019). Electroconvulsive therapy for treatment-resistant schizophrenia. Schizophr Bull, 45, 730732.Google Scholar
Wagner, E., Lohrs, L., Siskind, D., et al. (2019). Clozapine augmentation strategies – a systematic meta-review of available evidence. Treatment options for clozapine resistance. J Psychopharmacol, 269881118822171.Google Scholar
Youn, T., Jeong, S. H., Kim, Y. S., et al. (2019). Long-term clinical efficacy of maintenance electroconvulsive therapy in patients with treatment-resistant schizophrenia on clozapine. Psychiatry Research, 273, 759766.Google Scholar
Huang, C. C., Gerhardstein, R. P., Kim, D. Y., et al. (1987). Treatment-resistant schizophrenia: Controlled study of moderate- and high-dose thiothixene. Int Clin Psychopharmacol, 2, 6975.Google Scholar
Kelly, D. L., Richardson, C. M., Yang, Y., et al. (2006). Plasma concentrations of high-dose olanzapine in a double-blind crossover study. Hum Psychopharmacol, 21, 393398.Google Scholar
Cohen, D. (2014). Prescribers fear as a major side-effect of clozapine. Acta Psychiatr Scand, 130, 154155.Google Scholar
Gee, S., Vergunst, F., Howes, O., et al. (2014). Practitioner attitudes to clozapine initiation. Acta Psychiatr Scand, 130, 1624.Google Scholar
Kelly, D., Glassman, M., Mackowick, M., et al. (2020). O9.1. Satisfaction with using a novel fingerstick for absolute neutrophil count (ANC) at the point of treatment in patients treated with clozapine. Schizophr Bull, 46, S20S21.Google Scholar
Baldelli, S., Clementi, E., and Cattaneo, D. (2018). Can we rely on AGNP therapeutic targets also for LAI antipsychotics? Pharmacopsychiatry, 51, 270271.Google Scholar
Melkote, R., Singh, A., Vermeulen, A., et al. (2018). Relationship between antipsychotic blood levels and treatment failure during the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Schizophr Res, 201, 324328.Google Scholar
Branchey, M. H., Branchey, L. B., and Richardson, M. A. (1981). Effects of neuroleptic adjustment on clinical condition and tardive dyskinesia in schizophrenic patients. Am J Psychiatry, 138, 608612.Google Scholar
Ereshefsky, L., Saklad, S. R., Jann, M. W., et al. (1984). Future of depot neuroleptic therapy: Pharmacokinetic and pharmacodynamic approaches. J Clin Psychiatry, 45, 5059.Google Scholar
Indivior Inc. (2019). Perseris package insert. North Chesterfield.Google Scholar
Janssen Pharmaceuticals Inc. (2019). Invega Sustenna package insert. Janssen Pharmaceuticals, Inc., Titusville, NJ.Google Scholar
Alkermes Inc. (2020). Aristada package insert. Walltham MA.Google Scholar
Eli Lilly and Company (2020). Relprevv package insert. Indianapolis, IN.Google Scholar
Janssen Pharmaceuticals Inc. (2020). Risperdal Consta package insert. Titusville, NJ.Google Scholar
Otsuka America Pharmaceutical Inc. (2020). Abilify Maintena package insert. Rockville, MD.Google Scholar

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