Searchlyte Research Studies: Participants Needed

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To download a PDF version of the above poster, please click here.

Also see:

Nova Scotia Early Psychosis Program

Dr. Heather Milliken

Dr. Lieberman's talk on the treatment of schizophrenia (June 21, 2011)

Uploaded to YouTube by NARSADorg on June, 23rd 2011.

Also see:

Dr. Jeffrey Lieberman's website.

NARSAD's website.

Clozapine Rarely Prescribed for Refractory Schizophrenia

An article posted yesterday by Medscape Medical News:

June 16, 2011 (Boca Raton, Florida) — Clozapine, an effective antipsychotic medication for treatment-resistant schizophrenia, is not being prescribed as often as it should be, researchers reported here at the New Clinical Drug Evaluation Unit (NCDEU) 51st Annual Meeting, sponsored by the American Society of Clinical Psychopharmacology.

"Study after study shows clozapine, which is the first of the second-generation antipsychotics, to be the most effective antipsychotic out there, but it’s hardly being used," Susan M. Essock, PhD [pictured], from the New York State Psychiatric Institute and Columbia University, New York, New York, told Medscape Medical News at a poster session.

Up to 30% of people with schizophrenia are potential candidates for clozapine because they have refractory psychotic symptoms that do not respond well to first-line antipsychotics.

Yet only 2% to 3% of people with schizophrenia in the United States, and fewer than 6% in New York State, take the drug, Dr. Essock said.

She and her colleagues used New York State Medicaid data to identify factors associated with the initiation of clozapine compared with other antipsychotic medications.

Their study sample included 7035 Medicaid recipients who had a primary diagnosis of schizophrenia or schizoaffective disorder and who filled a prescription for an antipsychotic medication in 2009 without a fill of that same medication in the prior 90 days.

The researchers found that just 144 patients (2%) started clozapine and that 6891 (98%) started another antipsychotic medication.

The most frequently prescribed agent was aripiprazole, with 1175 prescriptions; closely followed by quetiapine, with 1161 prescriptions; risperidone, with 1127 prescriptions; and long-acting injectables, with 1078 prescriptions.

There were 663 prescriptions for olanzapine, 559 for haloperidol, 333 for ziprasidone, 253 for paliperidone, and 199 for fluphenazine.

The study also found that individuals who started clozapine were more likely to be younger (mean age, 36 ± 12 years vs 44 ± 13 years), male, and white. Patients in state-operated facilities were also more likely to get clozapine than patients in other types of facilities. Patients started on clozapine also had higher Medicaid costs (mean, $58,861 ± $65,367) than those not receiving clozapine ($16,687 ± $27,767).

Clozapine is well known to be the most effective antipsychotic for refractory schizophrenia, so why is its use so low?" Dr. Essock asked. "It is true that you need a blood test to make sure that the patient’s white blood cell count is adequate, but the data show that it is worth it to do this extra test."

Commenting on this study for Medscape Medical News, American Society of Clinical Psychopharmacology president John Kane, from the Albert Einstein College of Medicine and the Zucker Hillside Hospital, Glen Oaks, New York, said, "These are important data in highlighting the underutilization of clozapine. Many more patients could potentially benefit from a trial of the medication that has the best chance of succeeding when others fail. We need to work towards reducing the existing obstacles to wider use of clozapine."

Dr. Essock has disclosed no relevant financial relationships. Dr. Kane reported that he has financial relationships with Astra Zeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Cephalon, Dainippon Sumitomo, Eli Lilly, Esai Inc., H. Lundbeck A/S, Intracellular Therapeutics, Janssen Pharmaceuticals, MedAvante, Merck, Novartis, Otsuka, Pfizer, and Rules Based Medicine.

New Clinical Drug Evaluation Unit (NCDEU) 51st Annual Meeting, sponsored by the American Society of Clinical Psychopharmacology (ASCP). Abstract #63. Presented June 14, 2011.

RG1678 looks promising for the treatment of schizophrenia

A January 28th posting by Gerson Lehrman Group:

Summary

This article will explore RG1678, a new schizophrenia drug from Roche.

Analysis

RG1678 (molecular structure pictured) is a new compound under investigation by Roche for the treatment of schizophrenia. It is a unique drug in that it targets the negative symptoms of schizophrenia such as apathy and social withdrawal. The currently available medications for schizophrenia usually target the positive symptoms such as delusions and hallucinations. Another very interesting thing about RG1678 is its mechanism of action. It acts as a glycine reuptake inhibitor which normalizes glutamate neurotransmission by increasing synaptic levels of glycine. Elevation of extracellular synaptic glycine concentration by blockade of GlyT1 has been hypothesized to potentiate NMDA receptor function and may represent a new approach for the treatment of schizophrenia and cognitive disorders. Namenda is another drug which also works at the NMDA receptor to affect cognitive function.

RG1678 is currently in Phase 3 studies at Roche and the early results look very promising. Side effects to date have been mild and include anxiety and dose dependent mild elevation of hemoglobin. RG1678 may represent a fresh approach to the treatment of a difficult and debilitating illness.

By Gregg L. Friedman MD, Hallandale Beach, FL

New Medication Approved in the US for Schizophrenia

A November 1st posting by PsychCentral:

By Rick Nauert, PhD, Senior News Editor

Reviewed by John M. Grohol, Psy.D., on November 1, 2010

The U.S. Food and Drug Administration has approved Latuda (lurasidone HCl) tablets for the treatment of adults with schizophrenia.

“Schizophrenia can be a devastating illness requiring lifelong treatment,” said Thomas Laughren, M.D., director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research.

“Some patients do not respond well to certain types of drug therapy, so it is important to have multiple treatment options available.”

Latuda is included in the atypical antipsychotic class of drugs. All atypical antipsychotics contain a boxed warning alerting prescribers to an increased risk of death associated with off-label use of these drugs to treat behavioral problems in older people with dementia-related psychosis.

No drug in this class is approved to treat patients with dementia-related psychosis.

Four six-week controlled studies of adults with schizophrenia demonstrated the effectiveness and safety of Latuda. In the trials, patients treated with Latuda had fewer symptoms of schizophrenia than those taking an inactive pill (placebo).

The most common adverse reactions reported by those in clinical trials were drowsiness, feelings of restlessness and the urge to move (akathisia), nausea, movement abnormalities such as tremors, slow movement, or muscle stiffness (Parkinsonism), and agitation.

Source: U.S. Food and Drug Administration

EEG predicts response to medication for schizophrenia

Pictured left to right are Dr. Gary Hasey, Department of Psychiatry and Behavioural Neurosciences; Professor James Reilly and Ph.D. student Ahmad Khodayari‑Rostamabad, Department of Electrical and Computer Engineering; Prof. Hubert de Bruin, McMaster School of Biomedical Engineering. Missing: Dr. Duncan MacCrimmon, Department of Psychiatry and Behavioural Neurosciences.


An August 4th media release from McMaster University:

A commonplace electroencephalography (EEG) test may hold the key to predicting whether a person will respond to certain prescribed drugs, particularly those related to psychiatric conditions.

In a study to be published by Clinical Neurophysiology, and now posted online, engineering and health sciences researchers at McMaster University applied machine learning to EEG patterns and successfully predicted how patients with schizophrenia would respond to clozapine therapy.

Clozapine is recognized as an effective treatment for chronic medication-resistant schizophrenia but can produce serious side effects such as seizures, cardiac arrhythmias or bone marrow suppression. Some patients can develop blood problems that are life-threatening. Weekly to monthly blood sampling is required.

"Some people can suffer terrible side effects from clozapine," said Dr. Gary Hasey, associate professor at McMaster and director of the Transcranial Magnetic Stimulation laboratory at St. Joseph's Healthcare Mood Disorders Clinic in Hamilton. "The logistic difficulties for the patient and treatment team are also substantial. A method to reliably determine, before the onset of therapy, whether a patient will or will not respond to clozapine would greatly assist the clinician in determining whether the risks and logistic complexity of clozapine are outweighed by the potential benefits."

To conduct the study, EEGs were taken from 23 patients diagnosed with medication-resistant schizophrenia before they began taking clozapine. Twelve were men and 11 were women, all of middle age. The brainwave patterns and response to the clozapine therapy of these patients were used to "train" a computer algorithm to predict whether or not a specific patient will respond to the drug. The prediction accuracy was approximately 89 per cent. This algorithm showed similar predictive accuracy when it was further tested in a new group of 14 additional patients treated with clozapine.

This innovative work grows out of the close collaborative relationship between members of the Department of Electrical and Computer Engineering (Prof. James Reilly, Ph.D. student Ahmad Khodayari-Rostamabad), the School of Biomedical Engineering (Prof. Hubert de Bruin), and the Department of Psychiatry and Behavioural Neurosciences (Drs. Gary Hasey and Duncan MacCrimmon).

"The computational power available today supports new machine learning methodologies that can help doctors better diagnose and treat illness and disease," said Prof. Reilly. "Large amounts of data can be processed very quickly to identify patterns or predict outcomes. We're looking forward to applying the findings to other areas."

EEG records the brain's electrical activity close to the scalp. Traditionally, it has been used to monitor for epilepsy, and to diagnose coma, encephalopathies, and brain death. EEG is still often used as a first-line method to diagnose tumors, stroke and other focal brain disorders.

"EEG is an inexpensive, non-invasive technique widely available in smaller hospitals and in community laboratories," explains Dr. MacCrimmon. "Also, EEG readings take only 20 to 30 minutes of a patient's time, with no preparation required, so pose minimal inconvenience."

Funding for the research was provided in part by The Magstim Company Ltd., a developer and manufacturer of medical and research devices for the neurological and surgical fields. The company is based in Wales, U.K.

The researchers now plan to test their findings on a larger sample group. They have successfully demonstrated the application of machine learning methods for analyzing EEG signals to predict the response to various treatments available for patients with other psychiatric conditions, specifically major depression. They have also demonstrated the effectiveness of machine learning methods as a diagnostic tool for distinguishing various forms of psychiatric illness. It may also be possible to incorporate a range of other clinical and laboratory data such as personality inventory scores, personal and demographic information and treatment history to improve performance.

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Antipsychotic medication research study

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