2009, volume 25, issue 2

Original article

Polish patients of EUFESTS after 12 months antipsychotic treatment: risk of drug discontinuation and parameters of metabolic syndrome

Jolanta Rabe-Jabłońska, Tomasz Pawełczyk, Jerzy Samochowiec, Marcin Olajossy, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii, 2009, 2, 75–83

The aim of the study was the assessment of antipsychotic treatment discontinuation risk during 12 months observation period and comparison of biochemical parameters changes of metabolic syndrome in Polish patients included in EUFEST.
94 patients with I episode of schizophrenia, schizophreniform and schizoaffective disorders (acc. DSM - IV), previously untreated with antipsychotics were enrolled in the study. They were randomized to receive haloperidol in low doses and SGAs in therapeutic doses: olanzapine, quetiapine, amisulpride. The following laboratory and antropometric parameters were assessed: glucose level, HDL and LDL cholesterol and TG, weight and height, waist circumstance, and BMI was calculated before the start and after one year of the study. Any cause discontinuation risk of different antipsychotics and differences in mean changes of biochemical parameters during the study were analyzed.
In the polish group of patients enrolled in EUFEST any–cause discontinuation risk of low dose haloperidol was signifi - cantly higher than SGAs. The risk of any cause discontinuation of individual SGAs was not signifi cantly different, although the risk of quetiapine discontinuation was the lowest. No statistical differences in the mean changes of biochemical parameters of metabolic syndrome were observed between patients treated with individual antipsychotics during the study, but quetiapine and amisulpride caused higher, but no signifi cant increase of lipids than olanzapine and haloperidol, and olanzapine caused higher, but no siginifi cant, increase of fasting glucose level than remaining antipsychotics.

Original article

Polish patients with I episode of schizophrenia in EUFEST study: change of the psychopatology level depending on the antipsychotic medication used

Marcin Olajossy, Marek Masiak, Jerzy Samochowiec, Jolanta Rabe-Jabłońska, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii, 2009, 2, 85–93

In 94 patients included to the Polish group of the EUFEST Study (European First Episode Trial), following drugs have been randomely used: haloperidol (27), olanzapine (26), amisulpride (26), quetiapin (12) and ziprazidon (3). Alike the whole EUFEST study group, Polish patients showed no differences in the severity of psychopathological symptoms after one year of antipsychotic treatment between the patients treated with haloperidol and patients treated with atypical antipsychotic agents. After one year of treatment, the level of negative symptoms was signifi cantly higher in patients treated with haloperidol. No signifi cant differences in the severity of psychopathological symptoms were observed between patients treated with atypical agents.

Original article

Clinical improvement and metabolic effects of antipsychotic drugs in schizophrenia

Katarzyna Olszewska, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii, 2009, 2, 95–100

Aim: The purpose of the present study was to asses the relationship between initial clinical improvement during treatment of schizophrenic exacerbation and metabolic effects of antipsychotic drugs.
Methods: 77 patients (30 females, 47 males) aged 18-70 (mean 38) years were studied. They all met the ICD-10 criteria for schizophrenia, were hospitalized for exacerbation of the illness in psychiatric hospital in Gniezno. Psychometric evaluation of patients performed with PANSS scale, blood pressure, waist circumference, body weight, fasting blood glucose level and lipid profi le were measured at the admission and after 4 weeks of treatment. Patients were treated with both typical and atypical neuroleptics.
Results: After 4 weeks of treatment 47 patients experienced clinical improvement (at least 20% reduction in PANSS scale). A statistical trend was revealed to higher value of body weight in those patients who responded to treatment (78 vs 71 kg). Participants who gained on weight experienced statistically signifi cant reduction in positive subscales of PANSS scale in comparison to patients who lost their weight. Statistically signifi cant correlation was found between reduction in PANSS scores and increase in body weight among patients treated with olanzapine and risperidone.
Statistically signifi cant correlation was also revealed between reduction in PANSS scores and increase in fasting glucose level and total cholesterol level in individuals treated successfully with olanzapine.
Conclusions: The initial clinical improvement during treatment of exacerbation of schizophrenia has been associated with metabolic changes, refl ected in gaining weight, as well as an increase in glucose and total cholesterol levels. Such changes have been especially evident in olanzapine-treated patients.

Review article

Selective agonist of the hypothalamic melanocortin receptors; bremelanotide as a new drug in pharmacotherapy of sexual dysfunctions

Artur Pałasz, Marek Krzystanek, Irena Krupka-Matuszczyk, Marcin Kamiński, Ryszard Wiaderkiewicz
Farmakoterapia w Psychiatrii i Neurologii, 2009, 2, 101–108

Undoubtfully, the neurochemical background of human sexual desire is still one of the most interesting and sophisticated problems in psychiatry and neurology. The phenomena of sexual excitation and arousal are strictly controlled and stimulated by hypothalamic and limbic neuronal pathways including peptydergic, dopaminergic, noradrenergic and neurosecretory tracts. On the other hand, some endogenous psychoactive peptides such opioids and cannabinoids as well as classical neurotransmitter serotonin involve the inhibition of sexual desire and behaviour. The novel selective melanocortin receptor agonist bremelanotide seems to be a valuable drug in pharmacotherapy of psychosomatic dysfunctions associated with decreased sexual desire, especially in women. Nasally administered bremelanotide is the only α-melanocyte stimulating hormone (α-MSH) analogue that has been clinically studied in men and women with sexual disturbances. Clinical studies have shown it is effi cient centrally acting drug that improves erection in men and arousal and sexual satisfaction in both genders. Bremelanotide can be used in monotherapy or combined with phosphodiesterase type 5 inhibitors.

Case report

A case of catatonic schizophrenia – successful outcome of treatment with aripiprazole and clozapine

Miłosz Krzywotulski, Paweł Wójciak, Janusz Rybakowski
Farmakoterapia w Psychiatrii i Neurologii, 2009, 2, 109–112

The topic of the article is a case report of catatonic schizophrenia diagnosed in twenty-two year old female. Her mental status underwent rapid deterioration showing clinical picture of catatonic syndrome. Pharmacological treatment by various antipsychotic drugs proved to be not successful or caused serious side effects. It was not until the administration of aripiprazole (up to 22.5 mg/day), with clozapine (up to 200 mg/day) that her mental status signifi cantly improved and all psychopathological symptoms gradually resolved. One and half year after this episode, the patient continues her academic activity (psychological faculty), taking aripiprazole, 7.5 mg/day.