The propensity of atypical antipsychotics (AAP) for having a therapeutic effect with fewer side effects and the balancing of these supposed benefits with tolerance are the subject of many studies.

We focused on adverse drug events (ADEs), occurred under AAP, in a population of patients with schizophrenia to assess the prevalences and describe how the practitioner deal with these ADEs.

We have used a retrospective and descriptive study of 63 Tunisian patients with schizophrenia, consulting in the adult outpatient of Razi hospital and treated by one type of AAP. The study period was 6 months from the 1st January 2015. We used the Birchwood Insight Scale (BIS), Positive and Negative Syndrome Scale (PANSS) and Udvalg for Kliniske Undersogelser (UKU) to assess the insight, psychotic symptoms and ADEs.

Twenty-four patients were on risperidone, 22 on olanzapine, 8 on amisulpride and 9 on clozapine. Antiparkinsonism drug (15.9%) was associated because of neurological ADEs mainly Parkinsonism. Asthenia had a prevalence of 20.6%. Hypersalivation and palpitation were estimated at 7.9% both. Weight gain's prevalence was 25.4%, including 1 case associated with hypercholesterolemia and 1 case of unbalanced non-insulin-dependent diabetes. The erectile dysfunction's prevalence was 36.3% and decreased libido 27%. There were 2 cases of neutropenia and thrombocytopenia. The management of these ADEs was observed when they moderately began to influence the patient's daily activity.

ADEs must be subject to an appropriate treatment and if necessary resort to a specialist consultation to confirm or deny imputability to AAP.

The authors have not supplied their declaration of competing interest.

Relapse prevention is one of the major goals in psychiatry because it will mark the prognosis and quality of life in patients. In this aspect, plays a very important role insight and adherence to treatment. Some studies show that long acting injectable treatments improve adherence as compared with oral medications.

The objective of this study is to analyse the degree of insight and adherence to treatment of a group of patients with aripiprazole long acting injectable ALAI treatment.

Descriptive study in a group of patients treated with ALAI. Three months of follow-up. To assess the insight we had use the 3 first items of the Unawareness of Mental Disorder SUMD. Adherence to treatment is evaluated by monitoring if patients come to administrate ALAI.

n = 6, 2 women (33.3%) and 4 men (66.7%). The mean age of the sample was 37 years. Diagnoses were 4 patients with psychotic disorder (66.7%;) 2 with bipolar disorder (33.3%). At the SUMD, mean score for the items consciousness of having a disorder and awareness of the effects of medication was 3, and for the item awareness of the social consequences of mental disorder 4. The mean score for the total punctuation was 10. Five (83.3%) had a 100% of adherence, just 1 patient discontinued de treatment on the third month.

On our sample adherence, it was almost complete in all patients. To highlight the scores for SUMD which means low insight. A large sample is required to increase the reliability of the study.

The authors have not supplied their declaration of competing interest.

Quality of life is defined by the World Health Organization as “Individuals’ perceptions of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns.” Schizophrenia is a severe, disabling, lifelong disorder, associated with severe social and occupational dysfunction. Aripiprazole Long Acting Injection (LAI) is indicated for maintenance schizophrenia treatment in adult patients stabilised with oral aripiprazole. It is the fourth second-generation antipsychotic depot formulation approved for treating schizophrenia.

Assessing quality of life in 4 patients treated with aripiprazole LAI.

In this paper, we evaluate of quality of life in 4 subjects with diagnosis of paranoid schizophrenia (less 10 years of diagnostic), male, age between 42 and 50 years, with poor adherence to oral treatment. These patients received aripirazol LAI 400 mg/month. We evaluate quality of life at baseline and after 3 months. We used the Quality of Life Scale (QOLS) and WHO-Quality of Life-Bref (WHOQOL-BREF).

Results demonstrated significant greater improvements in all QLS scores. No significant changes in the WHOQOL-BREF total, but improvement in subscale scores.

Quality of life in schizophrenia is adversely influenced by the presence of clinical symptoms, especially negative and depressive. Depot medications can improve treatment adherence, however, long-term antipsychotic use can lead to irreversible adverse effects (dyskinesias), which in some cases were reduced by using newer antipsychotics (risperidone, paliperidone, aripiprazole). Aripiprazole LAI can be useful to improve quality of life. Further methodologically robust studies are needed to generate evidence-based conclusions.

The authors have not supplied their declaration of competing interest.

Attention Deficit Hyperactivity Disorder (ADHD) is more prevalent in people with intellectual disabilities (ID). Drug therapy is the primary treatment for ADHD targeting the core signs of inattention, impulsivity, and hyperactivity (NICE 2013). Knowledge on ADHD has been gleaned from studies in children and children with ID. People with ID have comorbid disorders for example, autism and epilepsy that can complicate the management of ADHD. Knowledge of the effects of treatment is essential in managing ADHD in people with ID. The current evidence on the application of drug therapy for ADHD in ID is described.

A literature review of publications in English language was undertaken.

Using medication to treat ADHD is effective in treating the signs of ADHD in people with ID. The response rates in ID to drug therapy for ADHD approximates to 55% that is lower than in the general population. People with ID experience more side effects from medication that can lead to withdrawal from treatment. Guidelines exist internationally on the appropriate prescribing of medication. Methylphenidate, a psycho-stimulant drug is the drug of first choice. Atomxetine, a non-stimulant drug, is effective in people with ID.

ADHD in people with ID is treatable but clinicians need to be knowledgeable and skilled in managing the disorder in people with ID. Newer drugs could offer more because of their different profile of more tolerable side effects.

The author has not supplied his/her declaration of competing interest.

Review of the diagnoses of the treated patients with palmitate paliperidone for one year in a mental health unit, as well as some of their key sociodemographic characteristics, the length of the hospital stay and the average treatment according to clinical diagnosis.

Descriptive epidemiological study including patients admitted to our hospital. It covers the period from January 2014 to December 2014.

For the period between January and December, a total of 315 patients were admitted in our mental health hospital unit, of which 45 were treated with paliperidone palmitate. The diagnosis were: schizophrenia (25 patients; 55.56%), schizoaffective disorder (7 patients; 15.56%), delusional disorder (5 patients; 11.11%), bipolar disorder (1 patient; 2.22%), personality disorder (2 patients; 4.44%), obsessive-compulsive disorder (1 patient; 2.22%), organic brain disorder (1 patient; 2.22%), schizophreniform disorder (1 patient; 2.22%) and mental retardation (1 patient; 2.22%). The mean age of patients was 35.7 years old. The most common marital status was unmarried state (30 patients; 66.6%). The average stay per hospital admission was 19.33 days. The most abused drugs were tobacco (31 patients; 68.8%). The mean dose of paliperidone palmitate was 137.5 mg. Schizophrenic patients need higher doses of treatment.

A significant improvement in functionality was observed in our patients. What's proven efficacy and good tolerability and adherence, so we consider paliperidone palmitate as a drug of first choice in the treatment of schizophrenia.

The authors have not supplied their declaration of competing interest.

Psychopharmacology study.

To evaluate Nalmefene effectiveness in clinical practice in patients diagnosed with alcohol use disorder.

Descriptive, prospective and observational study with patients diagnosed with alcohol use disorder, treated with Nalmefene during 6 months.

Twenty-seven patients (9 women and 18 men); average age: 47.92. A total of 64.28% with F10 as an exclusive main diagnosis. Drink urge perception at the beginning: 6.37 points over 10.6 months later, 3.25 points. Loss of alcohol drinking control perception at the beginning: 6.03 points over 10. Six months later, it is reduced down to 2.37 points. GGT reduction (from 107.18 to 36.5 U.I./L) and Mean Corpuscular Volume reduction (from 90.2 to 88.9 fl). The average of days/month with binge drinking at the beginning was 16.18 SD (standard drinks); and monthly total of alcohol consumption is 182.75 SD. After a month: 4.6 days and 66.52 SD. After 6 months, it decreases to 4 days/month and 63.3 SD. The results of the Rhode Island Change Assessment scale are: 7.4% in pre-contemplation stage, 70.37% contemplation stage, 3.7% action stage and 18.5% in maintenance stage. Six months later: 75% contemplation, 12.5% action and 12.5% maintenance stage. The main side effects were: nausea and vomiting, 22.22% at the beginning and 12.5% that persist with intakes; sexual side effects in 22.22% throughout the treatment; the 14.8% report increased sleeping and dreaming, 14.8% report restlessness, after six months drowsiness prevails with a 18%. At first, orthostatic dizziness appears in a 14.8%, disappearing 4 weeks later.

Nalmefene is effective in reducing alcohol consumption, with few side effects and good acceptance.

The authors have not supplied their declaration of competing interest.

Antipsychotic polypharmacy is not supported by current guidelines. However, it is often present in practice. A common reason for this is to gain a greater, faster therapeutic response and reduce the doses of individual drugs, thus reducing the adverse effects.

The aim of this study is to analyze the prevalence of antipsychotic polypharmacy at the Clinic of Psychiatry, Clinical Centre of Serbia and to compare it with the data from 10 years ago when similar research was conducted.

This is a cross-sectional study conducted in 2015. The data were obtained from the patients’ charts and compared with the results of a more extensive study conducted at the same hospital during 2002–2005 period. Statistics was performed using standard statistical methods.

Of the total number of patients (n = 44), 81.8% (n = 36) were on antipsychotic monotherapy, while in the previous study, which included 198 patients, monotherapy was noted in just 32.3% hospitalizations (n = 64) (Chi = 34.5; P < 0.001). Among patients treated with polypharmacy, the majority was prescribed the combination of a first- and second-generation antipsychotic (n = 7, 87.5%), while just one patient was treated with two first-generation antispychotics (n = 1, 12.5%). In the 2002–2005 period, the combination of two first-generation antipsychotics was dominant (58.9%, n = 79).

This study indicates that in Serbian psychiatry there is a strong tendency towards reduction of antipsychotic polypharmacy. However, this is a single-centre study with a relatively small number of participants and more extensive research on the national level is warranted to confirm this trend.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The integrated care in dual diagnosis units involves selecting pharmacological treatment strategies for both substance use disorder and the non-addictive psychiatric disorder. It is recommended to choose drugs with a favorable balance between efficacy/tolerability, an adequate side effects profile and the minimal drug interactions.

To evaluate the tolerability and side effects after first administration-first dose of an extended-release injectable suspension of aripiprazole in a group of patients admitted to an acute dual diagnosis unit.

The study included a series of patients admitted in our unit from May to August 2015 that received the first dose of the aripiprazole preparation (400 mg). Evaluations included different scales for side effects (SAS, ESRS, UKU) and the clinical global impression scale (CGI).

A total of 9 patients were included and evaluated (all men, mean age: 39-years-old). Diagnoses were: bipolar disorder (5/9), schizophrenia (2/9), schizoaffective disorder (1/9) and delusional disorder (1/9) with concomitant substance use disorder (6 cannabis, 2 alcohol, 1 cocaine). All of them without outpatient control and treatment at admission. The results of the clinical scales conclude that none of them had significant side effects, including extrapyramidal, with an improvement in the ICG scale.

Tolerability of extended-release injectable suspension of aripiprazole was good in all cases. In the future, new cases should be included to extend the sample and to evaluate other aspects such as the craving for substances.

The authors have not supplied their declaration of competing interest.

To evaluate factors of therapeutic efficacy of paliperidone palmitate, such as the speed of action and its maintenance in patients who experienced a first psychotic episode that led to a hospital admission in the acute unit.

Two-year observational and descriptive study. Patients admitted to the Mental Health Hospital Unit (MHHU) from January 2013 to July 2014, with a first psychotic episode and under paliperidone palmitate treatment. Monitoring and evaluation six months after hospital discharge. They were evaluated using the PANSS and BPRS scales at four different time points of the evolutionary process.

Average scores of the BPRS scale: 39 on admission day, 27 on day of discharge, 23 on the third month and 20 on the sixth month. Average score of PANSS scale: PANSS-PG: 64 on admission day, 48 on day of discharge, 25 on the 3rd month, and 20 on the 6th month. PANSS-P: 41 on admission day, 21 on day of discharge, 12 on the 3rd month, and 10 on the 6th month. PANSS-N: 21 on admission, 11 at discharge, 8 on 3rd month and 7 on 6th month. No clinically significant side effects were observed that would lead to the modification of the doses or the abandonment of the treatment in this period.

The results of this observational study show that the start of the treatment with PAP is associated with an observable clinical response on the 4th day. The evaluation scales at the 3rd and 6th months also suggest the maintenance of efficacy of the treatment.

The authors have not supplied their declaration of competing interest.

The use of PAP is already much extended in general. The recommended doses in the technical specifications of the drugs, as the result of trial studies, differ from the doses administered in habitual clinical practice. Therefore, the justification of this study is to monitor the average doses prescribed, to be able to reach an agreement on the best doses. To retrospectively analyze the first 32 patients in our area of healthcare, who were prescribed PAP, the doses used at the start of treatment and after 3 years.

Two initial doses of PAP were analyzed, maximum and current (outpatient) in 32 patients attended in the area of mental health of North Jaen, who started the treatment with PAP between 2012 and 2013, with an average length of time of 2.55 years (SD 2.02). We evaluated the diagnosis (schizophrenia and related disorders, ICD-10 F20), the number of hospital admissions previous and posterior to the start of the treatment and change in weight.

Average doses: initial: 110.15 mg (SD 32.83), maximum: 165.51 mg (SD 29.76) and maintenance: 146.81 mg (SD 29.59). Average hospital admissions: prior and posterior to the start of treatment: 1.5 and 0.83. An average reduction of 44.06% in admissions was observed.

The data obtained suggests that a dose of 75–200 mg could be effective in the maintenance of patients with schizophrenia and for decreasing the number of new hospital admissions. Fifty percent of the cases can be compensated with long acting peliperidone as a monotherapy.

The authors have not supplied their declaration of competing interest.

Long-acting antipsychotics (LAIs) provide certain advantages over oral medications. The aim of our study is to determine whether there are differences between the various long-acting injectable antipsychotics available in our environment.

A retrospective observational study with psychotic patients discharged with LAIs was designed. Data on discontinuation, relapses and associated drugs in the discharge and in a year follow-up were collected. Fifty-seven patients were included: 21 risperidone (RLAI), 20 paliperidone palmitate (PP) and 16 first-generation LAIs (FG). Odds ratio was used to compare discontinuation, χ2 test for categorical variables and Kruskal-Wallis test for independent samples.

Discontinuation was lower with PP: ORRLAI/PP = 2.74 and ORFGLAI/PP = 3.09. There were significant differences in readmissions: rehospitalizations (χ2 = 7.072, P = 0.029) and days of stay (χ2 = 8.251; P = 0.016), both lower in the PP group. We found less use of psychoactive drugs with PP, with significant differences in the discharge (χ2 = 11.518; P = 0.003) and in the follow-up (χ2 = 7.097; P = 0.029). There were also significant differences in the use of oral antipsychotics in the discharge (χ2 = 27.049, P = 0.000); anticholinergic drugs in the discharge (χ2 = 7.001, P = 0.03) and in the follow-up (χ2 = 11.699, P = 0.003) and benzodiazepines in the follow-up (χ2 = 8.493, P = 0.014), always lower in the group of patients treated with PP.

Treatment with paliperidone palmitate may be more suitable than other long acting antipsychotics when it starts during the acute episode.

The authors have not supplied their declaration of competing interest.

Patient adherence to a treatment regimen is of utmost importance for successful outcomes in schizophrenia. Long acting aripiprazole (LAA) is a new drug of depot antipsychotic type placed in the market recently that could prevent non-adherence and in reducing relapse in schizoprenia administered every 28 days.

A descriptive, observational study designed to explore the efficacy and tolerability of long acting aripiprazole in a sample of patients diagnosed with paranoid schizophrenia that were admitted to Acute Unit in 2014. LAA was introduced on the admission.

Sociodemographic variables: age, sex, and marital status. Clinical variables: average time since diagnosis, concomitant consumption of toxic substances, reason to change medication, subsequent readmissions after LAA was introduced, evaluation of the modification of the oral regimen. PANSS and CGI. Metabolic profile: weight, glycaemia, and total cholesterol, LDL and HDL, triglycerides. Cost at the beginning and after 6 months.

Mean age: 44.50 years, 54% women. Marital status: 54% single, 27% married, 27% divorced. Mean time from diagnosis: 11 years. Toxic consumption: 27% active, 18% ex-drug users. Three patients were readmitted after introducing LAA, 2 of them were for abandoning medication (including LAA). PANSS at 6 months showed statistically significant differences in negative subscale (3 points). No statistical differences in positive and general psychopathology subscales. No metabolic side effect was found. Average saving per patient 37.05 euros per month (Fig. 1).

This study signalizes that LAA is an effective treatment. Clinically, it has been shown that our patients improve adherence and prevent relapse. Moreover, no metabolic side effects were found. Besides, LAA is also efficient and we would save 407,55 euros per month.

The authors have not supplied their declaration of competing interest.

Lack of adherence is a common cause of relapse in schizophrenia. Long-acting antipsychotics have shown in recent studies that they improve compliance. However, some randomised controlled trials showed no difference in relapse rates between oral medication and long-acting injections.

To report the use of paliperidone palmitate in an Acute Psychiatrist Unit in Spain.

Retrospective observational study of 42 patients prescribed paliperidone palmitate (PLAI) during an admission at Acute Psychiatric unit in Málaga. In the mirror image analysis, the main outcome measure was the total number of days of psychiatric inpatient care twelve months before and after patients started Paliperidone palmitate.

Most common reason for starting paliperidone palmitate was lack of adherence to oral medication (54%) followed by lack of efficacy on previous medication (31%). Olanzapine (47%) and risperidone (41%) were most commonly antipsychotics prescribed before PLAI. Thirty-four patients continued PLAI over twelve months (80%). Poor compliance was the most common reason of withdrawal. Three patients had a movement disorder adverse effect. Only one was lost because adverse effects. Total admissions and inpatients days were significantly reduced from the previous treatment to PLAI-treatment period (Table 1).

PLAI was associated with a reduction in total inpatient days. The financial saving from reduced admissions stays exceeded the acquisition and administration cost of PLAI. Improved compliance because of PLAI is the most plausible explanation of this result (Fig. 1).

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Schizophrenia is a chronic, severe, and disabling mental disorder. An evaluation of clinical predictors to clozapine was described.

Identify clinical predicting factors to clozapine.

This is a cross-sectional study including patients diagnosed with schizophrenia or schizoaffective disorder according to the DSM 5 criteria and treated with clozapine.

Of the 33 patients, 78.8% were males and 69.7% of them were single. The mean age was 36 years old. The mean age at the onset of the disorder was 24 years old. The mean number of hospitalizations was 6. The beginning of the mental disorder was acute in 21.2% of the cases. The mean duration of the disease course before starting clozapine treatment was 11 years. The mean duration of treatment was 19 months. The diagnosis according to DSM 5 criteria was schizophrenia in 87.9 and schizoaffective disorder in 12.1% of cases. The outcome was assessed by PANSS and BPRS scales with a symptomatic remission in 63.63% of cases. The analytical study revealed a significant correlation between favorable evolution and the latest onset of the disorder (P = 0.04), the number of previous hospitalizations (P = 0.009), disorder's duration (P = 0.032), male sex (P = 0.0004) and secondary resistance (P < 10−3).

The evaluation of clinical factors is important in our practice in order to improve the response to clozapine. Otherwise, adherence to treatment and quality of insight are determining factors of the treatment response.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The aims of this study were to investigate the new models of research and development in infectious diseases that emerged after the pharmaceutical industry ceased their investments and to model how these can be used in psychiatry.

A systematic review. We searched PubMed, EMBASE and Web of Science for the keywords “infectious diseases”, “research and development” and “pharmaceutical industry”.

The searches gave a total of 248 references. Among the findings, we want to highlight the Drugs for Neglected Diseases initiative (DNDi) and the WHO Research and Development Treaty (R&D Treaty). DNDi is a non-profit organization that has developed six new drugs since 2003. The development costs were €150 millions per drug, which is considerably below the costs for drug development claimed by the pharmaceutical industry. The R&D Treaty will commit member states of the WHO to fund development for neglected health needs using alternative incentives like milestone prizes, patent pools and direct grants. The treaty has not yet been agreed upon.

Though a low priority from the pharmaceutical industry, other funding models have proven able to deliver new treatments. This could also lead to more development of non-patentable treatments, e.g. psychotherapy.

The author has not supplied his/her declaration of competing interest.

There are relatively few studies of Long-acting injectable antipsychotics (LAI), although poor adherence to treatment is one of the main problems in patients with psychotic disorders.

The aim of the study is to describe socio-demographic and clinical characteristics of a sample of outpatients with LAI treatment.

This is a cross-sectional study. A randomized sampling was performed among the outpatients that were receiving LAI in an outpatient clinic in Barcelona (Spain). For each patient, socio-demographic, clinical and pharmacotherapeutic data were collected through interviews and clinical history.

The sample consisted of 30 subjects (50% men, average age 48 years). Most of the patients in the sample have basic education (50%) and are unemployed, receiving permanent disability pension (39.3%). In addition, 44.8% of the subjects were living with family members and were not married (56.7%). Of the patients, 70% were diagnosed with schizophrenia, 13.3% schizoaffective, 10% bipolar and 6.7% delusional disorder. The main reason to initiate LAI treatment was due to non-compliance of the prescribed oral treatment (85.7%). The 40% of patients were also with oral antipsychotic treatment. Average punctuation in the 3 first items of the Scale to Assess Unawareness of Mental Disorder: 11. Average punctuation in the short version of the Simpson-Angus Scale: 1.68.

In our sample, the outpatients with LAI treatment had a low functioning and disease awareness. Although the main reason to start LAI is the non-compliance, 40% of the patients were concurrently treated with oral antipsychotics. The extrapyramidal side effects are mild.

The authors have not supplied their declaration of competing interest.

Dementia with lewy bodies (DLB) is commonly considered the second most common form of dementia. The purpose of this study is to investigate the treatment effects of aripiprazole in patients with DLB.

Eleven patients who had meet the criteria for DLB participated in this study. The presence of psychotic symptoms was confirmed by scores of either the delusions or hallucinations items of the Neuropsychiatric Inventory (NPI) score. Patients who had 25 or more on the Mini-mental State Examination Scale (MMSE) at the entry or having brain damage were excluded. Aripiprazole was initiated at a low dose (3 or 6 mg/day) and titrated to higher doses at 2-weeks intervals or more rapidly based on investigator's judgment. Previous medications prior to aripiprazole administration were not changed through this trial. Patient's clinical status was assessed at baseline, then 2 weeks during the study by using NPI, Clinical Global Impression (CGI) and Brief Psychiatric Rating Scale (BPRS) to measure psychotic behavioral symptoms, and Simpson-Angus Scale (SAS) to measure parkinsonism symptoms. Clinical Dementia Rating (CDR) and MMSE were carried out at screening and end point to evaluate cognitive function.

The mean scores of the SAS and CDR were significantly decreased at the study endpoint compared to baseline. The mean scores of the NPI and BPRS improved up until 4 weeks after having started aripiprazole. After 4 weeks, improvements slowed. The mean score of the CGI-S was decreased up until 8 weeks.

This study shows that aripiprazole may be effective for the treatment of psychotic symptoms in patients with DLB.

The authors have not supplied their declaration of competing interest.